Intended for healthcare professionals



BMJ 2012; 344 doi: (Published 04 April 2012) Cite this as: BMJ 2012;344:e2443

A prospective randomised controlled trial compared three types of bearing for total hip replacement: cobalt-chrome on ultra high molecular weight polyethylene (standard), cobalt-chrome on highly crossed linked polyethylene, and ceramic on ceramic. Eighty seven patients with 97 hip replacements were available for review five years later (Journal of Bone and Joint Surgery Br 2012;94B:459-65, doi:10.1302/0301-620X.94B4.27735). A comparison between the standard and highly cross linked polyethylene showed an almost threefold difference in the mean annual linear wear rates (0.151 mm/year versus 0.059 mm/year). There were no significant differences in pain and stiffness.

The morbidity among doctors and their resistance to dealing with their own health needs are discussed in The Psychiatrist (2012;36:81-4, doi:10.1192/pb.bp.111.037903). When depressed, doctors become pessimistic and often view the role of the regulator (the General Medical Council) and their employer with distrust. Beliefs about invincibility and perceived weakness, and the scourge of “presenteeism,” all make doctors a difficult bunch of professionals to help. A bespoke service—not triage—is probably the best model of care for doctors.

A US programme to encourage hospitals to “Get with the Guidelines-Heart Failure” implemented …

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