Unicompartmental knee replacement (UKR) is associated with higher revision rates than total knee replacement and it has been suggested that surgeons should receive specific training for this prosthesis. We investigated the outcome of all UKR in a district general hospital over ten years.

All patients who had received UKR from 2003 to 2013 were identified from theatre records, as were all revision knee arthroplasties. We contacted all patients (or their GP) with no known revision to ascertain UKR status. A life table analysis was used for three categories: all surgeons and types of UKR, Oxford UKR only and Oxford UKR by surgeons with specific training.

There were 319 UKR (one loss to follow up), four types of prosthesis, 21 failures and a 5-year cumulative survival rate of 91.54%. There were 310 Oxford UKR with 17 failures and 5-year survival 93.56%. Surgeons with training in use of Oxford UKR completed 242 replacements with 10 failures and 5-year survival of 95.68%.

In comparison with results for Oxford UKR in 11th annual NJR report, our results are satisfactory and support continued use of this prosthesis in a non-specialist centre. Our established programme of surveillance will monitor the survival of UKR in our hospital.

Patella instability can be a disabling condition predominately affecting younger patients, restricting activity and potentially leading to premature osteoarthritis. We describe and evaluate a new technique of stabilising the joint.

Between November 2000 and January 2002 we operated on 24 unstable knees (belonging to 23 patients). All patients had failed a course of conservative treatment and the average number of dislocations pre-operatively was 7. All patients had an extra-synovial lateral release and stabilisation by harvesting the semitendinosus tendon which was then tunnelled through a vertical hole in the patella, under the vastus medialis, wrapped around the adductor magnus and tied to itself at the lower border of the patella.

The patients were assessed clinically and radiologically at an average of 19 months, following the procedure.

There were 19 knees assessed: 13 female /6 male, 10 left /9 right, average age 22 years. 13 patients had retro-patella chondral damage none had meniscal or cruciate pathology. The visual analogue score increased from 4 pre-op to 7.5 after operation. The Kujala patello-femoral score was 74 post procedure. 53% of patients described their knee as excellent, 47% as good. Only one patient has re-dislocated to date (single event). There were no specific risk factors.

Conclusion: Stabilisation of an unstable patello-femoral joint with a semitendinosus loop is a highly successful procedure with good patient satisfaction. We are also happy to use this procedure in the skeletally immature as its use does not preclude a later realignment procedure, should it be indicated.

Introduction and Aims: The clinical studies of knee disorders utilise patients’ activity levels to measure issues that are really important to the patients. Knowing the large variations among patients in terms of the frequency and intensity of sports participation and frustrated by the lack of relevance and specificity of current questionnaires to the Australian public, the authors have devised their own.

Method: The new questionnaire was sent to all members of the Australian Knee Society in an attempt to formulate a consensus view that could then be sent for reliablility and validity testing. The score is represented by two numbers. The first one represents the activity performed and the second, the level at which it was played. These scores are multiplied to give a variable score ranging from one to 20.

Results: An 80% response rate was achieved. Of those that responded, 30.5% agreed completely with the questionnaire as it stood, 69.5% agreed with few modifications, and none disagreed.

Conclusion: A rating of activity level is critical for studies comparing two treatments to ensure that the patient groups are equivalent. We believe that the new Wood-ford activity level scale is fast, easy to use and will facilitate a more accurate comparision among patients with knee injuries in sports medicine. It is easily transferred between different countries and their common sports.

Introduction Osteochondritis Dissecans of the elbow is a rare condition classically affecting teenage males playing throwing sports. The aim of this study was to evaluate the longer term outcome following arthroscopic debridement in patients with osteochondritis of the elbow that had failed conservative management.

Methods All clinically, radiologically and arthroscopically proven patients (since 1989) with Osteochondritis Dissecans (OCD) that had failed six months of non-operative management were recalled for clinical, performance indices and radiological review. A 91% follow-up rate was achieved (62% full clinical and radiological follow-up). The group consisted of 29 patients (20 male, nine female) with an average age of 22 years. Patients were mobilised post-operatively as symptoms allowed.

Results At an average of 77 months after the operation, the majority of patients had mild or no pain with activities of daily living but with some discomfort during heavy lifting/sports. Only four out of 27 had to give up their preferred sport because of persistent elbow problems. Thirty-eight percent had recurrence of locking or catching, though these symptoms were described as much better than prior to the operation and were not felt severe enough to consider any further intervention.

Conclusions We conclude that arthroscopic debridement and removal of loose bodies is a safe and reliable procedure for patients with persistent symptoms from OCD of the elbow.

Introduction There are clear theoretical advantages to support the use of bioabsorbable interference screws in the reconstruction of the anterior cruciate ligament. The purpose of this study is to determine how long it takes for an ACL screw marketed as bioabsorbable to be absorbed in the tibia.

Methods Eight patients that underwent an ACL reconstruction utilising a femoral endobutton and tibial bio-absorbable screw (Arthrex Bio-interference) made of Poly-L-Lactide (PLA) were followed up radiographically with sequential MRI scans at one, two and four years post-operatively. The scans, (Axial T1 and T2 with minimal interslice gap) were assessed by two independent consultant radiologists.

Results There was no evidence radiologically of progression to absorption of the tibial screw on any scan. The MRI appearance remained unchanged from one to four years with the exception of the presence of a small cyst in the tunnel of one of the patients.

Conclusions Despite claims by manufacturers of rapid rates of bio-absorption of their products, this study questions the accuracy of such statements not tested in-vivo. Our study clearly shows the continued presence of such a bioabsorbable screw at four years post-operatively.

Objective: To assess the Universal Spine System and Kaneda Anterior Scoliosis System. Does one system have particular advantages over another?

Design: A retrospective review of patients with idiopathic scoliosis undergoing anterior fusion and instrumentation. The patients undergoing USS instrumentation were treated between 1994–1998, KASS patients 1997–2001.

Subjects: Thirty two consecutive patients were reviewed. Seventeen patients were in the USS group and 15 in the KASS group, 28/32 were female.

Outcome measures: Preoperative and postoperative radiographs, ISIS scans, and patient review. The in-patient notes were assessed for duration of surgery, blood loss, hospital stay and complications. Correction of Cobb angle and union were assessed.

Results: The patients in the KASS group had less flexible curves (correctability 45% vs. 53%). Despite this correction of Cobb angle was better in patients undergoing KASS instrumentation (38.0 degrees vs. 27.8 degrees, P=< 0.05). The secondary curves also improved more in the KASS group (55% vs. 29%, p=< 0.05). Complications occurred in 30%, but there was no difference between the two groups. There were no non-unions. In every other respect there was no difference between the groups for surgery time, blood loss, loss of correction or progression of secondary curve.

Conclusions: KASS instrumentation has better ability to correct spinal deformity in the short term. Further follow-up is required to assess long term results.

Objective: To assess early results with the KASS system for scoliosis correction. To assess lateral curvature, rotational correction and complications.

Design: The first 22 patients requiring anterior correction of scoliotic curves were retrospectively reviewed. Pre- and post-operative curve measurements were made with a Cobbometer. Topographical assessment (ISIS) scan was used to assess rotation and correction of the rib hump. The notes were reviewed to determine complications and time to discharge.

Subjects: Twenty-two patients: 18 idiopathic scoliosis (4 others); average age 15.4 years; 5 King One, 10 King Two, 6 King Three and one non-definable; 5 thoracic curves

Results: Average pre-op scoliosis 54.85 degrees

Average post-op scoliosis 19.4 degrees. Average correction 65%. One patient required second operation for long screws. Four self limiting rninor complications. Average time to discharge eight days

Conclusion: KASS instrurnentation is a safe, effective and reliable method to correct scoliotic curves including rotational deformities. It was not possible to correct the Cobb angle of purely thoracic curves as much as thoracolumbar curves. Cosmetic correction however has been excellent as demonstrated with ISIS. Long term review will be necessary to confirm that correction is maintained.