Introduction: The variability of clinical results and the complexity and cost of total knee replacement (TKR) require efficacy assessments and the determination of prognostic factors with the aim of optimizing this procedure.

Purpose:

Study of the evolution at 36 months of health-related quality of life (HRQofL) in patients with significant knee arthritis that undergo TKR and

Materials and methods: This is a three-year prospective study. HRQofL was assessed by means of a specific WOMAC questionnaire. An assessment was made of the following: sociodemographic characteristics of the population, their knee arthritis, intraoperative parameters, complexity of the operation and immediate and late postoperative complications. The statistical study was performed using linear regression models. During the preoperative period 90 patients were included.

Results: On assessment at 3 years we were able to assess 67 patients (54 were women); mean age: 74.83, SD 5.57. Pre-postoperative evolution determined by the specific HRQofL questionnaire shows significant differences in improvement at 3 years. Non-knee-arthritis related pain has been associated with worse results in the different WOMAC dimensions (pain, stiffness and function). Morbid obesity (IMC & #8805;38) was significantly associated with severe pain.

Conclusions: In patients with severe gonarthrosis that undergo TKR, HRQofL has improved when assessment is performed 3 years later. No significant differences are found between intra and postoperative variables in the evolution of HRQofL. The presence of non-gonarthrosis related chronic pain and morbid obesity are negative factors in postoperative WOMAC assessment.

Aims: The study we present compares quantitatively the bone regeneration in experimental animals obtained with autologus and homologus grafts against a calcium phosphate cement. Methods: We performed cavitary defects o 6 mm of diameter in the metaphiseal region of the distal femur of 48 rabbits of albine race. They were divided in 4 groups, and received respectively autologous grafts, homologous freezed graft, calcium phosphate cement or the absence of any implant (control group). Results: The results are valued by radiological, histological and histomorphometrical studies (with digitalysed images). Histological study shows a correct integration of the calcium phosphate cement, without þbrous interphase, and a bone regeneration which is progressive and centripetal. Statistical analysis of the histomorphometrical data shows that bone regeneration obtained with the calcium phosphate cement its similar to the one obtained with the grafts. Conclusions: Calcium phosphate cement is a biocompatible material, biodegradable and conductor.

Introduction and Objectives: Periprosthetic fractures present some difficult problems: the inability to use intramedullary implants, difficulty in inserting screws (since the cavity is occupied), bone fragility, great mechanical demands, elderly patients, and associated conditions. We have used two osteosynthesis reinforcement techniques in these cases: massive intramedullary cementation and implantation of bone allograph counterplates. Both techniques give a simple solution for complex peri-prosthetic fractures.

Materials and Methods: We used this technique to treat 9 periprosthetic fractures of the femur between 1999 and 2003. In 3 cases, massive intramedullary cementation was used (Johansson type III, distal to the prosthetic stem) and in 6 cases a bone allograft counterplate (Johansson type II, around the prosthesis), associated with the stem replacement in 2 cases. Allografts came from the Tissue Bank of the Institut Clinic de l’Aparell Locomotor (ICAL). There were 7 females and 2 males, with an average age of 76 years (range: 66–83). Average follow-up time was 14 months (range: 6 months to 3.5 years).

Results: In 8 of 9 cases (89%), fracture consolidation was achieved in 3.5 months, with patients regaining the same ability to walk as before the injury. In one case with intramedullary cementation, non-union developed with breakage of the plate at 10 months post-intervention. This case was treated with compression osteosynthesis with a new plate and bone allograft counterplate, and final outcome was satisfactory (consolidation at 4 months) with the patient walking with full weight bearing without crutches.

Discussion and Conclusions: We believe both techniques are useful in the resolution of periprosthetic fractures of the femur over porous bone. However, a very precise surgical technique is necessary, as well as respect for the classical principles of osteosynthesis: fracture fixation with anatomic reduction, interfragmentary compression, and maximum care afforded soft tissue.