Introduction Hip resurfacing is a method of treating the degenerative hip joint in higher demand patients. In this study we present the results of the first four years of using this technique in a typical District General Hospital.

Materials and Methods This is a review of the outcome of 303 consecutive hip resurfacing procedures performed at Ashford and St. Peter’s Hospitals NHS Trust. All the operations were carried out through a posterior approach to the hip joint, followed by standard resurfacing using metal on metal components. The patients were evaluated radiographically and clinically pre-operatively and post-operatively. All patients had regular follow up.

Results The mean age was 56 years old with a range from 24 to 75 years. There was a statistically significant improvement between the pre-operative Harris Hip Score and the score at the latest follow up. All patients achieved a full range movement in the hip within twelve weeks following surgery. There were four fractures of the femoral neck, one was intra-operative and was converted to a traditional total joint arthroplasty. Three fractures occurred later, two were revised to a hybrid standard hip arthroplasty with a cemented stem and uncemented cup and one was treated conservatively. Two patients had transient femoral nerve palsies. There were no cases of dislocation or deep infection. All the prostheses remain well fixed with no signs of osteolysis.

Three procedures were performed because of avascular necrosis of the femoral head; none of these show signs of further collapse.

Conclusions The short and medium term results that have been achieved in a District General Hospital are comparable to those that have been achieved in the originator’s institution.

Introduction: Hip resurfacing is a method of treating the degenerative hip joint in higher demand patients. In this study we present the results of the first four years of using this technique in a typical District General Hospital.

Materials and Methods: This is a review of the outcome of 303 consecutive hip resurfacing procedures performed at Ashford and St. Peter’s Hospitals NHS Trust. All patients had a posterior approach to the hip joint, followed by standard resurfacing using metal on metal components. The patients were evaluated radiographically and clinically pre-operatively and post-operatively. All patients had regular follow up.

Results: The mean age was 56 with a range from 24 to 75 years old. There was a statistically significant improvement between the pre-operative Harris Hip Score and those at the latest follow up. All patients achieved a full range movement in the hip within twelve weeks following surgery. There were four fractures of the femoral neck, one was intra-operative and was converted to total joint arthroplasty. Three further fractures occurred, two were revised and one was treated conservatively. Two patients had transient femoral nerve palsies. There were no cases of dislocation or deep infection. All the prostheses remain well fixed with no signs of osteolysis.

There were three cases of avascular necrosis, all of which show no signs of further collapse.

Conclusions: The short and medium term results that have been achieved in a District General Hospital are comparable to those that have been achieved in the originator’s institution.

This study was designed to assess the standard of orthopaedic training of Senior House Officers in the U.K. and to determine the optimum time that should be spent in these posts before registrar training.

Two MCQ papers were constructed. One for the pre test and one for the post test. Questions covered all aspects of orthopaedics and trauma including operative surgery. The paper was firstly tested on controls including medical students, house officers, registrars of various grades and consultants. There was no statistical difference in the results for the two papers within the groups indicating that pre and post test papers were of similar standard. In addition the average scores in the tests increased proportionately to the experience and grade of the control.

129 SHOs from 25 hospitals in 10 different regions were tested by MCQ examination at the beginning of their 6-month post. They were again tested at the end of the job. The differences in score were compared. This difference was then correlated with the experience and career intention of the SHO.

There was no statistical difference between pre and post test results in all groups of SHOs in the study (student t test). The best improvement in scores during this six month period were seen in SHOs of 1–1.5 years orthopaedic experience. SHOs of more than 3 years experience demonstrated the smallest improvement in their score. There was a net loss of seven trainees with a career intention of orthopaedics to other disciplines.

In the vast majority of Senior House Officer posts in this country, very little seems to be learnt during a six-month attachment. This is especially so for those who are doing orthopaedics for the first time as well as very experienced SHOs.

To assess the results and complications of this method in a consecutive study of 99 segments with a 5 year follow up

The Vilarrubias method of limb lengthening aims to reduce soft tissue tension and protect joints in order to achieve longer lengthenings with fewer complications. Between 1988–1993 we operated on 99 segments using a modification of this method. The procedure combines a Wagner fixator with percutaneous soft tissue releases, static joint splintage and non-weightbearing mobilisation in a semi-reclining wheelchair. During the consolidation phase the fixator is removed and a moulded plaster applied. In Sheffield we used the Orthofix lengthener and permitted weight bearing and dynamisation in the consolidation phase. The criteria for patient selection were a lengthening aim of greater than 20% of the original bone length or other at risk features (Saleh and Hamer). There were 54 children, 19 with short stature and 35 with asymmetry, age range 4–19 years.

The mean length gained was 92 mm (range 21–173) and the mean BHI 41.3 days/cm (range 16.9–308). In 19 patients there were no complications. In the remainder there were 47 pin site problems, 33 flexion contractures, 33 angular deformities and 15 stress fractures. There were no deep infections or neurological sequelae. Some complications such as flexion contracture; angulation of the regenerate and stress fracture could be secondary to excessive soft tissue tension. Therefore, the length gained and BHI was compared for segments with these complications and those without, using the Students t test, and this was not significant (p> 0.15).

The method appears effective in achieving long lengthenings. Callus formation was satisfactory despite long periods non weight bearing. Considering the lengthening aims and high-risk cases it compares favourably with other reported series. We believe it remains an effective technique for cases of intermediate complexity.