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Background: A 37‐year‐old female with a hyperkinetic movement disorder due to chorea‐acanthocytosis developed severe painful degenerative arthritis of her left knee as a consequence of repetitive involuntary flexion and extension dystonic and ballistic movements. Case Report: Despite profound limitation in her mobility a total knee replacement was successfully undertaken. Discussion: The case emphasizes that patients with progressive neurodegenerative disorders may derive relief or resolution of pain by joint replacement even if mobility does not improve following surgery. A multidisciplinary approach to care is essential.

We have investigated whether patient reported outcomes provided by patients with Birmingham Hip Resurfacing (BHR) changed after negative media coverage of metal-on-metal (MOM) hip replacement. We also investigated whether patients whose procedures were performed by a designer surgeon behaved differently to those performed elsewhere. 1178 consecutive BHR procedures performed between January 2002 and December 2006, by one of the designer surgeons in his private practice, were reviewed. We also reviewed 402 BHRs undertaken by two non-designer surgeons in both their NHS and private practice. 150 of the latter cohort were undertaken at an NHS hospital and 252 at an independent private hospital. All patients had annual Oxford Hip Scores (OHS) collected. We chose 2007 as pre-"media attention" and compared scores from this year against subsequent years. We found no clinically significant change in OHS between 2007 and subsequent years, at all centres. We conclude that negative media reporting does not appear to have had an impact on patients' perceived outcome after BHR. In consequence, patients who have undergone this type of hip resurfacing and show deterioration should be investigated.

Hip pain in young adults is not always caused by intra-articular pathology, even in the presence of abnormal examination and imaging findings. Therefore, management of young adult hip pain requires processes that identify patients who are likely to benefit from surgical intervention. An important investigation in the diagnostic pathway is the intra-articular injection; a negative response to this should alert the surgeon to the presence of symptomatic extra-articular causes of hip pain. Our aim was to identify the proportion of patients referred with intra-articular pathology whose primary cause of pain was of extra-articular origin. A total of 143 intra-articular hip injections (local anaesthetic + corticosteroid) were performed over a 2-year period. Mean patient age was 41.95 (95% confidence interval: 39.50-44.41) years with a mean body mass index of 27 (95% confidence interval: 25.77-28.23); 26% of patients (n = 37) had no relief of symptoms after intra-articular injection. Of the patients with no relief, 81.1% (n = 30) were found to have extra-articular pathology as the cause of their pain and the remainder are under on-going investigation. Intra-articular hip injection is an important investigation in the diagnostic pathway of young adult hip pain, as it can highlight and differentiate those patients with referred pain from extra-articular pathology. This benefit may be further enhanced if injections are performed in theatres using image intensifier, under sedation, as it allows direct penetration into the joint without any local anaesthetic infiltration of surrounding tissue. The latter allows immediate objective assessment of symptom relief, eliminating the need to rely on retrospective patient recall of symptom change.

This study aimed to assess if patient-matched cutting blocks reduce operating time, blood loss and length of stay on top of improving implant alignment and offer operational or economic benefits, as claimed by manufacturers. We retrospectively reviewed patients undergoing TKA using patient matched technology and compared them with patients undergoing TKA using standard instrumentation; all were operated on between September 2010 and June 2012. All procedures were performed by a single surgeon at a single centre using the same implants. We collected data on operating time, length of stay and blood loss and also measured component alignment. Thirty-nine patients underwent TKA using patient-matched technology during the study period. Data was compared with that from 50 patients undergoing TKA using standard instrumentation during the same period. We found no significant difference in operating time, length of stay or blood loss between the two groups. There was also no difference in femoral or tibial component alignment although we did observe that the femorotibial angle of TKAs using patient-matched technology was 0.9 degrees more valgus (183.5 degrees versus 182.6 degrees, p = 0.035). In this study, patient-matched technology did not appear to give any clinical advantages over standard techniques although, equally, it did not appear to show any disadvantages. Further studies are needed to evaluate whether operational or economic benefits may be achieved by adoption of patient matched instrumentation.