Background Several reports have confirmed the ability of intraoperative periarticular injections to control pain after THA. However, these studies used differing combinations of analgesic agents and the contribution of each, including the local anesthetic agent, is uncertain. Understanding the independent effects of the various agents could assist in improved pain management after surgery. Questions/purposes We therefore determined the ability of intraoperative periarticular infiltration of levobupivacaine to (1) reduce postoperative pain, (2) reduce postoperative morphine requirements, and (3) reduce the incidence of nausea and urinary retention. Patients and Methods A double-blinded, randomized, placebo-controlled trial of patients undergoing primary THAs was performed. Patients were randomized to receive a periarticular infiltration of 150 mg levobupivacaine in 60 mL 0.9% saline (n = 45) or a placebo consisting of 60 mL 0.9% saline (n = 46). We obtained a short-form McGill pain score, visual analog scale (VAS), and morphine requirements via patient-controlled analgesia (PCA) as primary measures. Postoperative antiemetic requirements and need for catheterization for urinary retention were determined as secondary measures. Results Subjectively reported pain scores and the overall intensity scores were similar for both groups in the postoperative period. At the same time the mean morphine consumption was less in the levobupivacaine group, most notable in the first 12 hours after surgery: treatment group 11.5 mg vs control group 21.2 mg. We observed no differences in the frequency of postoperative nausea and vomiting or urinary retention. Conclusions Our observations suggest periarticular injection of levobupivacaine can supplement available postoperative analgesic techniques and reduce postoperative morphine requirements after THA.

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Cementless hemiarthroplasty in hip fracture surgery has been associated with poorer outcomes and more pain than cemented hemiarthroplasty. The aim was to investigate clinical and radiographic outcomes for a cementless tapered titanium fully hydroyxapatite-coated (Corail® System) stem in this consecutive cohort of hip fracture patients. We retrospectively evaluated the results of 68 consecutive elderly patients with displaced intracapsular hip fractures, treated with this implant. Mean clinical follow-up was 4.3 years (2-6 years). One-year mortality was 24%. 95% of patients had no/occasional/mild mid-thigh pain, with moderate pain in 5%. 39% achieved independent or walking-stick mobility. 36 patients had follow-up radiography. Osseointegration was noted in 34, with a mixed bony/fibrous in-growth in 2. One patient had revision for subsidence of an undersized implant, with no conversions to total hip arthroplasty. The Corail® stem can be used effectively for the treatment of femoral neck fractures in the elderly.

Surgical training faces a challenge with the implementation of EWTD Rotas. Major changes need to be made to the surgical training structure to train surgeons to the highest standard and to retain Irish-trained surgeons in the Irish healthcare system.

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