Introduction Risk factors for mortality associated with COVID-19 have been reported to include increased age, male sex and certain comorbidities. Fracture neck of femur (NOF) patients is high-risk surgical patients, often with multiple comorbidities and advanced age. We quantify the 30-day mortality rate in fractured NOF patients with a positive peri-operative COVID-19 antigen test and identify risk factors for increased mortality. Methods This is a retrospective multi-centre review of all patients admitted with a fractured NOF and a confirmed laboratory diagnosis of COVID-19 between 1 March and 26 April 2020. Demographic data, comorbidities, ASA grade and date of death (if applicable) were collected. Results There were 64 patients in the cohort with an overall 30-day mortality rate of 32.8% (n = 21). Thirty-five (55%) were female, and mean age was 83 (SD 9, range 46-100) years. There was significantly increased mortality for those with a history of myocardial infarction (p = 0.03). Sixty-four percent of patients underwent surgery within the 36-h target, which is comparable to previous data for the same time of year. Overall mortality increased to 50% (n = 32) at 45 days post-operatively. Conclusion This is a large review of 30-day mortality in NOF patients with concurrent COVID-19 infection. We report a substantial increase from the pre-COVID-19 mean 30-day mortality rate (6.5% in 2019). We highlight the need for counselling patients when presenting with a NOF in relation to peri-operative COVID-19 infection and the associated increased risks. Keywords COVID-19 • SARS-CoV-2 • Fractured neck of femur • Mortality • Hip fracture All collaborators assisted with data collection, drafting of the paper and reviewing the final article. North West COVID NOF Study Group authors listed in Acknowledgements section.

To support the global restart of elective surgery, data from an international prospective cohort study of 8492 patients (69 countries) was analysed using artificial intelligence (machine learning techniques) to develop a predictive score for mortality in surgical patients with SARS-CoV-2. We found that patient rather than operation factors were the best predictors and used these to create the COVIDsurg Mortality Score (https://covidsurgrisk.app). Our data demonstrates that it is safe to restart a wide range of surgical services for selected patients.

Further research is needed into the effects of orthotic walkers on knee and hip joint mechanics, which should help to inform future designs of walker, with greater focus on obtaining a more normal gait pattern.

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Recurrent dislocation of Total Hip Replacement (THR) is often multifactorial and remains a significant surgical challenge with a significant risk of further instability. Dual Mobility Cups (DMC) have been used widely with good long term results in France with few studies in the British literature, especially assessing their use for recurrent instability. We set out to assess whether recurrent instability can be successfully treated solely with revision of acetabular component to a dual mobility cup. Methods: We retrospectively reviewed a prospectively collected electronic database for all consecutive dual mobility cups implanted to address recurrently instability in THR. Radiological and clinical data have been analysed. Results: From September 2013 to September 2017 54 dual mobility cups have been implanted, mean age 78 (range 49-97). 47 were 1st time revision procedures, 7 were following previous revisions including 5 failed PLADs. Average time post primary was 10 years (range 8 months-23 years). Twenty cases are cement in cement revisions which has become our primary technique for revision of cemented cups. Mean follow up is 1.9 years (range 6 months-5 years), 37 cases have 2 year follow up available. 8 patients have died. There have been no episodes of further instability. One patient has had reoperation for infection (1st stage revision). Conclusions: This series demonstrates satisfactory early to mid-term results for the use of dual mobility cups to treat recurrent instability. The technique is particularly useful when femoral components are well fixed and can be used with monoblock implants such as the Charnley stem. Cement in cement revision is a convenient technique and potentially reduces complications and cost. Further analysis of longer term data is required but these results suggests this could be a valid solution to a complex problem.