Introduction: We present preliminary short term results of medial opening wedge high tibial osteotomy with hemicallotasis using a monolateral external fixator, combined with microfracturing, in younger active patients with established Grade IV medial compartment osteoarthritis.

Methods: Prospectively collected data was analysed for 28 consecutive knees in 27 patients undergoing this procedure. Mean age was 47 years (range 28 to 64), follow up was 23 months (range 7 to 61).

Results: Mean Lysholm scores improved from 63.6 before surgery (range 42 to 85) to 81.6 at latest follow-up (range 46.5–100) (p< 0.001). Similarly, the mean Tegner activity scale improved from 1.7 (range 1 – 4) to 3.3 (range 1 – 6) (p< 0.001). Average IKDC score at last follow-up was 68 (range 35.6 – 100). Mean pain score (visual analogue scale 0 to 10) improved from 5.5 pre-operatively (range 1 – 9), to 3.5 at latest follow-up (range 0 – 8) (p< 0.001). All but 4 patients reported improved pain scores.

Superficial pin site infection occurred in 6 patients (21.4%) and settled with oral antiobiotics in all cases. One patient had persistent patellofemoral (PF) pain.

Discussion: The use of hemicallotasis for high tibial osteotomy (HTO) in association with extensive microfracturing of the medial compartment provides a viable, minimally invasive method for management of the young active patient with medial compartment osteoarthritis, without the risk of serious complications. In the short term even with advanced full thickness cartilage damage, this provides effective pain relief, helps put off more major arthroplasty alternatives and improves activity levels.

Introduction: We present preliminary short term results of medial opening wedge high tibial osteotomy with hemicallotasis using a monolateral external fixator, combined with microfracturing, in younger active patients with established Grade IV medial compartment osteoarthritis.

Methods: Prospectively collected data was analysed for 28 consecutive knees in 27 patients undergoing this procedure. Mean age was 47 years (range 28 to 64); follow up was 23 months (range 7 to 61).

Results: Mean Lysholm scores improved from 63.6 before surgery (range 42 to 85) to 81.6 at latest follow-up (range 46.5–100) (p< 0.001). Similarly, the mean Tegner activity scale improved from 1.7 (range 1–4) to 3.3 (range 1–6) (p< 0.001). Average IKDC score at last follow-up was 68 (range 35.6–100). Mean pain score (visual analogue scale 0 to 10) improved from 5.5 pre-operatively (range 1–9), to 3.5 at latest follow-up (range 0–8) (p< 0.001). All but 4 patients reported improved pain scores, one of whom had patellofemoral pain. Superficial pin site infection occurred in 6 patients (21.4%) and settled with oral antibiotics in all cases.

Discussion: The use of hemicallotasis for high tibial osteotomy in association with extensive microfracturing of medial compartment provides a viable, minimally invasive method for management of the young active patient with medial compartment osteoarthritis, without the risk of serious complications. In the short term even with advanced full thickness damage, this provides effective pain relief, helps put off more major arthroplasty alternatives and allows patients an improved activity level. The external fixator provides a very stable functional stabilization, superior to other available methods of internal fixation.

Aims: The aim of this study was to reassess whether the use of a Ôone knife techniqueñ can be considered as safe as the current practice of using separate skin and inside knives for elective orthopaedic surgery. Methods: A tatal of 609 knife blades from 203 elective orthopaedic operations consisting of equal numbers of skin, inside and control blades, were cultured using direct and enrichment media. Results: Thirty-one skin blades (15.3%), 22 inside blades (10.8%) and 13 control blades (6.4%) gave bacterial growth. In only 3 cases (1.4%) skin and inside knife cultures grew corresponding organisms. However, in the presence of skin knife contamination the same organism was found on 10% of inside blades. It remains to be seen whether in the remaining 90% contamination of deeper layers was prevented by changing the knife after the skin incision, since the incidence of late deep sepsis is not yet known in these cases. Conclusions: The organisms cultured in this study were predominantly coagulase-negative staphylococci, known to be major culprits in early and late peripros-thetic infection. Our study suggests that the rationale for separate skin and inside knives can be supported, since the cost of a single deep infection in human and þnancial terms can be considerable