Purpose: To measure any observed migration and rotation of humeral and ulnar components using radiostereometric analysis.

Methods: From 2002–2004 in a prospective study, twelve elbows in patients treated with either a linked(3) or unlinked(9) Acclaim total elbow prosthesis were included in a radiostereometry study. Six tantalum markers were introduced into the humerus another 3 markers were located on a humeral component. Four markers were placed in to ulna and three markers located on the ulnar component. RSA radiographs were taken postoperatively, six, twelve and twenty-four months. The radiographs were digitised and analysed using UmRSA software. The relative movement of the humeral and ulnar implants with respect to the bone was measured.

Results: At twelve months, the largest rotation of the humeral component was anteversion/retroversion with a mean of 20, anterior tilt had a mean of 1.10 and varus/valgus tilt was minimal mean 0.60. Mean difference between twelve and 24 months segment rotation was no more than 0.50. Rotation in unlinked humeral implants reached a plateau at 12 months this did not occur in linked implants. Paired t-tests between twelve and 24 months segment translation data showed the mean differences to be no more than 0.04mm. In contrast, humeral tip motion produced a mean of 1.3mm at 12 months dominated by movement in the horizontal plane with a mean difference at 24 months of 0.2mm. Mean micro-motion of the ulna implant tip was 0.32mm at 12 months with a mean difference at 24 months of 0.1mm.

Conclusions: Early micromotion of the Acclaim humeral implant occurs mostly by rotation about the vertical axis accompanied by anterior tilt. In unlinked implants this motion reaches a plateau at 12 months after operation but does occur in linked implants.

Aim of Study To assess the efficacy of commonly used sutures materials with commonly described arthroscopic knotting techniques in as close a physiological pattern as possible.

Methods The investigation was carried out in three phases. Initially the ultimate strength of the suture material was tested. Materials compared were 1PDS, 2 Ethibond, 1 Panacryl The suture was then tested to failure by two surgeons comparing five different knotting techniques. Knots tested were Tennessee slider, Duncan loop, SMC, Tautline hitch, and Surgeons knot. Finally the test was repeated after soaking the suture with normal saline.

Results As expected, 2 ethibond has a higher ultimate strength than either 1 PDS or 1 Panacryl. The Tautline hitch and Surgeon’s knot had a significantly lower slippage rate when compared to the other knotting techniques. (P value < 0.002). The Tennessee slider, Duncan Loop and SMC knots slipped in > 50% of experiments. No difference was observed when the suture material had been soaked in normal saline. The number of half hitches required to provide maximum knot holding capacity was 3, confirming previous experimental findings by other investigators.

Conclusions Tautline hitch is recommended for use with all suture materials due to low slippage rates, ease of tying, ease of sliding and overall high knot strength.

Our study examines a group of patients less than fifty years of age who underwent Total Elbow Arthroplasty with the Souter Strathclyde Elbow Replacement and compares their survivorship with a dataset of older group of patients.

309 patients were who underwent standard long stemmed Souter Implants as a primary procedure for rheumatoid arthritis over the last 16 years were included in this study. Patients were divided into two groups according to the their age at the time of surgery. In the first group of older patients greater than or equal to 50 years of age (Mean Age =64.4 years) there were 263 patients with a mean follow up of 7.3 years. The second group consisted of patients less than 50 years of age (Mean Age 42.04 years) who had a longer mean follow up period of 9.3 years. The survivorship of the implants for three different failure events was compared for both groups. The radiographs were evaluated using the Kaplan-Meir survival analyses, to produce survival curves for revision, revision due to aseptic loosening of the humeral component and finally gross loosening of the humeral implant (Hidex> 1). For each terminal event there were two curves and the age group analyses were all non-significant when log rank tested. The rates of loosening/revision were comparable in all curves.

We set out to determine the role of age as predictive factor for loosening. Our conclusions were that Total Elbow Arthroplasty is suitable for younger patients with rheumatoid elbow. Using survivorship data there does not appear to be any difference in loosening when compared to patients of an older age group. As previously published the position of the humeral component within the humerus is crucial for long-term survivorship. Thus age alone should not be the sole discretionary factor for withholding the benefits of elbow Arthroplasty in younger patients.

The study assesses the efficacy of commonly used suture materials with commonly described arthroscopic knotting techniques in as close a physiological pattern as possible.

The investigation was carried out in three phases. Initially the suture material strength was tested. The suture was then tested to failure using the different knotting techniques. Finally the test was repeated after soaking the suture with normal saline.

A Hounsfield tensometer was utilised with a load cell of 1000N, strain rate of 25mm/min, bar separation of 7.5mm and standard temperature and pressure. Suture material tested was 2 ethibond, 1 PDS and 1 Panacryl. Knotting techniques compared were the Tennessee slider, Tautline hitch, Duncan Loop, SMC knot and Surgeon’s knot. Two surgeons tied each knot 10 times after first becoming practiced with each technique. Each knot was tested to failure on 10 sequential experiments.

Ultimate strength of the suture material and of the knotting techniques was assessed. In addition the mode of failure, whether the knot slipped or suture material fractured was investigated.

As expected, 2 ethibond has a higher ultimate strength than either 1 PDS or 1 Panacryl. The Tautline hitch and Surgeon’s knot had a significantly lower slippage rate when compared to the other knotting techniques. (P value < 0.002). The Tennessee slider, Duncan Loop and SMC knots slipped in more than 50% of experiments. No difference was observed when the suture material had been soaked in normal saline. The number of half hitches required to provide maximum knot holding capacity was 3, confirming previous experimental findings by other investigators.

The Tautline hitch is recommended for use with all suture materials due to low slippage rates, ease of tying, ease of sliding and overall high knot strength