Between 1975 and 2OO1, Five Hundred unicompartmental kne arthroplasties (UKA) were performed by a surgeon (M.R.C.) In more than 6O% of the cases it was an internal UKA for knee degenerative arthritis. Axis deformity was noted in 43,2% of the cases, with a genu varum in 33,6% of the cases. Isolated necrosis of the medial femoral condyle was noted in 6 cases (1,2%) and 13 cases (2,6%) showed with sequellae of a trauma. A Single procedure was performed in 425 knees. Bilateral arthroplasty was done in in 15% of the cases. Epidemiology of the series shows that the left knee was operated in 46.6% and right one in 53.4% of the cases. The Average age was 7O.6 for male and 71.8 for the female patients. 7O.4% of the patients were Female and 29.6% were Male. Several types of implants were used: The Marmor knee in 295 cases, the Miller-Galante (75 cases), Cartier (75 cases) Oxford III (5O cases), but also the Mansat and PCA prosthesis.

Methods and Results: Retrospective study with patients assessed in 2 separate series in 2OOO and 2OO6. Analysis of the results was performed using the Lequesne score, the Mansat protocole and the Hungerford functional score for the most recent cases. The results were excellent and good in 87% of the cases. Walking improoved in over 9O% of the cases. No primary or late infection was noted in this series and no severe post-operative complications. Prosthesis removal and change was performed in 9% of the cases, mainly for loosening or for polyethylene degradation.

Discussion and Conclusions: This study confirms the good results with the UKA and allows to understand the reasons for failure, to notify the differences between Lateral and Medial UKA

The correct indication should take in account the persistance of the ACL and of a mild knee deviation in the frontal axis.

The purpose of this study is the assessment of the shoulder function after a proximal humeral nail insertion for trauma, using a minimal invasive approach.

Material and methods: 22 patients had osteosynthesis for proximal humeral fractures using the Telegraph Nail. 15 patients underwent percutaneous osteosynthesis. The indication for the percutaneous procedure was determined at the per-operative control under fluoroscopy when the fracture was reducible by external manoeuvres. 12 of the fractures involved the surgical neck and 3 fractures were three-part fractures of the proximal humerus. The proximal interlocking was made using two screws in all the cases. The distal static interlocking was made with a single screw in all the cases.

All the patients followed a standardised rehabilitation protocol including early mobilisation and passive and active assisted muscular activity. The shoulder function was assessed using the Simple Shoulder Test (SST) and the Constant score. The mobility was assessed using the flexibility ratio described by Harryman as compared to the opposite healthy arm. The patients were assessed at 6, 12, 26 and 52 weeks after surgery.

Results: All the fractures showed consolidation within 6 weeks. Two fractures united with internal rotation and presented at controls with limited external rotation. Stable results were obtained at an average of 3 months. Return to previous activities was possible between 8 and 10 weeks after surgery in all the cases excepting two. In one case subacromial conflict between the nail and the rotator cuff was due to malpositioning of the proximal part of the nail and of the screws and required early removal and cuff repair. Average forward elevation was 12O25. Average external rotation was 4515. The SST score reached an average of 8.2/12 within 6 months and practically was unchanged at 12 months for all the series. The pondered Constant score was 76.7/1OO at six months. All the patients were improved after surgery.

Conclusion and discussion: The percutaneous insertion of a proximal humeral nail for shoulder fractures is a minimally invasive alternative to heavy open surgery. The results are acceptable for the patients and stable in time. The advantage of minimal bleeding and short hospital stay recommend this technique in all the cases when reduction is possible without opening, as showed by the fluoroscopy.

Purpose: The purpose of this study was to define the normal shoulder in patients over 75 years of age and to search for correlations between shoulder function, mental status, and general health.

Material and methods: One hundred eighty subjects aged 75 years or older with no history of surgery involving the shoulder or neighbouring regions (breast, axillary area, elbow) were included in the study. We noted shoulder motion (flexibility ratio), rotator cuff force (Mayo scale) and searched for abnormal movements. The Quetelet body mass index (BMI) was also noted. Patients responded to a self-administered questionnaire, the Simple Shoulder Test, on shoulder function, and the Constant score was determined for each shoulder. Beck test was used to search for geriatric depression. A standard x-ray series and ultrasound exploration were performed if joint function was abnormal.

Results: Only 44% of the shoulders were entirely disease-free. Clinically silent lesions (cuff tears, osteoarthritis, stiffness) were identified in 56% of the subjects but had no impact on daily life activities. The dominant shoulder presented 56.4% of the cuff tears; 13.9% of the subjects had bilateral degenerative joint disease and 23.3% bilateral stiffness. Associated conditions were numerous: cardiovascular (33%), pulmonary (28%), gastrointestinal (25.6%), diabetes (12.2%), neoplasia (10.6%). 18.3 % of the patients had signs of depression and 14.4% were treated for depression. Shoulder motion and force varied with the BMI and nutritional status. Thin patients (BMI < 20) had more rotator cuff tears. Heavy patients (BMI > 29.9) had more osteoarthritis and stiffness. 76.8% of the subjects were satisfied with their shoulder function. Demand for care and examination was greater in depressive patients.

Discussion: In very old subjects, shoulder function is compatible with the demands of daily life activities. Shoulder function is correlated with general health status, the BMI, and the mental status. Shoulders should be prudently evaluated in the elderly because function, even when altered, is often compatible with moderate stiffness, osteoarthritis, and cuff tears which do not necessarily require treatment.