Introduction: Several techniques have been described for revision of acetabulum associated with severe superior bony defects. An Oblong cup inserted without bone cement has the advantage of restoration of the centre of hip rotation and maintenance of bone stock. The aim of this study was to analyse the medium-term results of acetabular revision using Oblong cup for severe superior bony defects.

Methods: Thirty-five acetabular revisions using porous coated Oblong cups (S-Rom, Depuy) in 34 patients were performed by the senior author between 1998–2001. All patients were followed-up clinically and thirty-one hips were analysed radiologically for a mean duration of 39.6 months (range 18 to 60). The clinical assessment was performed using Harris hip score and subjective patient’s satisfaction. The acetabular defects were classified according to the method described by Paprosky et al. The position of the acetabular implant, restoration of the centre of hip rotation and the extent of osseo-integration of the acetabular shell were assessed in the post-operative radiographs.

Results: The mean Harris hip score has improved from a preoperative value of 40.6 to 69.4 post-operatively. According to the Leprosy’s method, two acetabula were classified as type 2B, 12 as type 3A and 17 as 3B. The post-operative radiographs showed a mean abduction angle of the Oblong cups of 54.2 degrees (range 40–80). Osseointegration was achieved in 29(94%) of cups. Three cups showed early migration, of which two eventually stabilised and osseointegrated by 12 months. The centre of rotation of hip improved from a mean lateral migration of 8.3 mm and superior migration of 23.5 mm in the pre-operative radiographs to 2.8 mm and 4.3 mm respectively post-operatively.

Discussion: Acetabular revision using porous coated oblong cup for severe superior acetabular defects provides satisfactory medium-term results with predictable restoration of hip centre of rotation.

Objective: To assess if a minithoracotomy gives sufficient access to undertake satisfactory anterior release and fusion of the thoracic spine.

Design: A prospective collection of data in patients undergoing anterior spinal surgery.

Subjects and Methods: Ten patients, nine with adolescent idiopathic scoliosis (AIS) and one with congenital thoracolumbar kyphosis underwent anterior release and fusion through a minithoracotomy. A minithoracotomy being defined as a thoracotomy through an incision of ≤ 6cm. The female to male ratio was 3: 2 with an average age at the time of surgery of 13.5 years (10–15) in the scoliosis group. The patient with congenital kyphosis was operated on at 24 years of age. The mean standing pre-operative Cobb’s angle in the AIS group was 78.4° (60–110°), and this was reduced to a mean of 64° (45–85°) on bending films, with a flexibility of 18.4% (2.7–40%). The pre-operative kyphosis angle in the kyphosis patient was 60°. The thoracotomy incisions were measured with a sterile measuring tape on the completion of closure.

Results: All anterior surgery was satisfactorily achieved through a minithoracotomy with mean incision length of 6.5 cm (5.5–7). The average time taken for thoracotomy and procedure was 99 minutes (40–120) and an estimated blood loss of 116mls (50–250). Satisfactory correction was achieved in all patients with the mean improvement of the Cobb’s angle of 56% and post-operative Cobb’s angle of 34° (18–52). The post-operative kyphosis angle in the thoracolumbar kyphosis patient was 45°. The mean post-operative stay in the intensive care unit was 1.2 days (1–2); the duration of chest drain 1.5 days (1–2); blood transfusion requirement 2.9 units (1–6) and the post-operative stay on the ward 7 days (6–8). Two complications were seen comprising of minor chest infection and superficial infection of the chest drain wound requiring a course of oral antibiotics.

Conclusion: A minithoracotomy provides satisfactory access to achieve anterior release as demonstrated by satisfactory correction achieved with improved cosmesis, acceptable operation time and blood loss and with minimal complications.

Purpose of study: Sixty four patellofemoral (PF) arthroplasties in 48 patients were evaluated to assess the effectiveness of this procedure in patients with a preoperative diagnosis of patellofemoral osteoarthritis.

Methods: All patients who underwent patellofemoral arthroplasty for patellofemoral osteoarthritis between 1992 and 1998 in two district general hospitals were studied. Three authors not directly involved in the patients care assessed the patients by:

both a modified Hungerford and Kenna knee rating system and Insall and Crosby grading system, and

Results: Preoperative diagnosis included 53 patients with primary PF arthritis, 1 with post-traumatic arthritis and 1 with PF osteoarthritis secondary to recurrent subluxation. The average patient age at surgery was 73 (range 42–89) and the average length of follow-up was 41 months (range 6–90 months).

Preoperatively 17 knees had undergone arthroscopy. 36 Lubinus, 17 Cartier and 2 PFV prostheses were used. 5 patients died with 8 PF arthroplasties in situ, 1 patient lost to follow up (these patients are not included further in the analysis). 48 Patellofemoral arthroplasty knees were reviewed. 38 knees were classed as good or excellent, 10 had unsatisfactory results, and 7 were revised. 5 implants were revised to TKR and 2 were revised to PF arthroplasty (for maltracking). Subjectively 41 patients felt they were better, 5 unchanged and 2 worse.

Overall we had 69% good or excellent results, 18% poor, and 12% revised. There were no infections, no revision for loosening, and no documented difficulty in revisions. The worst results were obtained in patients with evidence of tiblo-femoral OA preoperatively and in patients with tracking problems.

Conclusion: PF arthroplasty is technically demanding. Nevertheless, providing one adheres to strict patient selection criteria, and the surgery is performed by a dedicated specialist knee surgeon, PF arthroplasty may be used to treat proven isolated patellofemoral arthritis.