Introduction

The removal of a well fixed cement mantle for revision of a total hip replacement (THR) can be technically challenging and carries significant risks. Therefore, a cement-in-cement revision of the femoral component is an attractive option.

The Exeter Short Revision Stem (SRS) is a 125 mm polished taper stem with 44 mm offset specifically designed for cement-in-cement revisions. Only small series using this implant have been reported.

Aim

Assess the incidence of Vitamin D deficiency from a cohort of new referrals to a general Paediatric Orthopaedic outpatient clinic and evaluate the relationship between Vitamin D deficiency and the diagnosis of radiological or biochemical nutritional rickets.

Introduction

Classification systems are used throughout Trauma and Orthopaedic (T&O) surgery, designed to be used for communication, planning treatment options, predicting outcomes and research purposes. As a result the majority of T&O knowledge is based upon such systems with most of the published literature using classifications. Therefore we wanted to investigate the basis for the classification culture in our specialty by reviewing Orthopaedic classifications and the literature to assess whether the classifications had been independently validated.

Introduction

More than 60% of patients presenting with a hip fracture have significant medical co-morbidities and a one year mortality rate between 14% and 47%. The rating scale for the American Society of Anaesthetists (ASA) is a reliable predictor of both surgical risk and mortality with ASA 4 patients having 100% mortality at one year.1,2

Introduction: Posterior dislocation of replacement hips may occur during extreme hip flexion and adduction. Hip braces restrict movement, but they are uncomfortable and have a low patient compliance. Knee braces are more comfortable, and also restrict hip movement, by tightening the hamstrings. This study investigated the effect of a knee brace on hip movement.

Methods: A magnetic tracker was used to measure the movement of 20 normal hips in 20 volunteers, aged 25–62. Sensors were attached over the iliac spine and lateral thigh. Subjects were asked to lie on a couch and flex and adduct their hip three times with their knee bent and three times with their knee braced in extension. During each movement the tracker recorded hip flexion and adduction angles, with an accuracy of 0.15 degrees.

Results: With the knee flexed, the mean hip flexion angle was 66.00 (SD 11.0). With the knee braced, the mean hip flexion angle was 35.30 (SD 15.4). Hence the knee brace reduced hip flexion by 46 % (30.70) (paired t-test, P < < 0.001).

With the knee flexed, the mean hip adduction angle was 23.70 (SD 7.1). With the knee braced, the mean hip adduction angle was 21.60 (SD 5.6). Hence the knee brace reduced hip adduction by 9 % (2.10). This was not significant (paired t-test, P = 0.3).

Discussion: These results indicate that a knee brace can restrict hip flexion by almost 50%. This information may be useful for patients in whom restriction of hip flexion provides hip stability. As the knee brace is more comfortable than the hip brace, a better patient compliance is expected.

Introduction: Posterior dislocation of replacement hip joints may occur during hip flexion and adduction. A hip brace is commonly used for recurrent dislocations in patients awaiting revision surgery or when unfit for it. However, these hip braces are cumbersome and have a low patient compliance.

Knee braces are more comfortable to wear, and they also restrict hip movement by tightening the hamstrings. With this background we investigated the effect of a knee brace, applied in full extension, on hip flexion and adduction.

Methods: The movement of 20 normal hips in 20 healthy volunteers aged 25–62, were assessed using a magnetic tracking system (Polhemus Fastrak). One tracking sensor was attached near the anterior superior iliac spine and another one on the lateral aspect of the thigh at a fixed distance from the knee joint. Subjects were then asked to lie on a couch and flex and adduct their hip three times each with the knee bent and then with their knee braced in extension. Two sets of three readings were recorded. During each movement the tracker recorded hip flexion and adduction angles, with a measurement accuracy of 0.15 degrees.

Results: With a flexed knee, the mean hip flexion angle was 66.0 degrees (CI95 = 61.1, 70.8). With the knee braced, the mean hip flexion angle was 35.3 (CI95 = 28.5, 42.1). Hence the knee brace reduced hip flexion by 46% (30.7 deg). A paired t-test found this highly significant, with P < < 0.001.

With a flexed knee, the mean hip adduction angle was 23.7 degrees (CI95 = 20.6, 26.9). With the knee braced, the mean hip adduction angle was 21.6 (CI95 = 19.2, 24.1). Hence the knee brace reduced hip adduction by 9% (2.1 deg). A paired t-test found this was not significant with P = 0.3.

Conclusion: The results indicate that a knee brace can restrict hip flexion by almost 50%. This information may be useful for patients in whom restriction of hip flexion provides hip stability. As the knee brace is more comfortable than the hip brace, a better patient compliance is expected.

Posterior dislocation of replacement hips may occur during hip flexion and adduction. Whilst hip braces can restrict hip movement, they are cumbersome and have a low patient compliance. Knee braces are more comfortable to wear and also restrict hip movement by tightening the hamstrings. This study investigated the effect of a knee brace on hip flexion and adduction.

The movement of 20 normal hips in 20 healthy volunteers aged 25–62, were assessed using a magnetic tracking system (Polhemus Fastrak). Tracking sensors were attached over the iliac crest and lateral thigh. Subjects were asked to lie on a couch and flex and adduct their hip three times with their knee bent. A knee brace was then applied and the hip movements were repeated with the knee extended. During each movement the tracker recorded hip flexion and adduction angles with an accuracy of 0.15 degrees.

When the knee was flexed, the mean hip flexion angle was 66.00 (CI95 = 61.1, 70.8). When the knee was braced, the mean hip flexion angle was 35.30 (CI95 = 28.5, 42.1). Hence the knee brace reduced hip flexion by 46 % (30.70). A paired t-test found this highly significant (P < 0.001).

When the knee was flexed, the mean hip adduction angle was 23.70 (CI95 = 20.6, 26.9). When the knee was braced, the mean hip adduction angle was 21.60 (CI95 = 19.2, 24.1). Hence the knee brace reduced hip adduction by 9 % (2.10). A paired t-test found this was not significant (P = 0.3).

These results indicate that a knee brace can restrict hip flexion by almost 50%. This information may be useful for patients in whom restriction of hip flexion provides hip stability. As the knee brace is more comfortable than the hip brace, a better patient compliance can be expected.