SHORT-TERM RESULTS OF TOTAL HIP REPLACEMENTS PERFORMED BY VISITING SURGEONS AT AN NHS TREATMENT CENTRE

Abstract

From 2004–2006, in an attempt to reduce the waiting time for patients listed for total knee and total hip arthroplasty at Cardiff and Vale NHS Trust, 156 total hip replacements (THRs) were performed by Swedish Orthopaedic surgeons at an NHS treatment centre in England.

All patients were contacted and invited to a review appointment with a Consultant specialising in hip and revision hip replacement. Oxford Hip Scores and clinical and radiographic evaluation were performed. Patients who declined an appointment were sent a postal questionnaire. Radiographs were analysed for component position, radiolucent lines, medial floor breach, leg length discrepancy.

One hundred and thirteen hips were reviewed at a mean 23 month follow-up. The mean Oxford score was 26. Mean age at surgery was 69. Cemented THR was performed in 104 hips; hybrid in 7; cementless in 2. The Exeter stem and Cenator cemented cup were used in the majority of cases. 16% had acetabular inclination greater than 55 degrees. Radiolucent lines around the cup were seen in 76/113 hips. Femoral stem position was greater than 4 degrees varus in 47/113. Medial floor breach seen in 13/113. 10/113 had leg length discrepancy > 1cm. There were 3 dislocations, 1 femoral fracture, 1 pulmonary embolus, 3 deep infections, 2 superficial infections.

Revision surgery has been performed in 18/113 – the majority for a painful loose acetabular component. A further 5/113 have been recommended for surgery. The further surgery rate was 12% at 2 year follow-up.

The revision rate far exceeds the 0.5% 5-year failure rate reported in the Swedish Registry for the components used. This initiative has left a legacy of unhappy patients, and increased the workload required in our unit to correct the problems. The lack of long-term ownership of patients may be an important factor.