Aim: We present the outcome of Birmingham Hip Resurfacing Arthroplasty performed by a single surgeon after at least five years follow up.

Patients and Methods: One hundred hips in 84 patients were studied with a mean follow-up of 6.4 years (5–8.3 years), performed by a single surgeon. Three patients died of unrelated causes and 2 patients were lost to follow-up, hence the study group comprised of 79 patients with 95 hips. Birmingham resurfacing femoral and acetabular components were used in all patients.

The clinical outcome was measured using Harris, Charnley, Oxford hip scores and quality of life using SF-36. Radiographs were systematically analysed for implant position, fixation, and loosening.

Results: The mean age was 54 years (20–74years) and BMI of 28 (19–35). Primary osteoarthritis was seen in 69 hips. Six patients (6.1%) underwent revision of the femoral component (3 for peri-prosthetic fractures of the neck of femur, 2 for deep infection and 1 for collapse due to AVN). None of the patients had evidence of loosening around the acetabular component and femoral components in 28 patients. Type 1 pedestal sign was seen in 61 hips and Type 2 in 2 hips.

The clinical scores were respectively, Harris 85 (25–100), Oxford 21.5 (12–52), mean Charnley score 4.8 for pain, 5.3 for movement and 4.3 for mobility; the mean SF-36 score were 44 (12–58) for the physical and 51.4 (19–71) for the mental component. With an end point of definite or probable aseptic loosening, the probability of survival at 5 years was 100% and 97.3% (95% CI = 2.9) for acetabular and femoral components respectively. Overall survival at 5years with removal or repeat revision of either component for any reason as the end point was 91% (95% CI: 82 to 97%).

Conclusion: The results of this study support the continued use of Birmingham Hip Resurfacing Arthroplasty in young active individuals. As loosening can occur as a late phenomenon, a longer follow up is needed to determine longevity, durability of this prosthesis.

Introduction: We aim to report the clinical and radiological outcome of consecutive primary hip arthroplasties using the JRI-Furlong Hydroxyapatite ceramic (HAC) coated acetabular components.

Methods: We reviewed 412 consecutive cementless primary THA using fully coated acetabular shell in 392 patients, with a minimum 12-year follow-up to 18 years, performed at two institutions between 1986 and 1994. Twenty (22 THA) were lost prior to 12-year follow-up, leaving 372 patients (390 THA) available for study. Fully HAC coated stems were used in all patients. The clinical outcome was measured using Harris, Charnley and Oxford hip scores. Quality of life using EuroQol EQ-5D. Radiographs were systematically analysed for implant position, loosening, migration, osteolysis. Polythene wear was digitally measured. The radiographic stability of the acetabular component was determined by Enghs criteria

Results: The mean age was 74.4 yrs. Dislocation occurred in 10 patients (3 recurrent). Re operations were performed in 9 patients (1.9%). Four acetabular revisions were performed for aseptic loosening. Other re-operations were for infection (3), periprosthetic fractures (1), cup malposition (1), revision of worn liner (3). The mean Harris and Oxford scores were 87 (78–97) and 19.1 (12–33) respectively. The Charnley score was 5.6 (5–6) for pain, 5.2 (4–6) for movement and 5.3 (4–6) for mobility. Migration of acetabular component was seen in 4 hips. Acetabular radiolucencies were present in 54 hips (9.7%). The mean linear polythene wear was 0.06mm/year. Mean inclination was 48.4deg(38–65). Radiolucencies were present around 37 (6.6%) stems. Mean EQ–5D description scores and health thermometer scores were 0.81 (0.71–0.89) and 86 (64–95). With an end point of definite or probable loosening, the probability of survival at 12 years was 96.1% for acetabular Overall survival at 12 years with removal or repeat revision of either component for any reason as the end point was 94.2%.

Discusssion and conclusion: The results of this study support the continued use of a fully coated prosthesis and documents the durability of the HAC coated components. In our clinical experience, the Furlong prosthesis revealed encouraging radiographic stability over a long term period.

Aim: To report the clinical and radiological outcome of consecutive primary hip arthroplasties using the JRI-Furlong Hydroxyapatite ceramic (HAC) coated femoral and acetabular components

Methods: We reviewed 586 consecutive cementless primary THA using HAC coated components in 542 patients, with a minimum 12-year follow-up to 18 years, performed at one institution between 1986 and 1994. Twenty eight (32 THA) were lost prior to 12-year follow-up, leaving 514 patients (554 THA) available for study. Threaded cups were used in 64% and press-fit cups with screws in the rest. Fully HAC coated stems were used in all patients. The clinical outcome was measured using Harris, Charnley and Oxford hip scores. Anterior thigh pain was quantified on a visual analogue scale (VAS) and quality of life using EuroQol EQ-5D. Radiographs were systematically analysed for implant position, loosening, migration, osteolysis and stress shielding. Polythene wear was digitally measured. The radiographic stability of the femoral component was determined by Enghs criteria

Results: The mean age was 75.2 yrs. Dislocation occurred in 12 patients (3 recurrent). Re operations were performed in 11 patients (1.9%). Four acetabular and one stem revisions were performed for aseptic loosening. Other re-operations were for infection (2), periprosthetic fractures (2), cup malposition (1), revision of worn liner (2). The mean Harris and Oxford scores were 89 (79–96) and 18.4 (12–32) respectively. The Charnley score was 5.7 (5–6) for pain, 5.3 (4–6) for movement and 5.4 (4–6) for mobility. Migration of acetabular component was seen in 4 hips. Acetabular radiolucencies were present in 54 hips (9.7%). The mean linear polythene wear was 0.06mm/year. Stable stem by bony ingrowth was identified in all hips excluding one femoral revision case. Mean stem subsidence was 2.2mm (0.30–3.4mm). Radiolucencies were present around 37 (6.6%) stems. Mean EQ- 5D description scores and health thermometer scores were 0.81 (0.71–0.89) and 86 (64–95). With an end point of definite or probable loosening, the probability of survival at 12 years was 96.1% for acetabular and 98.3% for femoral components. Overall survival at 12 years with removal or repeat revision of either component for any reason as the end point was 97.2%.

Conclusion: The results of this study support the continued use of a fully coated prosthesis and documents the durability of the HAC coated components. In our clinical experience, the Furlong prosthesis revealed encouraging radiographic stability over a long term period.

Aim: To compare the clinical effectiveness, functional outcome and patient satisfaction following intra articular injection with Hylan G-F-20 and Sodium Hyaluro-nate in patients with osteoarthritis (OA) of the knee.

Methods: In this independent study, 382 consecutive patients with OA of the knee were prospectively randomized into two groups to receive Hylan G-F-20 -Syn-visc (n=196) or Sodium Hyaluronate -Hyalgan (n=186) and reviewed by blinded independent assessors at pre injection, 6 weeks, 3, 6, 12 months. Knee pain, patient satisfaction was measured on a VAS. Functional outcome was assessed using WOMAC, UCLA, Tegner, Oxford knee score and EuroQol- 5D scores. Mean follow up was 14 months.

Results: Patients in both groups predominantly had grade III OA. Knee pain on VAS improved from 6.7 to 3.2 by 6 weeks (p=0.02) and was sustained until 12 months (3.7, p=0.04) with Synvisc. In the Hyal-gan group, pain improved from 6.6 to 5.7 at 6 weeks (p> 0.05) and to 4.1 at 3 months (p=0.04) but was sustained only until 6 months (5.9, p> 0.05). Improvements in the WOMAC pain and physical activity subscales were significantly superior in the Synvisc group at 3 months (p=0.02), 6 months (p=0.01) and 12 months (p=0.02). General patient satisfaction was better in the Synvisc group at all times although statistically significant at 3 months (p=0.01) and 6 months (p=0.02). There was local increase in knee pain in one patient who received Synvisc, which settled by 4 weeks. Total treatment cost was 23% more in the Hyalgan group due to the two additional visits.

Conclusion: Although both treatments offered significant pain reduction, it was achieved earlier and sustained for a longer period in patients with Synvisc with early increase in activity levels. However, a local reaction of pseudo sepsis was observed with Synvisc in one patient. The total treatment cost, both for the patient and the hospital are higher with Hyalgan. From this study, it appears that the clinical effectiveness and general patient satisfaction are better amongst patients who received Synvisc.

Firearm injury is a potentially increasing public health problem worldwide. It is increasingly the subject of media and public attention. We aim to analyze the epidemiology, pattern and outcome as experienced.

Data such as age, sex, race, scene and nature of injury, firearm used, alcohol and drug factors, anatomy involved, surgical requirements, transfusion details, ICU/HDU stay, complications, deaths, and outcome were collected from medical notes, WYMAS and Coroners office of all patients who presented with firearm injuries from January 1995 to December 2001. Seventy-eight cases presented to our institution. There were 19 fatalities at the scene of injury. 69 were male. 51 sustained injuries in public places, 20 at their homes and 7 in outdoor areas. Low velocity firearms were involved in 49 cases. 50 were crime related. Alcohol was identified in 34 patients and illicit drugs in 6 cases. 19 cases had bony injury with associated vascular injury in one case. Primary neurological injury was diagnosed in 5 cases. Lower extremities and upper limb injuries accounted for 59% and 26%. 3 had head and neck wounds. 4 patients had thoracic trauma and 5 had abdominal injury. 86% required surgical intervention. 11 patients had a total of 16 complications, the most common being secondary infection. 6% of patients died at the emergency department and 3 after. Chest injuries caused 5 deaths and head wounds caused 3 deaths illustrating criminal intention to cause fatal body harm.

Conclusion: Males in younger age groups are disproportionately affected and the majority were crime- related injuries. Alcohol and other drugs were identified as a significant factor. There has been no significant decrease in the reported cases of firearm injuries or firearm-related deaths after the amendment made in the Firearm Rules in September 1998 (No:1941). The incidence of non-fatal firearm injury is comparable to centres involving similar population.

We have reviewed the patients with vertical shear fractures of the Pelvis and report on our treatment protocol and long-term functional outcome.

Methods: Between January 1993 and January 2002, out of 581 pelvic ring injuries treated in our unit, we identified 31 vertical shear fractures in 29 (4.9%) patients (4 female). Data such as age, sex, aetiology, associated injuries, ISS, resuscitation and transfusion requirements were recorded. ICU/HDU stay, surgical stabilization, urological injuries, systemic complications, neurological injury and mortality were recorded and analysed. Functional outcome was assessed using the following generic tools: EuroQol EQ-5D, SF36v2, SMFA, Majeed score and VAS.

Results: The mean age was 43.5 (16–71). The median ISS was 22 (12–32). Motorcycle accidents were responsible for 27%. Associated injuries included the chest (12 patients), abdomen (8 patients) and extremities (14 patients). Urethral injury was present in 9 and ruptured viscus was identified in 3 patients. Neurologic deficit was present in 9 cases. Posterior ring was stabilized in 3 (0 – 13) days. 6 patients developed systemic complications – ARDS in 4 (12%) patients, sepsis in 2 (6%). The mean follow up was 39 (12–101) months. Functional outcome using the Majeed score revealed that one-third of the patients were fair. SF-36 (physical and mental scores) and EQ 5-score revealed that one-third of the patients were fair. SF-36 (physical and mental scores) and EQ 5-score revealed that one-third of the patients were fair. SF-36 (physical and mental scores) and EQ 5- D revealed a moderate functional outcome. The SMFA and the visual analogue score also revealed similar outcomes.

Conclusion: Prompt resuscitation and early temporarily stabilization of the pelvic ring is essential. Sound reconstruction of the pelvic ring is not always associated with good results, probably due to the extensive pelvic floor trauma seen in this series of patients. Younger individuals seem to have a relatively better outcome when compared to the older age group.

Aim: To report the intermediate clinical and radiological results of a consecutive series of knee arthroplasies using PFC Sigma endoprosthesis.

Methods: 525 total knee replacements (469 patients) were performed from Aug 97 to Jun 01 using the PFC Sigma components. Cruciate retaining femoral component was used in 219 knees. All patients were prospectively followed up at 6 weeks, 3 months and yearly. Pre operative HSS knee scores and Oxford knee scores were compared with annual scores. Quality of life was assessed using SF12 questionnaire. Knee Society scores were used to assess the radiographs. The average follow up was 61 months (36–84). 11 patients lost to follow up.

Results: Of the 469 patients, 64% were females. Mean age was 74.2 yrs (59–90). Pre operative valgus deformity of at least 10 deg was present in 87 (16.5%). Patella resurfacing was performed in 80.5%. A lateral release was performed in 20 patients. Post operative mobilisation was standardised in all patients. 34 patients developed radiologically proven DVT. 24 patients died from unrelated causes. 16 (3%) patients developed superficial and 6 developed deep infection. 4 patients underwent revision surgery (3 for infection, 1- catastrophic failure). The HSS scores improved from 29(16–65) to 86(59–97) at final follow up (p=0.004). Pre operative Oxford knee scores improved from 10(6–31) to 43(37–48) at last follow up (p=0.008). Radiological knee society score for the femur were less than 5 in 477/478 patients and 7 in 1 patient. The scores for the tibia were less than 5 in 475/478 patients and 6 in 3 patients. Average femoral flexion was 1–9.2 deg (3.9), knee valgus angle 0.5–7.4 (3.5) degrees and the tibial slope was 3.1 deg (0–7.1). SF 12 health scores revealed a good functional outcome of both the physical and mental components. With failure defined as repeat revision because of aseptic loosening, the rate of survival at 5 years months was 99.1% and overall survival at 5 years with removal or repeat revision of any component for any reason as the end point was 97.5%.

Conclusion: Our prospective study of patients with primary knee arthroplasties supports the use of PFC sigma total knee endoproshesis. Our results show excellent clinical outcome comparable with other prosthesis. A longer follow up is needed to establish the durability and longevity of this prosthesis given its excellent intermediate term results

Aim: To report the intermediate clinical and radiological results of a consecutive series of knee arthroplasies using PFC Sigma endoprosthesis.

Methods: 525 total knee replacements (469 patients) were performed from Aug 97 to Jun 01 using the PFC Sigma components. Cruciate retaining femoral component was used in 219 knees. All patients were prospectively followed up at 6 weeks, 3 months and yearly. Pre operative HSS knee scores and Oxford knee scores were compared with annual scores. Quality of life was assessed using SF12 questionnaire. Knee Society scores were used to assess the radiographs. The average follow up was 61 months (36–84). 11 patients lost to follow up.

Results: Of the 469 patients, 64% were females. Mean age was 74.2 yrs(59–90). Valgus deformity of at least 10 deg was present in 87 (16.5%). Patella resurfacing was performed in 80.5%. A lateral release was performed in 20 patients. Post operative mobilisation was standardised in all patients. 34 patients developed radiologically proven DVT. 24 patients died to unrelated causes. 21 were lost to follow up. 16 (3%) patients developed superficial and 6 developed deep infection. 4 patients underwent revision surgery (3 – infection,1- catastrophic failure). The HSS scores improved from 29(16–65) to 86(59–97) at final follow up (p=0.004). Pre operative Oxford knee scores improved from 10(6–31) to 43(37–48) at last follow up (p=0.008). Radiological knee society score for the femur were less than 5 in 477/478 patients and 7 in 1 patient. The scores for the tibia were less than 5 in 475/478 patients and 6 in 3 patients. Average femoral flexion was 1– 9.2 deg (3.9), knee valgus angle 0.5 – 7.4 (3.5) degrees and the tibial slope was 3.1 deg(0–7.1). SF 12 health scores revealed a good functional outcome of both the physical and mental components. With failure defined as repeat revision because of aseptic loosening, the rate of survival at 5 years months was 99.1% and overall survival at 5 years with removal or repeat revision of any component for any reason as the end point was 97.5%.

Conclusion: Our prospective study of patients with primary knee arthroplasties supports the use of the PFC Sigma total knee proshesis. Our results show excellent clinical outcome comparable with other prostheses. A longer follow-up is needed to establish the durability and longevity of this prosthesis given its excellent intermediate term results

Purpose: We report the clinical and radiological outcome of revision of cemented hip arthroplasties using Hydroxyapatite ceramic (HAC) coated femoral and acetabular components.

Methods: 86-revision hip arthroplasties were performed in 82 patients with JRI Furlong HAC coated femoral and acetabular components. 2 surgeon series. The patients were followed for a mean 12.6 years (7–15). The femoral component was revised in all hips and the ace-tabular cup was revised in 62 hips (72%). Threaded cup used in 37 (59%) patients and press fit cups with screws in the rest. Acetabular bone grafting was performed in 24 (38%) hips. The clinical outcome was measured using Harris, Charnley, Oxford hip scores. Anterior thigh pain was quantified on a visual analogue scale (VAS). The quality of life was assessed using EuroQol EQ-5D.

Results: The mean age was 78.2 yrs. The mean time to revision was 96 months. None lost to follow up. 11 patients died. Dislocation was seen in 2 patients (1 recurrent). 2 hips were infected (1 re revision, 1 excision arthroplasty). Cup liner revised in 1 patient. The mean Harris and Oxford scores were 82 (59 96) and 24.4 (12–52) respectively. The Charnley score was 5.0 (3–6) for pain, 4.9 (3–6) for movement and 4.4 (3–6) for mobility. Migration of acetabular component was seen in 2 (4%) hips. Acetabular radiolucencies were present in 26 hips (41%) The mean linear polythene wear was 0.05mm/year. Mean stem subsidence was 1.6mm (0.30– 2.4mm). Radiolucencies were present around 21 (33%) stems. Stress shielding was seen in 40 of 56 stems. Calcar resorption was seen in 11 stems (16%). Bony ingrowth was seen in 76(89%) of stems. Ectopic calcification was seen in 12 (19%) hips. Of the 3 hips re- revised, 2 were for deep sepsis and 1 for recurrent dislocation. Mean EQ- 5D description scores and health thermometer scores were 0.69 (0.51–0.89) and 79 (54–95). With an end point of definite or probable loosening, the probability of survival at 12 years was 95.1% (95% CI =2.7),96.3% (95% CI = 2.1) for acetabular and femoral components respectively. Overall survival at 12 years with removal or repeat revision of either component for any reason as the end point was 93% (95% CI= 2.3).

Conclusion: The results of this study support the continued use of this prosthesis and document the durability of the HAC coated components. Our study had fewer cases of loosening of the components and had a better survival than bipolar implants or cemented acetabular components

Purpose: To analyze the long-term functional outcome of vertical shear fractures to other forms of severe pelvic injuries: APC-III, LC-III, and complex acetabular fractures.

Methods: We identified 31 VS fractures in 29 consecutive patients. A retrospective chart analysis was performed and analyzed in a control group comprising of 98 patients matched for age and sex: 34 APCIII, 32 LC-III and 32 complex acetabular fractures. Functional outcome was assessed in all patients using EuroQol EQ-5D, SF36, VAS, SMFA, Majeed score. Merle d Aubigne and Postel scores (Matta 1986) and radiologic degenerative hip scores (Matta 1994) were used to assess patients with acetabular fractures.

Results: Mean age of patients was 43.5 yrs, median ISS-22. In VS group 35% returned to their previous jobs (49% in control group), 30% had changed jobs (30%) and 25% (14%) had retired from regular work. In acetabular group 10 patients had neurologic injury and 3 patients had total hip arthroplasties at 29,40,51months. The clinical outcome (Matta scores) of patients in the acetabular group was:5 excellent (3 THA), 4 good, 13 fair,10 poor. The radiologic Matta score for acetabular group was: 4 excellent, 8 good, 14 fair, 3 poor. Mean EQ-5D description scores were 0.43, 0.63, 0.69, 0.49 and mean valuation scores were 46.1, 62.3, 78, and 51.4 for the VS, LCIII, APIII, and acetabular groups respectively. SF 36 physical health scores were 44.4, 62.5, 78.3, 54,2 and mental health score of 26.2, 68, 76.5 and 56.3 for VS, LCIII, APIII, and acetabular groups. SMFA dysfunction index was 63.3, 44.6, 38.3, 54.1 and the bother index was 60.5, 49, 34.2 and 57.2. There was a significant difference in EQ-5D score, SMFA, SF36 scores indicating poor outcome in the VS group compared to AP-III, LCIII group. There was no significant functional difference between the VS and acetabular group.

Conclusion: VS fractures represent the spectrum of high-energy pelvic disruption. Functional outcome is significantly better in patients with APC III, LC III fractures when compared to VS and complex acetabular fractures reflecting the severity of injury. Secondary osteoarthritis, neurologic injuries appear to contribute to the poor outcome of acetabular fractures. Sound reconstruction of pelvic ring is not always associated with good results probably due to extensive pelvic floor trauma as seen in this series of patients. Younger individuals seem to have a relatively better outcome when compared to the older age group.

Introduction and Aims: To analyse the long-term functional outcome of vertical shear fractures to other forms of severe pelvic injuries: APC-III, LC-III, and complex acetabular fractures.

Method: Out of 561 patients with pelvic ring injuries we identified 31 vertical shear fractures in 29 consecutive patients. We selected 34 patients with APC–III, 32 patients with LC-III and 32 patients with complex (at least bicolumnar) acetabular fractures to form the control group, who were matched for age and sex with the vertical shear fracture group. The mean follow-up was 62 months. Functional outcome was assessed in all patients using the following generic outcome measurement tools: EuroQol – EQ 5D, SF36 v2 (Short form), VAS, SMFA (Short musculoskeletal functional assessment) and Majeed score. In addition, Merle d’Aubigné-Postel scores (Matta, 1986) and radiologic degenerative hip scores (Matta 1994) were used to assess patients with acetabular fractures.

Results: The mean age of all the patients in the study was 43.5 years (16–71) and the median injury severity score was 22 (12–32). All patients had their pelvic ring stabilised at least temporarily within 24 hours and all acetabular fractures were reduced and stabilised by seven days. Functional outcome was assessed in all patients of the control group and in 28/29 patients of the vertical shear fracture group. In the vertical shear fracture group, 35% of the patients have returned to their previous jobs (49% in control group), 30% have changed their professions (30% in control group) and 25% (14% in control group) have retired from regular work. In the acetabular group, 10 (31%) patients had neurologic injury (six sciatic, three common peroneal, one femoral). Of these, four were iatrogenic. Six patients had complete neurologic recovery. Heterotopic ossification was seen in 19 (59%) patients. Three patients (9%) with acetabular fractures (all had associated posterior wall fracture) had total hip replacements at 29, 40, 51 months. The clinical outcome of patients in the acetabular fracture group was: five excellent (three THA), four good, 13 fair and 10 poor.

The radiologic score of degenerative hip disease (Matta 1994) for the acetabular fracture group was: four excellent, eight good, 14 fair and three poor. Analysis of the functional outcome is shown in Table 1.

Introduction and Aims: Prospective review of the patients who underwent stabilisation of displaced acetabular fractures in our unit in order to evaluate the presence of neurological lesions and functional outcome.

Method: Out of 136 patients operated over six years we identified 27 patients with neurological lesions. A standard protocol was followed for the clinical and neurophysiological evaluation of nerve injuries. Electromyography (EMG) was used to determine the anatomical location of the neurological lesions and the type of lesion, which act as a valuable tool in the diagnosis of double crush lesion in the sciatic nerve. Neurological recovery was evaluated with EMG studies and clinically rated as described by Clawson et al. Functional outcome was graded by the system proposed by Fassler and Swiontkowski.

Results: EMG studies revealed sciatic nerve lesions in all the cases. Additionally, in nine patients with a dropped foot there was evidence of a proximal (sciatic notch) and distal (neck of fibula) lesion – ‘double crush syndrome’. At final follow-up, clinical examination and associated EMG studies revealed full recovery in five cases with initial muscle weakness, and complete resolution of sensory symptoms (burning pain, hyposthesia) in four cases. There was improvement of functional capacity (motor and sensory) in two cases with initial complete drop foot and in four cases with muscle foot weakness. In 11 of the cases with dropped foot (all nine with double crush) at presentation, there was no improvement in function. Functional outcome was unsatisfactory in all patients with double crush injury.

Conclusion: In cases where there is evidence of ‘double crush lesions’ the prospect of functional recovery is low as seen in this group of patients. The patients with double crush syndrome are not expected to recover and could be considered as a sign of unfavourable outcome following neurological impairment after acetabular fractures. Single lesions appear to be associated with a more favourable prognosis.

Introduction and Aims: We report the clinical/radiological outcome of revision of cemented hip arthroplasties using Hydroxyapatite ceramic (HAC) coated femoral and acetabular components

Method: Sixty revision hip arthroplasties were performed in 64 patients with JRI Furlong HAC coated femoral and acetabular components. Mean follow-up was 10 years. Clinical outcome was measured using Harris, Charnley and Oxford hip scores. Anterior thigh pain was quantified on a visual analogue scale (VAS) and quality of life using EuroQol EQ-5D.

Results: The mean age was 78 years. The mean time to revision was 96 months. Eleven died to causes unrelated to index revision. Mean Harris and Oxford scores were 82 and 24.4. The Charnley score was 5.0 for pain, 4.9 for movement and 4.4 for mobility. Migration > 4mm of the acetabular component was seen in two hips. Acetabular radiolucencies were present in 26 hips. Mean linear polythene wear was 0.05mm/year. The mean subsidence was 1.6mm. Radiolucencies were present around 21 stems. Stress shielding was seen in 40; calcar resorption in 11; and endosteal cavitation around two stems. Ectopic calcification was seen in 12 hips. Three hips were re-revised – two for deep sepsis, one for recurrent dislocation. Mean EQ- 5D description and health scores were 0.69 and 79 (p> 0.05). With failure defined as repeat revision because of aseptic loosening, the rate of survival at 12 years was 100% for acetabular and femoral components. Overall survival at 12 years with removal or repeat revision of either component for any reason as the end point was 93% (95% CI ± 2.3).

Conclusion: The results of this study support the continued use of this prosthesis and document the durability of the HAC coated components, with fewer cases of loosening of the components, and a better survival than bipolar implants or cemented acetabular components. As loosening can occur as a late phenomenon, a longer follow-up is needed to determine the longevity of the HAC coated prosthesis.

We report the clinical and radiological outcome of 86 revisions of cemented hip arthroplasties using JRI-Furlong hydroxyapatite-ceramic-coated acetabular and femoral components. The acetabular component was revised in 62 hips and the femoral component in all hips. The mean follow-up was 12.6 years and no patient was lost to follow-up.

The mean age of the patients was 71.2 years. The mean Harris hip and Oxford scores were 82 (59 to 96) and 23.4 (14 to 40), respectively. The mean Charnley modification of the Merle d’Aubigné and Postel score was 5 (3 to 6) for pain, 4.9 (3 to 6) for movement and 4.4 (3 to 6) for mobility. Migration of the acetabular component was seen in two hips and the mean acetabular inclination was 42.6°. The mean linear polyethylene wear was 0.05 mm/year. The mean subsidence of the femoral component was 1.9 mm and stress shielding was seen in 23 (28%) with bony ingrowth in 76 (94%). Heterotopic ossification was seen in 12 hips (15%). There were three re-revisions, two for deep sepsis and one for recurrent dislocation and there were no re-revisions for aseptic loosening. The mean EuroQol EQ-5D description scores and health thermometer scores were 0.69 (0.51 to 0.89) and 79 (54 to 95), respectively. With an end-point of definite or probable loosening, the probability of survival at 12 years was 93.9% and 95.6% for the acetabular and femoral components, respectively. Overall survival at 12 years, with removal or further revision of either component for any reason as the end-point, was 92.3%.

Our study supports the continued use of this arthroplasty and documents the durability of hydroxyapatite-ceramic-coated components.

Purpose: We report the clinical and radiological outcome of revision of cemented hip arthroplasties using Hydroxyapatite ceramic (HAC) coated femoral and acetabular components.

Patients and Methods: 66-revision hip arthroplasties were performed in 64 patients with JRI Furlong HAC coated femoral and acetabular components. The patients were followed for a mean 10.6 years (7–15). The femoral component was revised in all hips and the acetabular cup was revised in 52 hips (79%). The clinical outcome was measured using Harris, Charnley and Oxford hip scores. Anterior thigh pain was quantified on a visual analogue scale (VAS). The quality of life was assessed using EuroQol EQ-5D. All pre op, immediate post op and last follow up radiographs were analysed for ace-tabular and femoral component loosening.

Results:The mean age was 78.2yrs (58–89yrs). The mean time to revision of the primary hip replacement was 96 months (24 to 161). 11 patients died due to causes unrelated to the index revision. At last follow up, the mean Harris and Oxford hip scores were 82 (59 – 100) and 24.4 (12-52) respectively. The Charnley score was 5.0 (3-6) for pain, 4.9 (3-6) for movement and 4.4 (3-6) for mobility. Acetabular bone grafting was performed in 26 (50%) hips. Migration > 4mm of the acetabular component was seen in 2 (4%) hips. Acetabular radiolucen-cies were present in 26 hips (55%). The mean linear polythene wear was 0.05mm/year. The mean stem subsidence was 1.6mm (0.30- 2.4mm). Radiolucencies were present around 21 (33%) stems. Stress shielding was seen in 40 of the 56 stems. Calcar resorption was seen in 11 stems (16%). Endosteal cavitation was seen around 2 stems. Ectopic calcification was seen in 12 (19%) hips. Of the 3 hips re- revised, 2 were for deep sepsis and 1 for recurrent dislocation. The mean EQ- 5D description scores and health thermometer scores were 0.69 (0.51-0.89) and 79 (54-95) respectively (p> 0.05 for both scores compared to average UK population scores). With failure defined as repeat revision because of aseptic loosening, the rate of survival at 12 years was 100% for the acetabular and femoral components. Overall survival at 12 years with removal or repeat revision of either component for any reason as the end point was 93% (95% CI ± 2.3).

Conclusion:The results of this study support the continued use of this prosthesis and document the durability of the HAC coated components. Our study had fewer cases of loosening of the components and had a better survival than bipolar implants or cemented acetabular components. As loosening can occur as a late phenomenon, a longer follow up is needed to determine the longevity and durability of the HAC coated prosthesis.

Injury to the sciatic nerve is one of the more serious complications of acetabular fracture and traumatic dislocation of the hip, both in the short and long term. We have reviewed prospectively patients, treated in our unit, for acetabular fractures who had concomitant injury to the sciatic nerve, with the aim of predicting the functional outcome after these injuries.

Of 136 patients who underwent stabilisation of acetabular fractures, there were 27 (19.9%) with neurological injury. At initial presentation, 13 patients had a complete foot-drop, ten had weakness of the foot and four had burning pain and altered sensation over the dorsum of the foot. Serial electromyography (EMG) studies were performed and the degree of functional recovery was monitored using the grading system of the Medical Research Council. In nine patients with a foot-drop, there was evidence of a proximal acetabular (sciatic) and a distal knee (neck of fibula) nerve lesion, the double-crush syndrome.

At the final follow-up, clinical examination and EMG studies showed full recovery in five of the ten patients with initial muscle weakness, and complete resolution in all four patients with sensory symptoms (burning pain and hyperaesthesia). There was improvement of functional capacity (motor and sensory) in two patients who presented initially with complete foot-drop. In the remaining 11 with foot-drop at presentation, including all nine with the double-crush lesion, there was no improvement in function at a mean follow-up of 4.3 years.

Aims: Firearm injury is a potentially increasing public health problem worldwide. It is increasingly the subject of media and public attention. We aim to analyse the epidemiology, pattern and outcome as experienced. Methods: Data such as age, sex, race, scene and nature of injury, þrearm used, alcohol and drug factors, anatomy involved, surgical requirements, transfusion details, ICU/HDU stay, complications, deaths, and outcome were collected from medical notes, WYMAS and Coroners ofþce of all patients who presented with þrearm injuries from Jan 1995 to Dec 2001. Results: 78 cases presented to our institution. There were 19 fatalities at the scene of injury. 69 were male. 51 sustained injuries in public places, 20 at their homes and 7 in outdoor areas. Low velocity þrearms were involved in 49 cases. 50 were crime related. Alcohol was identiþed 34 patients and illicit drugs in 6 cases. 19 cases had bony injury with associated vascular injury in one case. Primary neurological injury was diagnosed in 5 cases. Lower extremities and upper limb injuries accounted for 59% and 26%. 3 had head and neck wounds. 4 patients had thoracic trauma and 5 had abdominal injury. 86% required surgical intervention. 11 patients had a total of 16 complications, the most common being secondary infection. 6% patients died at the emergency department and 3 after. Chest injuries caused 5 deaths and head wounds caused 3 deaths illustrating criminal intention to cause fatal body harm. Conclusions: Males in younger age groups are disproportionately affected and the majority were crime related injuries. Alcohol and other drugs were identiþed as a signiþcant factor. There has been no signiþcant decrease in the reported cases of þrearm injuries or þrearm related deaths after the amendment made in the Firearm Rules in Sep 1998 (No:1941). The incidence of non-fatal þrearm injury is comparable to centers involving similar population.

Aim: We have reviewed the patients treated in our institution with vertical shear fractures of the pelvis and report on our treatment protocol and long term functional outcome. Methods: Between Jan 1993 and Jan 2002 patients with vertical shear fractures were identiþed. Data such as age, sex, aetiology, associated injuries, ISS, resuscitation requirements, transfusion requirements, ICU/HDU stay, treatment, urological injuries, systemic complications, neurological injury and mortality were recorded and analysed. Functional outcome assessment was performed using the following generic tools: Euro-qol 5D (EQ), SF36 v2 (Short form), SMFA, Majeed score and VAS. Results: Out of 380 pelvic ring injuries we identiþed 31 vertical shear fractures in 29 consecutive patients (4 female). The median ISS Score was 22. Motorcycle accidents were responsible for 27%. Injuries were identiþed in the chest (12 patients), abdomen (8 patients) and extremities (14 patients). Urethral injury was present in 9 patients. Ruptured viscus was identiþed in 3 cases. At presentation neurologic deþcit was present in 9 cases. Posterior ring was stabilised in 3(0–13) days. Systemic complications developed in 6 patients Ð ARDS in 4 patients and sepsis in 2 (6%). The mean follow up was 39 months. Functional outcome using the Majeed score revealed that 1/3 of the patients did fair. TheSF-36 v2 analysis, EQ 5-D revealed a moderate functional outcome. The SMFA and the visual analogue score also revealed similar outcomes. Conclusions: Prompt resuscitation and early temporarily stabilisation of the pelvic ring is essential. Sound reconstruction of the pelvic ring is not always associated with good results probably due to the extensive pelvic ßoor trauma as seen in this series of patients. Younger individuals seem to have a relatively better outcome when compared to the older age group.

Purpose: To analyze the long-term functional outcome of vertical shear fractures to other forms of severe pelvic injuries: APC-III, LC-III, and complex acetabular fractures.

Patients and Methods: Out of 561 patients with pelvic ring injuries we identified 31 vertical shear fractures in 29 consecutive patients (4 female). A retrospective chart analysis was performed and the following data was recorded: age, sex, mechanism of injury, associated injuries, Injury Severity Score (ISS), resuscitation requirements, method of stabilization, intensive care unit (ICU) or high dependency unit (HDU) stay, duration of hospital stay, urogenital injuries, neurological injury, systemic complications, time to union and mortality. The same parameters were assessed and analyzed in a control group comprising of 98 patients: 34 patients with APC–III, 32 patients with LC-III and 32 patients with complex (at least bicolumnar) ace-tabular fractures. All patients in the control group were matched for age and sex with the vertical shear fracture group. The mean follow up was 62 months. At final follow up, functional outcome was assessed in all patients using the following generic outcome measurement tools: Euro-Qol 5D (EQ), SF36 v2 (Short form), VAS (Visual analogue score), SMFA (Short musculoskeletal functional assessment) and Majeed score. In addition Merle d’ Aubignæ and Postel scores (Matta modification – 1986) and radiologic degenerative hip scores (Matta 994) were used to assess patients with acetabular fractures.

Results: The mean age of all the patients in the study was 43.5 years (16–71) and the median injury severity score was 22 (12–32). Motor vehicle accidents accounted for 79% of the injuries. All patients had their pelvic ring stabilized at least temporarily within 24 hours and all acetabular fractures were reduced and stabilized by 7 days. The mean hospital stay was 26 (9–176) days. Functional outcome was assessed in all patients of the control group and in 28/29 patients of the vertical shear fracture group (1 patient died as a result of a cerebral vascular accident 11 months after injury). In the vertical shear fracture group, 35% of the patients have returned to their previous jobs (49% in control group), 30% have changed their professions (30% in control group) and 25% (14% in control group) have retired from regular work. In the acetabular group, 10 (31%) patients had neurologic injury (6 sciatic, 3 common peroneal, 1 femoral). Of these, 4 were iatrogenic. 6 patients had complete neurologic recovery. Heterotopic ossification was seen in 19 (59%) patients (12 had Brooker Grade 1, four had Grade 2, three had Grade 3). Three patients (9%) with acetabular fractures (all had associated posterior wall fracture) had total hip replacements at 29,40,51months (2 secondary osteoarthritis and 1 osteonecrosis). The clinical outcome (Matta modification-1986 of Merle d’ Aubignæ and Postel scores) of patients in the acetabular fracture group was: 5 excellent (3 THA), 4 good, 13 fair and 10 poor. The radiologic score of degenerative hip disease (Matta 1994) for the acetabular fracture group was: 4 excellent, 8 good, 14 fair and 3 poor.

Conclusion: Patients with vertical shear fractures represent the spectrum of high-energy pelvic disruption. The functional outcome is significantly better in patients with APC III and LC III fractures when compared to vertical shear and complex acetabular fractures thus reflecting the severity of the injury. Secondary osteoarthritis and neurologic injury appear to contribute to the poor outcome of acetabular fractures. Sound reconstruction of the pelvic ring is not always associated with good results probably due to the extensive pelvic floor trauma as seen in this series of patients. Younger individuals seem to have a relatively better outcome when compared to the older age group.

The aim of revision hip arthroplasty for infection is to eradicate infection and restore function. There is, in current literature, little evidence to suggest an optimal time interval between first (excision) and second (reconstruction) stage procedures in revision hip arthroplasty.

Our aim was to assess the difference in outcome, in terms of patient pain, function and satisfaction, in relation to the time interval between surgeries.

A prospective analysis was made of 22 consecutive patients who underwent two-stage revision total hip replacement between 1992 and 2001. There were 12 male and 10 female patients. The mean age at the time of revision surgery was 63.5 years (range 35–83 years). The indication for surgery was infection in all cases. Patients were subdivided into two groups according to the time interval between first and second stages : Group 1 – time interval 6 months or less; Group 2 – time interval greater than 1 year. Outcome was assessed at 1 year post-operatively using change in pain and function scores and patient satisfaction scores.

Pre-operative pain and function scores were similar in the two Groups. Both Groups reported a similar improvement in pain at 1 year post-operatively. The patients in Group 1 also showed an improvement in function score, however, the patients in Group 2 showed no improvement in function. All patients felt the operation to be worthwhile as reflected in the patient satisfaction scores.

The results suggest that good improvements in pain can be achieved after short and longer time intervals. A longer time interval may well be associated with a poorer outcome in terms of restoring function.