We retrospectively reviewed, ten years after surgery, 100 consecutive total hip replacements in which the Duraloc 300 cup had been used. Post-operative radiographs were analysed for placement of the cup and interface gaps and follow-up radiographs for lucent lines, osteolysis, wear and migration. All the components were found to be stable with no evidence of loosening. The mean rate of wear was 0.12 mm/year. Three hips developed acetabular osteolysis at the level of the apex hole. Two have successfully undergone bone grafting without removal of the implants and one patient is awaiting surgery. The Duraloc 300 cup has a survival of 100% at ten years with no aseptic loosening and a low incidence of pelvic osteolysis.

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.

We describe a simple method of inserting the distal screws in a locked femoral nail. The method requires no aiming device and no assistant. The only equipment needed is a 3 mm Kirschner wire and an air drill.

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