Background: Mobile-bearing knee designs represent an alternative to conventional fixed-bearing TKA designs. We present the results of a prospective, long-term clinical follow-up study of the Rotaglide (Corin UK) rotating – translating platform total knee design.

Methods: Between October 1990 and December 1998, 326 primary consecutive knee replacements were performed in 260 patients (223 women and 37 men). The average age of the patients at the time of the index procedure was 66.84 years (range 20–82 years). Osteoarthritis was the etiologic factor in 297 knees (91.10%) and rheumatoid arthritis in 25 knees (7.66%). Twenty knees (6.13%) had previous operations (including 16 osteotomies). Both femoral and tibial components were cemented in all knees and the patellae were resurfaced in 199 knees (61.04%). The polyethylene (GUR 1050) mobile inlay was at that time sterilized by Gamma irradiation (2.5 Mrad), packed and stored in air permeable ‘paper bag’. Patients were evaluated at three and six months post operatively and yearly thereafter with use of the KSS. In addition, a radiographic analysis of the tibial, femoral, and patellar components was carried out at each interval and at the last assessment. Twenty four knees (7.36%) were excluded from the study out of which ten knees (3.07%) of eight patients who had died and fourteen knees (4.29%) of ten patients who were lost to follow up. Thus 302 knees (92.64%) were assessed clinically and radiologically in 242 patients. Average follow-up 12.13 years (range 9 to 17).

Results: Pre-operative KSS Knee score 30 (range, 22 to 56) and KSS function score 39 (range, 32 to 58) improved to 88 (range, 62 to 96) and 85 (range, 56–95) respectively. Knee alignment was achieved in 279 out of 302 knees (92.38%). Knee stability was achieved in 292 knees (96.68%). Knee flexion was improved from an average of 92 degrees pre-op to an average of 113 degrees post-operatively. Zonal radiographic analysis revealed fourteen (4.63%) instances of radiolucent lines, ten of which measured < 1 mm in width. None of these lines were deemed to be progressive. Four of the remaining knees with a radiolucent line > 2 mm followed-up carefully and three of them eventually were revised. There were twenty four (7.36%) failures that resulted in revision surgery. In seventeen (5.21%) of them the findings were those of worn out or broken polyethylene with no sings of metal wear or component loosening and therefore only polyethylene exchange was carried out. The other seven knees (2.15%) were totally revised. Kaplan-Meier survivorship using revision of polyethylene mechanical failure as the end point was 94.76%. Overall survivorship of the implant at seventeen years was 92.64%.

Conclusions: This mobile-bearing, total knee prosthesis was associated with a good survival rate and demonstrated clinical efficacy during the 9 to 17 years follow-up interval.

The choice of the surgical exposure in total hip arthroplasties for osteoarthritis is a significant parameter for a successful outcome.

The aim of this study is to evaluate complications or/and advantages related to the most often used approaches for total hip arthroplasties: the direct lateral or transgluteal (Hardinge) and the posterior (Moore) one.

During the period 1997–2000, 50 patients with lateral approach and 50 patients with posterior approach were randomly selected from a pool of 394 total hip arthroplasties (382 patients). Patients with surgery of the contralateral hip were excluded. The mean age of the patients was 72 years (62–84 years) and the indication was degenerative osteoarthritis. The operating time and the postoperative, early and late, complications were studied. The average follow-up was 18 months (12–24 months) and included clinical and radiographic control.

The mean operating time was 76 min. (63–91 min.) and 92 min. (83–110 min.) for lateral and posterior approach, respectively. Complications (early and late) associated with transgluteal approach were 16 patients with positive trendelenburg sign, which disappeared within one year post op, 8 with sympathetic knee effusion which subsided within 6 weeks, 2 with ectopic periarticular ossification and 1 with severe thigh pain. In total hip arthroplasties with posterior approaches, 4 cases were complicated with ectopic ossification, 3 with sympathetic knee effusion which subsided within 4 weeks, 2 with posterior dislocation which needed revision surgery and 2 with peroneal nerve paresis which recovered within 6 months. Except for the trendelenburg sign (p< 0.001), all the other complications did not differ statistically significantly (p> 0.05).

In conclusion, the posterior approach seems to be related with more severe postoperative complications compared to the transgluteal approach. The gluteus medius’ loss of strength (responsible for limping in equal legs’ length), could be treated with prompt strengthening of the muscle within the first postoperative year.

The purpose of this study was the investigation and treatment of all the complications that may occur from the epidural postoperative analgesia in patients who have undergone major orthopaedic surgery.

From October 1999 to April 2002, 200 patients ASA I- III, aged 45–90 (average 72) were studied. They all received postoperative epidural analgesia and were given a mixture of local anaesthetic and Opioid analgesic, more specifically Ropivacaine 2% 10 ml/h and Morphine 0, 1 ug/h via the epidural catheter by means of a stable infusion pump.

The analgesic effect covers the patients for the first 2–3 postoperative days and permits earlier and pain free mobilization and physiotherapy. The analgesic result of this method was completely satisfactory with a mean of VAS 96.

The most frequent side-effects were nausea and vomiting. Pruritus, mild hypotension, hypaesthesia and motor blockage were documented as well but in a very small percentage. No case of respiratory depression or medical toxicity was mentioned, neither epidural haematoma nor infection due to the placement of epidural catheter. The complications during the recovery phase were treated easily by discontinuation of the infusion or by symptomatic therapy.

Epidural analgesia with a steady infusion pump is a secure method of analgesia. However it is of great importance that the patient is informed about the epidural anaesthesia and postoperative analgesia, in a such a way as to attain his/ her consent, participation and collaboration for the best therapeutic result.