Background External tibial torsion causes an abnormal axis of joint motion relative to the line of progression with resultant abnormal coronal plane knee moments and affects lever arm function of the foot in power generation at the ankle. However, it is unclear whether surgical correction of the tibial torsion corrects the moments and power.

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A valuable technique for femoral stem revision in total hip replacement: The in-cement revision -A case series and technical note IntroductionRevision of a cemented femoral stem can be a challenging procedure. Removing the cement mantle requires time and patience with a risk of further bone damage and possible fracture.1-4 Retention of the old cement mantle and insertion of a smaller or shorter stem -the cement-in-cement revisiondescribed for taper stems -provides a good alternative if the cement mantle is stable, but is limited if a smaller size or offset stem is already in situ. We present a newly described technique, the ''In-cement'' revision -the introduction of a stem, the same size as the original implant, into the previous cement mantle, without additional cement or downsizing. This has not been previously described or investigated in the literature. We present the technique and a series of 23 cases. In-cement revision requires an intact and stable cement mantle in the correct version. The benefits include improved view of the acetabulum, time efficiency, the ability to use the same size stem and utilisation of the previous distal centralised spacer plug to facilitate subsidence. TechniqueAfter either general or spinal anaesthetic, the patient is positioned laterally. An incision is made through the previous scar and the hip is exposed through a posterior approach. After appropriate dissection and debridement, the hip is dislocated, the head tapped off and the cemented, polished, tapered stem is removed (Fig. 1).There are three primary keys in the technique:1. Inspection of the cement mantle for stability and version (Fig. 2).Inspect the cement mantle for cracks and coverage. Forceps or a pituitary rongeur are used to attempt to mobilise the cement and therefore determine if it is stable. Version is assessed and is deemed either appropriate or not appropriate. If the version of the previous stem is not appropriate or the cement mantle is not stable, an in-cement revision should not be pursued. 2. Protection of the cement mantle (Fig. 3).Place a moist swab in the canal to prevent debris from the acetabular revision dropping into the cement mantle.The acetabulum is then exposed and revised as appropriate. 3. Reinsertion of the same size stem without a centraliser (Fig. 4).No centraliser is used to facilitate subsidence. Tap in the stem until it re-engages with the taper. Double check the length of the Revision of a cemented femoral stem can be a challenging procedure. We present a series of cases utilising the ''In-cement'' revision, whereby the same size stem is introduced into the original cement mantle, without additional cementing. It requires a stable cement mantle in the correct version.We describe the technique and present a review of 23 revision total hip replacements performed over a 5 year period. At average follow-up of 67 months (12-128 months), the overall survivorship was 91.3% with no patient requiring re-revision for stem loosening or mechanical failure. Two patients required rerevision for...

Background:The COVID pandemic highlights utility of remote patient follow-up. We observe a Virtual Clinic (VC) follow-up model for arthroplasty used at a metropolitan hospital. Patients aged <70 that exhibit no issues in face-to-face review (F2F) progress to VC. We aimed to review VC's cost-effectiveness, and identify potential improvements to patient allocation and retention. Method: A retrospective database was collated of all hip and knee joint arthroplasties performed at Frankston Hospital over a 12-month period in 2017-2018. Patient encounters were followed from operation to discharge from F2F and, if appropriate, VC (involving imaging and a paper-based qualitative questionnaire). VC attendance was compared to that of the year in which it was introduced (2014). The Clinical Costings Department provided average hospital spending for each of these modes of follow-up. Results: Of 516 joint arthroplasties performed, 500 attended outpatient clinic (OPC). There were 884 F2F appointments (average 1.7 per person, range 0-12). One-hundred-and-fiftyfour arthroplasties were correctly assigned to subsequent VC as per protocol (30%). Completed VC responses were received for 86 arthroplasties (56% response rate). In the period studied, VC attendance increased significantly compared to the year following introduction (36-56%, p < 0.05), with the questionnaire revealing a high-level of patient satisfaction for this method of follow-up. Over the period studied, we estimate VC has saved $250 000 and 300 review hours from OPC. Conclusion: Implementing VC for follow-up of arthroplasty may demonstrate a method of saving hospital resources. Appropriate early enrolment of patients to reduce F2F burden, and VC retention, should be encouraged.