Total hip replacement can be performed successfully via a number of approaches. A patient's time to discharge following a THR is influenced by many factors. The anterior hip approach has recently been popularised as a true muscle sparing approach. This study looked at the association between operative approach (anterior, lateral or posterior), and length of hospital stay.

A retrospective review was conducted at Western Health, Victoria of 113 consecutive THRs performed at 3 hospitals (Footscray, Sunshine and Williamstown) by 16 surgeons over a 12 month period. The data was collected from the prospective information entered into the digital database ‘Sunray’ and a review of the postoperative notes in order to perform a retrospective audit. Statistical analysis included analysis of variance and pair-wise comparisons. Surgeons performed the surgery as clinically warranted, and no alteration was made of standard postoperative care or physiotherapy.

Of the 113 patients audited, the anterior approach for THR was found to be associated with a shorter length of stay in hospital when compared to both posterior approach (p=.0039) and lateral approach (p = .0512). The average length of stay after elective THR replacement was 6.9 days. The average length of stay for each approach was 4.3 days, 8.4 days and 6.4 days for anterior, posterior and lateral approach respectively. No significant difference was associated between operative approach and age.

Anterior approach to THR was associated with a shorter length of hospital stay.

The closed management of fractures and the application of plasters remains a core component of orthopaedic trauma management. A prospective audit was undertaken to analyse the quality of plasters presenting from various sources to the Fracture Clinic Plaster Technicians.

A prospective audit was conducted of 120 consecutive cases that presented to the Plaster Technicians at Western Health which had plasters applied by other institutions or other departments. The plasters were assessed on a number of criteria for adequacy and appropriateness using a standardised questionnaire and set guidelines.

63% of plasters applied were found to be deficient, inadequate or needed improvement. Of those applied by Theatre doctors, only 20% were appropriate. Of plasters applied by Emergency doctors only 10% were appropriate and those applied by General Practitioners were consistently deficient. Only trained plaster technicians had an acceptable rate of >90%. A large portion of the errors were due to incorrect moulding, joint position and fracture alignment.

Improperly applied plasters lead to increased morbidity, require reapplication or unnecessary operative procedures due to loss of position. Ongoing education and review is critical to address this situation, and a national online database is being designed and implemented to monitor this situation nationally.