Robert A.E. Clayton

He association between the degree of osteoporosis and the severity of distal radial fractures....

Metal-on-metal resurfacing arthroplasty of the hip has been used increasingly in Europe over the last ten years for the treatment of osteoarthritis of the hip in younger (<65 years of age), active patients. In 2005, 6,153 procedures were performed in England and Wales1. Marketing of the Birmingham hip replacement for resurfacing arthroplasty was approved by the United States Food and Drug Administration in May 2006. Metal-on-metal resurfacing of the hip is known to be associated with elevated concentrations of metal ions within the hip joint and systemically, but, to our knowledge as of this writing, no adverse effects of this process have been identified. However, the United Kingdom Medicines and Healthcare Products Regulatory Agency (MHRA) issued an alert in June 2007 about the Ultima metal-on-metal bearing total hip arthroplasty prosthesis (DePuy International, Leeds, United Kingdom) following reports of the need for early revision due to periprosthetic soft-tissue necrosis2. The bearing in question was a cobalt-chromium-molybdenum alloy similar to that used in the Birmingham hip replacement. We report the development of an ipsilateral mass associated with markedly elevated intralesional cobalt and chromium levels and a femoral nerve palsy in a patient who underwent a Birmingham metal-on-metal resurfacing arthroplasty of the hip one year previously. Our patient was informed that data concerning the case would be submitted for publication, and she consented. A sixty-three-year-old woman presented to another institution with painful idiopathic osteoarthrosis of the right hip. She had undergone a total abdominal hysterectomy, oophorectomy, and lysis of bowel adhesions five years previously but had no other contributory medical history. She underwent metal-on-metal resurfacing arthroplasty of the hip with the Birmingham hip replacement (Smith and Nephew Orthopaedics, Warwick, United Kingdom) in June 2005 (Fig. 1). The surgery and the early postoperative recovery were uncomplicated. Fig. 1 Pelvic radiograph made one …

Objectives: To assess the experience gained by pre-registration house officers (PRHOs) at the end of their first post. To assess confidence in managing common emergencies and experience gained in practical procedures. To compare traditional six month posts with four month posts and to compare the experiences of PRHOs posted in teaching hospitals (THs) with those based in district general hospitals (DGHs). Design: Interview questionnaire. Participants: 152 graduates from Edinburgh University Medical School in 2000 who had completed their first PRHO post by February 2001. Results: There were few significant differences in confidence in managing emergencies and in numbers of practical procedures attempted between respondents from four and six month posts or between those holding TH and DGH posts. PRHOs had gained little experience in practical procedures: fewer than 15% had performed five or more of a number of procedures including lumbar puncture, pleural aspiration, chest drainage, and insertion of nasogastric tube. A high proportion of PRHOs indicated that they felt confident initiating management of conditions in specialties of which they had little or no experience. Conclusions: Rotations of three four month posts do not seem to reduce overall experience in the PRHO year. There is little difference in experience gained between TH and DGH posts. PRHOs perform few practical procedures and some may be overconfident in their own abilities.