Malpositioning of the component of a total knee implant and malalignment of the leg is one of the significant factors for the outcome after Total Knee Arthroplasty.

Previous studies have shown that the use of a navigation system can improve these. This article presents the initial results of a prospective and non-randomised study describing navigated implantation in TKA with special reference to soft tissue balancing in knees with posttraumatic deformity. The secondary objective is to found out reproducibility of the software.

Methods: Since January 2004, 15 patients with post-traumatic arthrosis of the knee and axial malalignment of more than 15 degrees, pre operative arc of motion 75 degrees admitted to our senior author for TKA have been followed up prospectively. The data were collected over a period of 25 months. Apart from the usual clinical evaluations, no patients had CT of the leg prior to the operation & postoperatively. Intra-operative and peri-operative morbidity data were collected and blood loss measured.

Results: A postoperative leg axis between 3 degrees varus and 3 degrees valgus was obtained in all of the navigated knees after soft tissue balancing. The alignment of the components using computer-assisted surgery in regard to femoral varus/valgus, femoral rotation, tibial varus/valgus, tibial posterior slope, tibial rotation are reproducible and consistent. Computer-assisted surgery took longer with a mean increase of 31 minutes for kinematic data acquition. Intraoperatively we achieved range of motion more than 120 degrees. No patient required manipulation postoperatively for improving range of motion

Conclusion: These results support that the precise surgical reconstruction of the mechanical axis of the knee and proper alignment of the component is achievable in patients who suffered posttraumatic deformities and secondary arthrosis by using an intraoperative navigation system.

It has been mentioned in the literature that minor deviations in the insertion point of Intramedullary instrumentation during TKA may result in malalign-ment of several degrees [Nuno-Siebrecht 2000], which can be avoided with these soft ware.

To illustrate our clinical experience of using a complete biological method of fixation in ACL surgery and correlate the histology at the graft and the host bone interface performed in an animal experiment.

Materials: 18 male patients of mean age were 31.2 years (range 18 to 50 years) were operated on. The autogenous graft prepared from lateral part of the quadriceps aponeurosis, part of the patella and ligament leaving distal tibial attachment, passed through the trans-osseous tunnel so that bony part of the graft stay within the femoral tunnel, remaining part was sutured with the iliotibial tract.

Patients began immediate knee exercises with continous-passive-motion devices in the recovery room. With 100 degrees of knee motion, they allowed to bear full weight on the operatively treated limb with knee in a brace in extension

Results: 3 patients had superficial wound infection and 2 had haemarthrosis. None had any laxity or flexion contracture, mean flexion arc was135 (130–145) degree.

Conclusion: Histology of the bone graft and host tunnel confirms full incorporation of the graft in experimental animals performed by our senior author. The procedure of biologic fixation method in ACL reconstruction surgery to preserve the biological integrity of the patellar ligament distally in the tibial end may avoid early failure in fixation method. The biological integration producing a bone block in the femoral tunnel may enable clinician to start early rehabilitation program.

Inappropriate use of surgical dressing cause blisters around the surgical wound and increase the incidence of peri-operative wound infection and patients dissatisfaction which influence the outcome of the surgery. It is more so when patients are being treated as a day case procedure. We have not found any study correlating with patient’s satisfaction and surgical dressing.

Objective: To evaluate patient’s preference of surgical dressing and analyse which type of dressing is associated with significant morbidity

Design: Prospective, Non randomised, Clinical study.

Materials and Methods: Two different dressings Opsite post op or Mepore were applied by a single surgeon on 100 patients (50 each group) undergoing same arthroscopic procedure of the knee under general anesthetic were included in this study. They were followed up to 10 days. An independent nurse practitioner evaluated the complication related to the dressing and assessed the satisfaction with the 5 item short questionnaires at outpatients clinic.

Results: Blisters developed in 6% of patients with Mepore dressing (p=0.24) and none with Opsite Post op. 14% Patients with Mepore dressing developed superficial inflammation and this is significantly greater (p< 0.001) than opsite. 86% patients with opsite dressing on were able to take bath and thereby reduce the chance of contamination from the skin flora. 90% patients with opsite rated the dressing as excellent compared to mepore 26%, (p< 0.001)

Conclusion: Patients preferred Opsite post op as the dressing of their choice. It is not associated with dressing related morbidity, may improve better post operative wound healing. It may help to prevent superficial wound infection by contamination. After this study, we have changed our policy.

Early mobilisation following Anterior Cruciate Ligament(ACL) reconstruction surgery is indicated for optimum results for accelerated rehabilitation. However, the graft used in reconstruction is at it’s weakest during the early post-operative period and can be prone to slipping.

Aim: This study compared two types of graft, bone-patellar tendon-bone (BPTB) and soft tissue tendon, with the hypothesis that BPTB grafts would lead to less slippage under cyclical loading conditi ons.

Materials & Method: A comparative biomechanical study was carried out using sixteen proximal tibiae of calves, aged 20–26 weeks and carrying out ACL reconstruction, 8 constructs with human Cadaveric BPTB and another 8 with calves’ extensor tendons. An interference screw measured 9 x 25mm was used to fix graft tissue in the transosseous tunnel. The specimens were tested in material-testing machine using Merlin software.

The constructs were subjected to cyclical loading. A load cycle of 0-150-0N was applied at a crosshead speed of 100mm/min, approximately 80 load cycles per minute simulating the forces applied in post-operative mobilisation. The crosshead position was noted at peak load at 1, 100, 300, and 1000 cycles.

Results: The value of the graft slippage found in the soft tissue tendon model was 1.83 ± 0.54 and that of bone tissue (BPTB) model was 0.76 ±0.29. Creep value showed no statistical significance. There was significantly less slippage when using BPTB-to-bone fixation than with soft tissue tendon-to bone fixation (p< 0.005).

Clinical relevance: BPTB grafts are more likely to resist the return of anterior-posterior laxity in the immediate post-operative period, prior to graft fixation by tissue healing. BPTB grafts should be used when accelerated rehabilitation is required.

Introduction: Sliding screws has been described to use in hip fractures since 1950s. Failure of fixation varies from 16 – 23%. We aim to assess the effect of audit and re auditing the failure rate after introduction of the Tip apex distance concept since January 2000 to December 2004.

Methodology: We measured the tip apex distance in 161 (93 in the audit group and the rest re audit patients, 140 available for analysis. Their mean age at diagnosis 82.2 years [range 56.2–100.6 years] and male and female ratio was 1:6. Average time to Operation 1.7 days form the day of admission. The average Hospital Stay was 15.8 days

Result & discussion: We found that Patients had recorded Lag screw length 92.6mm [75–115], Side plate: 4 hole:6 hole = 4:1, Measured TAD 27.6 mm [6.3–66.4] in 140 patients,

The mean radiation time was 38.27 sec (7–71) and the dosage 0.68 Cgycm2 (0.93–2.06),

The mean Tip Apex Distance in the failed fixation group of 16 patients with cut out screw (13 in the audit group and 3 in the re audit group) is 43.05 [27.2–65.8]

Conclusion: We found the auditing and re auditing could potentially improve the surgical outcome. Although the Risk of cut out depends on many variable such as increasing age, Unstable fracture, poor reduction, high angle side plate 150deg, TAD is the stronger predictor than any other variable. This variable can be controlled by regular audit of the surgical practice.