All patients with a MOM THR implanted at our unit were recalled for clinical examination, Oxford hip score, radiographs, MARS MRI and cobalt/chromium ion levels. Patients were sub-classified, determining further follow up: a regular screening programme or referral to a revision arthroplasty surgeon.

We identified 299 MOM THR's. 59 patients reported a recent deterioration in symptoms. 67 had an abnormal x-ray. 232 hips underwent MARS MRI: 66 showed mild MOM disease, 31 moderate MOM disease, 17 severe MOM disease. 117 had a substantial fluid collection around the hip. Serum cobalt/chromium ions were raised in 135 patients. 46 had one or both above 7 ppb. 148 THR's were referred to a revision surgeon. 21 have been revised and 14 are awaiting revision.

In total 64 hips have been revised. 13 were histologically proven ALVAL, 19 had clinical findings of ALVAL (not histologically confirmed), and 1 non-specific reaction to metal wear. 53 asymptomatic patients had evidence of soft tissue reaction on MRI and/or rising metal ions.

Our screening programme identified asymptomatic patients with evidence of a suspicious reaction to their MOM THR. We recommend all patients with a MOM THR are fully screened for ARMD regardless of symptoms and metal ion levels.

This study reviewed all patients who received an EXOGEN Express bone stimulating device (BSD) to treat delayed union / non-union following operative treatment for a long bone fracture & evaluate if our results are comparable with the NICE guideline expectations.

A retrospective review of records between December 2004 & January 2013 revealed 113 patients treated with a BSD. A total of 59 patients were eligible for analysis, (operative treatment for a long bone fracture with adjuvant EXOGEN BSD for non-union or delayed union). Twenty-one were open fractures.

The BSD was applied at a mean of 264 days post-operatively. Thirty-five patients went on to have a 2nd operation before union was achieved. Forty-two patients went on to union following application of the BSD. Mean time to union was 293 days. Seventeen patients failed to unite by the end of the study. There were no adverse reactions to the EXOGEN BSD in this cohort.

This study has shown that the use of an EXOGEN BSD is a safe, non-invasive method to successfully treat long bone non-unions following initial operative surgery, with potential cost savings (a potential saving of £48,888 to the hospital according to NICE estimations) compared to the standard re-operative management.

Background:

Higher than expected revision rates have been observed in large bearing metal-on-metal total hip replacements. We have introduced a metal on metal hip screening clinic at our unit and report the results.