The MediShoe (Promedics Orthopaedics Ltd, Glasgow) is a specific post-operative foot orthosis used by post-operative foot and ankle patients designed to protect fixations, wounds and maximise comfort. The use of rigid-soled shoes has been said to alter joint loading within the knee and with the popular use of the MediShoe at our centre in post operative foot and ankle surgery patients, it is important to ascertain whether this is also true.

An analysis of the knee gait kinetics in healthy subjects wearing the MediShoe was carried out. Ten healthy subjects were investigated in a gait lab both during normal gait (control) and then with one shoe orthosis worn. Force plates and an optoelectronic motion capture system with retroreflective markers were used and placed on the subjects using a standardised referencing system. Three knee gait kinetic parameters were measured:- knee adduction moment; angle of action of the ground reaction force with respect to the ground in the coronal plane as well as the tibiofemoral angle. These were calculated with the Qualisys software package (Gothenburg, Sweden).

A two-tailed paired t-test (95% CI) showed no significant difference between the control group and the shoe orthosis-fitted group for the knee adduction moment (p = 0.238) and insignificant changes with respect to the tibiofemoral angle (p = 0.4952) and the acting angle of the ground reaction force (p = 0.059).

The MediShoe doesn't significantly alter knee gait kinetics in healthy patients. Further work, however is recommended before justifying its routine use.

Reverse polarity shoulder replacements are indicated in cases of gleno-humeral arthritis with the presence of rotator cuff muscle dysfunction. Despite some studies demonstrating early improvement in function and pain, limited information still exists regarding the durability and longer term outcomes of these prostheses. The reported complication rates have been reported to range from 0–68%.

Post-operative clinical complication rates of three commonly used reverse polarity total shoulder replacements (Delta, Verso and Equinoxe) were evaluated against those mentioned in the literature to predict satisfactory outcome.

A retrospective review of 54 patients (3.5F:1M) and 64 operations (27L:37R) between 2004–2011 was carried out. Post-operative complications were searched for through medical records, the local hospital database (BLuespearIT) and the Picture Archiving and Imaging System (PACS). All operations were performed by two experienced consultant-grade orthopaedic shoulder surgeons.

The mean age at time of operation was 75.9 years (range 64–94). 33 Delta, 19 Equinoxe and 12 Verso prostheses were inserted. Three patients were excluded from the study due to insufficient information from medical records and radiography. Total complications were seen in 25 % of operated cases:- dislocation (6), fracture (4), deep infection (2), significant post-operative pain (1) and deltoid muscle dysfunction (3). Complications categorised according to prosthesis type were:- Delta (24%), Equinoxe (32%) and Verso (8%).

Short to medium term complication rates using reverse polarity total shoulder replacements are higher than the majority of the current literature suggests. The Verso is associated with the least number of complications which may correlate with its minimally invasive approach.

The Lubinus SP2 femoral stem has a 10 year survivorship of 96%. Curiosity lies in that force-closed stem designs such as the Exeter appear to be more superior to that of the composite-beam like the Lubinus which performs best compared with all other stem types. Biomechanical comparisons of the stress distributions between native and implanted human femora with a cemented Lubinus stem simulating an everyday clinical activity were made. Rosette strain gauges were placed onto fourth generation composite cortical sawbone femora and placed within a hemipelvis rig simulating the dynamic position of the femur during single-legged stance. The femora were then implanted with the Lubinus and principal strain measurements calculated for both intact and implanted femora. These values correlate directly with stress. Statistical calculations were carried out including a two-way ANOVA and Student's unpaired t-test so as to ascertain any relationship between the intact and implanted femora strain values.

There were significant decreases (p<0.05) in principal tensile and principal compressive strains upon implantation in the proximal and distal areas of the femur. However, there were insignificant changes (p>0.05) in principal tensile strains at the mid-stem and insignificant changes (p>0.05) in principal compressive strains at both the mid-stem and distal areas.

This is the largest biomechanical study to be carried out on this stem and the first in the English language. Changes in principal stresses were not significant in all aspects of the femur upon implantation which appears to give some biomechanical explanation to its clinical success.