Range of Motion (ROM) assessments are routinely used during joint replacement to evaluate joint stability before, during and after surgery to ensure the effective restoration of patient biomechanics. This study aimed to quantify axial torque in the femur during ROM assessment in total hip arthroplasty to define performance criteria against which hip instruments can be verified. Longer term, this information may provide the ability to quantitatively assess joint stability, extending to quantitation of bone preparation and quality.

Joint loads measured with strain-gaged instruments in five cadaveric femurs prepared using posterior approach were analysed. Variables such as surgeon-evaluator, trial offset and specimen leg and weight were used to define 13 individual setups and paired with surgeon appraisal of joint tension for each setup. Peak torque loads were then identified for specific motions within the ROM assessment.

The largest torque measured in most setups was observed during maximum extension and external rotation of the joint, with a peak torque of 13Nm recorded in a specimen weighing 98kg. The largest torque range (19.4Nm) was also recorded in this specimen. Other motions within the trial reduction showed clear peaks in applied torque but with lower magnitude. Relationships between peak torque, torque range and specimen weight produced an R2 value greater than 0.65.

The data indicated that key influencers of torsional loads during ROM were patient weight, joint tension and limb motion. This correlation with patient weight should be further investigated and highlights the need for population representation during cadaveric evaluation. Although this study considered a small sample size, consistent patterns were seen across several users and specimens. Follow-up studies should aim to increase the number of surgeon-evaluators and further vary specimen size and weight. Consideration should also be given to alternative surgical approaches such as the Direct Anterior Approach.

We reviewed 100 consecutive primary sarcoma patients identified from coding records from January 2009 to April 2011. A computerised system was used to access theatre records, and operative details were checked against patient notes to ensure accuracy. Data on demographics, pathology, surgical and oncological management was collected.

Of the 100 patients reviewed, 52 were male and 48 female with an average age of 64.9 years (range 23–102 years). Of the 100 operations performed, 13 had primary reconstruction with a myocutanoeus flap, of which 9 varieties were used. Twenty-five patients had reconstruction with a split or full thickness skin graft and 9 patients had a limb amputation. Length of inpatient stay ranged from 0 to 63 days and was greatest for our amputee's. Mean operative time did not increase significantly with rise in case complexity. 31 of our patients received post-operative radiotherapy, one patient had induction radiotherapy whilst another had induction chemotherapy.

5 out of the 100 patients underwent re-excision due to incomplete margins being obtained at primary wide local excisions. We had one patient with a failed free latissimus dorsi flap, in which secondary reconstruction with pedicled gastrocnemius and skin grafting was successful. One patient had a scalp flap following a re-excision of a positive margin of an angiosarcoma.

Using a combined oncological orthopaedic and reconstructive plastic surgery approach, in our centre 38% of patients require some form of soft tissue reconstruction following tumour resection, with 13% of all patients requiring microvascular flap reconstruction. We have a 9% amputation rate, which is comparable with other published series.

Reconstruction following soft tissue sarcoma is complex and highly demanding, the challenges being best met by a combined orthoplastic surgical team.

Distal femoral LCP was used in 41 consecutive distal AO type A and type C fractures; Vancouver C periprosthetic femoral shaft fractures and Lewis and Rorabeck Type 2 periprosthetic supracondylar fractures of the femur between Oct 2005 and Feb 2008 at a District General Hospital in UK. We aim to present the functional and radiological results at a mean duration of 18.7 months after the surgery.

Between Oct 2005 and Feb 2008, forty patients with a total of forty-one fractures were treated with a distal femoral LCP. There were seventeen male patients and twenty three female patients with a mean age of 73.8 years. There were 29 distal femoral fractures (AO type A = 20; type C = 9) and 12 periprosthetic fractures (Vancouver C = 4; Lewis and Rorabeck Type 2 = 8). Six of the fractures were open. Clinical and radiographic results, including union time, malalignment and implant complications were assessed. Function was assessed by using the Knee Society score. The mean duration of follow-up was 18.7 months (range, seven to thirty five months).

Thirty seven fractures united during this follow up. Three fractures which showed features of delayed or non union needed additional procedures. Screw loosening necessitating screw removal was required in three patients. Deep infection was seen in one patient. Malalignment more than 10 degrees in AP or Lat views was evident in five cases. Excellent to good Knee Society score was achieved in 82 percent of cases. Fair to poor score was seen in 18 percent of cases.

Distal femoral locking plates offer more fixation versatility without an apparent increase in mechanical complications or loss of reduction.