6 prostheses that used ball bearings to achieve length (designed in 1981) were implanted, 3 (50 %) were revised due to mechanical failure. 19 prostheses that utilised external C-washes (1998) to achieve length were implanted, 6 (32 %) were revised, half of these for mechanical failure. Of the 98 minimally invasive prostheses (1992) that utilized an Allan key and screw-jack mechanism to lengthen, 14 (14 %) were revised, half of these for infection. 17 non-invasive extendable endoprostheses (2001) that are lengthened by electromagnetic coupling have been implanted so far. There has only been 1 (6 %) revision. This was due to full extension being reached.
Key Words: Bone tumour, children, endoprosthesis, survivorship.
The modified Cincinnati scores (MCRS) of eighty-six patients were evaluated prospectively at one year and at the latest follow-up following ACI-C (mean follow-up= 4.7 years. Range= 4 to 7 years). All these patients underwent biopsies of their cartilage repair site performed at variable periods between six months and five years following ACI-C (mean=22.2 months). The neo-cartilage was graded as hyaline (n=32), mixed fibrohyaline (n=19), fibrocartilagenous (n=35) and fibrous (n=0).
However, their clinical scores at the latest follow-up demonstrated a significantly superior result for those with hyaline repair tissue when compared to those with mixed fibro-hyaline and fibro-cartilagenous repair tissue (p=0.05). The percentage of patients with excellent and good results for those with hyaline, mixed fibro-hyaline and fibro-cartilagenous repair was 75, 42 and 68.6 respectively. Their mean MCRS were 70.6, 56.8 and 63.9 respectively.
Introduction: The distal tibia is an uncommon site for primary malignant bone tumours and the treatment of choice for most patients is a below knee amputation. Patients who decline an amputation may be offered an endoprosthetic replacement. This is a technically challenging operation and may be associated with high morbidity.
Clinical outcomes during the first two postoperative years did not vary according to repair morphology type, though hyaline repair was associated with better clinical outcomes beyond 2 years; At 1 year, good to excellent clinical scores were observed in 29 (78.4%) patients with hyaline-like repair, 23 (76.7%) patients with fibrohyaline repair, and 54 (74.0%) patients with fibrocartilage repair. By years 3 and 4 post-implantation, clinical scores further improved in patients with hyaline-like repair yet declined in those with fibrocartilage and fibrohyaline. The difference was significant at 3 years though not at 4 due to the small number of cases.
We prospectively randomised 104 consecutive patients undergoing primary cemented total knee arthroplasty to receive either a standard suction drain© (Redivac) or autologous transfusion drain® (Bellovac). There were fifty two patients in each group. Randomisation was performed using a software program (Minim) which set to stratify patients based on their age, sex and body mass index (BMI). All procedures were performed under pneumatic tourniquet. Drains were released in recovery room 20 minutes after surgery and were removed 24 hours following surgery. Blood collected in the standard suction drain was discarded but blood collected in the autologous transfusion drains was transfused unwashed to the patient within six hours of collection. 13 patients (25%) in the study group had two or more units of homologous blood transfused in addition to the blood collected postoperatively and re-transfused (Average= 438mls). 12 patients (23%) in the control group had two or more units of homologous blood transfused. No sepsis, transfusion reactions, or coagulopathies were associated with the autologous blood re-transfused in the study group. The use of autologous transfusion system (Bellovac) proved to be safe but failed to reduce the need for postoperative homologous blood transfusion following uncomplicated total knee arthroplasty.
These figures represent the early results of this study performed at this unit.
The mean Harris hip score increased from 44 points (range, 27 to 71 points) preoperatively to 71 points (range, 21 to 98 points) at the time of the most recent follow-up. 9 patients required subsequent revision; 4 for aseptic loosening, 1 for septic loosening and 4 for fracture of the femoral component.