Between January 2000 and December 2007, 31 patients 90 years of age or older underwent total hip replacement at our hospital. Their data were collected prospectively. The rate of major medical complications was 9%. The surgical re-operation rate was 3%. The requirement for blood transfusion was 71% which was much higher than for younger patients. The 30-day, one-year and current mortality figures were 6.4% (2 of 31), 9.6% (3 of 31) and 55% (17 of 31), respectively, with a mean follow-up for the 14 surviving patients of six years. Cox's regression analysis revealed no significant independent predictors of mortality. Only 52% of patients returned immediately to their normal abode, with 45% requiring a prolonged period of rehabilitation. This is the first series to assess survival five years after total hip replacement for patients in their 90th year and beyond. Hip replacement in the extreme elderly should not be discounted on the grounds of age alone, although the complication rate exceeds that for younger patients. It can be anticipated that almost half of the patients will survive five years after surgery.

No abstract

Total hip replacement has shown good outcomes for patients with rheumatoid arthritis. Can hip resurfacing give similar results for patients with rheumatoid arthritis? Using an international hip resurfacing register, 47 patients with rheumatoid arthritis were identified and age and gender matched to a group of 131 randomly selected patients with osteoarthritis of the hip joint. Patients completed a questionnaire to record function and implant revision. Hierarchical regression, Cox regression and Kaplan-Meier method were used for analysis. There was a significant increase in post operative hip score in both groups (p<0.001) with rheumatoid group scoring higher as compared to the osteoarthritis group (p=0.23). The post operative score was not significantly influenced by pre-operative score and age (p=0.15 and 0.84, respectively) but the preoperative score was a predictor of implant failure (p=0.02). Patient mobility was affected by age with younger patients scoring high on mobility as compared to older patients (p= 0.01). The Kaplan-Meier analysis showed a survival rate of 96.3% in the rheumatoid group and 97.8% in the osteoarthritis group. This difference was not significant (Log rank test, p=0.45). Our results from an independent and international register show that hip resurfacing provides good postoperative hip function and excellent implant survival for patients with rheumatoid arthritis of the hip joint. This procedure can be considered as a viable option for management of rheumatoid arthritis of the hip joint.

We conclude that hip resurfacing can be offered to patients with osteonecrosis.

Background: To assess the usefulness of erythrocyte glycated haemoglobin (HbA 1C ) as a screening tool to identify those subjects with impaired fasting glycaemia (IFG) who do not have impaired glucose tolerance (IGT) or diabetes mellitus (DM) on a 75 g oral glucose tolerance test (OGTT). Design and methods: All subjects undergoing an OGTT had HbA 1C measured at baseline. Receiver operator characteristics analysis was used to identify optimal HbA 1C cut-off values for diagnosing and excluding IGT and DM. Results: We studied 140 subjects (69 women) with IFG (fasting capillary plasma glucose between 6.1 -6.9 mmol/L). Using World Health Organisation criteria, 27 had isolated IFG, 56 had IGT and 57 had DM. HbA 1C was higher (P , 0.001) in patients with DM (6.8 + 0.93%) when compared with those with IGT (6.3 + 0.68%) and isolated IFG (6.2 + 0.30%), but HbA 1C was similar in those with IGT and isolated IFG. There was no HbA 1C cut-off value differentiating isolated IFG from IGT or DM. None of the subjects with isolated IFG had HbA 1C concentration of .6.8%, but 76% and 54% subjects with IGT and DM, respectively, had HbA 1C of 6.8%. Conclusions: HbA 1C measurement is of limited value in differentiating isolated IFG, IGT and DM in subjects with IFG. It cannot be used to identify which subjects with IFG do not require an OGTT.