The 2004 United Kingdom (UK) National Health Service (NHS) Improvement Plan stated that: “By 2008, no one will have to wait longer than 18 weeks from GP referral to hospital treatment.” Over the same time period, on the other side of the Atlantic, the provincial government of British Columbia (BC) allocated funding for a specialist centre accommodating 2 new operating rooms and a 38 bed inpatient ward. The centre was designed to augment existing surgical capacity for hip and knee joint replacement by 1600 cases per year to help achieve the Canadian waiting time target of 26 weeks. Core design principles were: to improve patient flow through a centralised joint clinic designed to assess patients with osteoarthritis and related disorders; to maintain the connection between patient and surgeon throughout the entire care pathway; to ‘ring-fence’ dedicated operating room capacity and ward space in order to minimise the risk of surgical cancellations; and to reduce the mean length of inpatient post-operative stay to 4 days. Analysis of the programme's results showed: 1609 and 1602 joint replacements were performed during each of the first two respective years of operation – an additional 16% of provincial capacity, thus achieving the headline target; a mean patient satisfaction score of 4.7 out of 5; a self-reported complication rate of 4.4% (47 of the first 1078 patients surveyed); a mean theatre time of 1hr 45min, a mean post-anaesthesia recovery stay of 2hr 4min and a mean post-surgical length of stay of 3.4 days; and delivery of the programme within budget. By maintaining the patient/surgeon relationship and adhering to other key principles a high standard of care has been achieved in this programme with high rates of patient and surgeon satisfaction and a low complication rate.
Successful total hip arthroplasty (THA) in the presence of developmental dysplasia of the hip (DDH) depends on restoration of the anatomic centre of hip rotation and may require simultaneous femoral osteotomy. Techniques using uncemented components are widely reported. In osteopenic bone an all-cemented technique may be more appropriate; however, the outcome following this procedure is not known. We present the results of a series of thirty-five cemented THA with simultaneous subtrochanteric osteotomy. 28 patients with DDH (35 hips) who underwent this procedure at a mean age of 47.3 years were retrospectively reviewed. Two patients (two hips) died within 12 months of surgery. The clinical notes and radiographs of the remaining patients were reviewed with a minimum follow-up of 2 years (mean, 5.6 years; range, 2-14 years). Complications were noted. SF-12 and Oxford hip scores (OHS) were recorded for 18 patients pre-operatively and after 6 and 12 months.Hypothesis
Methods and analysis
Unidirectional mobile bearing knees (RP) were developed to optimise the tibio-femoral articulation in an effort to enhance function and reduce polyethylene wear. The self-aligning bearing should also benefit the patello-femoral joint further improving outcome. This study was designed to assess whether these potential benefits are realised in the clinical setting. A total of 352 patients undergoing a PS PFC Sigma TKR were randomly allocated to receive either a Mobile Bearing (176 knees) or a Fixed Bearing (176 knees) tibial tray. Within each group a further randomisation for patella resurfacing versus retention was included. All knees were scored using standard outcome tools (Oxford, AKSS, Patella Score) by independent nurse specialists.Introduction
Methods
