Patient satisfaction and clinical results at a mean eight years following BHR arthroplasty: results from a district general hospital.

We present the clinical and radiological results of a prospective study of a consecutive series of patients treated with the Birmingham Hip Resurfacing (BHR) prosthesis between 1999 and 2006 and followed for six to 12 years. Patients were reviewed preoperatively and six, 12, 26 and 52 weeks postoperatively and annually thereafter. They were assessed clinically and radiographically and the Merle d'Aubigne Postel and Oxford Hip scores were calculated at each visit. A SF-36 form assessed general health. Patient satisfaction was assessed by a Visual Analogue Score. Kaplan Meier survival analysis was performed.One hundred and seven patients (109 hips) were included (45 males, 62 females). Median age was 44 years. Mean follow-up was 97.4 months. Median preoperative Merle d'Aubigne Postel and Oxford hip scores were 10 (3-14) and 42 (26-55) respectively. Median SF36 score was 29 (0-65) and patients rated their level of pain as 7.7 on a scale of 0-10 (10 being the worst score). At final follow-up, median MDP and OHS scores were 17 (16-18) and 25 (12-46). Median SF36 score was 72 (27-97). Seven revisions were performed in six females and one male patient. Survival was 96.2% with revision for any reason as the end point. No revisions were performed in the group with hip dysplasia.The BHR prosthesis provides pain relief, high levels of patient satisfaction and improvement of function and well being in the medium-term. Failures occurred primarily in the female group.

A multidisciplinary enhanced recovery programme allows discharge within two days of total hip replacement; three- to five-year results of 100 patients.

We present three- to five- year results of 100 sequential patients undergoing total hip replacement (THR) through a multidisciplinary rapid recovery programme, with mean length of stay (LOS) 1.99 nights. Patients attend pre-admission 'bone school', with talks and assessments by the senior sister, physiotherapist and occupational therapist. All receive an uncemented Corail-Pinnacle THR via piriformis-sparing mini-posterior approach. 'Low dose' spinal plus light general anaesthesia provides sensory block whilst retaining motor function; painfree mobilisation is predictably achieved within four hours. Following radiograph and haemoglobin check next morning, patients are discharged on meeting specific nursing/physiotherapy criteria. Those within 20 miles receive outreach follow-up. Follow-up assessment is undertaken using SF36, Visual Analogue, Merle d'Aubigné-Postel and Oxford Hip Scores. Mean age was 65 years (25-91), mean BMI 28.7 (19-43). ASA ranged 1-3 (mode 2), Charlson comorbidity index from 0-9 (mode 3). Major complications were: one dislocation with deep infection; one myocardial infarction; one trochanteric bursitis requiring exploration; one ceramic fracture; and three metal debris reactions. Several more minor complications occurred. LOS was longer in older patients (p = 0.03) and those with higher Charlson index (p = 0.02).Eighty-two patients remain under follow-up, (mean 37.8 months, range 36-61). Six have died; five underwent revision; seven have moved away or been lost. Ninety-seven percent remain quite or very satisfied. Our LOS is amongst the shortest in the United Kingdom, with encouraging outcomes. The SSP succeeds by involving all team-members, and managing patient expectation. At a time of limited healthcare resources we propose that our SSP could readily be reproduced elsewhere with similar benefits.