Patrick C. Weinrauch

EARLY PROSTHETIC COMPLICATIONS AFTER UNIPOLAR HEMIARTHROPLASTY

Background:  In Australia, the most frequently used hemiarthroplasty prosthesis for the management of displaced intracapsular femoral neck fractures is the Uncemented Austin Moore (UAM). Despite concerns regarding poor functional outcomes and increased early revision rates associated with the UAM prosthesis, apprehension regarding the systemic side‐effects of polymethylmethacrylate cement implantation in the elderly patient continues to influence prosthesis selection. This study examines the incidence of early prosthesis related complications after UAM and Cemented Thompson (CT) hemiarthroplasty procedures for the management of femoral neck fractures.

Proximal femoral fracture after hip resurfacing managed with blade-plate fixation. A case report.

Internal fixation of an intertrochanteric proximal femoral fracture distal to a hip resurfacing implant using a fixed angle blade plate is presented.

Proximal Femoral Fracture After Hip Resurfacing Managed with Blade-Plate Fixation

Internal fixation of an intertrochanteric proximal femoral fracture distal to a hip resurfacing implant using a fixed angle blade plate is presented.

Intra-operative error during Austin Moore hemiarthroplasty

Purpose. To examine the frequency of technical errors during implantation of the Austin Moore prosthesis in a public hospital. Methods. Radiographs and charts of 147 consecutive uncemented Austin Moore hemiarthoplasty patients were retrospectively reviewed with particular reference to intra-operative errors associated with early failure of the prosthesis. Results. 48% of the patients had at least one error pertinent to implantation and 14% sustained intraoperative fractures. The error rates between relatively junior doctors and consultants were not significantly different. Conclusion. The uncemented Austin Moore prosthesis is a technically demanding prosthesis that is difficult to implant well. Greater selectivity should be exercised when considering its use for femoral neck fractures.

In vitro cyclic testing of the Exeter stem after cement within cement revision.

Cement-within-cement (C-C) revision arthroplasty minimizes the complications associated with removal of secure polymethylmethacrylate. Failure at the interfacial region between new and old cement mantles remains a theoretical concern. This article assesses the cyclic fatigue properties of bilaminar cement mantles after C-C revision in vitro with the Exeter stem. Seven Exeter stems were cemented into Sawbone femurs and removed, and new undersized stems were cemented into the preserved mantle. The new constructs were loaded for 1,000,000 cycles at body temperature. Cement mantles were inspected postcycling. In no case was there delamination or failure of the cement mantle. The findings support the hypothesis that use of a thin revision cement mantle in conjunction with a polished double-tapered stem is not detrimental to the overall success of the implant. In the presence of a secure cement-bone interface in suitable patients, we recommend C-C revision techniques using double-tapered polished femoral stems.

Ultrasonography-Assisted Arthroscopic Proximal Iliotibial Band Release and Trochanteric Bursectomy

We describe arthroscopic iliotibial band release and trochanteric bursectomy assisted by intraoperative ultrasonography for accurate placement of arthroscopic portals and to ensure adequate decompression of the peritrochanteric space. We have found ultrasonography for endoscopic iliotibial band release a useful tool to assist with localizing the site and length of decompression.

The use of a ureteric stone basket for removing loose bodies at hip arthroscopy.

We present the use of a ureteric stone basket for arthroscopic removal of loose bodies from the hip joint. The technique is easy to perform and reduces the time required for loose body retrieval while minimizing the risk of iatrogenic damage to the cartilage surfaces of the joint.

Re: Is ‘informed consent’ a deceptive notion with negligible protection value for doctors?

Lum suggests that there should be a common surgical curriculum across the Association of Southeast Asian Nations (ASEAN) countries: a commendable initiative, but one with significant challenges and risks: (1) The ASEAN Mutual Recognition Arrangement on medical practitioners’ agreement could well improve the quality of surgical care in many ASEAN nations, and recognizes that surgical training programmes should meet the specific needs of the community. However, the scope and depth of surgical practice (actual or desired) may differ across ASEAN countries. They range from those with sophisticated first world surgical capacity to others with poorly resourced and predominantly rural surgical services. A single curriculum may not be equally relevant or appropriate to each nation. (2) Criteria for foreign medical graduates (IMGs) to practise medicine across the ASEAN countries include a common curriculum and common standards for each specialty (for which Lum has proposed an ASEAN Board of Surgery as a vehicle to oversee this), but this would work only if these standards reached the minimum requirements of the most advanced ASEAN countries. (3) A common surgical qualification transferable across countries has merit. But this carries with it risk of losing many of the most valuable surgeons from the poorest countries who are attracted by better prospects (quality of life and remuneration) elsewhere or are head-hunted for their actual expertise. This compounds the crisis of surgical workforce in the poorer donor country. (4) As the Royal Australasian College of Surgeons has discovered when determining the comparability of IMGs wishing to work in Australia and New Zealand, the tools used to assess surgical competence are imprecise. Defining standards across the broad range of surgical competence (both technical and non-technical) is challenging. Lum deserves credit for bringing this important issue to our attention, and as an Australasian College, we may well learn from these initiatives of our ASEAN neighbours.

Proximal femoral fracture after hip resurfacing managed with blade-plate fixation. A case report.Weinrauch P1, Krikler S.

Internal fixation of an intertrochanteric proximal femoral fracture distal to a hip resurfacing implant using a fixed angle blade plate is presented.