The 'Quartered Head Technique': a simple, reliable way of maintaining leg length and offset during total hip arthroplasty.

Introduction: Various techniques have been described for restoring leg length and offset during total hip arthroplasty (THA). We herein describe a novel "Quartered Head Technique" (QHT) involving a series of femoral osteotomies.

Methods: 124 hips were included in the analysis.

Dual mobility hip arthroplasty: iatrogenic intraprosthetic dislocation of a 22 mm head.

We describe the first intraprosthetic dislocations of a 22 mm head in a dual mobility hip replacement in the literature. This case emphasises the importance of information gathering and planning when dealing with arthroplasty complications. Furthermore, it highlights the necessity of adequate muscle relaxation and analgesia when dealing with hip dislocations.

Surgical management of renal cancer metastasis in the humerus: novel use of a trabecular metal spacer.

Humeral metastases from renal cell carcinoma are not uncommon. Current surgical practice centres around adequate tumour resection, but often at the expense of functional outcome. The use of trabecular metal (TM) implants is well described in spine and joint surgery.

Effect of institution volume on mortality and outcomes in osteoporotic hip fracture care.

Unlabelled: Hospitals that treat more patients with osteoporotic hip fractures do not generally have better care outcomes than those that treat fewer hip fracture patients. Institutions that do look after more such patients tend, however, to more consistently perform relevant health assessments.

Introduction: An inveterate link has been found between institution case volume and a wide range of clinical outcomes; for a host of medical and surgical conditions.

Dual Mobility hip replacement in hip fractures offer functional equivalence and a stability advantage - A case-controlled study.

Background: Hip fracture is a common and serious injury in the elderly. Hip arthroplasty is the most frequently performed procedure for patients with an  intracapsular hip fracture. The majority of national guidelines recommend total hip arthroplasty (THA) for more active patients.

Use radiography rarely, not routinely, for hip hemiarthroplasty.

Purpose: Hip hemiarthroplasty (HA) is a commonly performed operation. A post-operative radiograph forms part of the routine hip fracture pathway, although patients are often mobilised prior to this investigation. This study seeks to provide evidence for a pragmatic clinical change to optimise patient safety and allocate limited resources within the National Health Service (NHS).

Orthopaedic surgery in a time of COVID-19: Using a low prevalence COVID-19 trauma surgery model to guide a safe return to elective surgery.

Aims: Elective surgery has been severely curtailed as a result of the COVID-19 pandemic. There is little evidence to guide surgeons in assessing what processes should be put in place to restart elective surgery safely in a time of endemic COVID-19 in the community.

Methods: We used data from a stand-alone hospital admitting and operating on 91 trauma patients.

The National Hip Fracture Database is only as good as the data we feed it - significant inaccuracy demonstrated and how to improve it.

Introduction: The National Hip Fracture Database of England, Wales and Northern Ireland (NHFD) is the largest such database in the world. Data errors in within the NHFD lead to spurious evidence which ultimately informs Orthopaedic, Anaesthetic and Orthogeriatric clinical practice.

Materials And Methods: This multi-centre quality improvement study investigated, and sought to improve data inaccuracy within the NHFD.

Novel use of a trabecular metal spacer in the treatment of a long-standing ulnar fracture non-union.

The use of trabecular metal (TM) implants in spine and joint surgery is well documented. However, their use has yet to be reported as an alternative to either allograft or autograft in the management of fracture non-unions. We present our experience in using a TM implant for treating a patient with a long-standing ulnar fracture non-union.

The posterior acetabular wall (PAW): an aid to acetabular orientation at primary THA.

Introduction: Incorrect acetabular component positioning during total hip arthroplasty (THA) may lead to dislocation, impingement, wear and revision. Surgeons commonly use the transverse acetabular ligament (TAL) as a landmark for acetabular component orientation. The posterior acetabular wall (PAW) is a structure easily viewed on plain radiography and its position can help guide acetabular component position.

Complications after revision surgery of malreduced ankle fractures.

Ankle fractures are common orthopedic injuries requiring reduction and cast immobilization or fixation. Fractures fixed in a malreduced (misaligned) position can require revision surgery. However, because this has been a relatively rare occurrence, little is known about the complications that can occur after such surgery.

Primary and revision THA using a stemless metaphyseal-loading implant above distorted proximal femoral anatomy.

Total hip arthroplasty is well established as a successful treatment for end stage arthritis, with a wide variety of components currently available. Using traditional stemmed implants in patients with a distorted proximal femur can be technically challenging with an increased risk of complications. We present seven patients with distorted proximal femoral anatomy or failed hip arthroplasty in whom a short, metaphyseal loading implant was utilised.

Serum lactate is a prognostic indicator in patients with hip fracture.

Background And Purpose: Serum lactate has been shown to be an indicator of adverse clinical outcomes in patients admitted secondary to general trauma or sepsis. We retrospectively investigated whether admission serum venous lactate can predict in-hospital mortality in patients with hip fractures.

Method And Results: Over a 38-month period the admission venous lactate of 807 patients with hip fractures was collated.

Early and ultra-early surgery in hip fracture patients improves survival.

Background: Hip fracture is a common injury with associated high mortality. Recent drives by the Department of Health have sought to prioritise these patients' care. In April 2010, the Best Practice Tariff was introduced in England and Wales.

Representation to the accident and emergency department within 1-year of a fractured neck of femur.

Background: The fractured neck of femur (NOF) is a leading cause of morbidity and mortality. The mortality attendant upon such fractures is 10% at 1 month and 30% at one year with a cost to the NHS of £1.4 billion annually.

Conversion of a long distally fixed uncemented revision femoral stem to a proximally fixed implant following fatigue fracture.

There has been increasing focus on bone conservation through proximal fixation in primary hip arthroplasty. However, the debate regarding fixation in revision arthroplasty and which factors influence implant choice remains less clear-cut. We report a case involving fatigue fracture of a long, distally well-fixed, uncemented revision stem.