The Exeter V40 cemented femoral component at a minimum 10-year follow-up: the first 540 cases.

Aims: The aim of this study was to report the initial results of the Exeter V40 stem, which became available in 2000. Patients and Methods: A total of 540 total hip arthroplasties (THAs) were performed in our unit using this stem between December 2000 and May 2002. Our routine protocol is to review patients postoperatively and at one, five, and ten years following surgery. Results: A total of 145 patients (26.9%) died before ten years and of the remaining 395 stems, 374 (94.7%) remain in situ. A total of 21 well-fixed stems (5.3%) were revised. Ten were exchanged using a cement-in-cement technique to facilitate acetabular revision. Three were revised for infection, one for instability, one for fracture of the stem, and six following a periprosthetic fracture. An additional 16 acetabular components (4.1%) were revised; five for aseptic loosening and 11 for instability. There were no revisions for aseptic loosening of the stem, and no evidence of aseptic loosening in any hip. The fate of every stem is known and all patients remain under review. Survivorship, with revision of the stem for aseptic loosening as the endpoint, was 100%. At 13.5 years, the Kaplan-Meier survival rate for all-cause revision of the stem was 96.8% (95% confidence interval (CI) 94.8 to 98.8) and all-cause revision (including acetabular revision, infection, and instability) was 91.2% (95% CI 88.3 to 94.1). Conclusion: Conclusion No stem was revised for aseptic loosening in this series. The contemporary Exeter V40 stem continues to perform well, and survival has remained comparable with that of the Exeter Universal stem. Cite this article: Bone Joint J 2018;100-B:1002-9.

The physiological cost of restricted weight bearing.

BACKGROUND: To identify the energy cost of placing restrictions on weight bearing status. METHODS: Measurement of the Physiological cost index (PCI) for 11 healthy volunteers carrying out three types of mobilisation over a 100 m course in a physiology laboratory: normal walking fully weight bearing (FWB); non-weight bearing (NWB) and feather touch weight bearing (FTWB). NWB and FTWB were performed using a walking frame for support. FTWB was defined as mobilisation with the foot flat, as in normal gait, but with less than 100 N force generated through the limb. RESULTS: Both NWB and FTWB developed significantly greater PCI than normal walking. There was no physiological cost benefit of FTWB over NWB, p=0.67, but FTWB was perceived by all participants to be less tiring. CONCLUSIONS: Restricting weight bearing status significantly increases energy expenditure; the PCI. FTWB may be a more tolerable form of restricted weight bearing, although the PCI does not reflect this perception. These findings should be borne in mind when recommending such restrictions in clinical practice and encouraging a patient to mobilise early and effectively.

Assessing the potential for major trauma transfusion guidelines in the UK.

BACKGROUND: Major trauma patients are invariably received in the emergency department by a combination of emergency department and trauma team staff. The initial assessment is largely protocol led, using Advanced Trauma Life Support (ATLS) guidelines. The task of ordering and prescribing blood products often falls to the more junior members of this team. AIM: The aim of this postal questionnaire survey was to quantify the use of transfusion guidelines for major trauma in the UK and to assess whether generic national guidelines might be beneficial. METHODS: A questionnaire was sent to all major emergency departments in the UK with an attendance >50,000 patients per year (total = 167). A reminder was sent to all non-responders. Each trust was asked whether guidelines are used; which blood products are specified; how useful they consider them to be; and how well they are adhered to. RESULTS: 109 questionnaires (65%) were returned, of which only 17 (16%) currently use major trauma transfusion guidelines. While few trusts currently use guidelines, those being used were found to be very similar. Each trust was asked how useful their guidelines are, using a linear score of 0 to 5 (mean score 3.7). Those without guidelines were asked how useful they thought major trauma guidelines would be (mean score 3.3). CONCLUSION: The appropriate ordering and use of blood products has major clinical and cost implications. Few trusts currently have guidelines for major trauma despite being enthusiastic regarding their use. The authors propose there is now a role for national major trauma transfusion guidelines within the UK.