Introduction: Osseointegration is known to occur around the uncemented acetabular cups which results in fill-in of peri-acetabular gaps. The objective of this study was to assess the gaps around uncemented acetabular cups radiologically in early post-operative period.

Methods: 53 primary uncemented total hip arthroplasties were performed at our hospital by a single surgeon between February 2003 and august 2005. There were 29 females and 22 males. Two patients had bilateral surgeries. Mean age of patients was 70 years (range, 52–88 years). Primary osteoarthritis of the hip was the indication for surgery in all the patients. Peri-acetabular gaps were measured on the radiographs taken at day-1 post-operatively and at 3 months follow-up. All the measurements were taken independently by two investigators on two different occasions using a picture archiving & communications (PACS) system. The two sets of data from each investigator were compared for intra and inter-observer variability using independent-samples t test.

Results: in 24 cases, no gaps were found around the ace-tabular cups on day-1 post-operative radiographs. In 29 cases, the mean gap was 4 mm (range, 1–8 mm) on postoperative day-1. Five gaps were in zone one, 24 in zone two and none in zone three. At 3 months follow-up, the mean gap was found to be 0.6 mm (range, 0–3 mm). The reduction in gaps from day-1 post-op to 3 months follow-up was statistically significant (chi square test, p< 0.05).

Discussion: We found a significant reduction in peri-acetabular gaps as early as at 3 months following uncemented total hip arthroplasties. We feel that settling of the cup within the acetabulum is responsible, rather than osseointegration, for these fill-in of gaps in early postoperative period. A larger study is required to analyse this phenomenon as screws fixation of uncemented cups may compromise their settling within the acetabulum.

Aim: This study involved a postal questionnaire survey to know the attitude of consultant orthopaedic surgeons in U.K. with regards to their postoperative management of Dupuytren’s surgery patients.

Methods & Results: A questionnaire was sent to Orthopaedic surgeons practising in UK. 573 consultants replied to the questionnaire. 169 surgeons (29.49%) stated to have special interest in hand surgery. 357 surgeons (62.3%) stated having no interest in hand surgery. 43 surgeons did not reply to the questionnaire. 81 surgeons (14.13%) always used post operative splintage.109 surgeons (19.03) used splintage most of the time, 126 surgeons (21.98%) rarely used it and 89 surgeons (15.53%) stated never using any form of splintage.

Most of them used static splintage (45.20%) and only 5.23% used dynamic splintage.11 surgeons stated using both the types of splintage. 267 surgeons did not questionnaire. Majority of the surgeons applied a static splint (pop slab, thermoplastic splint) after the surgery while others applied it after reducing the dressing within 2 weeks of the operation. 264 (46.07%) surgeons did not reply to the question.

In majority of cases the splint was applied by the occupational therapist. The surgeon, physiotherapist, and orthotist in some cases also applied the splint. Individual comments from surgeons made an interesting reading. After an initial period of continuous splintage majority of the surgeons used night splintage only. 265 surgeons did not reply to the question. Mostly the splint-age was used for 4–6 weeks. Although the spectrum of splintage varied from 2 weeks to 24 weeks. Some of the surgeons stated their own clinical practice in their comments.

179 surgeons stated always referring their patient for postoperative physiotherapy.

13 surgeons (2.26%) never referred their patients for physiotherapy.

77 surgeons on very odd occasions had postoperative physiotherapy for their patients.

Majority of surgeons started the physiotherapy between 1 and 2 weeks, after the stitches have been removed. 107 surgeons favoured early commencement of hand exercises within first week of surgery. 224 surgeon did not reply to this question.

Most of the surgeons followed the patients for two to four months. Longer follow up was done for patients with recurrence, severe or bilateral disease. Also those patients, who had proximal interphalangeal joint contracture and other risk factors, were followed for a longer period. Some of the surgeons commented following them for life in their clinical practice.

Conclusion: This survey revealed interesting facts regarding the management of Dupuytren’s contracture surgery patients. The disparity in reply clearly indicates the need for further research with attention to long term funtional results.

Congenital vertical talus was diagnosed in 15 feet of 10 children, and was treated by operative reduction. Forefoot deformity was corrected first, using anterolateral soft-tissue release on 11 feet, and manipulation alone in four feet. After prolonged immobilisation in plaster the affected feet had posterior release at the ankle and elongation of the calcaneal tendon. Clinical and radiographic examination at follow-up 15 months to 21 years later showed that a satisfactory outcome had been achieved in 12 of the 15 feet.