The purpose of this study was to assess whether subsidence occurs in collarless Corail hip replacement (CCHR) and to ascertain the extent and timing of subsidence if present. Retrospective case notes analysis was performed. Sixty eight patients who had CCHR were identified from our database. Male to female ratio was 32:36. Their mean age was 74.2 years (range 37-95 years). Indications for surgery were osteoarthritis in 64 (94%) patients, rheumatoid arthritis in two (3%) patients and avascular necrosis in two (3%) patients. Subsidence was measured at 6 weeks, 6 months and 1 year post-op compared to initial post-op x-rays. At 6 weeks x-ray 21 patients did not have any subsidence, 18 patients had 1 millimeter (mm) subsidence, 10 patients had 2mms subsidence, 4 patients had 3mms subsidence, 5 patients had 4mms subsidence, 1 patient had 5mms subsidence, 4 patients had 6 mms subsidence and 1 patient each had subsidence of 7mms, 9mms, 11mms, 13mms and 26 mms respectively. When compared with 6 months x-rays only 2 patients had a further subsidence of 2mms while another patient had 3mms subsidence. No further subsidence occurred at 1 year follow up x-rays. One patient had revision surgery due to symptomatic subsidence (29mms) at 6 months follow up. Subsidence does occur in the first 6 weeks in collarless Corail hip replacement, and to a lesser extent until 6 months postoperatively, but does not progress further.

IntroductionCongenital vertical talus (CVT) is a rare deformity. Traditionally, CVT correction involved extensive soft tissue releases, and this was associated with high complication rates. The Dobbs method is less invasive and comprises serial manipulation and casting, followed by minimally invasive reduction and K-wire fixation of the talonavicular joint and percutaneous Achilles tenotomy.AimThe purpose of our study was to compare the outcomes of using the Dobbs method for CVT correction in idiopathic and teratological patients.MethodsA retrospective analysis of all patients treated with the Dobbs method for CVT between the years 2007 and 2012 was carried out. Notes, electronic records and radiographs were reviewed for every patient. The Oxford ankle foot score was obtained at follow-up.ResultsThere was a total of ten children with 18 affected feet. Five children (ten feet) had teratological CVT. Recurrence was noted in six feet (two from the idiopathic group and four from the teratological group). The median age was 5 months (range 2–8 months). The mean follow-up was 53 months (range 24–80 months). There was a significant difference between pre-operative to initial post-operative and pre-operative to latest follow-up measurements for all angles in the successfully treated CVT group (p < 0.000001). The mean Oxford ankle foot scores for each domain in all patients are 59.9 (physical), 88.8 (school and play) and 99.1 (emotional).ConclusionThe Dobbs method is a less invasive technique of CVT correction. It is an effective initial method of treatment in both teratological and idiopathic patients. A higher recurrence rate was observed in the teratological group, although this was not statistically significant.

Patello-femoral arthroplasty (PFA) is successful in a selected group of patients and yields a good functional outcome. Robotic-assisted knee arthroplasty has been shown to provide better implant positioning and alignment. We aim to report our early outcomes and to compare Mako's (Robotic Arm Interactive Orthopaedic System [RIO]) preoperative implant planning position to our intraoperative PFA implant position. Data for this study was prospectively collected for 23 (two bilateral) patients who underwent robotic-assisted PFA between April 2017 and May 2018. All preoperative implant position planning and postoperative actual implant position were recorded. Presence of trochlear dysplasia and functional outcome scores were also collected. There were 17 (two bilateral) female and 6 male patients with a mean age of 66.5 (range: 41–89) years. The mean follow-up period was 30 (range: 24–37) months. Eighteen knees (72%) had evidence of trochlear dysplasia. The anterior trochlear line was on average, 7.71 (range: 3.3–11.3) degrees, internally rotated to the surgical transepicondylar axis and on average 2.9 (range: 0.2–6.5) degrees internally rotated to the posterior condylar line. The preoperative planning range was 4-degree internal to 4-degree external rotation, 4-degree varus to 6-degree valgus, and 7-degree flexion to 3-degree extension. The average difference between preoperative planning and intraoperative implant position was 0.43 degrees for rotation (r = 0.93), 0.99 degrees for varus/valgus (r = 0.29), 1.26 degrees for flexion/extension (r = 0.83), and 0.34 mm for proudness (r = 0.80). Six patients (24%) had a different size component from their preoperative plan (r = 0.98). The mean preoperative Oxford Knee Score (OKS) was 16 and the mean postoperative OKS was 42. No patient had implant-related revision surgery or any radiological evidence of implant loosening at final follow-up. Our early results of robotic PFA are promising. Preoperative Mako planning correlates closely with intraoperative implant positioning. Longer follow-up is needed to assess long-term patient outcomes and implant survivorship.

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Developmental dysplasia of the hip (DDH) is a common paediatric orthopaedic problem. There are various options for treatment dependent on the age and presentation. In closed and open reduction of DDH, we use a hip spica cast for immobilisation after the procedure. We present an unusual case of fungal growth on a hip spica. A 7-month-old girl presented to our institution with clusters of yellowish-white outgrowths resembling mushrooms from her spica. To the best of our knowledge, this is the first reported case of fungal growth on a hip spica following DDH treatment. It is of utmost importance to be aware of any growth on a hip spica, as this requires a prompt change of spica to avoid further complications. We recommend that the integrity of the spica and the skin be checked at regular intervals in patients with a hip spica.

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Total Knee Arthroplasty (TKA) is one of the most successful orthopaedic procedures. Around 100,000 TKAs are performed yearly in the United Kingdom. The aim of this study was to report the mortality rate within 30 days after a TKA in an Orthopaedic Centre of Excellence. We reviewed prospectively collected data of 7067 TKAs performed between April 2009-November 2016. All mortalities within 30 days of a TKA were recorded. Data such as age, sex, ASA, comorbidities and cause of death was recorded. There were 14 (0.198%) deaths within 30 days of TKA. There were eight male patients and six female patients who died. No statistical difference was demonstrated between gender. (p = 0.37). The mean age was 77.9 years (66-94 years). Means days to death from post-op were 9.6 days (2-30 days). One patient was ASA 1, six patients were ASA 2, six patients were ASA 3 and one patient did not have an ASA recorded. There was no statistical difference between the difference ASA groups. (p = 0.27). Cause of death documented was as follow: acute left ventricular failure-3; myocardial infarction-2; pneumonia-2; pulmonary oedema-1; gastrointestinal bleed-1 and multiorgan failure-1. Four patients did not have their cause of death recorded. The 30-day mortality rate after TKA in our institute is low and is comparable to other institutes. This emphasizes that primary TKA is a safe procedure. The predominant cause of perioperative mortality is cardiopulmonary disease.