Abstract

Abstract

Between 1989 and 1992 102 knees adjudged suitable for Unicompartmental replacement (UKR) were randomised to receive either a St Georg Sled UKR or a Kinematic modular total knee replacement (TKR). The early results demonstrated that the UKR group had less complications, and more rapid rehabilitation. At 5 years there were equal failures but the UKR group had more excellent results and a greater range of movement.

Despite this doubt persisted about whether these advantages would be maintained these cases have been followed regularly by a research nurse at 8, 10, 12 years. We now report the final outcome at 15 years. 43 patients (45 knees) have died with all their knees intact. Throughout the review period the Bristol Knee Scores (BKS) of the UKR group have been better and at 15 years 77% and 53% of the surviving UKRs and TKRs achieve an excellent score. 6 TKRs and 4 UKRs have failed during the 15 years of the review.

Infection in total knee replacement is a devastating complication. Current literature supports two-stage revision as the gold standard treatment. The alternative single stage procedure has been reported to have favourable results. We assessed the early clinical results of single stage revision for infected total knee replacement.

Between February 2005 and August 2007, 12 patients had revision total knee replacement for infection by the senior authors at two centres. In the majority of the patients, the infective organism was isolated by arthroscopic synovial biopsy prior to revision. Standard single stage procedure included the explantation, debridement and re-implantation of the prosthesis. All the patients received intravenous antibiotics for six weeks and oral antibiotics were continued for further 6 weeks. All the patients had the inflammatory markers monitored during follow-up.

Significant improvement was noted in the SF-12 PCS, WOMAC pain and stiffness scores at the latest follow-up. None of these patients required re-revision. Radiological evaluation was done using the Knee Society system. None of the knees showed evidence of progressive loosening. Radio-opaque lines were found around the stems and were present on immediate post-operative radiographs; this did not indicate loosening or infection at a mean follow-up of two years.

Early clinical and radiological results of the single stage revision for infected total knee replacement appear to be promising. One operation, one anaesthetic and quicker recovery are the advantages for the patient and with the reduced hospital stay it is cost-effective. The problems of stiffness in the knee and muscle wasting with cement spacer are avoided.

Introduction and Aims: To evaluate the clinical outcome of Titanium hemiarthroplasty in the management of hallux metatarsophalangeal joint arthritis.

Method: Fifty-five joints in 46 patients were treated surgically with Titanium implant for arthritic hallux meta-tarsophaelangeal joints. There were 35 women and 11 men. The pathological indications were hallux rigidus (74%), rheumatoid arthritis (10%) and degenerative changes associated with hallux valgus (16%). Six cases were done as a revision of sialastic to titanium prosthesis due to severe silicone synovitis.

Results: The mean age was 60 (range 43–76) years, and the mean follow-up was 56 (range 28–86) months. The mean time taken to get back to normal activities is 36.6 (range 21–90) days. The mean range of motion achieved was 32 (range 20–64) degrees and the relief of pain was excellent or good in 86% of the patients. There were no surgical complications in the form of infection, osteolysis or instability. The synovitis in the revision group has subsided.

Conclusions: The clinical results of Titanium hemiarthroplasty were good. The advantages of this procedure were preservation of joint movement and good pain relief.

Introduction: The incidence of younger people requiring arthroplasty is on the rise. Metal on metal Hybrid hip resurfacing arthroplasty is an exciting alternative to conventional arthroplasty, to Orthopaedic surgeons, in young active patients where preserving bone stock is important.

Materials and Methods: All patients with a hybrid Birmingham hip resurfacing arthroplasty (cemented femoral component and a hydroxyappitie coated press fit acetabulum) from 1997–2001, operated by the senior surgeon were followed up. They had annual AP and lateral x-rays, the pre and post op Harris hip scores were recorded and a patient satisfaction survey was done. Results: There were 36 patients, aver follow up 17.2 months, the aver age was 52.Except for 2 patients with femoral neck fractures which required revision there were no other significant complications. Both these patients had a notched femoral neck intraoperatively. There were no revisions for aseptic loosening .The average preop and post op Harris hip scores were 45.5 and 92.1 respectively. There were no radiological signs of loosening. 93% said they would recommend it to others, 93 % rated the surgery as being excellent to good and 96 % returned to normal or near normal level of activity as

Conclusions: We feel that Conservative Hip arthroplasty with resurfacing of the femoral head is an attractive concept particularly in younger patients.

The advantages are preservation of bone stock, non violation of the proximal femur, reduction of stress shielding in the proximal femur and it is quite physiological.

The one important thing is to avoid notching the neck to prevent disastrous fractures. The implant is less forgiving and the learning curve is steep. The ultimate usefulness can only be gauged once longer follow-ups are available.

Introduction: Distal humeral fractures represent a constant challenge to the most experienced surgeon. This is the first report of the use of an unlinked prosthesis for the treatment of distal humeral fractures in elderly persons.

Materials and Methods: From July 2000 to June 2001, 9 iBP elbow arthroplasties were performed in patients with acute fractures of the distal humerus. The average age of the group was 71 years. The mean interval between injury and TER was 11 days. The follow-up period averaged 12 months (range 5 to 16).

Results: Functional outcome was evaluated with patient-completed questionnaires. All patients had a flexion contracture of the elbow ranging from 15 to 30 degrees. All patients were able to perform daily activities, pain relief was satisfactory and patient satisfaction was high. All elbows met the criteria for functional motion and were stable at the latest follow-up examination. There were no major complications such as dislocation, ulnar nerve dysfunction or deep infection.

Conclusion: Unlinked non-congruous elbow arthroplasty when combined with a surgical exposure that allows proper soft tissue balance and instrumentation that enables correct positioning of the components can be a successful alternative in the management of acute distal humeral fractures in selected patients when conventional fixation is not a viable option.