A retrospective review was conducted of patients undergoing either total hip replacement or hemiarthroplasty for intra-capsular neck of femur fractures between April 2013 and April 2014; identified from entries into the National Hip Fracture Database. PACS and the electronic database encompassing operation notes and discharge summaries were reviewed. 309 patients were identified, 3 of whom fractured both hips during the study period giving a total of 312 operations. The age range was 46 to 102 with a mean age of 82. 59 cemented bipolar hemiarthroplasties, 143 cemented unipolar hemiarthroplasties, 2 uncemented hemiarthroplasties and 108 total hip replacements were performed. 10 patients required further operations. There have been 5 dislocations: 2 underwent MUA only, 2 treated by excision arthroplasty and 1 converted to THR. 1 patient developed a haematoma requiring wound washout. There were 4 wound infections - 1 treated by a washout, 2 by excision arthroplasty and one patient has undergone first stage revision; an overall reoperation rate of 3.2% comparing well with data published elsewhere.

Malformation and hypoplasia of the clavicle can result in pain, impaired function, restricted shoulder movement, subjective feeling of instability and cosmetic deformity. There are no reports of clavicle lengthening by osteotomy and distraction osteogenesis (DO). This is a retrospective review of 5 patients (7 clavicles) who underwent clavicle lengthening by DO using a monolateral external fixator for clavicular hypoplasia. There were 3 males and 2 females with mean age 15 years (9 to 23) and mean follow-up 21 months (8 to 51). Preoperative diagnoses included Klippel-Feil syndrome, cleidocranial dysplasia with torticollis, congenital myopathy and Noonans syndrome and obstetric brachial plexus injury. Mean length gained was 31 mm (15 to 41) which represens an average of 24.7% of overall bone length. Mean time in fixator was 174 days (161 to 263) and mean external fixation index was 56 days/cm. Two patients required internal fixation following fixator removal to consolidate union and one required additional internal fixation for atrophic regenerate. Mean preoperative oxford shoulder score improved from 28.5 to 41 and all patients were extremely satisfied with their result. Two patients developed pin site infections. Clavicular lengthening by distraction osteogenesis for congenital clavicular hypoplasia is a previously unreported technique that enables gradual correction of deformity without risking brachial plexus traction injury following acute correction. It has the potential to improve shoulder pain, function, range of movement and cosmesis. Distraction ≥25% of overall bone length may require additional plate fixation to consolidate union.

Reverse polarity total shoulder arthroplasty (RTSA) has gained popularity over recent years for the treatment of the painful cuff deficient shoulder. Although proposed over 20 years ago and despite good clinical outcomes the RTSA has struggled to gain popularity due to reported high levels of complications.

One such complication is post-operative instability with frequencies of up to 30% (De Wilde 2002). The Bayley-Walker RTSA was designed specifically for patients with difficult reconstruction problems in whom an unconstrained prosthesis would not offer sufficient stability. It is a reverse anatomy fixed fulcrum constrained prosthesis. The glenoid component has a long HA-coated tapered helical screw, with large pitch and depth, fixation is augmented by a grooved HA coated glenoid plate.

The purpose of this study was to review the clinical experience from The Royal National Orthopaedic Hospital Stanmore and to ascertain the rate of glenoid component loosening. We also carried out a radiographic review to correlate loosening with patterns of lucency on post-operative radiographs. One hundred and five B-W TSRs in 103 patients were included, 24% of which were performed as revision of previous failed arthroplasty. In total, 8/105 glenoids required revision. Of those eight patients, two were cases of septic loosening. Of all nine specified areas of glenoid, tip lucency on x-ray appeared to be most strongly associated with need for glenoid revision. 5/9 cases with tip lucency progressed to loosening of the glenoid. Where tip lucency was not seen, 93/96 glenoid components remained secure, giving tip lucency a negative predictive value of 97%. Excluding the two infected cases, the glenoid remained secure in 97/103 patients undergoing BW-TSR with follow-up up to 13 years. The BW-TSR is a satisfactory and durable solution to the cuff-deficient shoulder in variety of challenging groups including younger patients and as a salvage procedure following failed, cuff-deficient arthroplasty.

With an increasing ageing population and a rise in the number of primary hip arthroplasty, peri-prosthetic fracture (PPF) reconstructive surgery is becoming more commonplace. The Swedish National Hip Registry reported that, in 2002, 5.1% of primary total hip replacements required revision due to PPF. Laboratory studies have indicated that age, bone quality and BMI all contribute to an increased risk of PPF. Osteolysis and aseptic loosening contribute to the formation of loosening zones as described by Gruen, with subsequent increased risk of fracture. The aim of the study was to identify significant risk factors for PPF in patients who have undergone primary total hip replacement (THR).

Logbooks of three Consultant hip surgeons were filtered for patients who had THR-PPF fixation subsequent to trauma. Risk factors evaluated included sex, age, bone density (Singhs index), loosening zones, Vancouver classification, prosthesis stem angle relative to the axis of the femur, and length of time from THR to fracture. A control group of uncomplicated primary THR patients was also scrutinised.

Forty-six PPF were identified representing 2.59% of THR workload. The male: female ratios in both groups were not significantly different (1:1.27 and 1:1.14 respectively). Average age of PPF was 72.1, which was significantly older than the control group (54.7, p>0.05). The commonest type of PPF was Vancouver type B. Whilst stem position in the AP plane was similar in both groups, in lateral views the PPF stem angle demonstrated significant antero-grade leg position compared to the non-PPF group (p.0.05). The PPF group demonstrated a greater number of loosening zones in pre-fracture radiographs compared to the control group (2.59 and 1.39 respectively, p>0.05)

Our workload from PPF reflects that seen in Europe. Age, stem position and the degree of stem loosening appear to contribute to the risk of a peri-prosthetic fracture.