Many factors have been demonstrated to influence the range of knee movement that an individual can achieve.

The purpose of this study was to objectively demonstrate how range of knee movement is affected when the influence of pain is abolished.

Sixty-eight patients with degenerative joint disease presenting for primary total knee arthroplasty were recruited. Using a digital camera, images were taken before and after the induction of anaesthesia with the lower limb in four positions- extension, forced extension, flexion and forced flexion. Camera set up was standard and the range of knee motion was measured from the digital images.

Average arc of motion before anaesthesia was 96° (range, 41°–157°). After induction of anaesthesia, the arc of motion increased to 115° (range, 410–161°). Knee extension improved by an average of 5° (range, 0–15°) and flexion improved by an average of 16° (range, 0–65°).

In conclusion, these results demonstrate that pain has a significant inhibitory effect on the measured range of knee movement before surgical intervention.

Dislocation of the polyethylene-rotating platform is a recognised complication of LCS knee arthroplasty.

We report ten cases of rotating platform dislocation out of 2151 primary total knee arthroplasties (0.5%) performed to date in our unit.

Of the ten cases (3 male: 7 female), six patients had a preoperative valgus deformity, two had a varus deformity and the remaining two patients were in neutral alignment, although the wear was predominantly within the lateral compartment. Two patients also had a previous patellectomy on the side of the platform spinout.

Of the ten cases, six patients were symptomatic as a result of their platform dislocation. The remaining four patients were asymptomatic and mobilising without any difficulty. In these patients, the dislocated platform was diagnosed on x-ray at outpatient review. Time to detection of the platform dislocation ranged from six days to two years.

Three patients required revision of their original insert to a larger, deeper dish insert. Three were managed by open reduction of the original insert. Of the remaining patients, one was managed successfully by closed reduction, one required an arthrodesis and one had the tibial insert cemented to the tibial tray. All patients at latest review have a functional and stable knee joint.

In conclusion, we feel that surgical error was to blame for the majority of our ten cases. Furthermore, we emphasise the importance of producing equal and balanced flexion and extension gaps at the time of knee arthroplasty in order to prevent mobile bearing dislocation. A novel technique for reducing a dislocated rotating platform is also described.