Aims

This study assessed the impact of COVID-19 on hip and distal femur fracture patient outcomes across three successive UK lockdown periods over one year.

1282 Primary total hip replacements were performed over the past 3 years at the Ravenscourt Park Hospital. Standardised post operative x-rays of the pelvis were archived on the Hammersmith Trust Picture Archiving and Communication System. 100 X-rays were randomly selected and reviewed by 3 independent observers (SHO, SPR, and a Consultant), and they were blinded as regards the Surgeon and their colleagues’ assessments. Surgeons who performed their procedure were excluded.

Digital radiographic analysis was performed using the OrthoView system (Meridian Technique Limited, Southamptom, UK). The acetabular component was studied with respect to cup version, the angle of inclination, the quality of cement technique, and the site of cup placement. The stems were studied for cementing technique and quality, stem alignment and limb length discrepancy. A hit was declared when excellence was achieved, whilst all others were declared as a miss. Inter observer rate in declaring a hit or miss was calculated (kappa). 58% of the radiographs studied were declared a hit, and 42% a miss.

All radiological reports were reviewed, and it was noted that no mention was made as regards the cup angles and the cementing quality. Each assessment took 3 minutes

(1.5). The aim of this post operative radiological assessment is to introduce a tool that could be used for appraisal of Surgeons, the surgical technique and for quality control.

The authors conclude that it is an easily reproducible technique, and can be performed by independent observers. These assessments will generate valuable data for research/auditing purposes, and act as an educational tool for trainees. They cautiously recommend this hit or miss approach, believing that it is a cost effective and efficient tool towards achieving better patient quality care and enhancing hip arthroplasty training skills.

Introduction: A subjective observation suggests that a significant percentage of patients offered a TKR could benefit from a relatively more conservative, less invasive unicompartmental knee arthroplasty. We set out to challenge this hypothesis.

Materials & Methods: 1147 TKRs were performed between 2002 and 2005 at Ravenscourt Park Hospital. 50 consecutive knee x-rays of patients who underwent a TKR were reviewed by three independent observers. Medial and lateral articular cartilage height, varus angulation, and femero-tibial anteroposterior and mediolateral translation were measured on antero-posterior and lateral weight bearing radiographs. Skyline views were analysed for patellofemoral disease. The most appropriate procedure according to local radiological criteria was recorded for all three observers. Unicompartmental arthroplasty was considered when the following criteria was met 1) anteromedial disease with preservation of posterior slope, 2) preservation of the tibial spines, 3) no anteroposte-rior or mediolateral translation, 4) normal tibiofemoral alignment and 5) preservation of patellofemoral joint. Osteophytes were disregarded. Tricompartmental disease merited a TKR while isolated patellofemoral (PFJ) disease considered for PFJ replacement. Patients were not formally examined. Preoperative Knee Society Scores (KSS) and WOMAC scores were noted.

Results: The three observers indicated that 26 (52%), 21 (42%) and 22 (44%) patients respectively could potentially benefit from a unicompartmental arthroplasty given the right clinical setting. Consensus was reached for unicompartmental replacement in 16 (31.2%) and for TKR in 18 (36%) of cases. There was no correlation between the operation performed and operation proposed (42% ± 8) suggesting that the surgeon’s preference is a dominating factor. Interestingly within the proposed unicompartmental group Knee Society Scores were higher (100 ± 22 vs 71 ± 26) giving an indication to the disease severity.

Conclusion: The clinical benefit and economic value of opting for a unicondylar knee arthroplasty when indicated is considerable. None the less it was only considered by a minority of surgeons who undertake knee arthroplasty.

We evaluated thirty six patients who underwent revision total hip arthroplasty for Vancouver type B periprosthetic femoral fractures. The implant used was a modular proximal femoral replacement stem cemented distally. All the patients were treated at Wrightington Hospital and included 15 males and 21 females. The primary diagnosis was OA in 28, RA in 2, AVN following femoral neck fractures in 3 and hip dysplasia in 3. The average age of patients was 75 years.

The fractures and bone loss were classified according to the Vancouver classification and included 23 B2 and 13 B2 fractures. The mechanism of injury was minor fall in 24 patients, spontaneous in 8 and intraoperative injury in 4.

Using a trans-trochanteric approach the existing prosthesis was removed and a long stem modular femoral stem was inserted bypassing the area of proximal femoral fracture/bone loss. Patients were typically mobilised within the first post-operative week. The patients were clinically and radiologically followed up at regular intervals. Fracture healing with significant improvement in bone stock was noted in 17 patients under 6 months, 13 patients at 12 months and 6 patients at 18 months.

Our series show that use of distally cemented long stem proximal femoral replacement prosthesis allows restoration of proximal bone stock and fracture healing in patients where conventional prostheses cannot be used because of massive bone loss in the proximal femur. This special modular prosthesis bypasses the area of bone loss/periprosthetic fracture, thus avoiding the need for bone allograft or other major reconstructive surgery in elderly patients.