The Exeter Contemporary flanged cemented acetabular component in primary total hip arthroplasty.

AIMS: We report on the outcome of the Exeter Contemporary flanged cemented all-polyethylene acetabular component with a mean follow-up of 12 years (10 to 13.9). This study reviewed 203 hips in 194 patients. 129 hips in 122 patients are still in situ; 66 hips in 64 patients were in patients who died before ten years, and eight hips (eight patients) were revised. Clinical outcome scores were available for 108 hips (104 patients) and radiographs for 103 hips (100 patients). PATIENTS AND METHODS: A retrospective review was undertaken of a consecutive series of 203 routine primary cemented total hip arthroplasties (THA) in 194 patients. RESULTS: There were no acetabular component revisions for aseptic loosening. Acetabular revision was undertaken in eight hips. In four hips revision was necessitated by periprosthetic femoral fractures, in two hips by recurrent dislocation, in one hip for infection and in one hip for unexplained ongoing pain. Oxford and Harris hip scores demonstrated significant clinical improvement (all p < 0.001). Radiolucent lines were present in 37 (36%) of the 103 acetabular components available for radiological evaluation. In 27 of these, the line was confined to zone 1. No component had migrated. CONCLUSION: Kaplan-Meier survivorship, with revision for aseptic loosening as the endpoint, was 100% at 12.5 years and for all causes was 97.8% (95% confidence interval 95.6 to 100) when 40 components remained at risk. The Exeter Contemporary flanged cemented acetabular component demonstrates excellent survivorship at 12.5 years. TAKE HOME MESSAGE: The Exeter Contemporary flanged cemented acetabular component has excellent clinical outcomes and survivorship when used with the Exeter stem in total hip arthroplasty.

Evaluation of an orthopaedic screening service in primary care.

Historically, provision of orthopaedic services has been hospital based with GPs referring patients for specialist opinion. Growing demands on the service have led to new initiatives to reduce waiting times. One such initiative has been the introduction of orthopaedic assistants, usually physiotherapists, working with an extended scope of practice who see patients after referral to secondary care and determine the patients' ongoing management. Studies to date have examined the effect of an orthopaedic assistant working alongside a consultant in the hospital environment. This study describes the impact on the management of the orthopaedic caseload in one general practice resulting from "screening" prior to referral to secondary care by a physiotherapist with an extended scope of practice. It demonstrates the successful management of the majority of patients within primary care.