Using general practitioner records, hospital medical notes and through direct telephone conversation with patients, we investigated the accuracy of nine patient-reported complications after elective joint replacement surgery of the hip and knee. A total of 402 post-discharge complications were reported after 8546 elective operations that were undertaken within a three-year period. These were reported by 136 men and 240 women with an overall mean age of 71.8 years (34.3–93.2). A total of 319 (79.4%; 95% confidence interval, 75.4%–83.3%) reported complications were confirmed to be correct. Very high rates of correct reporting were demonstrated for infection (94.5%) and further surgery (100%), whereas the rates of reporting deep venous thrombosis (DVT), pulmonary embolism, myocardial infarct and stroke were lower (75%–84.2%). Dislocation, periprosthetic fractures and nerve palsy were associated with modest rates of correct reporting (36%–57.1%). More patients who had had knee surgery delivered incorrect reports of dislocation (p = 0.001) and DVT (p = 0.013). Despite these variations in accuracy, it appears that post-operative complications may form part of a larger patient-reported outcome programme for monitoring outcome after elective joint replacement surgery.

Introduction

The outcomes programme of our institution has been developed from a system first used at Epsom and St Helier NHS Trust 15 years ago. The system was implemented at our institution when it opened in 2004, and has been used to collect data on over 17,000 joint replacement operations so far. A bespoke database is used to collect, analyse and report outcome data.

Introduction

The need for the stringent surveillance of new devices was recognised by the NICE review of hip replacement surgery in 2000 and led to the Orthopaedic Data Evaluation Panel (ODEP) developing criteria for post-marketing surveillance (PMS) studies. This requirement has been reinforced by the recent recall of ASR devices.

Introduction

Femorotibial malalignment exceeding ±3° is a recognised contributor of early mechanical failure after total knee replacement (TKR). The angle between the mechanical and anatomical axes of the femur remains the best guide to restore alignment. We investigated where the femoral head lies relative to the pelvis and how its position varies with respect to recognised demographic and anatomic parameters. We have tested the hypothesis of the senior author that the position of the centre of the femoral head varies very little, and if its location can be identified, it could serve to outline the mechanical axis of the femur without the need for sophisticated imaging.

There is a known association between femoroacetabular impingement (FAI) and osteoarthritis of the hip. What is not known is whether arthroscopic excision of an impingement lesion can significantly improve a patient’s symptoms.

This study compares the one-year results of hip arthroscopy for cam-type FAI in two groups of patients. The study (osteoplasty) group comprised 24 patients (24 hips) with cam-type FAI who underwent arthroscopic debridement with excision of their impingement lesion. The control (no osteoplasty) group comprised 47 patients (47 hips) who underwent arthroscopic debridement without excision of their impingement lesion. In both groups, the presence of FAI was confirmed on pre-operative plain radiographs. The modified Harris hip score (MHHS) was used for evaluation pre-operatively and at one year’s follow-up. Non-parametric tests were used for statistical analysis.

A tendency towards higher median post-operative MHHS scores was observed in the study than in the control group (83 vs. 77, p = 0.11). This was supported by a significantly higher portion of patients in the osteoplasty group with excellent/good results (83% vs. 60%, p = 0.043). It appears that even further symptomatic improvement may be obtained after hip arthroscopy for FAI by means of the femoral osteoplasty. When treating cam impingement arthroscopically, both central and peripheral compartments of the hip should always be accessed.

Introduction and Aims: Although the association between femoroacetabular impingement and osteoarthritis is established, it is not yet clear which hips have the greatest likelihood to rapidly progress to end-stage disease. We investigated the possible relation of specific radiological parameters, each indicative of a structural aspect of the hip joint, to progression of osteoarthritis.

Materials and Methods: Pairs of plain anteroposterior pelvic radiographs, spaced at least 10 years apart, of 43 patients (47 hips) with pistol-grip deformity of the femur and mild (Tönnis grade 1) or moderate (Tönnis grade 2) arthritis were reviewed. Radiological measurements included the α-angle, the neck-shaft angle, the Tönnis angle, the centre-edge angle of Wiberg and the anatomical medial proximal femoral angle (MPFA). The presence of the cross-over sign and the posterior wall sign was also recorded. Grading of osteoarthritis was repeated on the final films. A logistic regression analysis model was constructed, to investigate the predictive ability of radiological parameters on progression of osteoarthritis.

Results: Of the 47 hips, 31 (66%) showed evidence of progression of arthritis. There was no difference in the prevalence of progression between hips with initial grade 1 and grade 2 arthritis (p = 0.32). Comparison of the hips that progressed and those that did not revealed a significant difference for the MPFA (82° vs. 85°, p = 0.006) and the presence of the posterior wall sign (39% vs. 6%, p = 0.04) only. The regression analysis model demonstrated a predictive ability of 32% for those two parameters, with an accuracy of 78.3%.

Discussion and Conclusion: Mild-to-moderate osteoarthritis in hips with a pistol-grip deformity will not progress rapidly in all patients. In one third of them, progression will take more than ten years to manifest. Other structural aspects, relating to the geometry of the proximal femur and the acetabulum, influence in part this phenomenon. A hip with cam impingement is not always destined to end-stage arthritic degeneration.

Introduction and Aims: There is a known association between femoroacetabular impingement (FAI) and osteoarthritis of the hip. What is not known is whether arthroscopic excision of an impingement lesion can significantly improve a patient’s symptoms.

Materials and Methods: This study compares the one-year results of hip arthroscopy for cam-type FAI in two groups of patients. The study (osteoplasty) group comprised 24 patients (24 hips) with cam-type FAI who underwent arthroscopic debridement with excision of their impingement lesion. The control (no osteoplasty) group comprised 47 patients (47 hips) who underwent arthroscopic debridement without excision of their impingement lesion. In both groups, the presence of FAI was confirmed on pre-operative plain radiographs. The modified Harris hip score (MHHS) was used for evaluation pre-operatively and at one year’s follow-up. Non-parametric tests were used for statistical analysis.

Results: A tendency towards higher median post-operative MHHS scores was observed in the study than in the control group (83 vs. 77, p = 0.11). This was supported by a significantly higher portion of patients in the osteoplasty group with excellent/good results (83% vs. 60%, p = 0.043).

Conclusions: It appears that even further symptomatic improvement may be obtained after hip arthroscopy for FAI by means of the femoral osteoplasty. When treating cam impingement arthroscopically, both central and peripheral compartments of the hip should always be accessed.

Aims: This is a retrospective study, comparing prosthesis survivorship, complications and functional results in geriatric patients treated with different types of prosthetic replacement for subcapital fractures of the hip. Methods: In the years 1985–1999, 292 elderly (aged 65–80 years) patients with displaced, nonpathologic sub-capital hip fractures were operated on. Of those, 143 were lost to follow-up; therefore, prospectively collected data of 149 patients were retrospectively reviewed. 54 patients received a unipolar, 48 a bipolar prosthesis and 47 underwent a primary total hip arthroplasty (THA). Mean follow-up was 5.3 years. The patients did not differ in pre-injury characteristics. Analysis of variance was used to compare the three patient groups in terms of early and late complications, need for revision surgery, and functional outcome. Results: A statistically signiþ-cant difference was noted, regarding need for revision surgery, since 5 (9.25%) of the unipolar and 5 (10.4%) of the bipolar prostheses had to be re-operated, compared to 2 (4.25%) from the THA group. Of note, 4 of the revised bipolar prostheses had loose stems. The THA group also proved superior, when recovery of instrumental activities was investigated. Conclusions: Elderly patients, whose biologic age poses high functional demands on them, with a displaced subcapital hip fracture, should receive a total hip arthroplasty. Stem loosening seems more likely, as a mode of failure, in bipolar prostheses, than acetabular erosion.

Aims: The purpose of this roentgenographic study is to quantify patellar tilt after total knee arthroplasty and substantiate which factors might affect it. Methods: We reviewed the þles of 446 patients with 485 primary total knee arthroplasties, solely on the diagnosis of degenerative osteoarthritis. Mean follow-up approximated 8.5 (range, 5–20) years. Resurfacing-type prostheses were exclusively used. Patellar resurfacing was accomplished in 51 (11.4%) knees. Patellar tilt was measured pre- and postoperatively using standard Merchant views. Chi-square analysis was used in an attempt to disclose any relationship of patellar tilt with variables like button positioning, lateral release, patellar thickness, limb alignment, joint line elevation, patellar height and posterior cruciate ligament retention or sacriþce. Results: Pre-operatively, 27%, 40% and 33% of patellae demonstrated neutral, lateral and medial tilt respectively. These þgures subsequently changed to 49%, 19% and 32% immediately post-op. However, at þnal follow-up, patellar tilt pattern looked much like the pre-operative one, namely, 31%, 38% and 31% respectively. A statistically signiþcant positive correlation was only documented for patellar thickness, buttonmedialization and pre-operative tilt. The rest of the parameters tested were found not to have any statistical signiþcance with post-operative tilt values. Conclusions: After knee arthroplasty, the patella has, on the long term, a tendency to revert laterally. Lateral release does not seem to ameliorate this tendency. Finally, pre-operative tilt does not correlate to post-operative external mechanism complications.