IntroductionTotal joint arthroplasty has become established as a very successful method of treating end-stage arthritis of the hip and knee with excellent long-term outcomes. 1,2 With an ageing population, there is an increased demand for services relating to joint arthroplasty. Individual patient's demands and expectations are also increasing, with patients desiring a quicker return to normal functioning with minimal discomfort after their joint replacement surgery.In today's climate of limited resources and global financial strain we need to investigate ways of containing cost while enabling and maintaining safe effective treatment with optimised results. Any alteration to the surgical management of hip and knee arthroplasty should never compromise patient safety and outcomes. AbstractIntroduction: A rapid recovery protocol for hip and knee replacement surgery is a multidisciplinary, standardised pathway to meet the increasing demands for surgery and enhancement of recovery. This is the idea behind the recent global push by funders for cost effective, elective primary hip and knee arthroplasty. We report on a pilot study to assess the implementation and feasibility of a standardised care pathway in a South African private hospital setting. Materials and methods:Eligible patients presenting for primary hip or knee arthroplasty were enrolled in a rapid recovery programme. The protocol that was implemented was based on current literature and international best practices. It involved members of a multidisciplinary team and the standardisation of the treatment of patients undergoing elective hip and knee arthroplasty.Results: Forty-six patients were enrolled in the pilot study and 43 patients were successfully discharged by the third post-operative day. There were no major complications and high patient satisfaction was recorded. Conclusion:This pilot study successfully implemented a multidisciplinary and standardised treatment protocol for hip and knee arthroplasty in a South African setting. The rapid recovery protocol proved to be safe and effective for the management of hip and knee replacements.

No abstract

No abstract

A 61-year-old polytrauma patient was admitted with a right distal comminuted metaphyseal femoral fracture with intra-articular extension (Orthopaedic Trauma Association 33C2.3 classification) among other injuries. Due to the high degree of comminution and massive bone loss, this was initially managed with a dual plating open reduction internal fixation. Dual plating has shown to be a superior fixation method than single variable angle locking compression plate (VA-LCP) plating providing greater fixation in metaphyseal bone. Our case reports the failure of dual plating which required removal of metalwork and subsequent fixation using intramedullary nail and plate technique. Failure of dual plating is not well documented in the literature. The most recent radiographs taken 15 months postrevision surgery show that the bone has started to heal with evidence of callus formation.

We have recently seen and successfully treated four patients with iliopsoas-related groin pain post total hip replacement. Their clinical pictures were all typical of iliopsoas-related groin pain. After the exclusion of other causes, surgical release of this tendon resulted in successful treatment with complete resolution of symptoms. We subsequently carried out an anatomic dissection of the iliopsoas tendon on a cadaver torso to better understand the relationship between the iliopsoas tendon and the acetabular component in total hip replacement surgery. It was apparent that cup position and placement were critical to prevent contact of the iliopsoas tendon with the rim of the acetabular component. We have subsequently modified our positioning of the acetabular component.