Hydroxyapatite ceramic-coated femoral components in younger patients followed up for 27 to 32 years.

Aims: This study reports the results of 38 total hip arthroplasties (THAs) in 33 patients aged less than 50 years, using the JRI Furlong hydroxyapatite ceramic (HAC)-coated femoral component. Methods: We describe the survival, radiological, and functional outcomes of 33 patients (38 THAs) at a mean follow-up of 27 years (25 to 32) between 1988 and 2018. Results: Of the surviving 30 patients (34 THAs), there were four periprosthetic fractures: one underwent femoral revision after 21 years, two had surgical fixation as the stem was deemed stable, and one was treated nonoperatively due to the patient's comorbidities. The periprosthetic fracture patients showed radiological evidence of change in bone stock around the femoral stem, which may have contributed to the fractures; this was reflected in change of the canal flare index at the proximal femur. Two patients (two hips) were lost to follow-up. Using aseptic loosening as the endpoint, 16 patients (18 hips; 48%) needed acetabular revision. None of the femoral components were revised for aseptic loosening, demonstrating 100% survival. The estimate of the cumulative proportion surviving for revisions due to any cause was 0.97 (standard error 0.03). Conclusion: In young patients with high demands, the Furlong HAC-coated femoral component gives excellent long-term results.

Short or long intramedullary devices for hip fracture? A systematic review of the evidence.

Trochanteric hip fractures may be fixed with either sliding hip screws or intramedullary devices. Current UK guidance is that intramedullary fixation should be used for AO/OTA 31A3 fractures but does not stipulate length of nail. We present a systematic review comparing short and long nails for these injuries in older patients. Three studies were randomized, all with methodological concerns. None demonstrated a clinically significant difference in outcome. There is no good evidence to support long over short intramedullary devices in this scenario. Evidence is required to demonstrate whether the potentially increased surgical risk confers any benefits in this group.

The use of warfarin as thromboprophylaxis for lower limb arthroplasty.

INTRODUCTION: Most orthopaedic surgeons in the UK use some form of prophylaxis against venous thromboembolic events. Warfarin has been recommended as one of the preferred methods to use. The period of in-hospital postoperative rehabilitation has reduced significantly since lower limb arthroplasty was introduced. We sought to identify and quantify any delay in discharge associated in using warfarin as chemical prophylaxis. PATIENTS AND METHODS: During a 12-week period, all patients undergoing a lower limb arthroplasty procedure were identified and any delay in discharge related to their warfarin prophylaxis was recorded. RESULTS: Of the 25 arthroplasties performed in this time period, 17 (68%) were subject to a delay. The total delay in discharge was 39 days. When the standard warfarin dosing protocol was followed, 33% of patients were still delayed. When the protocol was not followed, only 23% were delayed. The majority of deviations from the protocol led to a shorter hospital stay. DISCUSSION: Patients using warfarin prophylaxis generate an additional cost of 417 pounds related to bed occupancy. There is considerable scope for significantly reducing this cost by moving the early postoperative anticoagulation monitoring into the community. Delayed discharge is an important consideration in the economic issues that surround the choice of thromboprophylaxis.