Background

The R3 cementless acetabular system (Smith & Nephew, Memphis, Tennessee, United States) is a modular titanium shell with an asymmetric porous titanium powder coating. It supports cross-linked polyethylene, metal and ceramic liners with several options for the femoral head component. The R3 cup was first marketed in Australia and Europe in 2007. Two recent papers have shown high failure rates of the MoM R3 system with up to 24% (Dramis et al 2014, Hothi et al 2015). There are currently no medium term clinical papers on the R3 acetabular cup.

Background

Fractures of the metatarsal bones are the most frequent fracture of the foot. Up to 70% involve the fifth metatarsal bone, of which approximately eighty percent are located proximally. Low-intensity pulsed ultrasound (LIPUS) has been shown to be a useful adjunct in the treatment of delayed fractures and non unions. However, there is no study looking at the success rate of LIPUS in fifth metatarsal fracture delayed unions.

Aims

We present a case series of five patients who had revision surgery following magnetic controlled growing rods (MGCR) for early onset scoliosis. Metallosis was found during revision in four out of five patients and we postulated a mechanism for rod failure based on retrieval analysis.

Most surgeons favour removing forearm plates in children. There is, however, no long-term data regarding the complications of retaining a plate. We present a prospective case series of 82 paediatric patients who underwent plating of their forearm fracture over an eight-year period with a minimum follow-up of two years. The study institution does not routinely remove forearm plates. A total of 116 plates were used: 79 one-third tubular plates and 37 dynamic compression plates (DCP). There were 12 complications: six plates (7.3%) were removed for pain or stiffness and there were six (7.3%) implant-related fractures. Overall, survival of the plates was 85% at 10 years. Cox regression analysis identified radial plates (odds ratio (OR) 4.4, p = 0.03) and DCP fixation (OR 3.2, p = 0.02) to be independent risk factors of an implant-related fracture. In contrast ulnar plates were more likely to cause pain or irritation necessitating removal (OR 5.6, p = 0.04).

The complications associated with retaining a plate are different, but do not occur more frequently than the complications following removal of a plate in children.

We compared 55 consecutive total hip replacements performed on 53 morbidly obese patients with osteoarthritis with a matched group of 55 total hip replacements in 53 non-obese patients. The groups were matched for age, gender, prosthesis type, laterality and preoperative Harris Hip Score. They were followed prospectively for five years and the outcomes were assessed using the Harris Hip Score, the Short-form 36 score and radiological findings.

Survival at five years using revision surgery as an endpoint, was 90.9% (95% confidence interval 82.9 to 98.9) for the morbidly obese and 100% for the non-obese patients. The Harris Hip and the Short-form 36 scores were significantly better in the non-obese group (p < 0.001). The morbidly obese patients had a higher rate of complications (22% vs 5%, p = 0.012), which included dislocation and both superficial and deep infection.

In light of these inferior results, morbidly obese patients should be advised to lose weight before undergoing a total hip replacement, and counselled regarding the complications. Despite these poorer results, however, the patients have improved function and quality of life.

Introduction: Langerhans Cell Histiocytosis (LCH) is a tumour-like condition that runs a variable clinical course. Recent series1,2 have suggested that skeletally immature patients with a solitary bony focus (eosinophilic granuloma) have an especially good prognosis.

Aim: To compare recurrence/progression rates for Scottish patients with solitary eosinophilic granulomas, according to skeletal maturity.

Methods: Retrospective case note review of patients identified from the Scottish Bone Tumour Registry.

Results: We identified 70 cases of biopsy-proven non-spinal eosinophilic granuloma of bone. Of these, 39 were skeletally immature (< 16 years) and 31 were skeletally mature (> 16 years). Follow-up (mean 8.25 years) was either continuing or to discharge/death. On the basis of initial screening (skeletal survey/bone scan), 9 cases (13 %; 4 and 5 patients, from the paediatric and adult groups respectively) were found to have multi-focal disease. Considering those with unifocal disease:

in the immature group, 6 patients (ex 35; 17%) developed a further manifestation of the condition (2 had recurrences at same site; 2 developed a distinct focus in bone; 1 developed a distinct soft tissue lesion causing spinal cord compression; 1 developed diabetes insipidus),

Conclusions: For this population, these data show that the prognosis for paediatric patients with isolated eosinophilic granuloma of bone must be more guarded than that suggested by other series1,2.