Introduction

Patient related outcome measures (PROMS) are now routinely undertaken in patients undergoing hip arthroplasty. These are in the form of the Oxford Hip Score (OHS) and EQ5D questionnaires pre-operation and at 6 months' post operation. MYMOPS is a patient specific outcome measure that allows patients to list their individualised symptoms and activities that are limited and is used is other medical specialities but not currently within orthopaedic surgery. The aim of this study was to validate the MYMOPS questionnaire for use in hip arthroplasty by comparing it to the OHS.

Aims

The study was designed to gauge adequacy of pain relief in the first 5 days following TKA, in particular comparing the Painbuster device (B Braun, Sheffield, UK) with more routine modalities.

We prospectively studied 15 proximal tibial and 30 distal femoral fractures treated with the Less Invasive Stabilisation System for periarticular fractures about the knee.

Of these 45 fractures, one patient returned to Russia and was thus lost to follow up. The mean age of the remaining patients was 64.4 years (range 15–94 years). There were 26 females and 13 males. All fractures were classified according to the AO classification.

We found the use of temporary external fixation and mobile radiolucent wedge leg supports very helpful during surgery for these cases. We developed an increasingly aggressive postoperative mobilisation regime with increased experience of using this fixation technique.

Functional assessment was performed using the Schatzker and Lambert scores. The average time to union was 14.78 weeks (range 10– 28 weeks). 43 fractures have united with one fracture showing signs of delayed union. There were two implant failures, two deep vein thrombosis and two compartment syndromes. Five patients died of unrelated causes and without problems relating to their fracture.

We conclude that the Less Invasive Stabilisation System is a satisfactory method of treating these complex and difficult fractures about the knee with a high rate of union and good functional outcome.

Aim: To report the early results of the Elite Hylamer hip with Zirconium femoral heads in patients younger than 60 years. Methods: 29 hips were implanted in 26 patients by a single surgeon with a specialist interest in hip arthroplasty. Third generation cementing techniques were used for all implants. All patients have been followed up. There has been one death. Results have been analysed using the life table method using the Peto method for 95% confidence intervals. Results: Mean age 49.2 years (range 31–57). 12 Females and 17 Males.15 of 29 hips (53.3%) have been revised or are currently on the waiting list for revision surgery. These failures have occurred in 7 Females and 8 Males. Mean time to failure 35.4 months (range 18 to 68 months). All failures have been as a result of aseptic loosening. Survivorship analysis reveals a 32.42% survival at 5 to 6 years (6.9% standard error). Conclusions: At the time of its introduction, Hylamer was thought to represent a significant step forward in the reduction of the problem of osteolysis. This however has not been our experience. In the light of the catastrophic failure rate in this series of patients, all postoperative X-rays were critically reviewed. We were unable to observe any dramatic technical errors by way of implant malpositioning and cement mantle deficiencies to account for the observed failures. We have also seen that statistically there is no difference in the hip scores for the patients whose hips have failed and those who have not yet met the criteria for failure. In view of this it is imperative that patients with this implant should be reviewed both clinically and radiologically. We feel that these results should be published earlier rather than later to ensure that others remain vigilant in the follow up of their patients

We report catastrophic early failure of a cemented total hip replacement comprising a modular femoral component with a Zirconia ceramic head and an acetabular component of cross-linked ultra-high molecular-weight polyethylene (Hylamer). Between 1995 and 1999 we implanted 29 hips in 26 patients with a mean age of 49.2 years. Survivorship analysis in this group revealed a failure rate of 67.6% at five years. All hips which failed did so because of aseptic loosening with progressive osteolysis or radiolucencies. We therefore recommend early and regular review of all patients with this combination of implants and early revision surgery in order to avoid massive bone loss.