Purpose: The increasing number of ACL reconstructions has led to the introduction of new techniques irrespective of the fact optimal tunnel angle placement has yet to be established. Improper tunnel angle placement is associated with a variety of complications including graft failure. The purpose of this retrospective study was to compare the reliability of tibial tunnel angles produced by two experienced surgeons using a free hand method or mechanical guide (HowellTM 65° Tibial Guide).

Method: Tibial tunnel angles in the coronal and sagittal planes were determined from anteroposterior and lateral radiographs, respectively, taken at 2 to 6 months postoperatively. Fifty-two sets of digital radiographs were analyzed (free hand = 28, mechanical = 24) with the knee in full extension 100 cm from the beam source. Tunnel angle measurements were calculated using NIH ImageJ software. Each angle was measured by two investigators on three separate occasions with minimum 7 days between each analysis.

Results: There was a significant difference (p< 0.05) in tibial tunnel angle placement between the mechanical guide (64.76 ± 5.88) and free hand (61.11 ± 5.04) group in the coronal plane. No significant difference in tibial tunnel placement in the sagittal plane was detected (mechanical guide =73.63 ± 7.69, free hand = 73.51 ± 6.68). Intra-rater and Inter-rater reliability for measurements in the sagittal (ICC = 0.809; 0.733) and coronal (ICC = 0.69; 0.812) plane ranged from high (> 0.75) to moderate (0.75–0.40), respectively.

Conclusion: Tibial tunnel angles in the coronal plane produced with a mechanical guide are more accurate than those drilled free hand when the intended angle of placement is 65°. The method used to measure tibial angles in this study was reliable within and between investigators. Further research will be conducted to investigate the correlation between tunnel angle placement and patient outcome measures.

Introduction: The Trent arthroplasty register reported that results of Hip arthroplasty in general setup were less than that reported from specialist centres by 5%. This independent prospective study tests the hypothesis that results of Birmingham Hip Resurfacing arthroplasty from specialist centres would not accurately represent the outcome of hip resurfacing when performed in general setup.

Material and Methods: All patients were prospectively followed for at least five years at Oswestry Hip outcome centre. The surgeons carrying out the operation prospectively provided surgical details and thereafter patients were followed using Oswestry hip questionnaire (OSHIP) at fixed intervals. Survival was assessed by Kaplan-Meier method. The results were compared to the published results of BHR from specialist centers

Results: There were 679 patients, and 58 surgeons in the study. Mean age at operation was 51 years and mean follow up was 5.63 years. The predominant preoperative diagnosis was osteoarthritis. The mean OSHIP score was 89.5. There were 29 (4.2%) failures mostly due to fracture neck of femur (62%); all of them were revised to conventional THR. The Kaplan-Meier survival at seven years is 95.354%.

Discussion: Compared to the published results, there were 2 to 19 times high failure rate which is significantly higher (p=0.001) than the published studies. Hence we prove our hypothesis, as the results of BHR from specialist centres do not accurately reflect on the outcome in general setup. The discrepancy in the results that we have identified would help to identify the weak areas in the general setup, where most of the patients get benefited from BHR arthroplasty.

1. A case of cryptococcosis (torulosis) of bone is described.

2. The diagnosis was established by microscopical examination of pus and culture of the organism.

3. The literature is briefly reviewed.