Twenty-three-year outcome of the porous coated anatomic total hip replacement: a concise follow-up of a previous report.

We previously reported the ten to fourteen-year results for 311 Porous Coated Anatomic total hip replacements that had been inserted by two surgeons in 279 patients. The purpose of the present report is to update that study and to report the outcome beyond twenty years. The patients were followed prospectively with clinical assessment with use of the Harris hip score and radiographic analysis, and the results were collected in a database. Two hundred and sixty-eight hips were functioning at the time of death or at the time of the latest follow-up. A total of forty-three hips (14%) underwent major revision for all causes, and an additional four hips underwent minor revision. At a mean of twenty-three years of follow-up, Kaplan-Meier analysis revealed a survival rate of 83% with revision for any reason as the end point. The survival rate was 95% for the femoral component and 88% for the acetabular component with revision for any reason as the end point. The rate of survival of the acetabular component was significantly higher in hips with a 26-mm femoral head than in those with a 32-mm femoral head (91% compared with 80%; p = 0.026).

Outcome of hip resurfacing in obese patients.

The effect of obesity on outcome for patients undergoing hip resurfacing has been evaluated. Pre and post-operative objective patient scored outcomes for a group of 181 cases of hip resurfacing performed over a three year period were collected. Cases have been stratified by body mass index (BMI) with evaluation of post-operative complications. Patient outcomes included: SF-36, WOMAC, and satisfaction scores, and were compared pre-operatively, and at one year. We found an increased rate of wound complications in the obese group (BMI > 30) with 4 cases of prolonged wound drainage and 2 superficial infections, compared to none in the non-obese group. A similar improvement in SF-36, WOMAC and patient satisfaction was found for both groups. No increase in the risk of femoral neck fracture or aseptic loosening was seen in the obese group. These results suggest excellent early outcomes for obese patients undergoing hip resurfacing with no added risk of early failure.

Outcome following Bankart repair for shoulder instability 1998-2002 using a subjective patient based shoulder questionnaire (Oxford).

Bankart repair for shoulder instability has been performed by the senior author since 1998. We employ a modification of the technique as described by Rowe et al., using suture anchors but without a coracoid osteotomy. If inferior instability was present this procedure was combined with a capsular shift. We performed a retrospective case note review and postal questionnaire incorporating the Oxford Instability Score (OIS) on all patients. Fifty Bankart repairs were performed in the study period, three patients had further dislocations and three patients had ongoing symptoms of instability. Response rate to the questionnaire was 62%. Mean OIS following primary stabilisation was 21.7 (possible scores from 12-excellent to 60-poor). OIS following Bankart stabilisation of the shoulder has not been previously reported. These results compare favourably to original scores published by Dawson et al. (1999) who included both patients treated by surgery or physiotherapy.