Objective

To compare clinical parameters associated with medial parapatellar and midvastus approaches for total knee arthroplasty in the early post-operative period.

Introduction: The commonest surgical approach for total knee arthroplasty is medial parapatellar approach. This involves splitting the quadriceps tendon, potentially destabilising the extensor mechanism. The midvastus approach involves splitting the vastus medialis muscle instead of entering the quadriceps tendon, therefore, minimising interruption of the extensor mechanism without compromising the exposure of the knee.

Objective: To compare clinical parameters associated with medial parapatellar and midvastus approaches for total knee arthroplasty in the early postoperative period.

Methods: and Results: We present a prospective observational study of 77 patients undergoing primary total knee arthroplasty using medial parapatellar or midvastus approach (37 midvastus approach, 40 medial parapatellar approach). Ethical approval was obtained for the study. The prosthetic design and physical intervention was standardised in all the patients. The Oxford Knee Score, pain scale, knee flexion, unassisted straight leg raise, standing and walking were compared at 3rd, 5th and 7th day postoperatively, then at 6 weeks and at 3 months. The patients and physiotherapist were blinded to the type of approach used. The average age was 67 years (range 42 to 88). There were 49 women and 39 men. The average hospital stay was 7 days (range 2 to 15). There was statistically significant difference in duration of hospital stay, unassisted straight leg raise and standing at 3 days (p=0.001) all in favour of midvastus approach. There was no statistically significant difference in Oxford Knee Scores, pain scale and range of motion. The average duration to achieving straight leg raise for the midvastus group was 5 days and for the medial parapatellar approach group was 8 days

Conclusion: The study shows that total knee arthroplasty performed through the midvastus approach resulted in less postoperative pain, earlier unassisted straight leg raise and ambulation, therefore, shorter hospital stay as compared to medial parapatellar approach. This may be of benefit to the patients due to less discomfort after surgery and to the healthcare system due to shorter hospital stay for patients.

Introduction: The surgical management of proximal humeral fractures continues to be an unsolved problem for the orthopaedic surgeon. Disagreement remains over how best to fix the more challenging complex fractures in younger patients where the ultimate goals of treatment are restoration of a painless shoulder, adequate function, and preservation of humeral head viability.

The PHILOS plate attempts to improve on previously designed implants by preserving the biological integrity of the humeral head articular fragment. The minimally invasive technique minimises soft tissue damage whilst at the same time securing the reduction using multiple locking screws with angular stability, thus allowing early mobilisation.

Methods: Retrospective review of the notes and x-ray images of 54 fractures treated with the PHILOS plate between Jan 2000 and Aug 2005. Data including baseline demographics, the presence of any complications and the need for reoperation were collected. In addition 43 (81%) patients were contacted and Oxford (OSS) and Disabilities of the Arm, Shoulder and Hand (DASH) scores were calculated to assess functional recovery. All patients were contacted at a minimum of 6 months following fixation with an average follow up of 18 months (Range 6–41 months)

We also present a cost analysis relating to the use of the PHILOS plate in practice.

Results: 54 fractures in 53 patients (25F:28M). Average age 54.4. There were 26 2-part, 15 3-part and 13 4-part fractures. A total of 11 (20%) patients had complications of which 7 (13%) required reoperation. These complications included deep infection (3 cases), AVN (4), Non Union (3) and plate impingement (1).

Mean OSS and DASH at follow up were 24.8 (S.D 11.6) and 28.0 (S.D 26.9) respectively. Worse scores were seen in those patients who had complications (OSS 39.4 Vs 22.6, DASH 58.2 Vs 23.4) although this difference was not statistically significant. There was also a trend for poorer scores with increasing fracture complexity and better scores in those patients operated upon by surgeons with a specific interest in the upper limb and in patients whose surgeon had performed more than 5 fixations.

Conclusion: Our series reports a much higher complication rate (20%) than that previously published. Whilst those patients who do not suffer complications reported good functional outcomes the presence of postoperative complications was associated with poorer results. Outcomes following surgery were affected by patient, implant and surgeon related factors. Given the high rate of serious complications and their detrimental affect on outcome surgeons should give serious consideration to the appropriateness of using such implants. To clarify these issues, further prospective randomised trials are needed.

Introduction: The commonest surgical approach for total knee arthroplasty is medial parapatellar approach. This involves splitting the quadriceps tendon, potentially destabilising the extensor mechanism. The midvastus approach involves splitting the vastus medialis muscle instead of entering the quadriceps tendon, therefore, minimising interruption of the extensor mechanism without compromising the exposure of the knee.

Objective: To compare clinical parameters associated with medial parapatellar and midvastus approaches for total knee arthroplasty in the early postoperative period.

Methods and results: We present a prospective observational study of 88 patients undergoing primary total knee arthroplasty using medial parapatellar or midvastus approach (44 in each group). The prosthetic design and physical intervention was standardised in all the patents. The Oxford Knee Score, pain scale, knee flexion, unassisted straight leg raise, standing and walking were compared at 3^rd, 5th and 7^th day postoperatively, then at 6 weeks and at 3 months. The patients and physiotherapist were blinded to the type of approach used. The average age was 67 years (range 42 to 88). There were 49 women and 39 men. The average hospital stay was 7 days (range 2 to 15). There was statistically significant difference in duration of hospital stay, unassisted straight leg raise and standing at 3 days (p=0.001) and pain scale at 5 days, all in favour of midvastus approach. There was no statistically significant difference in Oxford Knee Scores and duration to achieving full flexion and walking. The average duration to achieving straight leg raise for the midvastus group was 5 days and for the medial parapatellar approach group was 8 days

Conclusion: The study shows that total knee arthroplasty performed through the midvastus approach resulted in less postoperative pain, earlier unassisted straight leg raise and ambulation, therefore, shorter hospital stay as compared to medial parapatellar approach. This may be of benefit to the patients due to less discomfort after surgery, and to the healthcare system due to shorter hospital stay for patients.