Introduction: Surgical fixation of intra-articular distal femoral fractures has been associated with nonunion & varus collapse. The soft tissuestripping associated with this fracture andthe surgical exposure have been factors associated with delayed union & infection. The limited soft tissue exposure has been lauded the as a solution to this fracture. However, it has occurred with the new fixation as well.(Locked Plate)

Aims: This study is an attempt to look at the fixation. Does the LISS system improve the results of this difficult fracture? Is there truly a difference in the outcome of this fracture utilizing the Locked plate system or is the percieved difference due to the surgical mini invasive approach.

Patients & Methods: One hunderd & forty patients were screened, only 53 were randomized and fixed in six academic centers over 5 years. All C3 fractures were excluded as they were felt not to be treatable by the DCS device, but they were treated appropiately. 35 females and 18 males were included in the study and randomized appropiatley.

Results: Fifty-three patients were randomized, 28 had the LISS implant and 25 had the DCS utilized. There were 3 nonunions in the LISS group plus two patients with early loss of reduction that required reoperation in the early post operative period. One patient developed arthrofibrosis requiring arthroscopic release and subsequently the implant failed necessitating refixation. In the DCS group, only one nonunion reported & required second surgery. This translated to a reoperation rate of 21% in the LISS group compared to 4% with DCS.

Conclusion: This prospective randomized multicentre trial showed a difference when comparing the LISS to the DCS in the supracondylar distal femur fractures.

Purpose: To comapre the clinical results and costs of a non-modular, all-polyethylene tibial component versus a modular tibial component in patients older than 70.

Methods: A multi-center (London, Ontario; Halifax, Nova Scotia) prospective randomized clinical trial was designed to compare modular metal-backed versus an all polyethylene tibial component in patients over 70 years. Primary outcome measures include Knee Society Clinical Rating System, WOMAC, SF-12, Kaplan-Meier Survivorship.

Results: Between September 1995 and August 1997, 127 total knee replacements (Genesis I, Smith & Nephew) were randomized to receive either a non-modular (all-polyethylene) tibial baseplate or a modular (metal-backed) baseplate. Minimum follow-up was 8 years. Excluding patients who died or became disabled due to medical problems, no consistent significant differences have been seen in regard to the WOMAC, SF-12, and Knee Society scores between the two groups. Kaplan-Meier Survivorship is 93% with a mean survival time of 9.36 years for the non-modular group and 94.1% with a mean survival time of 9.49 years for the modular group. The cost saving in the non-modular group was approximately $800 per TKR without any compromise in clinical outcome.

Conclusions: There was no difference found in the clinical outcome scores between an all polyethylene tibial baseplate and a modular tibial component in patients over 70 years of age. Non-modular tibial baseplates have a list price of 23–65% the cost of their modular counterparts. A high mortality rate exists in this age group limiting the numbers available for longer term review. The use of an all polyethylene tibial component is a cost effective and clinically successful alternative in the older patient requiring total knee replacement.