Background: Primary hip arthroplasty and revision arthroplasty are some most commonly performed orthopaedic procedures worldwide, therefore, cost effectiveness is of optimum importance. Financial tariffs currently poorly reflect the true cost of hip arthroplasty. Further analysis is needed into financial systems and calculating efficiency of hip arthroplasty so that operating hospitals are paid accurately. Objectives: To investigate the discrepancy between cost and reimbursement of primary and revision hip arthroplasty with current tariffs. Methods: We collected data on primary hip arthroplasty (n = 442) and revision arthroplasty (n = 50) between April 2017 and April 2018. This included the cost, income, margin in profits, length of stay and time in theatre for each operation. We then performed a retrospective financial analysis using the Mann-Whitney Test (as the data sets were not normally distributed). Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) version 21.0. Results: For primary hip arthroplasty (n=442) there was a mean cost of £6412 with mean reimbursement of £6547 resulting in a net profit of £135 per operation. For revision hip arthroplasty (n=50) there was a mean cost of £10,824 with mean reimbursement of £8065 resulting in a net loss of £2759 per operation. Revision surgery was associated with statistically significant longer operating times and longer lengths of stay (p <.0001). Conclusion: This retrospective study demonstrates that revision surgery is not being accurately reimbursed with current tariffs. If tariffs continue to poorly reflect costs it threatens the viability of performing such surgery.

Introduction: Neck of femur (NOF) fractures are increasing, and the need to improve mobility and reduce complications whilst improving discharge time is an ongoing challenge. The hip fracture pathway is designed to optimise patients peri-operatively, with common problems being pain, delirium and mobility. Hip fracture fixation and arthroplasty are essential in improving pain and mobility long-term. NOF patients often undergo a fascia iliaca block (FIB) to improve outcomes and overcome these challenges. Patients on anticoagulants are typically refused bedside blocks, however, we are unsure if they truly impact adverse outcomes in FIB for NOF patients.
Methods: A retrospective observational study was undertaken to assess complication rates in 53 NOF patients who had a FIB at St Mary’s Hospital between 07/01/2020 and 26/06/2020. Patients whose NOF was due to an inpatient fall were excluded. Pre-existing anticoagulant and antiplatelet use were noted, as were the A&E admission blood coagulation results. Local complications which may have arisen post-FIB were closely screened for in documentation until the patient’s discharge.
Results: There were no local complications in 53 out of 53 patients. Interestingly, one patient had a documented thigh haematoma pre-nerve block, but did not have any evolution of the haematoma with good pain relief from the block.
Conclusion: FIBs appear to be a safe and effective analgesic tool in perioperative NOF patients and use is reported to reduce early complications in those undergoing hip fracture treatment. We aim to implement these findings and increase the rate of nerve block procedures in NOF fractures.

Background
High-quality and cost-effective health care are highly recommended especially in joint replacement surgeries, particularly in total hip arthroplasty. Therefore, it is indispensable for orthopaedic surgeons to spot the potential areas of quality improvement. Evaluating the efficacy of the different ways of skin closure is an unacknowledged topic.
Patients and methods:
We included all randomised control trials and retrospective cohort studies undergoing primary total hip arthroplasty who either received staples or subcuticular sutures for skin closure. The primary outcome was the incidence of wound infection. Secondary outcomes included length of stay (LOS), time to skin closure, total cost, and patient’s satisfaction.
Results:
We included five studies in our cumulative meta-analysis. We conducted them using Review Manager V.5.0. We computed the risk ratio as a measure of the treatment effect, taking into account heterogeneity. We used Random-effect models. Primary skin closure with subcuticular sutures had insignificant marginal advantages for wound infections, LOS, and wound oozing. On the contrary, staples were more cost-effective and had less time for closure with higher patient’s satisfaction.
Conclusions: Except for closure time and patient satisfaction , no significant difference between the two groups. The use of staples after THA may have several slight clinical advantages over the subcuticular sutures. However, owing to the complexities associated with wound closure, future clinical and laboratory studies assessing their complication outlines must be examined before an optimum technique can be determined.

At present, approximately 71,000 patients in the United Kingdom have a metal-on-metal(MoM) hip. Owing to rising concerns, MHRA has laid out guidelines to follow them up at regular intervals. However, there is little knowledge about the long term follow up of patients with MoM hip replacements. The purpose of our study is to compare the blood metal ions between patients with a unilateral and bilateral MoM hip implant over a period of 20yrs.Methods: A retrospective study of 281 patients with MoM hip replacements was conducted at Hinchingbrooke Hospital. 50 patients have been revised and some patients were lost to follow up and thus were excluded from the study. The blood cobalt and chromium ion levels of 115 Unilateral and 45 Bilateral patients with MoM implants were analyzed. Results: In patients with Unilateral MoM implants, the average cobalt and chromium levels were 34.22 nmol/L and 36.86 nmol/L respectively, while in Bilateral MoM cases, the average chromium and cobalt levels were 38.52 nmol/L and 42.04 nmol/L respectively. Our findings was within the normal limits (Cobalt: 119nmol/L and chromium: 134.5nmol/L) as per the MHRA guidelines for MoM implants. Conclusion: Our data suggests that there was no significant difference in metal ion levels in patients with unilateral and bilateral hip replacements over a period of 20yrs. Even after 20yrs, patients with well functional MoM hip implants had acceptable blood metal ion levels till date.

Introduction: Short stems in primary THA have gained popularity over the last decade. To date, however, short stems are not eligible to be used as revision implants. While early results of hip resurfacing arthroplasty (HRA) have been promising, complications, such as increased metal debris and metallosis have been reported, leading to a high rate of revision surgery. The aim of this study was to retrospectively evaluate the outcome of revision surgery of failed HRA using short-stem THA. Methods: 6 consecutive patients were retrospectively reviewed who had initially undergone HRA between 2004 and 2013 and on which revision THA was performed from 2016 to 2017 using a calcar-guided short stem. Patient reported outcome measurements (PROMs) were recorded using the Harris hip score (HHS) and The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The health status was evaluated by the EQ-5D-5L score. Pain and satisfaction was obtained using the visual analogue scale (VAS). Complications were documented. Results: The mean follow-up was 3.25 years (SD 0.45). Clinical outcome in five patients was excellent (HHS ≥90) and in one patient it was good (HHS = 87). The mean WOMAC score was 5.73% (SD 3.66%). The mean EQ-5D-5L index was 0.914 (SD 0.07). Pain and satisfaction on VAS was 1.83 (SD 5.18) and 8.67 (SD 0.94), respectively. No major complications occurred. To date, no re-revision surgery was necessary. Conclusion: The outcomes of the present case series propose that HRA can be safely revised using short-stem THA in a selected patient group by experienced surgeons.

Background: There is a great variation in the utilization of Total Joint Arthroplasty services in different ethnic groups. Does ethnicity influence the postoperative recovery and length of hospital stay after Total Joint Arthroplasty or there is no difference as such between different ethnic groups. Objectives: To address this question we conducted a retrospective study to evaluate the influence of ethnicity in the postoperative recovery and length of hospital stay after elective Primary Total Hip and Knee Arthroplasty. Methods: We retrospectively reviewed the records of all the patients that underwent elective Primary Total Hip and Knee Arthroplasty at Solihull and Good Hope hospital from January 2018 to December 2018. All the required information like ethnicity, procedure, ASA code, any postoperative event or complications, length of stay in the hospital were recorded. Results: Overall, there is no difference in the average length of hospital stay between Asian and White ethnic groups after elective Primary Total Hip and Knee Arthroplasty. However, there is an increased length of stay in the Black ethnic group as compared with Asian and White. Conclusion: Ethnicity does not have a significant influence on the length of hospital stay between Asians and White in our pilot study. However, more research in the form of a multicenter study with large sample size is needed for its relevance and it will also help to find out the reasons for increased length of hospital stay in the Black ethnic group when compared to Asian and White.

INTRODUCTION: At our centre the cut of B.M.I. for elective listing of such patients is 35.The purpose of this study was to filter the primary G.P. referrals with a high BMI (>35) at their level and educate the patients to loose weight prior to opting joint replacement route. METHODS: We audited the B.M.I. of all the patient who underwent hip and knee arthroplasty at our centre between Jan 2017 – Dec 2018 and compared them against patients with the cut off value( <35). We assessed the complication rate of all the patients who underwent joint replacements and categorised them as high BMI ( >35) Vs Acceptable BMI (< 35).Inclusion Criteria were elective Hip & Knee arthroplasty, irrespective of past medical history and exclusion criteria was ankle and shoulder arthroplasty. RESULTS: Total patients - 630,Time period – Jan 2017- Dec 2018 (24 months), BMI <35 – 499 patients (79%) 61 patients (12%) complications, 5 mortality. BMI 35 & > - 131 (21%), 22 patients (17%) complications, no mortality. DISCUSSION & CONCLUSIONS: Challenges associated with Joint Arthroplasty are a stress factor to surgeon and patient. The most important aspect of this is to understand the patient’s expectations and give a realistic picture of the potential risks. The concept of shared decision making is extremely important here and patients willing to undergo such procedures should be educated about the potential risks with High BMI and at the same time take this opportunity to loose weight prior to this major undertaking.

Backround: The Superior Capsular Portal Assisted Total Hip (SuperPATH) approach does not require surgical
dislocation for femoral preparation. There is a theoretical advantage of possibly reduced Proximal Femoral Fracture
(PFF) rate in cementless THR.
Objectives: To compare the PFF rate in a consecutive series of THR performed by the same surgeon using the same surgical implant between SuperPATH and conventional mini-posterior approach. The study compared 390 THR ( 53 % females; 53% right sided): 121 SuperPATH (group A) and 255 mini-posterior (group B).
Results: There were no differences between groups in regard to age, BMI, preoperative Dorr type femoral canal, incidence of osteoporosis, and postoperative femoral stem alignement. All patients had a fast recovery programme.
All fractures occurred either intra-operatively (group A: 0; group B: 2) or within the first 3 weeks after surgery (group A: 1; group B: 11). There was 1 peri-operative PFF in group A (0.8%) and 13 in group B (5%). This difference was significant (p<0.05). Female gender and age >60 were risk factors for PFF for this particular THR design, while femoral component alignement and BMI were not.
Discussion: The present study confirms that SuperPATH approach potentially reduces the peri-operative PFF rate in cementless THR. Only a particular stem was investigated; further research is required if this finding is valid for other types of implants.