The Femoro Patella Vialli (FPV) is indicated for isolated patello-femoral joint replacement (PFJR). It is now the second most commonly used PFJR in the UK, however there are limited studies evaluating its outcome. Key differences include a larger component sulcus angle of 140 degrees which more closely mimics the normal knee.

Between 2006 and 2012, we performed 53 consecutive FPV patellofemoral arthroplasties in 41 patients with isolated patellofemoral joint osteoarthritis. Mean age was 62.2years (39–86) and mean follow-up was 3.5 years. Mean Oxford Knee scores improved from 19.7 to 37.7 at latest follow-up. Ninety four percent of patients were happy or very happy with their knees. Progression of tibiofemoral osteoarthritis was seen 12% of knees. 2 knees required revision to TKR at 7 months post-operatively, which we attribute to poor patient selection. There were no cases of maltracking patella or patella dislocations at final follow-up, which we attribute to the larger sulcus angle. There were no cases of radiological loosening.

Our findings suggest the FPV patellofemoral prosthesis has good mid-term functional outcomes.

Purpose of study: With the increasing demand for arthroplasty surgery, it is important to maintain a high quality of care. We describe a clinical governance framework for a simple, easy to implement method of assessing and monitoring radiological outcome following total knee arthroplasty.

Methods: We completed a two-year prospective study (January 2006 to December 2007 inclusive) of all total knee arthroplasty operations. This included 1,295 procedures, the majority of which were undertaken by two Consultant Surgeons and up to eight independent middle grade surgeons. The two Consultant Knee Surgeons assessed component position on standard post-operative weight-bearing antero-posterior and lateral knee radiographs on a weekly basis. They were blinded to both the patient and surgeon details, and used our own simple grading system, whose weighted Kappa variance showed ‘moderate’ interobserver (K = 0.41) and intraobserver reliability (K = 0.51). Our system comprised of only three ordinal scores, which were good (score of 1), acceptable (score of 2) and poor (score of 3).

Results: We provided individual surgeons with their results on a six-monthly basis. The average score for all the surgeons was good. The scores of the independent middle-grade surgeons were analysed by the Consultants, and feedback was provided in the form of formal advice and supervised surgery sessions. Repeat proportional analysis of their radiological scores showed significant improvements for all the individual surgeons (Pearson-Chi Square p value < 0.05).

Conclusions: Clinical governance is an important facet of excellence in medical practice. Our system allows continued prospective assessment of radiological outcome following total knee arthroplasty. By utilising such systems and ensuring an atmosphere of clinical excellence, we are able to employ more surgeons and undertake an increased workload, whilst maintaining high standards. This assessment tool can also be used to assess and appraise trainees during their progression.

Purpose of study: With the increasing demand for arthroplasty surgery, it is important to maintain a high quality of care. We describe a clinical governance framework for a simple, easy to implement method of assessing and monitoring radiological outcome following total knee arthroplasty.

Methods: We completed a two-year prospective study (January 2006 to December 2007 inclusive) of all total knee arthroplasty operations. This included 1,295 procedures, the majority of which were undertaken by two Consultant Surgeons and up to eight independent middle grade surgeons. The two Consultant Knee Surgeons assessed component position on standard post-operative weight-bearing antero-posterior and lateral knee radiographs on a weekly basis. They were blinded to both the patient and surgeon details, and used our own simple grading system, whose weighted Kappa variance showed ‘moderate’ interobserver (K = 0.41) and intraobserver reliability (K = 0.51). Our system comprised of only three ordinal scores, which were good (score of 1), acceptable (score of 2) and poor (score of 3).

Results: We provided individual surgeons with their results on a six-monthly basis. The average score for all the surgeons was good. The scores of the independent middle-grade surgeons were analysed by the Consultants, and feedback was provided in the form of formal advice and supervised surgical sessions. Repeat proportional analysis of their radiological scores showed significant improvements for all the individual surgeons (Pearson-Chi Square p value < 0.05).

Conclusions: Clinical governance is an important facet of excellence in medical practice. Our system allows continued prospective assessment of radiological outcome following total knee arthroplasty. By utilising such systems and ensuring an atmosphere of clinical excellence, we are able to employ more surgeons and undertake an increased workload, whilst maintaining high standards. This assessment tool can also be used to assess and appraise trainees during their progression.

Purpose of the Study: To study the results of resection of giant cell tumour around the knee and limb salvage by distraction osteogenesis using Ilizarov construction over intramedullary nail.

Summary: The treatment of GCT has ranged from curettage and en-bloc resection. It has always been a challenge to reconstruct the resected gap especially across the joints. We have done juxta articular resection of the tumour followed by interlocking nailing across the resected gap as first stage. In the second stage simple Ilizarov construct was used for transportation of bone across the resected gap.

Results and Discussion: There were 6 male and 2 females. The mean age at presentation was 27 years. 3 lesions were in proximal tibia and 5 in the distal femur. The mean length of bone defect was 13.9 cm. With trifocal distraction the mean duration of Ilizarov external fixation was 90 days. We used colour doppler to asses the quality of regenerate during follow-ups. Mean duration of follow up was 44 months. A good quality of regenerate was seen at last follow up and all patients were fully weight bearing.

Allografts are an alternative to endoprosthetic reconstruction but high incidence of complications such as fracture, deformity and infection makes the outcome unpredictable. The treatment option of reconstructing the resected gap with endoprosthesis is limited in our Indian subcontinent set up because of limited resource and availibility. The advantage include, the method we used has given us best alternative which allowed us to fill the large resected gap without the need of massive bone grafts. The distraction from both sides of resected gap has reduced the transportation time and use of DCP plate across the docked bone has allowed us to remove the fixator earlier. The regenerate had sufficient biological strength and durability. The disadvantages include the long duration of external fixation and related problems such as pin tract infections and frustration of patients due to the long period of treatment.

Conclusion: Resection of tumour across the joint especially around the knee and recostruction by distraction osteogenesis using Ilizarov construct over the nail to fill the large gaps without using grafts is very encouraging.