Background: Durable long-term independent results with the Low Contact Stress rotating-platform (mobile-bearing) and the Insall Burstein-II (fixed-bearing) total knee prostheses have been reported, but no studies describing either the mid-term or long-term results and comparing the two prostheses are available, to our knowledge.

Methods: Thirty-two patients who had bilateral arthritis of the knee with similar deformity and preoperative range of motion on both sides and who agreed to have one knee replaced with a mobile-bearing total knee design and the other with a fixed-bearing design were prospectively evaluated. Comparative analysis of both designs was done at a mean follow-up period of six years, minimizing patient, surgeon, and observer-related bias. Clinical and radiographic outcome, survival, and complication rates were compared.

Results: Patients with osteoarthritis had better function scores and range of motion compared with patients with rheumatoid arthritis. However, with the numbers available, no benefit of mobile-bearing over fixed-bearing designs could be demonstrated with respect to Knee Society scores, range of flexion, subject preference, or patellofemoral complication rates. Radiographs showed no difference in prosthetic alignment. Two knees with a mobile-bearing prosthesis required a reoperation: one had an early revision because of bearing dislocation and another required conversion to an arthrodesis to treat a deep infection.

Conclusions: We found no advantage of the mobile-bearing arthroplasty over the fixed-bearing arthroplasty with regard to the clinical results at mid-term follow-up. The risk of bearing subluxation and dislocation in knees with the mobile-bearing prosthesis is a cause for concern and may necessitate early revision.

Introduction: The occurrence of bony ankylosis in ankylosing spondylitis (AS) is not precisely known. Bony ankylosis, especially in stiff spine may present several exclusive challenges in its management. The current study is an endeavor to evaluate the clinical and the radiological results of cementless THA in patients with bony ankylosis of hip due to ankylosing spondylitis.

Materials and Methods: We retrospectively reviewed 54 patients (92 hips) who underwent cementless total hip arthroplasty for bony ankylosis in ankylosing spondylitis between September 1988 and 2002. Clinical assessment was done at follow-up, which envisages assessment of the pain, function, deformities and range of motion using the Harris Hip Score. Radiographic analysis was done. Kaplan-Meier survivorship analysis was done at 5 and 8.5 years using the revision for the removal of femoral component, acetabular component or both due to any cause as the end point

Results: The mean age of the patients was 25.5 years. The mean duration of follow up was 8.5 years. The average preoperative Harris Hip Score of 49.5 improved to 82.6 post operatively. Post operatively 10 hips had mild to moderate pain. Anterior dislocation occurred in four hips (4.3 %) and sciatic nerve palsy in one hip. Heterotopic ossification was seen in 12 patients, reankylosis rate was 0%. Thirteen arthroplasties were revised due to aseptic loosening. Kaplan-Meier survivorship analysis with revision as end point revealed 98.8% survival at 5 years and 85.8% survival at 8.5 years 11 follow up

Discussion: Cementless THA in osseous ankylosis in ankylosing spondylitis is a worthwhile surgical intervention in bony ankylosis. Newfound mobility, maneuverability and improved ability to sit comfortably were the outcomes, which alleviated the patients’ daunted morale. However, the technically demanding nature of the procedure should not be underestimated

Introduction: Spine fractures are common manifestation of osteoporosis. After an acute osteoporotic vertebral compression fracture pain persisting even after 3 months and clinical tenderness should raise the suspicion of pseudarthrosis. Pseudarthrosis is not a rare complication of a benign osteoporotic vertebral collapse occurs in about 10% of cases after an acute collapse. Treatment plan needs to be individualized. Cement augmentation procedures such as kyphoplasty and vertebroplasty can be performed in the absence of neurological deficit, whereas decompression and stabilization is necessary in presence of neurological deficit.

Study Design: Prospective cohort study

Methods: 31 patients who were diagnosed to have an acute osteoporotic vertebral compression fracture were managed conservatively. Pain persisting after 3 months and clinical tenderness in 5 patients prompted further investigation, revealing pseudarthrosis. None of them had neurological deficit. Imaging of two patients revealed vacuum sign with intravertebral cleft on plain radiographs and on MRI. All of them were at the Dor-solumbar junction and of crush typeof VCF.

Results: The incidence of pseudoarthrosis after an oste-porotic VCF was found to be 16.12%. One patient was treated with kyphoplasty, one with vertebroplasty with good pain relief and restoration of functional ability, and rest three are awaiting kyphoplasty.

Conclusion: High suspicion of pseudarthrosis is to be kept in mind as it is not an uncommon complication of benign osteoporotic collapse. Vertebral augmentation procedures such as kyphoplasty and vertebroplasty are promising procedures for treatment in absence of neurological deficit.

Chronic infection of bone with nonunion is traditionally treated by a 2-stage procedure involving initial debridement and antibiotic delivery and then definitive internal fixation. Alternatively, external fixators are used to provide stability. A technique with which single stage antibiotic cement-coated intramedullary nails are prepared in the operating room with the use of Kuntscher Nails and materials that generally are available is described herein. Although useful for all infected nonunions this technique is particularly useful for patients who are not ideal candidates for external fixation and for those who do not want to have an external fixator applied. We evaluated 10 cases treated with antibiotic cement-coated K nail with application of an additional unicortical plate in 7 cases. Autologous iliac crest bone grafting was done in all cases and additional bone substitutes used in 2 cases. 9 patients had stable union with complete control of infection. One patient had persistent infection at the time of last follow

Introduction: Factures of the acetabulum are the result of high-energy trauma. Long-term function of the hip joint is compromised in many cases as a result of imperfect reduction, chondral injuries to the acetabulum, femoral head lesion and post-traumatic avascular necrosis of the femoral head.Total hip arthroplasty is one of the treatment option for such patients who present with symptomatic post-traumatic arthritis or avascular necrosis with collapse of the femoral head following acetabular fractures

Materials and Methods: Twenty total hip arthroplasty were performed with use of a cementless cup in 17 patients and cemented cup in a cage in 3 patients for the treatment of posttraumatic osteoarthritis following acetabular fracture. The average age of the 4 women and 16 men was 49 (range, 26 to 86 years) at the time of the arthroplasty. The median interval between the time of injury and the total hip arthroplasty was 37 months (range, 8 to 144 months). The average operative time was 120 minutes and average intraoperative blood loss was 700 ml. Eight patients had previous open reduction and internal fixation of the acetabular fracture and twelve had been treated nonoperatively.Following total hip replacement,each patient was evaluated clinically and radiographically at six weeks, three months, six months and twelve months, and then yearly following total hip replacement. The average duration of clinical and radiographic follow-up was 40 months (range, 26 to 60 months).

Results: At the time of final follow-up, of twenty acetabular components, 10 had no evidence of periacetabular radiolucency, 7 components had a partial radiolucency that was < 1 mm wide,2 had a complete radiolucency < 1 mm wide and 1 component was surrounded by a complete radiolucency of > 2 mm in width without showing component migration. According to Engh’s criteria,16 (80%) femoral stems had bony ingrowth and 4 (20%) stems had stable fibrous ingrowth. The average preoperative Harris hip score improved from 35 points to 78 points at the time of final followup.

Conclusion: We conclude that total hip arthroplasty for degenerative arthritis following acetabular fractures,is a gratifying but often technically more difficult than a routine total hip arthroplasty because of extensive scarring, heterotopic bone, retained internal fixation devices, and residual deformity of the acetabulum.

Background: Joint replacements are being performed on ever younger patients at a time when average expectancy of life is continuing to rise. Any reduction in the strength and mass of periprosthetic bone could threaten the longevity of implant by predisposing to loosening and migration of prosthesis, periprosthetic fracture and problems in revision arthroplasty.

Aims & Objectives: This study aims to analyse and compare prospectively the femoral periprosthetic stress-shielding around 4/5th and 1/3rd porous coated cementless femoral stems in patients undergoing unilateral cementless total hip replacement done using DEXA scan by quantifying the changes in bone mineral density around femoral component.

Material & Method: Femoral periprosthetic bone mineral density was measured in the seven Gruen Zones with DEXA scan at 2 weeks, 1 years and 2 years after surgery in 60 patients who had undergone unilateral cementless total hip replacement, of which 30 patients had been implanted with 4/5th porous coated stems and other 30 patients with 1/3rd porous coated stems.

Results: At both one and two years postoperatively, bone loss due to stress-shielding was seen in both stems with maximum loss in zone VII and minimum in zone III, IV, V. The maximum mean percentage bone mineral density loss in 4/5th porous coated stems in zone VII was 16.03% at one year and 22.42% at 2 years as compared to loss of 10.07% and 16.01% in 1/3rd porous coated stems. Increased bone loss was seen in patients who had larger diameter stem (> 13.0 mm) and in patients with low bone mineral density in the unoperated hip.

Conclusion: Bone loss as a result of stress-shielding is more pronounced in 4/5th porous coated stems as compared to 1/3rd porous coated stems.

Introduction: There has been an introduction of short femoral stems with the aim of conserving bone. We present the short term results of short metaphyseal cement-less stem(Proxima^®, Depuy).

Material and methods: 25 patients in age group (25–40yrs), 15 males,10 females were implanted with a short metaphyseal cementless stem (Proxima^®, Depuy) and cementless acetabular cup. The average follow up was 2.3 years (1.4–2.5 yrs). Clinical evaluation using Harris Hip Score, Radiological evaluation and Bone Mineral Density were evaluated at 2weeks, 6 months, 12 months and yearly thereafter. a new zonal method suitable for short stem was used for radiological evaluation.

Results: The mean Harris Hip score improved from 44 to 95 at final follow up. There was no evidence of any radiolucent lines or osteolysis around the stems. All the stems showed evidence of osseointegration at one year follow up. There was no decrease in bone mineral density around the stems.

Discussion: The Short Metaphyseal cementless femoral stem is a bone conserving as well as bone preserving option for young patients especially in those in whom surface replacement is not an option.

Background: Joint replacements are being performed on ever younger patients at a time when average expectancy of life is continuing to rise. Any reduction in the strength and mass of periprosthetic bone could threaten the longevity of implant by predisposing to loosening and migration of prosthesis, periprosthetic fracture and problems in revision arthroplasty.

Aims & Objectives: This study aims to analyse the femoral periprosthetic stress-shielding following unilateral cementless total hip replacement using DEXA scan by quantifying the changes in bone mineral density around femoral component.

Materials and Methods: Femoral periprosthetic bone mineral density was measured in the seven Gruen Zones with DEXA scan at 2 weeks, 1 year and 2 year after surgery in 60 patients who had undergone unilateral cementless total hip replacement, of which 30 patients had been implanted with 4/5th porous coated CoCr stems and other 30 patients with 1/3rd porous coated titanium alloy stems.

Results: At both one and two years postoperatively, bone loss due to stress-shielding was seen in both stems with maximum loss in zone VII and minimum in zone III, IV, V. The maximum mean percentage bone mineral density loss in 4/5th porous coated CoCr stems in zone VII was 16.03% at one year and 22.42% at 2 years as compared to loss of 10.07% and 16.01% in 1/3rd porous coated Ti alloy stems. Increased bone loss was seen in patients who had larger diameter stem (> 13.0 mm) and in patients with low bone mineral density in the unoperated hip.

Conclusion: Bone loss as a result of stress-shielding is more pronounced in 4/5th porous coated CoCr stems as compared to 1/3rd porous coated titanium alloy stems.

Background: Joint replacements are being performed on ever younger patients at a time when average expectancy of life is continuing to rise. Any reduction in the strength and mass of periprosthetic bone could threaten the longevity of implant by predisposing to loosening and migration of prosthesis, periprosthetic fracture and problems in revision arthroplasty.

Aims & Objectives: This study aims to analyse the femoral periprosthetic stress-shielding following unilateral cementless total hip replacement using DEXA scan by quantifying the changes in bone mineral density around femoral component over a period of one year and identify the factors influencing the bone loss.

Material & Method: Femoral periprosthetic bone mineral density was measured in the seven Gruen Zones with DEXA scan at 2 weeks, 3 months and 1 year after surgery in 20 patients who had undergone unilateral cementless total hip replacement, of which 10 patients had been implanted with 4/5^th porous coated CoCr stems and other 10 patients with 1/3^rd porous coated titanium alloy stems.

Results: At both 3 months and one year postoperatively, bone loss due to stress-shielding was seen in both stems with maximum loss in zone VII and minimum in zone III, IV, V. The maximum mean percentage bone mineral density loss in 4/5^th porous coated CoCr stems in zone VII was 16.03% at 3 month and 22.42% at 1 year as compared to loss of 10.07% and 16.01% in 1/3^rd porous coated Ti alloy stems. Increased bone loss was seen in patients who had larger diameter stem (> 13.0 mm) and in patients with low bone mineral density in the unoperated hip.

Conclusion: Bone loss as a result of stress-shielding is more pronounced in 4/5^th porous coated CoCr stems as compared to 1/3^rd porous coated titanium alloy stems.

We compared the safety and outcome of one-stage bilateral total hip arthroplasty with those of a two-stage procedure during different admissions in a prospective, randomised controlled trial in an Asian population. Of 168 patients included in the study, 83 had a single- and 85 a two-stage procedure. Most of the patients (59.9%) suffered from inflammatory arthritis.

The intra-operative complications, early systemic complications, the operating time, positioning of the components, the functional score, restoration of limb length and survival rates at 96 months were similar in the two groups. The total estimated blood loss was significantly lower in patients undergoing a one-stage procedure than in patients who had a two-stage procedure, but the transfusion requirements were significantly higher in the former group (p = 0.001). The hospital stay was significantly shorter in the one-stage group, 7.25 days (sd 1.30; 5 to 20) compared with 10 days (sd 1.65; 8 to 24) in the two-stage group (p = 0.023). We believe that a one-stage procedure is safe and appropriate in our population.

We present seven patients with recurrent haemarthroses after total knee arthroplasty, caused by an inherent platelet function defect. These patients developed painful knee swelling, persistent bleeding and/or wound breakdown, a platelet factor 3 availability defect being identified in all cases. Surgical exploration, with joint debridement, lavage and synovectomy, was performed in four patients who did not improve with conservative therapy. Histopathological examination of synovium revealed a focal synovial reaction with histiocytic infiltration, and occasional foreign-body giant cells. One patient required an early revision because of aseptic loosening of their tibial component. The condition was treated by single-donor platelet transfusions with good results. The diagnosis, management, and relevance of this disorder are discussed.

Giant-cell tumour of the tendon sheath, also called pigmented villonodular synovitis, is a benign tumour with a high incidence of recurrence. We have tried to identify risk factors for recurrence. Of the 48 patients included in the study, 14 received radiotherapy after surgery. Only two (4%) had a recurrence. This compares favourably with previously reported incidences of between 25% and 45%.

We have reviewed 26 patients treated by trapezius transfer for deltoid paralysis due to brachial plexus injury or old poliomyelitis. We assessed the power of shoulder abduction and the tendency for subluxation. There were good results in 16 patients (60%); five were fair and five poor.

Trapezius transfer appears to give reasonable results in the salvage of abductor paralysis of the shoulder.