Polyethylene wear debris can cause osteolysis and the failure of total hip arthroplasty. We present the five-year wear rates of a highly cross-linked polyethylene (X3) bearing surface when used in conjunction with a 36 mm ceramic femoral head.

This was a prospective study of a cohort of 100 THAs in 93 patients. Pain and activity scores were measured pre- and post-operatively. Femoral head penetration was measured at two months, one year, two years and at five years using validated edge-detecting software (PolyWare Auto).

At a mean of 5.08 years (3.93 to 6.01), 85 hips in 78 patients were available for study. The mean age of these patients was 59.08 years (42 to 73, the mean age of males (n = 34) was 59.15 years, and females (n = 44) was 59.02 years). All patients had significant improvement in their functional scores (p < 0.001). The steady state two-dimensional linear wear rate was 0.109 mm/year. The steady state volumetric wear rate was 29.61 mm³/year. No significant correlation was found between rate of wear and age (p = 0.34), acetabular component size (p = 0.12) or clinical score (p = 0.74).

Our study shows low steady state wear rates at five years in X3 highly cross-linked polyethylene in conjunction with a 36 mm ceramic femoral head. The linear wear rate was almost identical to the osteolysis threshold of 0.1 mm/year recommended in the literature.

Cite this article: Bone Joint J 2015;97-B:1470–4.

The early results with highly cross-linked polyethylene have been encouraging and have increased the ability to use larger head diameters to improve the range of motion and decrease the dislocation rate, the commonest cause of early complications following total hip arthroplasty (THA). Wear rates with 32 mls heads have been satisfactory however there have been very few independent studies looking at early polyethylene wear in 36 mm heads. This study assessed the rate of polyethylene wear of a 36mm ceramic femoral head and a highly cross-linked polyethylene (X3 Stryker) liner in THA.

This prospective study reviewed 100 consecutive THAs in young patients (mean age 58 years) who had undergone THA with the same 36mm ceramic femoral head and highly cross linked polyethylene liner. All patients received the same femoral stem (ABG, Stryker) and acetabular cup (Trident, Stryker). Two surgeons performed all procedures. Patients were assessed radiologically immediately postoperatively, at 10 weeks and at one year. Validated computer software (Polyware) was used to assess both volumetric and linear wear.

At one year the mean two-dimensional linear wear rate was 0.51 mm/yr. Mean three-dimensional linear vector wear rate was 0.59 mls per year with a mean volumetric wear rate of 322.6 mms per three years. Cup size ranged from 52–62 mms and the correlation coefficient between cup size and three-dimensional linear wear rate was −0.100. The correlation coefficient between cup size and volumetric wear rate was −0.009 confirming no significant correlation between cup size and wear.

Larger size femoral heads are associated with a higher volumetric wear compared to linear wear rate when using conventional polyethylene. This study demonstrated much higher early linear wear rates compared to other studies using 28 and 32 mms heads. This higher rate may be associated with the creep phenomenon and early bedding-in in the early stages after a THA and although this is of concern these results should be interpreted with caution.

Introduction: Lumbar discectomy is now the operation of choice for lumbosacral radicular syndrome. Few studies of high quality have been performed on the post surgical management of these cases. The studies that have been reported compare one exercise regime to another.

The aim of this study was to compare long term outcomes of usual surgical advice, involving no formal post-surgical rehabilitation, with a non-aggravating six month gym rehabilitation programme post lumbar discectomy. This study is a prospective randomized controlled trial using a cohort followed for three years.

Methods: The patients were computer randomised into two groups. Group A, the control group followed usual surgical advice which was to resume normal activity as soon as pain allowed. Group B, undertook the gym rehabilitation programme. Inclusion criteria were: Age 17 to 65 years, good health and no major medical problems. The surgical level had to be L3, L4, or L5. Patients were excluded if they had central neurological disorders, communication difficulties, any condition making gym-based exercises unsafe, or if the surgery was indicated for spinal infection, tumour or inflammatory disease. Patients were followed for a three year period using validated outcome measures (Roland-Morris Questionnaire and Oswestry Low Back Pain Index) and an annual Quality of Life (QoL) questionnaire. A sample of 40 per group provided the study with 80% power (P< 0.05) to detect a 3.5 point change in the RMQ and a 10% change in the ODI. The annual questionnaire reported information on number of GP visits, other therapist visits, medication levels and time off work.

Results: Ninety three participants were randomised; Control n=46 and trial n=47. Eighty nine participants completed the study. Randomisation achieved a balance of confounding factors, with the exception of work heaviness, where there were a greater number of participants in the very heavy and heavy categories in the trial group (P< 0.01). Thirty nine of 47 participants completed the gym programme (83%). Functional outcome measures did not show statistically significant differences between groups over the three year period. Key findings of cumulative 3 year data for the QoL questionnaire are: on intent-to-treat analysis; fewer patients having GP visits in the trial group P=0.048 (18% vs 5%). In the per protocol subset; fewer episodes off work P=0.074 (range control 0–3 vs trial 0–2), GP visits P= 0.089 (range control 0–12 vs trial 0–3) and in the per-protocol minus re-operation group; GP visits P< 0.008 (range control 0–3 vs trial 0–2), patients requiring medication use P=0.05 (37% control vs 17% trial) days off work P=0.099 (range control 0–30 vs trial 0–3).

Discussion: The results reveal an advantage in terms of episodes off work, GP visits and medication use for participants in the trial group who completed the programme. Time off work is a significant consideration for funding providers. These results suggest that surgeons should consider referral of discectomy patients to appropriate post-surgical rehabilitation programmes.

Lumbar discectomy is now the operation of choice for lumbosacral radicular syndrome. Few studies of high quality have been performed on the post surgical management of these cases. The studies that have been reported compare one exercise regime to another.

The aim of this study was to compare long term outcomes of usual surgical advice, involving no formal post-surgical rehabilitation, with a non-aggravating six month gym rehabilitation programme post lumbar discectomy. This study is a prospective randomised controlled trial using a cohort followed for three years.

The patients were computer randomised into two groups. Group A, the control group followed usual surgical advice which was to resume normal activity as soon as pain allowed. Group B, undertook the gym rehabilitation programme. Inclusion criteria were: age 17 to 65 years, good health and no major medical problems. The surgical level had to be L3, L4, or L5. Patients were excluded if they had central neurological disorders, communication difficulties, any condition making gym-based exercises unsafe, or if the surgery was indicated for spinal infection, tumour or inflammatory disease. Patients were followed for a three year period using validated outcome measures (Roland-Morris Questionnaire and Oswestry Low Back Pain Index) and an annual Quality of Life (QoL) questionnaire. The annual questionnaire reported information on number of GP visits, other therapist visits, medication levels and time off work.

Ninety three participants were randomised; Control n=46 and trial n=47. Eighty nine participants completed the study. Randomisation achieved a balance of confounding factors, with the exception of work heaviness, where there were a greater number of participants in the very heavy and heavy categories in the trial group (P< 0.01). Functional outcome measures did not achieve statistical difference over the three year period. Other studies have shown these measures to be reliable for short term follow up but their reliability diminishes with time (1,2). Key findings of cumulative three year data for the QoL questionnaire were in the intent-to-treat analysis: fewer GP visits in the trial group p< 0.008; and per protocol: fewer episodes off work p< 0.01 (49% versus 15%), fewer days off p< 0.053 and fewer GP visits p< 0.009.

The results reveal an advantage in terms of episodes off work and GP visits for participants in Group B who completed the programme. Time off work is a significant consideration for funding providers. These results suggest that surgeons should consider referral of discectomy patients to appropriate post-surgical rehabilitation programmes.

Lumbar discectomy is now the operation of choice for lumbosacral radicular syndrome. Few studies of high quality have been performed on the post surgical management of these cases. The studies that have been reported compared one exercise regime to another. This study compares an exercise group with a true control group involving no exercise or formal rehabilitation. This is a randomized controlled trial comparing post surgical lumbar discectomy management regimes.

Ninety three lumbar discectomy patients were randomized to two groups. Group A; the control group followed usual surgical advice which was to resume normal activity as soon as pain allowed. Group B; undertook a six month supervised non aggravating gym rehab programme. Both groups were followed for a one year period using validated outcome measures and a questionnaire. The results are based on an intention-to-treat analysis.

Patients in both groups improved during the one year follow up period (P=0.001). However there was no statistical difference between groups at the clinical end point (Roland Morris P=0.83, Oswestry Low back index P=0.90). Group B patients returned to work seven days earlier than group A patients and had fewer days off work in the one year follow up period but this difference was not statistically significant.

There was no statistical advantage gained by the patients who performed the gym rehabilitation programme after one year follow up. These are the preliminary one year results of a three year follow up study.

Introduction Lumbar discectomy is now the operation of choice for lumbosacral radicular syndrome. Few studies of high quality have been performed on the post-surgical management of these cases (Ostelo RWJG, et al; Spine 2003). The studies that have been reported compared one exercise regime to another. This study compares an exercise group with a true control group involving no exercise or formal rehabilitation. This is a randomised controlled trial comparing post surgical lumbar discectomy management regimes.

Methods Ninety-three lumbar discectomy patients were randomised to two groups. Group A; the control group followed usual surgical advice which was to resume normal activity as soon as pain allowed. Group B; undertook a six month supervised non- aggravating gym rehab programme. Both groups were followed for a one year period using validated outcome measures and questionnaires (Roland Morris, Oswestry Low-back Score). The results are based on an intention-to-treat analysis.

Results Patients in both groups improved during the one-year follow-up period (P=0.001). However there was no statistical difference between groups at the clinical end point (Roland Morris P=0.83, Oswestry Low-back Index P=0.90). Group B patients returned to work seven days earlier than group A patients and had fewer days off work in the one year follow-up period but this difference was not statistically significant.

Discussion There was no statistical advantage gained by the patients who performed the gym rehabilitation programme after one year follow-up. These are the preliminary one-year results of a three-year follow-up study.

Our aim was to assess the clinical and radiological medium-term outcome of a series of 153 consecutive total hip arthroplasties performed by two surgeons in Christchurch using the ABG hydroxyapatite-coated femoral stem and Duraloc 100-series uncemented acetabulum.

An independent clinical review using interviews and patient notes and radiological review of immediate postoperative and most recent x-rays was carried out.

At six to eleven years with approximately 95% follow-up, there were no stem failures, but two revisions following a fracture from significant trauma. Two cups were revised for loosening and one cup bone grafted for osteolysis. A dislocation occurred in 4.7% of cases requiring two liner exchanges and one cup revision. A low incidence of thigh pain and excellent radiographic results of the stem with high rates of bony ingrowth and no incidence of significant loosening was a feature of this series.

We report excellent results at medium-term follow up for an unceme4nted HA- coated femoral stem.

L5-S1 interbody fusion is a successful technique for treating patients with isolated degenerative disc disease. Traditionally through an open technique, the anterior laparoscopic approach for this was first described in 1991.

The purpose of this study was to review the long-term outcome results of L5-S1 interbody spinal fusion, using an anterior endoscopic technique, performed on patients with isolated degenerative L5-S1 disc disease. The first 41 spinal fusions performed by the senior authors were analysed. Patients received clinical, functional and radiological review by an independent assessor.

Clinical outcomes were excellent with > 90% of patients having significant improvement in back assessment scores (Fraser and Greenough, Japanese Orthopaedic Association). There were no intraoperative complications, no vascular complications, and no reports of retrograde ejaculation.

The anterior endoscopic approach for L5-S1 inter-body fusion results in good clinical outcomes, with a very low rate of morbidity. Surgical recovery time is quicker compared to open techniques, however, two skilled surgeons and an increase in theatre resources is required.

Introduction: The optimal treatment for acute thoracolumbar burst fractures remains controversial, particularly in the patient with minimal or no neurologic deficit. While this group could be treated conservatively, at Burwood we prefer to utilise short segment instrumented stabilisation.

We wished to review the indications for surgical intervention and the outcomes in this group with emphasis on safety, rate of rehabilitation, function, and pain levels.

Methods: The clinical notes and X-rays were reviewed for 34 consecutive patients with thoracolumbar burst fractures with minimal or no neurologic deficit, and treated by Dick fixator between August 1995 and September 2001. A questionnaire was mailed to all patients.

Results: At presentation this group had a mean age of 30.7 yrs (range 16–59), mean kyphotic deformity (Cobb method) of 16.1°, decrease in vertebral body anterior height of 40.9%, and decrease in canal area of 41.2%. Operative fixation was successful in greatly improving both height and kyphosis. No major complication such as metal-ware breakage, thromboembolism, deep infection, or neurologic deterioration was encountered. Average operating time was 71 min, time to discharge was 8.4 days, except where an associated injury limited mobility (17.1 days).

Questionnaires were returned by 29 of 34 patients at a mean of 3 years post-injury. All of these had returned to work or usual level of activity at 14.3 weeks (4–36 wks). Pain was experienced never or occasionally by 18 (62%), in relation to activity by 9 (31%), and on most days by 2 (7%). The average visual analog pain score was 2.1/10. No patient required regular or opioid analgesia.

Discussion: This form of operative fixation appeared to benefit this group of patients by allowing rapid rehabilitation with early mobilisation, discharge, and return to work. Pain frequency and severity were both low at medium term follow up and no major complication was encountered.

INTRODUCTION: The optimal treatment for acute thoracolumbar burst fractures remains controversial, particularly in the patient with minimal or no neurologic deficit. While this group could be treated conservatively, at Burwood we prefer to utilise short segment instrumented stabilisation.

We wished to review the indications for surgical intervention and the outcomes in this group with emphasis on safety, rate of rehabilitation, function, and pain levels.

METHODS: The clinical notes and X-rays were reviewed for 34 consecutive patients with thoracolumbar burst fractures with minimal or no neurologic deficit, and treated by Dick fixator between August 1995 and September 2001. A questionnaire was mailed to all patients.

RESULTS: At presentation this group had a mean age of 30.7 years (range 16–59), mean kyphotic deformity (Cobb method) of 16.1°, decrease in vertebral body anterior height of 40.9%, and decrease in canal area of 41.2%. Operative fixation was successful in greatly improving both height and kyphosis. No major complication such as metalware breakage, thromboembolism, deep infection, or neurologic deterioration was encountered. Average operating time was 71 minutes, time to discharge was 8.4 days, except where an associated injury limited mobility (17.1 days).

Questionnaires were returned by 29 of 34 patients at a mean of three years post-injury. All of these had returned to work or usual level of activity at 14.3 weeks (4–36 weeks). Pain was experienced never or occasionally by 18 (62%), in relation to activity by 9 (31%), and on most days by 2 (7%). The average visual analog pain score was 2.1/10. No patient required regular or opioid analgesia.

DISCUSSION: This form of operative fixation appeared to benefit this group of patients by allowing rapid rehabilitation with early mobilisation, discharge, and return to work. Pain frequency and severity were both low at medium term follow-up and no major complication was encountered.

Eleven patients were reviewed an average of 23 years after they had been treated by excision of a symptomatic calcaneonavicular bar in 16 of their feet. Of these feet 69% (11 feet) had a good or excellent result. Of the five failures, three feet had good results after subsequent triple arthrodesis, but two treated by repeated excision of the bar were still unsatisfactory. Beaking of the talus seen before operation correlated with poor results.

A retrospective review of medial compartment arthroplasty in 22 patients (22 knees) is reported. The operations were performed between 1973 and 1978. Eighty-six per cent were rated good or excellent using the knee rating system devised by the Hospital for Special Surgery, New York. Excellent or good results were achieved in six patients who had previously had a high tibial osteotomy. At the time of follow-up significant loosening had not occurred, although progression of patellofemoral disease was noted. This study supports the promising results reported for unicompartmental resurfacing arthroplasty in the elderly.