Aims: We performed a prospective randomised controlled clinical trial of a comparison of PCL excison and PCL retention whilst using a standard PCL retaining cemented PFC knee relacement in order to answer two questionsòa) is the PCL functional if retained in PCL retaining TKRs. b) does PCL excison affect the results of a standard PCL retaining knee replacement. Methods: 129 knees suitable for a standard PCL retaining cemented total knee replacement were randomised into two groups, one in which the PCL was retained in the normal way, the other group having the PCL fully resected. Both groups received a PCL retaining implant. The two groups were well matched with a predominance of females and a mean age of 67 years. Results: There was no statistically significant difference in the HSS scores at an average of 57 months in the two groups. Pain relief, deformity correction, range of motion, stability and strength were comparable in the two groups. A radiological assessment revealed significant rollback in approximately 20% of cases with a slightly higher incidence in the PCL sacrificed group. There was no significant loosening detected in either of the categories at two years review. At five years one TKR in the PCL retained group has been revised due to an infection and one each in the two groups are awaiting revison surgery for loosening. Conclusions: Our findings have shown that there is no significant difference in the 5 year results of a PCL retaining total knee replacement if the PCL is excised or preserved. This suggests two significant points –a) the PCL is not functional in most patients with a total knee replacement even when retained. b) patients with excised PCLs show good results with PCL retaining implants, thereby questioning the need for posterior stabilised designs in all such cases.

Aim: To evaluate the functional and radiographic results of dorsal capsulodesis in predynamic and dynamic scapholunate instability. Methods: Nineteen patients underwent a scapholunate interosseous ligament repair combined with a dorsal capsulodesis as described by Blatt, in as many wrists for scapholunate instability between 1994 and 1999. The diagnosis was based on a clinical, radiographic and arthroscopic assessment. Mean follow up was 22 months (8 months – 5 years). 15 patients were available for follow up. Most (13 of 15) of the patients presented with predynamic or dynamic instability. Results were analysed clinically and radiologically. Results: Thirteen patients showed a good or excellent clinical result. There was a statistically significant improvement in pain relief (VAS scores) and grip strength (58% of the opposite side). Mean extension and ulnar deviation was significantly better (62% and 53% of the opposite side respectively) and there was a significant reduction in wrist flexion (49% of the opposite side). 13 patients returned to their original level of activity. There was no significant change in the mean SL gap and angle after surgery. Thirteen patients would recommend this operation. Conclusions: We thus believe that this procedure can produce encouraging results in cases of pre dynamic and dynamic instability in a patient population with low demand wrists. Larger case loads and more complete follow ups would be desirable to derive strong evidence based conclusions.

Aims: To compare the lateral vs medial approaches for TKRs in valgus knees. Methods: 67 knees (59 patients) with a valgus deformity of more than 10° suitable for total knee replacement were randomised to two different approaches. One group (36 knees) had their knees replaced by the standard medial para-patellar approach, whilst the other (31 knees) received a modified lateral approach (without an osteotomy of the tibial tubercle and with repositioning of the contracted vastus lateralis). Both groups were well matched with a predominance of females and mean age of 66.2 years. Average follow up was 28 months. Patients were assessed both pre and post operatively by the HSS (Hospital for Special Surgery) and Oxford knee scores, radiologically by weight bearing AP and lateral radiographs and by patient satisfaction scores on a scale of 10. Results: The mean pre operative HSS and Oxford scores for the medial group were 36.0 and 46.6 respectively and for the lateral group were 35.3 and 46.3 respectively. The mean post operative HSS and Oxford scores for the medial group were 77.4 (mean improvement of 41.4 points) and 26 respectively and for the lateral group was 81.2 (HSS score, mean improvement of 45.9 points) and 26.8 (Oxford score). 79.4% of patients in the medial group and 88% of patients in the lateral group showed good to excellent results (using the HSS scoring system)At two years none of the knees were radiologically loose, mal aligned or showed any evidence of an avascular necrosis. Average patient satisfaction on a scale of 10 was 7.9 for the medial group and 8.5 for the lateral group. One patient reported no relief of pain and an acute limitation of function at two years. She suffers from severe Parkinson’s disease and disabilities arising from multiple joint pathologies. There was no incidence of an early/ late infection. Pain relief, range of motion and deformity correction were comparable in the two groups. Conclusions: Our findings so far have shown that at an average of two and half years there seem to be better results in the group which had a lateral approach. However, this was not statistically significant. There are certain operative difficulties that can be overcome by using the lateral approach. Also, the incidence of the requirement of a stage II lateral release (release of the fibular collateral ligament and the popliteus) was found to be lower in the knees approached laterally. There was no need for any type of prosthetic constraint. Only one case of post operative valgus instability was seen in a lady suffering from severe Parkinsonism. This is a prelimnary report on a study now containing 97 patients.