Introduction. The management of degenerative arthritis of the knee in the younger, active patient presents a challenge to the orthopaedic surgeon. Surgical treatment options include: high tibial osteotomy (HTO), unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA). The aim of this study was to examine the long-term survival of closing wedge HTO in a large series of patients up to 19 years after surgery. Methods. Four hundred and fifty-five consecutive patients underwent lateral closing wedge HTO for medial compartment osteoarthritis (MCOA) between 1990 and 2001. Between 2008-2009, patients were contacted via telephone. Assessment included: incidence of further surgery, current body mass index (BMI), Oxford Knee Score, and British Orthopaedic Association (BOA) Patient Satisfaction Scale. Failure was defined as the need for revision HTO or conversion to UKA or TKA. Survival analysis was completed using the Kaplan-Meier method. Results. High tibial osteotomy survival was determined on 413 patients (91%) and, of the 397 patients who were alive at the time of final review, 394 (99%) were contacted for follow-up via telephone interview. The probability of survival for HTO at 5, 10 and 15 years was: 95%, 79% and 56% respectively. Multivariate regression analysis showed that age < 50 years (p=0.001), BMI < 25 kg/m. 2. (p=0.006) and ACL deficiency (p=0.03) were associated with better odds of survival. Mean Oxford Knee Score was 40/48 (range 17-48). Overall, 85% of patients were enthusiastic or satisfied and 84% would undergo HTO again at mean 12 years follow-up. Conclusion. High tibial osteotomy can be effective for periods longer than 15 years. However, results do deteriorate over time. Age < 50 years, normal BMI and ACL deficiency were independent factors associated with improved long-term survival of HTO

In 1972, unicondylar arthroplasty (UKA) was introduced, along with total knee arthroplasty (TKA), as an option for managing gonarthrosis. Although the early clinical results with the first generation of implants were equivalent to those of total knee arthroplasty, little interest in UKA was sustained. If unicondylar arthroplasty is to realise a role in the management of degenerative arthritis, even as a temporising procedure, the results must be predictable and reproducible. Patient satisfaction must be equivalent to or better than that of TKA. Finally, the conversion of UKA to TKA must be uncomplicated, avoiding complex reconstructive procedures and the use of revision implants. UKA achieves these goals. As documented by such things as reduced blood loss and risk of infection, morbidity has always been less with unicondylar arthroplasty. Patients with both a UKA and a TKA on the contralateral side generally prefer the unicondylar knee. This is partly because a UKA provides a superior range of motion and better function with such activities as stair climbing. Adapting the surgery to an outpatient operative procedure using a minimally invasive incision has enhanced patient satisfaction. In most studies, the revision of a failed unicondylar arthroplasty using primary TKA components has been predictable and durable. Osteolysis has not been reported with failed UKA; therefore bone defects usually are minimal. If major tibial bone defects are present, a revision tibial component and proper bone defect management will achieve excellent results. In conclusion, we cannot only justify UKA as a temporising procedure, but also as a definitive procedure with long-term results that are comparable to TKA for gonarthrosis

Purpose: The management of degenerative arthritis of the knee in the younger, active patient often presents a challenge to the orthopaedic surgeon. Surgical treatment options include: high tibial osteotomy (HTO), uni-compartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA). The purpose of this study was to examine the long-term survival of closing wedge HTO in a large series of patients 8–19 years after surgery. Method: The results of 458 consecutive patients undergoing lateral closing wedge HTO for medial compartment osteoarthritis (MCOA) between 1990 and 2001 were reviewed. Between 2008–2009, patients were contacted via telephone and assessment included: incidence of further surgery, Oxford Knee Score, and British Orthopaedic Association (BOA) Patient Satisfaction Scale. Failure was defined as the need for revision HTO or conversion to UKA or TKA. Survival analysis was completed using the Kaplan-Meier method. Results: We were able to contact 400/458 (87%) patients for follow-up via telephone interview. Five patients (1%) who declined participation were excluded. Fifty-eight patients (13%) were lost to follow-up. Of the 395 patients, 12 (3%) had died of unrelated causes and 124 (31%) required further knee surgery. The remaining 259 (66%) completed the BOA patient satisfaction score and Oxford Knee Score. The probability of survival for HTO at 5, 10 and 15 years was 95%, 79% and 55% respectively. Multivariate regression analysis showed that only age < 50 years (p< 0.001) was associated with significantly longer survival. Mean Oxford Knee Score was 40/48 (range 17–60). Ninety-two percent (239/259 patients) were enthusiastic or satisfied and 90% (234/259 patients) would undergo HTO again at mean 11 years follow-up. Complications included: 5 pulmonary embolisms, 8 deep vein thromboses, 1 non-union, 1 post-operative subarachnoid hemorrhage and 1 transient peroneal nerve palsy. Conclusion: To our knowledge, we have reported the long-term follow-up of lateral closing wedge HTO in the largest group of patients in the literature. We found that the results of HTO do deteriorate over time but that HTO can be effective for as long as 19 years. In appropriately selected patients and circumstances, HTO gives high patient satisfaction and affords patients unrestricted activity for many years

Aims

The mobile bearing Oxford unicompartmental knee arthroplasty (OUKA) is recommended to be performed with the leg in the hanging leg (HL) position, and the thigh placed in a stirrup. This comparative cadaveric study assesses implant positioning and intraoperative kinematics of OUKA implanted either in the HL position or in the supine leg (SL) position.

Aims

Calcium sulphate has traditionally been used as a filler of dead space arising during surgery. Various complications have been described following the use of Stimulan bio-absorbable calcium sulphate beads. This study is a prospective observational study to assess the safety profile of these beads when used in revision arthroplasty, comparing the complication rates with those reported in the literature.