Introduction

The Direct Anterior Approach (DAA) offers potential advantages of quicker rehabilitation compared to posterior approach THR. The aim of this study was to compare hospital based and early clinical outcomes between these two groups with utilisation of Enhanced Recovery After Surgery (ERAS) protocol.

Aim: Long term results of the Stanley& Winson procedure on the elbow.

Material: 15 patients in the last 10 years. 2 lost to follow-up and 13 were evaluated with Andrews and Carson scoring system. The mean time for follow-up was 2.3 years. Primary OA in 8, post-traumatic arthritis in 4 and rheumatoid arthritis in 1 patient was responsible for the symptoms.

Results: Before operation, the mean pain score was 9.23 (range 5–20) out of 60 on the Andrew Carson rating scale. Postoperatively this score increased to 18 (range 10–25) i.e. 50% beneþt of pain.

Changes in ROM of Elbow: All patients returned towork in mean of 6.5 weeks (range 4–24). Postoperatively 2 patients developed haemarthrosis, which was aspirated. Conclusion: O-K procedure has good to excellent results, it is technically simple, has low morbidity and avoids extensive release for stiff elbows.

Aim: The purpose of this study was to determine the long-term results of tibial tubercle osteotomy in a series of revision and difþcult primary total knee replacements. Method: A consecutive series of total knee replacements in which tibial tubercle osteotomy was performed were reviewed retrospectively. 18 revision knees and 5 primary knee replacements were identiþed. All of the operations performed were by the senior author. The technique was the same in all cases, involving 9cm osteotomy with screw þxation. In cases with marked restricted ßexion and patella baja, the tubercle was deliberately moved proximally to gain length in the extensor mechanism. In 3 revisions the index component had a porous in-growth stem. The osteotomy facilitated explantation. Results: All osteotomies had united by 8–12 weeks. Range of movement increased on average 45û in the revisions, and by 60û in the primaries. An active extensor lag in 4 cases (all deliberate proximalisations) post operatively which all recovered.5 patients underwent MUA for stiffness at 12 weeks. Conclusion: Tibial tubercle osteotomy allows predictable extensile exposure in primary and revision total knee replacement. It also allows lengthening of a contracted extensor mechanism. Union rate was excellent and complications low. It allows preservation of the quadriceps mechanism and a normal postoperative rehabilitation.