The thrust plate prosthesis in the treatment of osteoarthritis of the hip. Clinical and radiological outcome with minimum 5-year follow-up.

The thrust plate prosthesis (TPP) is a neck preserving femoral component in total hip arthroplasty (THA). We present our mid-term results from using the thrust plate prosthesis in young patients with hip arthritis. We conducted a retrospective review of a consecutive series of patients with a minimum of 5 years follow-up after total hip arthroplasty using the thrust plate prosthesis. Harris Hip Score (HHS) and Oxford Hip Score (OHS) were recorded preoperatively and at the last clinical review. Radiographic analysis was performed and patient satisfaction levels and complications were recorded. Between 1996 and 2000 we implanted 41 prostheses in 38 consecutive patients (3 bilateral). The mean age at time of surgery was 56 years (41-67) and the mean length of follow-up was 71 months. The HHS improved from a mean of 42 points preoperatively to 88 points at the last clinical review and the mean OHS also improved from 40 points to 18 points. Eighty-three percent of patients expressed that they were 'very satisfied' with the procedure. Implant survivorship was 95% at 5 years follow-up with revision surgery being the end point. Eight patients suffer discomfort when lying on the operated side. Many patients treated with the TPP show excellent improvement in clinical outcome scores and a high level of patient satisfaction but the complication rate gives some concern. We support the selective use of the TPP to treat young patients with hip osteoarthritis.

The role of the IPSS (International Prostate Symptoms Score) in predicting acute retention of urine in patients undergoing major joint arthroplasty.

BACKGROUND: Acute urinary retention following major joint arthroplasty is common. It does necessitate instrumentation, puts patients at risk of complications, and causes discomfort and embarrassment. The aim of the study was to find a test to help the surgeon to predict the possibility of acute retention of urine. METHODS: Male patients admitted for elective major joint arthroplasty filled in an IPSS (International Prostate Symptoms Score) during the pre-operative visit. They were observed post-operatively to document if they passed urine spontaneously or went into acute retention. RESULTS: There was a strong correlation between the IPSS and the likelihood of developing acute retention. Patients with moderate to high IPSS had a 55% to 100% chance of developing acute retention of urine, respectively. CONCLUSION: The IPSS proved to be a simple and reliable test to help the surgeon in predicting the possibility of developing acute retention. It might be a good addition to the pre-admission clinic investigations in patients undergoing major surgery. It could consolidate the decision to pre-emptive catheterisation in patients at risk.

Intra-articular fractures of the calcaneum treated operatively or conservatively. A prospective study.

We report a prospective trial of 66 patients with intraarticular fractures of the calcaneum. All fractures were assessed by CT. Patients with displaced fractures were randomised to receive either conservative (n = 31) or operative treatment (n = 25). Undisplaced fractures (n = 10) were treated conservatively. Operation involved open reduction of the posterior subtalar joint, and fixation with Kirschner wires. All 66 patients were reviewed at a minimum of one year (mean 23 months). After conservative treatment the undisplaced fractures had slightly better results than the displaced fractures. There was no significant difference in outcome between the operatively and the conservatively treated displaced fractures. We have also documented prospectively the natural history of the injury, which is of use in assessing prognosis for both clinical and medicolegal purposes.

The ABC carbon and polyester prosthetic ligament for ACL-deficient knees. Early results in 31 cases.

We treated 39 knees with chronic deficiency of the anterior cruciate ligament by reconstruction using the ABC carbon and polyester prosthetic ligament; 31 (79.5%) were reviewed at an average follow-up of 34 months. There had been four complete failures requiring revision. The remaining 27 were studied in detail. On the Lysholm rating, only 11 knees (41%) had good results with a score of over 76. The mean anterior drawer movement was reduced from 7.6 mm before operation to 5.8 mm at review. The mean difference from the opposite uninjured knee was 3.9 mm before operation, 1 mm (in 21 patients) at mean follow-up of 7.4 months and 2.5 mm (in 27 patients) at 34 months, indicating progressive loss of effect. In our opinion the results are unsatisfactory: we do not recommend the use of this prosthetic ligament.

Neck injuries from rear impact road traffic accidents: prognosis in persons seeking compensation.

We studied the natural history and prognostic factors in 100 patients who had sustained neck sprains in rear impact road traffic accidents, and who had all originally been seen for medicolegal reports. They were seen for clinical and radiological review at a mean of 8 years after injury. The detailed medicolegal reports from the early years were available on all patients, and were used to supplement the information obtained at review. Of the patients, 50 per cent had significant pain at 8 months, decreasing to 22 per cent at 2 years and 18 per cent at 3 years. At review, 45 per cent were free of pain, and 14 per cent had significant pain. Front seat position, pain within 12 h of injury, past history of neck pain and degenerative changes on radiographs were associated with a longer duration of significant pain (P < 0.05). Early onset of pain was also associated with a worse level of pain at review. The timing of compensation was not associated with improvement in symptoms. The injury had not accelerated the development of degenerative changes.