The purpose of the current study was to compare mid-term outcomes of posterior cruciate retaining(CR) versus posterior cruciate substituting (PS)procedures, using the Genesis II total knee arthroplasty (TKA) system(Smith and Nephew, Memphis TN). Ninety nine CR and 93 PS TKA’s were analysed in this prospective, randomised, clinical trial. Surgeries were performed at seven medical centres by participating surgeons. Clinical outcomes (Knee Society Score, Range of Motion, WOMAC, SF 12 : and radiographic findings), in addition to postoperative complications, were evaluated with a minimum follow-up of five years. Following data analysis, there were no Significant differences in patient demographics or pre-operative clinical measures between the two groups. At the latest follow-up interval, no Significant differences were found between the CR and PS groups with regard to functional assessment, patient satisfaction or post-operative complications. However the PS group did display statistically Significant improvements in range of motion when compared with the CR group. The results of this investigation would suggest that while comparable in regards to supporting good clinical outcomes, the PS Genesis II design does appear to support significantly improved post-operative range of motion when compared with the CR design

Current evidence suggests that in Australia more than 80% of individuals are not receiving treatment for osteoporosis following an initial osteoporotic fracture. The earliest opportunity to identify many individuals with osteoporosis is following their first osteoporotic fracture, which is usually less severe than subsequent fractures. As these fractures are usually treated by orthopaedic surgeons it was decided to survey Australian orthopaedic surgeons to determine their understanding, attitudes and involvement in the management of osteoporosis.

Methods: The AOA in conjunction with the BJD distributed a questionnaire to 945 members. The results of 449 (48%) returned questionnaires were collated and sent to the Swedish National Competence Centre for Musculo-skeletal Disorders for analysis.

Results: Responding surgeons claimed to treat at least 24,000 osteoporotic fractures per year. Sixty per cent felt they had ‘none’ or ‘insufficient’ training in osteoporosis and considered they had ‘no’ or only ‘slight knowledge’ in managing the condition. Approximately 65% of surgeons either ‘never’ or only ‘sometimes’ initiated investigation or treatment of patients with osteoporotic fractures; only 11% ‘always’ or ‘very often’ initiated investigation or treatment. If an osteoporotic fracture is suspected most (70%) refer to a GP or osteoporosis specialist, with only 22% evaluating the condition themselves. Although 46% claimed that they referred patients for a BMD study always or most of the time, only 14% did so routinely. Fifty percent felt it was the GP’s responsibility to identify and initiate the evaluation of the underlying osteoporosis of patients with fragility fractures, compared with 29% who considered that this was the orthopaedic surgeon’s responsibility.

Eighty five per cent of the respondents do not prescribe any pharmacological treatment for osteoporosis management. Most commonly (36%) there was a preference for surgery rather than drug prescription. Twenty four percent had access to a specific osteoporosis team for treating osteoporosis. No experience with treating osteoporosis (23%) and no formal education in osteoporosis (16%) were other common reasons. Very few orthopaedic surgeons felt it was their responsibility to treat osteoporosis, however 52% were interested in attending a course on osteoporosis.

The findings are contrasted with those of an international study conducted by the Bone and Joint Decade and the International Osteoporosis Foundation, using the same questionnaire.

Conclusions: The evidence of under- treatment of osteoporosis after first fragility fractures, suggests that it may be necessary for orthopaedic surgeons to re-evaluate their approach to the management of osteoporosis, either by themselves or others. Further educational opportunities in this area should be considered.

Aims: To compare digital imaging sent via email versus conventional radiographs in diagnosing and managing ankle fractures. Methods: Radiographs on a viewing box were photographed using a digital camera with a resolution of 1024 x 768 pixels at 24-bit colour depth. The resultant images were compressed using the JPEG (Joint Photographic Experts Group) format at a medium compression ratio and transmitted as email attachments. The mean size of the resultant files was 165 kByte (range146–209). The study radiographs, including 66 radiographs (33 A-P and 33 Lateral), were viewed by seven orthopaedic surgeons and assessed according to the classification of ankle fracture and the surgeons’ choice of management for that fracture. Over a four month interval, each surgeon was independently shown each set of patients’ radiographs 4 times: twice via JPEG format on a computer screen and twice via a conventional light box. Results: Results were analysed using weight kappa scores, interclass correlation and variance, for interobserver and intraobserver error for both diagnostic classification and for management decision. These results were then used to determine if there was a difference between interpretation of radiographs presented in the two different formats. There were no significant difference in diagnostic accuracy or management decisions between conventional radiographs and telemedicine reading. Conclusions: JPEG compression is suitable for transmission of X-ray

Aim: To evaluate the repair of articular cartilage defects in the knee treated by autologous chondrocyte implantation (ACI), using arthroscopic assessment.

Method: One hundred and six articular cartilage defects in 79 knees of 77 patients were treated by ACI. The chondrocytes were injected beneath a periosteal flap (Brittberg et al, 1994).

Arthroscopy and removal of the metal implants were performed nine months following implantation. The ICRS score was used to assess the repairs.

Results: Of the 79 knees 43.5% of the lesions involved the patella, 35.2% the femoral condyles, 16.7% the trochlea, and 4.6% the tibial condyles. The average defect size was 254.65mm². It was found that 20% of knees had more than one defect. Associated biomechanical procedures were carried out in 88.7%.

Seventy lesions in 58 knees (56 patients) have been assessed; four eligible patients were not assessed arthroscopically. The ICRS scores (maximum 12) were: tibial condyle 11.5; patella 11.3; femoral condyle 11.0, and trochlea 10.7. Synovitis was markedly reduced in all knees with well-healed defects. Adhesions between the periosteal graft and the synovium caused a click in 11 patients, which was relieved by arthroscopic resection. Incomplete healing occurred in one patient with a wound dehiscence, in two following a fall in the post-operative period, and in one patient with a non-contained defect. Biopsies at arthroscopy showed predominantly hyaline cartilage.

Conclusions: We concluded that ACI was an effective method of repairing articular cartilage defects. In this series the results for the patella matched those for the femoral condyle, attributed to the simultaneous biomechanical correction of patellofemoral dysplasia. Stabilisation of the articular surface resulted in resolution of synovitis.

Method: One hundred and twenty-eight knees treated by carbon fibre resurfacing pads and rods for grades III and IV articular cartilage lesions were assessed arthroscopically, with an average follow-up of 22.6 months. The mean age was 37.4 years. Results were scored by an independent observer, using the ICRS scale (1–12) as grade I, normal; grade II, nearly normal; grade III, abnormal; grade IV, severely abnormal.

Results: The mean scores were: medial femoral condyle, 10.5; lateral femoral condyle, 9.76; trochlea, 9.9; patella 9.4. Grades I & II scores for rods were: medial femoral condyle, 95.1%; lateral femoral condyle, 76.0%; trochlea, 86.1%; patella, 89.7%. The pads were used in significant numbers only on the patella. Of the total, 76.7% of the repairs were for grades I and II changes.

Patellar resurfacing was combined with realignment and an ‘anteriorisation’ procedure in 77 knees. We found that 96.7 % of repairs for grades I & II disease were seen with rods on the patella, when combined with a mechanical correction, compared with 66.0%, when used on the patella without a realignment procedure. However, when the use of pads was combined with mechanical corrections the score was 76% and a lower proportion were grade I repairs (13%) than with rods (30.0%).

The mean Waddell Score (0–4) was 2.9. From the survey 81.8% regarded the procedure as worthwhile and 9.1% were doubtful.

Conclusions: We concluded that carbon fibre resurfacing was an effective method of treating articular cartilage defects. Rods were more effective than pads and are recommended as the universal method. The results were improved by the correction of abnormal biomechanical alignment. Stabilisation of the cartilage defects resolved synovitis.

It is now clear that vitamin K1 is part of a biochemical cycle that is essential for the conversion of specific bone peptides into a form that can bind calcium. We have used a recently described procedure for assaying vitamin K1 in plasma to test the involvement of this vitamin in fracture healing. Markedly depressed circulating levels were found in patients with fractures and the time taken for this level to return to normal appeared to be influenced by the severity of the fracture.