CURRENT PRACTICE IN PRIMARY TOTAL HIP-REPLACEMENT - RESULTS FROM THE NATIONAL HIP-REPLACEMENT OUTCOME PROJECT

As part of the National Study of Primary Hip Replacement Outcome, 402 consultant orthopaedic surgeons from three regions were contacted by p ostal questionnaire which covered all aspects of total hip replacement (THR). There was a 70% response rate of which 71 did not perform hip surgery, a further 33 refused to take part, leaving 181 valid response s. Preoperative assessment clinics were used by 89% of surgeons, but a naesthetists and rehabilitation services were rarely involved at this stage. Of respondents, 99% used routine thromboprophylaxis, with 79% u sing a combination of mechanical and chemical methods. Of surgeons, 84 % routinely used stockings, whereas 95.5% used chemical prophylaxis, 6 3% employed low molecular weight heparins. Theatre facilities were sha red with other surgical specialties by 6% of surgeons and 18% regularl y used body exhaust suits for THR. Antibiotic loaded cement was used b y 69% of surgeons, the majority (65%) used a single brand of normal vi scosity cement with 9% using reduced viscosity formulations. Modern ce menting techniques were commonly used at least in part, 87% used a cem ent gun and 94% a cement restrictor for femoral cementing. On the acet abulum, 47% pressurised the cement. In all, 36 different femoral stems and 35 acetabular cups were in routine use, but the majority of surge ons (55%) used Charnley type prostheses. Of the surgeons, 57% performe d only cemented THR, while 3% exclusively used uncemented THR. Of cons ultants, 21% followed up their patients to 5 years, the majority disch arge patients within the first year. Of concern is a large proportion of surgeons using low molecular weight heparins despite a lack of evid ence with regard to reducing fatal pulmonary embolism, and also the sm all number of surgeons using prostheses of unproven value. Third gener ation cementing techniques have yet to be fully adopted. The introduct ion of a national hip register could help to resolve some of these iss ues.