Introduction: With recent concerns about the prevalence of Clostridium difficile, some Orthopaedic departments have changed their antibiotic prophylaxis for hip arthroplasty patients. Are these decisions evidence-based and are the changes in the best interests of the patient? We have gathered information from hospitals across the UK to investigate whether prophylactic regimens are changing and what is driving this change.

Methods: Information was gathered using a questionnaire. This was sent via e-mail to hospitals in the Mersey Deanery, the East Anglian Deanery and other hospitals across the UK.

Results: Replies were received from 21 hospitals in total. The vast proportion is still using cefuroxime 1.5g on induction with 2 post-op doses of cefuroxime 750mg. Those that have changed are mainly using flucloxacillin/gentamicin although decisions regarding prophylaxis are being driven by microbiologists/management (cost implicated in 10%) rather than clinicians/clinical evidence.

Discussion: The AAOS has recommended that antibiotics used for prophylaxis should be carefully selected. They should be consistent with current recommendations in the literature, taking into account issues of resistance and patient allergies. In 2007, the DoH recommended prudent antibiotic prescribing to reduce the use of broad spectrum antibiotics as an important component in preventing and controlling Clostridium difficile. Nelson postulated in a Cochrane Database Review in 2007 that in treating Clostridium difficile-associated diarrhoea in adults, teicoplanin appeared to be the best choice because evidence suggests that it is better than vancomycin for bacteriologic cure and has borderline superior effectiveness in terms of symptomatic cure. The combination of teicoplanin (covering Gram positive organisms including MRSA and enterococci) an gentamicin (covering aerobic Gram negatives and staphylococci) would surely be in the best interests of the patient despite the cost.

Introduction: The Birmingham Hip resurfacing was commercially introduced in 1997 and early originating centre series show good functional outcomes. Concerns have been raised over the longevity, functional outcomes and metal ion release from the implants. There are no series of medium term results from an independent district general hospital reported in the literature. We present a prospective series of 100 patients with mean 5 year follow up from a district general hospital. Each patient underwent yearly clinical, hip scoring, and regular radiographic evaluation.

Radiographic analysis was undertaken using Harris’, Hodgkinson’s and Amstutz’s criteria, evaluation of component position, neck narrowing and migration using diagnostic PACS workstations with standardised scaled images.

Results: Between June 2001 and Feb 2004 100 Birmingham Hip replacements were performed by two consultant surgeons (MP, AA). Mean follow up is 61.2 months (range 38–76 months). Harris hip scores (fig 1) improved from 46 pre-operatively to 90 post-operatively and no significant change over the next five years. There were no revisions in this period. Obese patients (BMI> 30) had a significantly (p< 0.03) lower post operative functional score as compared normal patients. No other factors were significant for outcome.

Component position was satisfactory in 93% of cases. Radiographic analysis showed no cups, or stems were definitely loose. Radiolucent lines were present in 8/100 acetabular and 3/100 femoral components, osteolytic lesions were seen in three acetabular components. Mean neck narrowing was 9mm. No patients show any radiographic evidence of avascular necrosis.

Conclusion This independent series shows the results of the Birmingham hip resurfacing are reproducible and comparable to those reported in the originating centre. The Birmingham hip resurfacing gives excellent clinical results, and there is no early evidence of radiographic failure. The high rate of neck narrowing gives us cause for concern and we would recommend regular radiographic follow up.

Introduction: We describe our experience with the Exeter femoral component in a District General Hospital. We implanted 230 Exeter Universal stems in 215 patients between 1994 and 1996, which were reviewed at a mean of 11.2 years. Unlike previous studies we have used one acetabular implant, the Elite Ogee Cup in the majority of patients (218/230 patients).

Methods: 76 patients (79 hips) had died, and 121 patients were alive and well enough to attend for radiographic analysis at a minimum of 10 years. One patient was lost to follow up.

Results: No stems were revised for aseptic loosening. Three hips were revised for deep infection. Six acetabular components were revised: 4 for loosening, and 2 for recurrent dislocations. Taking the worst-case scenario including the one patient lost to follow up, the overall survival rate was 94.2%.

Discussion: Our results confirm excellent medium term results of the Exeter Universal femoral component, implanted outside of a specialist centre (either originating centre or teaching hospital). The excellent survival of the Exeter stem, in mix and match combination with the Ogee cup would indicate that this is a successful pairing.

We describe the survivorship of the Exeter femoral component in a District General Hospital. Between 1994 and 1996, 230 Exeter Universal cemented femoral components were implanted in 215 patients who were reviewed at a mean of 11.2 years (10 to 13). We used one acetabular implant, the Elite Ogee component, in 218 of the 230 hips.

During the period of this study 76 patients (79 hips) died. Of the remaining 139 patients (151 hips), 121 were able to attend for radiological analysis at a minimum of ten years. One patient was lost to follow-up.

No femoral component was revised for aseptic loosening. Three hips were revised for deep infection and six acetabular components required revision, four for loosening and two for recurrent dislocation. Taking the ‘worst-case scenario’ including the one patient lost to follow-up, the overall survival rate was 94.4% at 13 years.

Our results confirm excellent medium-term results for the Exeter Universal femoral component, implanted in a general setting. The excellent survival of this femoral component, when used in combination with the Ogee acetabular component, suggests that this is a successful pairing.

Background: In times of blood shortage, the department of health plan to cancel elective surgery requiring more than 2 units of blood cross matching preoperatively. We assessed the use of blood products in scoliosis surgery and identified factors increasing the need for post operative blood transfusion.

Methods: Prospective data collection. Forty four patients underwent corrective spinal surgery between January 2003 and June 2004. Numbers of units of blood cross matched pre operatively and transfused post operatively were calculated. Subtype of scoliosis and surgical approach were also identified.

Results: All patients were cross matched 6 units of blood pre operatively, total of 264 units. Only 133 units were actually transfused, giving an overall 50.4 % product use rate. All syndromic patients were transfused blood irrespective of surgical approach. Idiopathic patients who had a one stage anterior approach did not require transfusion. Idiopathic patients were transfused a mean of 2.4 units and 2.9 units for one stage posterior and 2 stage approaches respectively. Syndromic patients were transfused a mean of 2.5 units, 5.8 units and 4.2 units for one stage anterior, one stage posterior and 2 stage procedures respectively.

Conclusion: The department of health published a paper on contingency planning for the shortage of blood products (1). In times of shortage, those surgeries requiring preoperative cross matching of more than 2 units will be cancelled first. Therefore, not only is it important to reduce the waste of blood products from a cost perspective, but also to cross match appropriately to avoid unnecessary cancellation if blood shortages occur. Surgical approach and underlying diagnosis need to be identified when cross matching patients for corrective scoliosis surgery. Idiopathic scoliosis patients only require 2 units of blood cross matching preoperatively. Patients with syndromes require 2–6 units depending on the surgical approach. A prospective validation trial has been implemented to validate our retrospective findings.