Cite this article: Bone Joint Res 2022;11(8):514–517.

Introduction: The aim of this study was to determine the outcome of Tomofix plate fixation, in joint retaining surgery, for Medial compartment Osteoarthritis of the knee in young patients

Methods: We report on 33 patients (36 knees) who underwent High tibial osteotomy for unicompartmental osteoarthritis of the knee. The mean age was 39.5 (30–49). There were 20 males and 13 female. All the patients had Medial opening-wedge type Osteotomy using the Tomofix device. The mean duration of follow-up was 48 months (44–60 months). The patients were assessed on the basis of pre and post-operative oxford knee score, knee range of motion, radiological evidence of healing of the osteotomy site and alignment of the knee.

Results: There were no nonunions at the osteotomy site and the medial open-wedge filled-in without any need for bone graft or its substitutes. The mean preoperative oxford knee score was 48 (S.D 4.7 Range 38–54). This improved to a mean score of 22 (S.D 5.9 Range 17–31) after 1 year follow-up. The improvement was significant (pvalue= 0.07). The preoperative average knee flexion was 103.1 (S.D 25.2 Range 10–125) which improved after 1 year follow up to 112 (S.D 15.9 Range 0–140). The mean preoperative Femorotibial angle was 10 degrees varus (range 9–15). The mean postoperative Femorotibial angle was 8 deg valgus (range 6–12). Radiologically, there was no loss of correction during our follow-up. One patient had post-operative DVT.

Conclusion: Our study shows that Tomofix plate fixation in High Tibial osteotomy gives immediate stability, good deformity correction and allows early rehabilitation. The osteotomy gap does not require bone grafting and the correction is maintained. The Short term functional results are encouraging. Longer-term follow-up is however needed to establish its effectiveness in deferring joint replacement surgery in young patients.

AIM: Operative treatment is the choice of management for unstable sub-trochanteric fractures because it allows early mobilisation thus preventing serious and fatal complications. This study was conducted to compare the results, advantages and disadvantages of using dynamic condylar screw and interlocking nail for treatment of subtrochanteric fractures.

METHOD: A prospective randomised controlled study was carried in our centre. The study included 64 patients presenting to our Trauma and Orthopaedic unit between July 2000 to November 2003. The criterias for inclusion were an age of less than 70 years, a non-pathalogical sub-trochtanteric fracture less than 4 weeks with no previous history of surgery and a femoral anatomy that allowed osteosynthesis with intramedullary nail or a dynamic condylar screw. The patients were randomly divided in 2 groups which was accomplished with use of computer generated random numbers. The group1 treated with DCS and group 2 was treated with interlocking nail. Both groups were comparable with regard to age, gender, body mass index, medical history according to index of Fitts et al and system of American Society of Aneasthesiologists, mental status and mobility score. The pre-injury functional status of the patients was recorded using Sikor-ski and Barrington pain and mobility scale and parker and palmer mobility score. The estimated intraoperative blood loss, operative time and intraoperative complications were recorded. Follow-up was done at 4th, 12th and 24th week and then 1 year. Patients were assessed for range of hip movements, muscle strength while functional recovery was assessed with Sikorski and Barrington pain and mobility scale. The radiograph at 1 year was used to assess the neck shaft angle.

RESULTS: The mean age of the patients was 49 (range 30–65). There were 38 males and 26 females. The intra-operative blood loss, average hospital stay and operative time was more in case of patients undergoing DCS fixation(p< 0.05). The time fracture union and full weight bearing mobilisation was better in patients who had intra-medullary fixation.1 patient in group1 had screw cut out from femoral shaft, this was treated by change of side plate to longer one with bone graft augmentation.1 patient in group 2 had non-union which was treated by removal of interlocking nail and refixation of fracture with DCS along with bone graft. There was no infection, DVT or mal-union in any group.1 pateint from each group was lost to follow-up. All other patients were evaluated with Sikorski and Barrington’s pain and mobility score. The difference was not significant between the goups(p< 0.05).

CONCLUSION: The results of our study support the use of interlocking nail especially in communited fractures of subtrochanteric region.

Aim: PFC Sigma total knee was introduced in 1997 incorporating a number of design changes. We report our medium-term results of a consecutive series of PFC sigma knees performed between Nov 1997 and Dec 1998.

Method: Between November 1997 and December 1998 a consecutive series of 166 TKAs (156 patients)were carried out using the PFC Sigma total knee replacement system at Wrightington Hospital. Out of the 156 patients 9 were lost to follow-up. This left 147 patients (156 knees) with a mean follow-up of 90 months (range 84 – 96 months). 137 patients (88%) had primary osteoarthritis, 14(9%) had R.A and 5(3%) had post-traumatic arthritis. The mean age was 70 yrs (53 – 88 yrs).85 were female and 62 male. All patients were followed at 3 months, 6 months,1 year and then yearly. Clinical evaluation was done by American Knee Society and Oxford knee scores. Knee society score was used to assess the postoperative radiographs.

Results: The mean Knee society score improved from the preoperative mean of 45 (range 30 – 65) to postoperative mean of 84 points(range 45 – 92). The mean preoperative functional score was 38(range 25 –5) and mean postoperative functional score was 73 points(range 50–95). According to the final scoring 90 % of the knees were rated excellent, 4% good, 4 % fair and 2 % poor. The mean preoperative Oxford knee score was 43 (range 33–52) and mean postoperative score was 17 (14–29). Range of motion improved from a mean of 90(range 50–125) to 105(range 65–130). There was no significant difference (p = 0.03) in the American Knee Society score and Oxford knee score when comparing patients with and without resurfacing of the patella and PCL-retaining with PCL-substituting implants.1 knee (0.6%) was revised within 18 months due to aseptic loosening.1 knee(0.6%) had superficial wound infection which cleared with oral antibiotics.2 patients(2 knees) developed deep infection out of which one resolved following early debridement, the other developed chronic infection requiring long term suppressive antibiotics. 3 patients had proven below knee deep venous thrombosis; one of them developed a non-fatal pulmonary embolism. Radiological review using radiological knee society scoring showed radiolucent lines under 35 % of the tibial components(56 knees)and 11 % of Femoral components(18 knees). For survivorship analysis, the actuarial life- table method was used with calculation of the numbers at risk and the survival rates at annual intervals. The 95% confidence limits were calculated by the method of Rothman. The survivorship at the end of eight year follow-up was 99.40. None of the patellar components failed.

Conclusion: Our study shows excellent clinical results of PFC Sigma Total knee replacement after almost eight years follow-up. We plan to continue monitoring this cohort of patients for long-term results.

We evaluated thirty six patients who underwent revision total hip arthroplasty for Vancouver type B periprosthetic femoral fractures. The implant used was a modular proximal femoral replacement stem cemented distally. All the patients were treated at Wrightington Hospital and included 15 males and 21 females. The primary diagnosis was OA in 28, RA in 2, AVN following femoral neck fractures in 3 and hip dysplasia in 3. The average age of patients was 75 years.

The fractures and bone loss were classified according to the Vancouver classification and included 23 B2 and 13 B2 fractures. The mechanism of injury was minor fall in 24 patients, spontaneous in 8 and intraoperative injury in 4.

Using a trans-trochanteric approach the existing prosthesis was removed and a long stem modular femoral stem was inserted bypassing the area of proximal femoral fracture/bone loss. Patients were typically mobilised within the first post-operative week. The patients were clinically and radiologically followed up at regular intervals. Fracture healing with significant improvement in bone stock was noted in 17 patients under 6 months, 13 patients at 12 months and 6 patients at 18 months.

Our series show that use of distally cemented long stem proximal femoral replacement prosthesis allows restoration of proximal bone stock and fracture healing in patients where conventional prostheses cannot be used because of massive bone loss in the proximal femur. This special modular prosthesis bypasses the area of bone loss/periprosthetic fracture, thus avoiding the need for bone allograft or other major reconstructive surgery in elderly patients.