Introduction: The popularity of hip arthroscopy has lagged behind that of other joints. However surgeons are increasingly using hip arthroscopy to investigate and treat disorders such as early osteoarthritis, inflammatory arthritis, labral tears, loose bodies and paediatric hip disease.

We present the indications, intra operative findings and outcomes of patients undergoing hip arthroscopy.

Methods: Prospective study of 43 patients from 2000 to 2005 undergone hip arthroscopy performed by the senior author. Pre & post operative visual analogue scores and oxford hip scores were recorded.

CT or MRI was performed were clinically indicated. Mean follow up 4 months, range(2– 10).

Results: 45 hips. 20 right. 21 left. 2 bilateral. 22 females. 21 males. Mean age 39.6yrs, Range 20–65yrs

Symptoms: Pain, Clicking, Giving way.

History: Idiopathic pain 30, DDH 5, Perthes 3, Trauma acetabulum fracture 2, RT A Dislocation 1, SUFE 1, Non union 1.

6 patients had pre-op CT scans and 22 had MRI.

MRI Findings: 3 loose bodies, 14 labral tears, 2 large filling defects, 3 normal MRI

42 Arthroscopic debridement and wash outs, 3 failed scopes.

Intra operative findings: 5 loose bodies, 4 degenerate labrum’s, 10 labral tears, 14 Grade 3–4 Osteoarthritic changes, 7 Torn ligament Teres,1 normal joint.

3 normal MRI findings had labral tears and articular cartilage defects.

Mean Pre-op VAS- 7.9 Range(5– 10). Mean Post-op VAS- 4.7 Range(1– 10)

Discussion: Hip arthroscopy is of value in assessing and treating patients with hip pain of uncertain cause. Our results indicated good patient satisfaction and outcomes with improved pain and Oxford hip scores. However patient selection and diagnostic expertise are critical to successful outcomes.

Introduction: Removal of well-fixed, cementless, acetabular components after resurfacing hip arthroplasty remains a challenging problem. Damage to host bone may limit options for reconstruction, compromise the long-term result of the revision operation and fundamentally defeat the aim of bone conserving resurfacing hip surgery.

Methods: A series of 6 consecutive patients who under-went removal of a secure, acetabular resurfacing component at the time of revision arthroplasty were included for review. During the operative procedure, the size of the component which was removed and the diameter of the final reamer used prior to implantation and final acetabular implant were recorded. The modification of the standard explant technique will be described which allows safe removal of any size of acetabular component.

Results: In all patients the indication for index arthroplasty was osteoarthritis. Three cases were MMT (Smith and Nephew), 2 Cormet 2000 (Corin, UK). and 1 DUROM (Zimmer). The indications for acetabular revision were infection in all cases. The median difference between the size of component removed and the size of final component implanted was 4 mm.

Discussion: Our modification uses a pre-existing system. The ease of removal with this modification and the lack of any further damage to the host bone illustrates that the Explant Acetabular Cup Removal System can be safely expanded to removal of well fixed resurfacing monoblock acetabular components. With experience, any manufacturers resurfacing shell can be removed with virtually no bone loss.

Introduction: Acetabular introducers have an inbuilt inclination of 45 degrees to the shaft. With the patient in the lateral position the operator aims to align the introducer shaft to vertical to implant the acetabulum at 45 degrees. We examined if a bulls-eye spirit level attached to an introducer improved the accuracy of implantation.

Methods: A small circular bulls-eye spirit level was attached to the handle of an acetabular introducer directly over the shaft. A sawbone hemipelvis was fixed to a horizontal, flat surface. A cement substitute was placed in the acetabulum and subjects asked to implant a polyethylene cup into the acetabulum, aiming to obtain an angle of inclination of 45 degrees. Two attempts were made with the spirit level dial masked and two attempts made with it unmasked. The distance of the air bubble from the spirit level’s centre was recorded by a single assessor. The angle of inclination of the acetabular component was then calculated. Subjects included a city hospital’s Orthopaedic consultants and trainees.

Results: Eighteen subjects completed the study, with no significant difference in performance between consultants and trainees. Accuracy of acetabular implantation when using the unmasked spirit-level improved significantly in all grades of surgeon. With the spirit level masked, 11 out of 36 attempts were accurate at 45 degrees, 19 attempts ‘closed’ (< 45degrees) and 6 were ‘open’ (> 45 degrees). With the spirit level visible, all subjects achieved an inclination angle of exactly 45 degrees on both attempts. The mean difference between masked and unmasked implantation angle was 0.94 degrees (95% CI 0.64 to 1.24, p< 0.0001).

Discussion: A simple device attached to the handle of an acetabular introducer can significantly improve the accuracy of implantation of a cemented cup into a saw-bone pelvis in the lateral position. This technique may be easily transferable into an in-vivo study

Objectives The objective of this study was to investigate accelerated bone healing in patients with femoral shaft fractures.

Methods Data on patients with diaphyseal femoral fractures admitted to our trauma unit between 1997 and 2002 was collected and analysed. Patients were categorised into three groups by the presence or absence of head injury, and the reamed or undreamed nailing technique used. Severity of head injury was quantified using abbreviated injury score (AIS) and Glasgow Coma Scale (GCS). Time to bony union was assessed from serial of x-rays and clinical examination.

Patients were followed to discharge in outpatient clinics until bony union.

Results Group 1 ( Patients with head injury)

In total 17 patients (14 male, 3 female)

mean age 29.4(14–53)

open fractures 2

Mean AIS 3.2 (2–5)

Fracture treatment was reamed femoral nail

Bony union 10.5(6–22)weeks

Group 2 ( Patients without head injury)

Intotal 25 patients(19 male, 6 female)

Mean age 32(16–81)

Open fractures 2

Fracture treatment was reamed femoral nail

Bony union 20.5(14–32)weeks

Group 3 ( Patients without head injury)

In total 24 patients(18 male, 6 female)

Mean age 47(17–83)

Open fractures 2

Fracture treatment was unreamed femoral nail

Bony union 26.9 (21–32) weeks

Conclusion This study supports rapid bone union in the presence of head injury. Further research is indicated to provide a definate answer, specially mesenchymal cell and their control pathways which could allow further development of their potential therapeutic uses.