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The current generation of metal-on-metal hip resurfacing designs has largely been characterized by cemented femoral fixation using a cementless cup. We present the clinical results of 135 entirely uncemented metal-on-metal hip resurfacing procedures. The primary outcome measures were revision for any cause and the Oxford hip score at the latest follow up. The average length of followup was 2.9 years. The mean Oxford hip score was 18.4 and no patient required revision of either component during the study period. Uncemented femoral fixation may be comparable to fixation with cement in metal-on-metal hip resurfacing.

Follow-up for patients undergoing simple knee arthroscopic procedures is variable between consultants.Follow-up appointments vary from none, to telephone consultations [1], to inconsistent outpatient follow-up times.There is currently no evidence in the literature to guide the ideal timing for follow-up appointments, or by whom the follow-up should be performed.Our aim was to determine the follow-up time that patients would prefer to be seen at following their knee arthroscopy, and whether in fact they would rather be followed up by their general practitioners (GP), rather than their surgeon. MethodArthroscopic surgery of the knee is performed in a day case unit setting with patients being discharged no later than 3 hours postoperation having been seen post surgery by the operating surgeon to explain the findings and being seen by a physiotherapist in order to institute an exercise programme. A copy of the operation note is sent to the GP. Patients are telephoned by a nurse on the day surgery unit 48 hours post operation in order to check that the patient has no problems. Follow-up appointments for review vary between the consultants working in the unit and are also influenced by available outpatient appointment slots being available.In order to assess whether patients were happy with their follow-up appointment a short questionnaire (Appendix 1) was handed out to a random group of patient at their first outpatient appointment following their simple (including meniscal trimming, removal of loose bodies, diagnostic and debridement) day case knee arthroscopic procedure. The patients given questionnaires were selected at random by clinic nurses not involved in the study.The results were then collated and analysed statistically using the chi-squared, 2 tailed test. A P-value of <0.05 was taken as statistically significant. ResultsWe collated the results of 73 questionnaires.The results are shown in Tables 1 & 2. If patients were followed up less than 3 weeks following surgery, 34 of 35 patients (97%) were happy with the timing of their follow-ups, compared with only 26 of 38 patients (68%) of patients who were followed up at greater than 3 weeks, this difference was statistically significant with P = 0.004.Of the 32% of patients who were unhappy with their follow-ups being greater than 3 weeks, all stated that they would have preferred their appointment to have been earlier.A total of 67 of the 73 patients answered the question with regard to further follow-up. There was no statistical difference (P = 0.49) in patients being given a further follow-up appointment following their initial post-operative appointment, with 13 of 34 (38%) being given a further appointment when their follow-up was less than 3 weeks, compared with 9 of 33 (27%) of those with a follow-up appointment of greater than 3 weeks.Of all the patients questioned 58 of the 73 (79%) would not have been happy to have been followed up only by their GPs. The main reason sited was that they wished to see the surgeon who had actually performed their surgery,...

BackgroundLisfranc fracture dislocations occur in approximately 0.1-0.9% of all fractures and are associated with long-term complications, including osteoarthritis and painful deformity. Our aim was to evaluate the best available evidence to assist in guiding clinical decision-making for open reduction and internal fixation compared with primary arthrodesis for acute Lisfranc injuries. MethodsWe systematically reviewed the effect of alternative methods of management of Lisfranc fractures on validated functional outcome scores and secondary outcomes of further surgery and pain. We identified 147 citations: 12 from MEDLINE, 135 from EMBASE and none from the Cochrane Central Register of Controlled Trials. Only three studies proved eligible. The authors graded and extracted the relevant data. ResultsAll studies compared the treatment of acute Lisfranc fractures by primary arthrodesis with open reduction and internal fixation. All three studies were comparative studies of the two treatment modalities. Two studies were randomized. The relative merits of open reduction and internal fixation compared with primary arthrodesis in the treatment of Lisfranc injuries remains uncertain. The current evidence is mixed. One study reviewed patients with primarily ligamentous injuries and suggested that primary fusion of Lisfranc fractures does improve the functional outcome, whereas the most recent study, assessing osseous and ligamentous injuries, did not show this effect. Both studies, however, did show that secondary surgery was higher in the open reduction and internal fixation groups. ConclusionsGiven the current level of evidence, further studies, preferably randomized controlled prospective trials, are required to fully ascertain the most favorable management method for these complex and debilitating injuries.