Two retrospective cohorts of patients who had undergone a primary total hip replacement (THR) were studied in Japan and England. We analyzed information from hospital case notes and self-administered questionnaires. THR was highly effective in both countries, with significant improvements in morbidity and health status. There were, however, important differences in clinical management and outcome. Japanese patients were more likely to be treated under regional anesthesia by means of an anterior/anterolateral incision, to be transfused, to have a prosthesis implanted without cement, and to stay longer in the hospital. A higher rate of serious in-hospital complications occurred in England, mostly due to the high frequency of hypotension. The incidences of minor complications were consistent with known differences in risks between the two countries. The persistent postoperative perception of limping reported by the English patients was unexpected.

There are several clinically useful techniques for delivering radical radiotherapy to the prostate. One such beam arrangement is a conformal four-field box technique. Patients who have undergone a total hip replacement have in place a metallic prosthesis, which presents challenges in achieving a homogenous dose distribution. This is due to the increased density of the metal in comparison to bone and soft tissue. The resultant effect is additional attenuation of the X-ray beam as it passes through the prosthesis. The interaction of the photons with the metal also causes increased scatter. Thus, the dose delivered to the tumour is reduced if it is not corrected for. Due to the uncertainty in the amount of attenuation, it is recommended to avoid irradiating through the hip concerned. This means that the four-field box technique cannot be used. Instead, different field arrangements are used such as three or four oblique fields. This is a retrospective investigation into which field arrangement would be the most appropriate for early stage prostate cancer patients. Ten previously treated prostate patients were planned with different beam arrangements avoiding the prosthesis. The results were analysed and are presented with reference to the doses to the organs at risk and the planning target volume. The results indicate that the beam arrangement of choice should be three fields (anterior, posterior and lateral) or a three-field oblique beam arrangement. It has been proved that these plans are acceptable as a solution in this scenario.

Fourteen patients who underwent Charnley or Howse total hip replacement using CMW bone cement were studied. Mean values of C4 and C3 determined before the induction of anaesthesia and insertion of bone cement and also after this procedure showed no significant difference and were within the normal range. Furthermore, no evidence of C3 breakdown products was found. It was therefore concluded that neither the general anaesthetic technique nor the insertion of bone cement activated the classical or alternative complement pathways and such a mechanism was not responsible for the hypotension which occurred shortly after the insertion of bone cement in 10 cases studied.

A report is made of respiratory complications which occurred following the insertion of Palacos bone cement during Howse total hip replacement under spinal anaesthesia in a 78-year-old female patient. Persistent cough and tachypnoea developed 30 s after the insertion of bone cement into the acetabulum and femur and persisted for 2–3 min producing considerable passive movement of the pelvis and femur. The probable cause, disadvantages and prevention of these complications are discussed.