Complications following hemiarthroplasty for displaced intracapsular femoral neck fractures in the absence of routine follow-up

Introduction Hemiarthroplasty is the most commonly performed surgery for displaced intracapsular femoral neck fractures. At present, it is not routine practice to follow up these patients despite the risk of all the complications associated with arthroplasty. This study aimed to determine the prevalence and nature of complications occurring following hemiarthroplasty that re-presented to this centre in the absence of routine postoperative follow-up. Methods Consecutive patients undergoing uncemented hip hemiarthroplasty for displaced intracapsular femoral neck fractures at a district general hospital between 2004 and 2009 were identified. Data were collected from the hospital database on all complications relating to the index procedure, further surgery performed and mortality. Results There were 490 hemiarthroplasties performed in 477 patients (mean age: 80 years, 75% female). Of these, 110 (22%) were referred postoperatively for specialist orthopaedic review. The prevalence of any complication following hemiarthroplasty was 12% (n=59) and the prevalence of hemiarthroplasty failure was 8% (n=40). The most common indications for failure were periprosthetic fracture (28%), aseptic femoral loosening (25%) and unexplained pain (25%). Persistent hip pain and poor mobility accounted for most complications not requiring further surgery (n=15). The mortality rate within 30 days and 1 year of hemiarthroplasty was 6% (n=31) and 29% (n=146) respectively. Conclusions In the absence of routine follow-up, complications were encountered frequently in patients undergoing hip hemiarthroplasty, with most requiring further surgery. Appropriate services should be implemented to allow timely referral for orthopaedic assessment, and enable the early identification and treatment of postoperative complications.

Ring Uncemented Plastic on Metal Hip Replacements-Results from an Independent Unit

We present 251 Ring uncemented plastic on metal (UPM) hip replacements with a follow-up of 2–5 years. Judging the functional results by the Harris hip evaluation for the surviving 234 hips, 79.8% were good to excellent, 11.7% fair, and 8.5% poor at an average of 3 years. The mortality within one month of surgery was 0.79%. There were 4 cases of deep infection (1.59%), 3 of which required excision arthroplasty. At 3 years, 6 hips (2.39%) had required revision, all for aseptic femoral loosening, 2 of which also had acetabular loosening. Ring UPM hip is both safe and reliable in the hands of many surgeons outside Ring's unit.

The Fixation of Femoral Components of Condylar Knee Prostheses

Although problems with fixation of cemented components have been more common with tibial components than with femoral, there is clinical evidence that femoral loosening may occur but after a longer interval of time. Experimental and theoretical studies were carried out to examine the motions and stresses in the implant-bone assembly. The effect of a central intramedullary stem, and of unbonding the interfaces of the patella flange and the posterior condyles, were particularly examined. Perfect bonding led to severe stress protection of the distal layer of bone. A central stem needed to project considerably above the flange to be effective and was recommended for special indications only.