Background. Jumper's knee is the result of violent and repeated contractions of quadriceps muscle caused by rapid acceleration and deceleration, jumping and kicking that load on patellar tendon stressing its mechanical resistance. The porpose of this retrospective study is to analyze the results, after the debridment of the patellar tendon and the patellar apex abrasion performed by arthroscopy, at a mean follow-up of seven years. Methods. From 1996 to 2006, sixty-four patients (seventy-three knees) affected by jumper's knee underwent surgical tretment after failure of nonoperative treatment. All knees were operated on by the same surgeon using the same surgical technique: arthroscopic debridement of the articular face of patellar tendon and arthroscopic abrasion of patellar apex. Pre-operative and post-operative evaluation was made according to IKDC score, Lysholm Knee Scale and VISA-P score. Results. The pre-operative subjective IKDC score was 52,96. This score significantly increased to 94,72 at 12 months post-operation, and has remained nearly constant at 10 years of follow-up. The mean pre-operative Lysholm Knee Scale was 51,57 and significantly increased to 86,48 at 12 months post-operation again remaining nearly constant at 10 years of follow-up. The score according to VISA-P which was pre-operatively 35,32 increased to 69,80 at 12 months post-operation and was 69,35 at 10 years of follow-up. Nineteen of the twenty-seven patients who were involved in competitive sport continued it at the same level and twenty-four were symptoms-free. Conclusions. For these satisfactory results, for the low aggressivity of this surgery, for the short recovery time and the faster return to sport we think that the debridment of the patellar tendon and the patellar apex abrasion performed by arthroscopy is the technique to prefer for surgical treatment of Jumper's Knee

Introduction. The number of total hip arthroplasties in young patients is continuosly increasing. Nowdays, the study of the materials wear, with the goal of improving the survivorship of implants, represents a fundamental subject in this kind of surgery. The role of ceramic materials in the valutation of types of wear is particularly known. Materials and Methods. We have selected 834 patients, underwent total hip arthroplasty, in which a ceramic head was impalnted with a maximum follow up of ten years. 367 patients were males and 467 were females, operated by 14 surgeons of the same equipe of Orthopaedic and Traumatology Department. A postero-lateral approach, according to Gibson Moore, and an extrarotator tendons transosseal repair was performed. Results. 446 ceramic liners, 354 polyethylene liners and 34 metallic liners were used. 18 types of stems, 5 of which stemless, were implanted. The mean survivorship of all cohrt of patients was 92% at 10 years. No ceramic heads and liners breakage occurred. In particular, of 69 total hip arthroplasties, implanted in 2005, only 3 were revised. Discussion. In our cohort review no major failures of ceramic components were observed. These datas suggested the importance of design and up grading of new materials, in order to achieve better long term results. Therefore, the ceramic components represent the gold standard, specifically in young active patients with good long term results reguarding functional outcomes and wear of implants. Conclusions. The use of ceramic head, assembled with ceramic or polyethylene liners, also demonstrated good results at 10 years follow up. Ceramic-on- polyethylene is a valid alternative to ceramic-on-ceramic in consideration of the lower cost and theoretical lower risk of breakage

Purpose. to analyze the survivorship of the RSA with a minimum 10 years follow up. Patients and Methods. Between 1992 and 1999, 145 Delta (DePuy) RSAs have been implanted in 138 patients. It was a mulicentric study. Initial etiologies were gathered as following: group A (92 cases) Cuff tear arthropaties (CTA), osteoarthritis (OA) with at least 2 involved cuff tendons, and massive cuff tear with pseudoparalysis (MCT); group B (39 cases) -failed hemiarthroplasties (HA), failed total shoulder arthroplasties (TSA), and fracture sequelae; and group C (14 cases) rheumatoid arthritis, fractures, tumor, and instability. Survival curves were established with the Kaplan-Meier technique. Two end-points were retained: -implant revision, defined by glenoid or humeral replacement or removal, or conversion to HA; - a poor clinical outcome defined by an absolute Constant score of less than 30. Results. At the time of review, 47 patients had died with their prosthesis in place and 30 were lost to follow-up. There were 12 revisions, 6 for infections, 3 for glenoid loosening, 1 for dislocation, 1 for glenoid dissociation (by unscrewing), and 1 for humeral loosening. The survival curve to prosthetic removal showed an overall survivorship of 92% at 10 years. Segmentation according to etiology showed a 97% survivorship for group A and 88% for group B This difference was not significant. No patients of group C had a minimum follow up of ten years because there were died or lost to follow up. The survival curve to a Constant score of less than 30 showed an overall survivorship of 90% at 10 years. Segmentation according to etiology showed a significant difference at 10 years in favor of group A (92%) compared to group B (86%) with a break of the curve after 9 years for group B. Discussion. Our results show that the overall survivorship of the reverse shoulder prosthesis to removal is good even 10 years after implantation, in particular if it had been implanted for CTA, OA, or MCT. However, functional results did deteriorate progressively after 9 years in particular if it had been implanted for revision (HA or TSA). Therefore, extreme caution must be observed in relation to the indications for reverse shoulder arthroplasty, especially in younger patients

Introduction: The Allofit cup is a hemispherical pressfit cup with a flattened pole for cementless implantation. Clinical use started in 1993 and we report our clinical and radiographic results of the first 100 cases. 75 hips of this group have been followed during the first 3 to 4 years using EBRA for migration analysis. These results also are presented. Material: Out of 100 hips 81 have been followed mith a mean of 10,1 years (9,8–11). 6 patients died, 11 did not show for follow up an 1 patient had a revision for deep infection with two-stage exchange meanwhile. The initial diagnosis was primary coxarthrosis in 63, rheumatoid arthritis in 10, congenital dislocation of the hip in 5 and necrosis of the femoral hed in 3. In all cases the cementless Alloclassic stem was used, as bearing material metasul was implanted in 73 and ceramic-polyethylene in 8 cases. Complications: For prolonged exsudation from the wound one soft tissue revision was necessary. 2 luxations were treated conservative. One early deep infection healed after synovectomy and irrigation, one late deep infection was cured by a two stage reimplantation. Results: The EBRA migration analysis after 3,6 years (2,3–4,2) showed cranial migration of 0,35 mm (0,2–0,6 mm), medial migration of 0,25 mm (0,10–0,40 mm) and a calculated total migration as a combination of both of 0,45 mm (0,22–0,72). Therefore at this time there was no evidence of early loosening or migration indicating later loosening. The preoperative Harris hip score was 53,13 pts (23–73), the postoperative score after 10 years 96,5 (78–100). Radiographic evaluation after 10 years showed no lucencies in 78 of 81 jpints. 3 hips had a lucent line of 1mm in zone III. We detected no signs of osteolysis, loosening or migration. No reoperations for any reason exept 2 septic cases have been performed yet. Summary: After 10 years the clinical and radiological results of this implant are very satisfying. These results confirm the early observations of a migration analysis performed 6 to 8 years before

This study evaluates the effect of lower limb post-operative mechanical axis on the long term risk of revision surgery following primary total knee arthroplasty (TKA). The study is relevant because many recent clinical trials have evaluated the optimal surgical technique for accurately aligning components in TKA, despite little evidence that alignment may effect the long-term clinical outcome. The data used in this study was collected prospectively as part of a randomized control trial comparing the long term survival of cemented versus uncemented TKA. The trial included 501 press-fit condylar posterior cruciate ligament-retaining prostheses performed by the senior author (PJG) or under his direct supervision. The post-operative mechanical axis alignment of the lower limb was measured following TKA using standard AP weight-bearing long leg alignment radiographs. A comparison was made between a well-aligned group with a mechanical axis alignment within 3° of neutral; and a poorly-aligned group whose mechanical axis alignment deviated greater than 3° from neutral. Survival analysis used revision surgery, with exchange of any of the three originally inserted components (femoral, tibial, polyethylene insert), as the endpoint. There was no loss to follow-up in this study. The minimum follow-up of TKAs in this study was 5.8 years. In the population of TKAs that were followed up at 10 years, 6% (17/270) required revision surgery. There was a significant difference in the rate of revision surgery between the well-aligned group 5% (11/227) and the poorly-aligned group 14% (6/43 p< 0.05). This study shows that post-operative lower limb mechanical axis alignment is an important determinant of the need for revision surgery at 10 years. Surgeons performing TKA should pay particular attention to the placement of the tibial and femoral components, so that a mechanical axis within 3° of neutral is achieved

The purpose of this study was to determine the survivorship for a MOM implant series performed by a single community surgeon followed using a practical clinical model. A retrospective cohort of 104 primary MOM THA procedures (94 patients) were all performed by one surgeon at three local hospitals now with 10–13 years follow-up. Sixteen patients are deceased and 16 patients have been lost to follow-up. In the remaining 62 patients, 8 are bilateral providing a total of 70 THA for study. The clinical follow-up model included: hip scores, X-rays, ultrasound, and metal ion concentrations (Co, Cr, Ti). Due to the diversity of patient location, a variety of clinical labs were utilized for metal ions. Statistical methods included Kaplan-Meier survival curve and One-way ANOVA. Hip scores were available for 70 THA and of these 61 had a hip score (HHS) above 80 (87%). X-rays were available for 49 hips and of these 38 (78%) had lateral/version angles in the safe zone (Fig 1: inclination ≤ 55 and anteversion ≤ 35). Thirty-eight ultrasound exams were performed and of these three yielded fluid collections (8%). Metal ion concentrations were documented in 39 of 62 patients (63%, either serum or whole blood). Six outliers were identified with high concentrations of metal ions (Fig 2); Co 0.3–143.9 ppb (median 3.6), Cr 0.2–200.3 ppb (median 2.2) and Ti 2-110 ppb (median 54). Six patients were revised by the original surgeon. Three of six with elevated ions were documented as wear problems and the other three were revised for infection, femur fracture and metal-ion sensitivity. The survivorship of 92.5% at 10 years (Fig. 3) may be partly due to the exclusive use of antero-lateral approach performed by one surgeon with 78% of cups well placed and the MOM design used exclusively

The topic of this study was to research the survival rate of ATLAS hip prosthesis (acetabular cup) performed by one operating surgeon only and with a minimum of 10 years follow up. Material and method: The ATLAS cup was hemispheric, in titanium alloy TA6V4, with a thin layer (2.5mm). It had a large central orifice as well as a radial slot allowing a certain elasticity enabling a pressfit impaction. Between January 1989 and December 1995, 297 ATLAS were implanted in the Clinique Saint André of Reims, 171 ATLAS II non hydroxyapatite coated and 126 ATLAS III hydroxyapatite coated. There were 176 women (59,2%) and 121 men (40,8%). The average age was 66 (20 to 94). Each patient was contacted by phone to find out if the prosthesis was still in place or whether a new operation had been performed. For the deceased patients, the family or the usual doctor were contacted by phone to answer the question with a maximum of details. The non-parametric survival rates were performed using the actuarial method according to Kaplan-Meier. The results were given with a reliability rate of 95%. The PRISM program was used. RESULTS: On the 1st of January 2006, out of the 297 patients present at the start, 38 patients (12,8%) could not be contacted, 70 patients (23,5%) had died, 35 were reviewed and 120 answered the phone inquiry. 32 patients had undergone a revision: 23 due to the cup: there were 15 cases of wear of the polyethylene, 4 osteolysis, 3 cases of recurring dislocation and a secondary tilt of the cup, 5 cases of acetabular and femoral revision for 4 femoral loosening (change of cup by principal) and 4 cases of revision of the femoral components only. The survival rate of the global series of 297 ATLAS (coated and non coated with hydroxyapatite) taking into consideration only the revisions due to the acetabular cup (wear of polyethylene, wrong position) was evaluated at 90% after 10 years and 85,5% after 15 years. The results were better for the ATLAS III coated in hydroxyapatite: 92,3% after 10 years and 88,4% after 14 years, which confirms the advantages of this surface treatment. In this series, the revision rate for wear of the polyethylene was less important (3%). With a maximum of 17 years follow up no mobilisation of the insert in the cup had been observed and no metallosis. Conclusion: The survival rate of the global series of 297 ATLAS (coated and non coated with hydroxyapatite), taking into consideration only the revisions due to the cup (wear of the polyethylene, wrong position) was of 90% after 10 years and 85,5% after 15 years. The rate was higher for the ATLAS III coated with hydroxyapatite: 92,3% after 10 years and 88,4 % after 14 years, which confirmed the advantages of this surface treatment

Introduction and Aims: Eight thousand Duraloc 300 cups were implanted worldwide in 2002. To our knowledge, no 10-year results have been published to date. We undertook this study to ascertain whether this optimism was justified. Method: One hundred consecutive total hip replacements using a Duraloc 300 cup were reviewed at a minimum of 10 years. Post-operative x-rays were analysed for cup placement and interface gaps. Follow-up films were analysed for lucent lines, osteolysis, wear and migration. Kaplan-Meier survivorship analysis was performed. Results: All components were found to be stable with no evidence of loosening or migration. The mean rate of wear was 0.12mm per year. Three hips developed pelvic osteolysis in zone 2 at the level of the apex hole, of which two have successfully undergone a bone grafting procedure and one patient is awaiting surgery. Conclusion: The Duraloc 300 cup has excellent 10-year results with no cases of loosening. There was a low incidence of pelvic osteolysis. Cementless fixation provides dynamic biological fixation, which is continuously renewed with the passage of time. There is no reason to believe that the durability of fixation will not extend well beyond 10 years

Introduction and Aims: This longitudinal prospective study reports the 10-year results of anterior cruciate ligament (ACL) reconstruction in 90 patients with isolated ACL rupture. Method: Three hundred and thirty-three patients undergoing endoscopic ACL reconstruction over a 15-month period using patellar tendon autograft and interference screw fixation were evaluated prospectively. Those patients with an associated ligament injury, chondral damage, previous meniscectomy, excision > 1/3 of one meniscus, an abnormal radiograph or contra-lateral knee, or a compensable injury were excluded. This left 90 patients in the study group. Evaluation was conducted annually for five years, then at seven and 10 years after surgery and included the IKDC Standard Evaluation, Lysholm knee score, kneeling pain, KT1000 testing and weight-bearing radiographs at two, five, seven and 10 years. Results: Repeat ACL injury occurred in a total of 23 patients (26%). There were six cases of graft rupture (7%) and 18 cases of contralateral ACL injury (20%). One patient suffered both a contralateral and graft ACL rupture. Eight patients (9%) underwent surgery for meniscal or chondral symptoms during the 10-year period. Of the 84 patients with intact grafts at 10 years, 75 (89%) were reviewed. On radiological examination at 10 years, 47% displayed mild to moderate evidence of osteoarthritis. The median Lysholm knee score was 95. Ninety-six percent felt their knee was normal or nearly normal. Forty-seven percent were still participating in moderate to strenuous activity after 10 years. Eighty-seven percent reported that their knee did not affect their activity level. Ninety-seven percent had grade 0–1 on Lachman and pivot shift testing. On instrumented testing 81% had < 3mm of anterior tibial displacement. Twenty-five percent displayed loss of extension range when compared to the contralateral limb, however this was < 5 degrees in 20% of patients. Pain on kneeling was present in 56%. On overall IKDC assessment, 77% were normal or nearly normal. Conclusion: Endoscopic ACL reconstruction using the PT autograft and interference screw fixation achieves and maintains excellent subjective results and objective stability. This combined with the low incidence of patients requiring subsequent meniscal or chondral surgery enforces the meniscoprotective function of ACL reconstruction. However, early signs of osteoarthritis are developing at 10 years, as displayed by radiological examination and early loss of extension

The aim of this study was to review the data held with the NHSLA database over the last 10 years for negligence in spine surgery with particular focus on why patients ‘claim’ and what is the likely outcome. Anonymous retrospective review. We contacted the NHSLA and asked them to provide all data held on their database under the search terms ‘spine surgery or spine surgeon.’. An excel sheet was provided, and this was then studied for reason of ‘claim’, whether the claim was open/closed and outcome. A total of 67 claims of negligence were made against spinal surgeries during this time (2000-09). The number of claims had increased over the last few years: 2000-03, n= 8, 2004-06, n= 46. The lumbar spine remains the most common area (Lumbar: 55/67, Thoracic : 6/67, Cervical 6/67). Documented reasons for claims were post-operative complications (n= 28; 42%), delayed/failure to diagnose (n=24; 36%), discontent with preoperative assessment including consent (n=2; 3%), intra-operative complications (n= 10; 15%) and anaesthesia complication (n=3; 4%). Twenty were closed and 47 remained open. The number of successful claims was 8/20 (40%). The mean compensation paid out was £33,409 (range was £820.5 to £60,693). The number of claims brought against spinal surgeries is on the increase, with the most common area being the lumbar spine which perhaps is not surprising as this is the most common area of spinal surgery. Common reasons are post-operative complications and delay/failure to diagnose. The ‘success’ of these claims over the last 10 years was 8/20 (40%) with mean compensation paid out was £33,409. Ethics approval: None;. Interest Statement: The lead author is the CEO and founder of a Personal Injury/Medico-Legal company

Purpose: We report a retrospective series of 98 consecutive total hip prostheses implanted without cement: the Aura stem and the Alizé cup coated with hydroxyapatite; reviewed at mean 9.6 years. The purpose of this analysis was to examine implant stability and wear. Material and methods: Total hip prostheses implanted in 98 patients from January 1991 to January 1992 were reviewed: 60 women and 38 men, operated on by the same surgeon using an Alizé cup and an Aura stem without cement. Mean age at implantation was 66.5 years (30–85). Mean follow-up was 9.67 years. We retained 56 patients for this analysis (17 patients had died, 13 were lost to follow-up, 9 could not be followed, and 3 stem removals (3.1%)). This was the first procedure in all patients. Clinical outcome was assessed with the Postel-Merle-d’Aubigné (PMA) score and with a self-administered questionnaire. Radiologically, we assessed stability (tilt, implant displacement) and implant wear using MetrOs software data processing of digitalized radiograms. We also searched for qualitative radiographic signs of bone reaction to the implant. Results: The overall PMA score improved from 11.96 preoperatively to 17.42 at the 5-year assessment and then fell to 15.67 at last follow-up. At five years 94% of the patients (92 hips) were satisfied and 98.3% (56 hips) were reviewed at 10 years. There were two fractures of the ceramic head after direct fall on the greater trochanter (requiring replacement of the femoral implant, the head and the polyethylene insert). There was one infra-prosthetic fracture which required stem replacement. Analysis of the radiograms did not demonstrate any abnormal ossification or lucency. MetrOs was used on 52 files: mean wear was 0.77 mm at 10 years (0.16–2.24 mm): wear and impaction (0.789 mm) of the stem were significantly correlated at 10 years while stem tilt was negligible. Discussion: This radioclinical analysis demonstrated that these hydroxyapatite coated implants are stable over time. The clinical results are satisfactory with a small regression of the PMA score related to patient ageing. The radiographic measurements obtained with a precise rigorous tool were very encouraging. We compared our results with those of series using comparable implants

Cervical Spondylotic Mielopathy (CSM) is the most common cause of spinal cord dysfunction in the adult population. Treatment implies surgical decompression as soon as possible after the diagnosis. In this study the authors present the long term results of minimal 10 years follow up of a prospective study of 98 patients that underwent anterior decompression and arthrodesis surgery for CSM. Patients that underwent surgery for CSM between January 1990 and December 1994 were evaluated for sex, age, number of levels operated, functional evaluation with Nurick Scale pre operatively, 1 year after surgery and at the final the revision that took place in 2007 and 2008, evidence of consolidation and complications. All the patients were operated by anterior approach. T-Student Test was performed with SPSS for statistical analysis. 99 patients were evaluated during the study, 73 male, 26 female, with a mean age of 56, 6 years (42–86) and mean follow up time of 14,4 years. 3 patients died in the immediate pos op period, 1 in the first year, 8 during the 15 year evaluation period. 16 patients were operated for 1 level, 22 for two levels, 36 for 3 levels and 22 for four levels (mean on 2,7±1,0 levels for patient). Pre op Nurick was 3,8±0,9. There was a significant improvement in neurological condition after one year surgery (Nurick 2,2±1,1; p< 0,001), and between pre op and final evaluation (2,3±1,2; p< 0,001). The degradation between the first year and the final evaluation was statistically significant (p=0,004). There was a strong correlation between age and the number of operated levels (r=0,391, p=0,01), age and initial neurologic status (r=0,238, p=0,05), initial neurological status and number of operated levels (r=0,251, p=0,05) and sex and number of operated levels, with women being operated for more levels (r=0,208, p=0,05). There was also e stronger neurological deterioration between year 1 and year 15 in young patients when compared to older ones (r=0,250, p=0,05). There is a strong clinical relation between first year recuperation and final recuperation (r=0,838, p=0,01). There was a 100% rate of consolidation. Surgical treatment for decompression and arthrodesis is considered for us the best option for the treatment of CSM in terms of improvement of pain, alignment and neurological function. A significant neurological improvement comes from surgery, and despite a significant clinical deterioration between the first year and the final evaluation, the benefits of surgery are still evident 15 years after, with a better neurological status when compared to the pre operative period

BACKGROUND. We originally performed metal-on-metal hip resurfacing using a Townley designed Vitallium Total Articular Replacement Arthroplasty (TARA) curved stemmed prosthesis. Neither the acetabular or femoral components were cemented or had porous coating. The bearing surfaces were consistently polar bearing. The surgical objectives were to preserve bone stock, maintain normal anatomy and mechanics of the hip joint and to approximate the normal stress transmission to the supporting femoral bone. The functional objectives were better sports participation, less thigh pain and limp, less perception of a leg length difference and a greater perception of a normal hip. Metal-on-metal was selected to conserve acetabular bone and avoid polyethylene associated osteolysis. Relatively few cases were performed until the Conserve Plus and later the Birmingham Hip Resurfacing systems became available. METHODS. We examined the results of metal-on-metal hip resurfacing in patient with at least 10 years of follow-up and an age less than 50 at the time of surgery. We did not have access to the Birmingham Prosthesis until 2006. We performed 101 TARA procedures and 397 Conserve Plus procedures for 357 patients. For the combined series the mean age was 43 and 62% of patients were male. 34 patients had a conventional total hip replacement on the contralateral side. We used both the anterolateral and posterior approaches. All acetabular components were placed without cement and all the Conserve Plus Femoral Components were cemented. RESULTS. There were no implant related failures with the TARA prosthesis. The average Harris Hip Score was 93. There were 2 revisions for femoral neck fracture at years 8 and 14 and one revision for infection. There was one dislocation but no instance of implant loosening. There were 29 (7%) revisions with the Conserve Plus Prosthesis. 14 revisions were for adverse reactions to metal wear debris and 10 of these patients had femoral components of size 46 mm or smaller. There were 5 revisions for acetabular loosening and 3 for femoral loosening. There were 7 revisions for femoral neck fracture and infection. The limb lengths were measured to be within 1 cm of equal in 98% of patients. 95% of patients had a UCLA activity score above 6 and 96% of patients rated their outcome excellent or good. 32 of 34 patients preferred their hip resurfacing to total hip replacement. The Kaplan-Meier survivorship was 93%. Narrowing of the femoral neck was seen in 9% of patients but acetabular osteolysis was not seen. Signs of impingement of the femoral neck against the acetabular prosthesis were seen in 14% of patients. CONCLUSIONS. Metal-on-metal hip resurfacing has been performed for more than 40 years using predicate prostheses such as the Townley TARA. The results of metal-on-metal resurfacing are favorable even in young and very active individuals. There were no instances of medical illness related to metal-on-metal implants with up to 41 years of follow-up. Metal-on-metal hip resurfacing has favorable outcomes at 10 years. There is an increased chance of an adverse reaction to metal wear debris with femoral component sizes 46 mm or smaller

Aims: To asses the outcome of the knee arthroplasty in patients under 55 years old. Methods: 59 knees were performed in patients who were 55 years old and above between 1976 and 1990. No patient was lost to follow-up. The assessment was done using the Knee Society scoring systems. Survivorship analysis was done using the Kaplan-Meier method and analysed with log rank test. Results: The average age at surgery was 48 (19–55) years. There were 25 male and 34 female. Osteoarthrosis was diagnosis in 38 knees and 21 had rheumatoid arthritis. All living patients had a minimum of 10 years (10–23) of follow up. Failure occurred in five (8.4%). 82% of patients had complete pain relief and 91% the knee had excellent knee score (of more than 85) at the final follow up. Survivorship analysis showed implant survival of 90% at 15 years, and 75% at 23 years for revision as end point. Diagnosis had no significant effect on the survivorship (p=0.66). Conclusions: The conventional total knee arthroplasty provides in this young group of patients with excellent clinical results and moderate survivorship analysis for 23 years follow-up

Clinical experience of the ICLH method of resurfacing the hip now spans 10 years. The first 36 arthroplasties, performed between 1972 and 1974, have been previously reported. This review covers in detail 204 such arthroplasties performed between 1975 and 1979 using a standard operative technique and prosthesis; these hips were consecutive and entirely unselected. Follow-up averaged 3.2 years (range two to six years). Successful hips are comparable to hips successfully replaced with stemmed prostheses. The rates of perioperative complications and failure due to infection, ectopic ossification, fracture of the femoral neck, and dislocation are favourably comparable to rates reported for stemmed total hip arthroplasties. The rate of aseptic loosening (17 per cent) greatly exceeded that found for stemmed total hip arthroplasties. Errors of patient selection, operative technique and prosthetic design have been identified. It is concluded that, although resurfacing arthroplasty of the hip may be an appealing procedure with theoretical advantages in certain instances, patient selection is essential, operative technique is demanding and changes in the design of the prosthesis are required. The procedure is still in evolution and therefore it should not yet be generally employed

Understanding the cause of failure of total knee arthroplasties (TKA) is essential in guiding clinical decision making and adjusting treatment concepts for revision surgery. The purpose of the study was to determine current mechanisms of failure of TKA and to describe changes and trends in revision surgery over the last 10 years. A retrospective review was done on all patients who had revision total knee arthroplasty during a 10-year period (2000–2009) at one institution. The preoperative evaluation in conjunction with the intraoperative findings was used to determine causes of failure. All procedures were categorizes as Sharkey et al. described previously. The data was analyzed regarding the cause of failure and displaying the incidence and trends over the last 10 years. 1225 surgeries were done in the time period with a steady increase of procedures per year (34 procedures in 2000 to 196 in 2009). The most common cause of revision TKA was aseptic failure in 65% and septic failure in 31% of the reviewed cases. However, we could observe a steady proportional increase of the septic classified revisions over the time. Both categories could be subdivided to specific causes of failure including aseptic loosening (24%), anterior knee pain (20%), instability (6,4%), arthrofibrosis (4,9%), PE wear (3,6%), malpositioning/malrotation (2,7%) periprosthetic fracture (2,0%) and other (4,6%), or in early (12,9%), late (15,4%) or low-grade infection (3,3%), respectively. Complementary to the classification Sharkey et al. described in 2002 we identified new subcategories of failure: malrotation (since 2003), Low-Grade-Infection (since 2006), allergic failure/loosening (since 2006), Mid-Flexion-Instability (since 2007), soft tissue impingement (since 2009). The incidence of the classic aseptic loosening due to PE wear shows a clear decrease in the last 10 years whereas we could observe an increase of the new diagnosis of instability, malrotation or low-grade-infection as determined cause of failure. The detailed analysis of the failure mechanism in total knee arthroplasty is important to understand the clinical problem and to adjust treatment strategies. We were able to complement present classifications and give a first overview on the incidence for specific causes of failure. Our data shows changes in the indication for surgery over the time and compared to the collective of Sharkey et al. from 1997–2000. This might be due to new diagnostic methods and better implant materials as well as to a generally increased awareness of the specific mechanism of TKA failure

Over the long term, the results of the insertion of a Grammont inverted shoulder prothesis are unknown. The present study reports survivorship curves and the role of the initial aetiology in patients re-examined after 5 to 10 years. Patients and methods Eighty prostheses (for 77 patients) were implanted between 1992 and 1998: 66 cases of massive cuff tear arthropathy (MCTA) and 24 cases for another aetiology (mainly rheumatoid arthritis and revision). At the time of follow-up, 18 patients had died and 2 could not be traced. The remaining patients (57 representing 60 prostheses) were seen by an independent examiner. The minimum follow-up was 5 years. The average follow-up was 69,6 months. Kaplan-Meir survivorship curves for the 60 prostheses were established in order to show the probability of failure as defined by: revision of the prothesis, glenoid loosening, and a functional level< 30 points according to the Constant score. Results The survivorship curves were as follow:. - for non revision of the prosthesis at 10 years: 91% overall; after 9 years: 95% for MCTA, and 77 % for the others aetiologies. This difference was statistically significant (p< 0,01) ; 6 implants were revised: 3 for MCTA and 3 for other aetiologies. - for non glenoid loosening at 10 years: 84 % overall ; after 7 years: 91% for MCTA and 77% for other aetiologies. This difference was statistically significant (p< 0,05). In addition to the cases of replaced implants mentioned above there was a case of glenoid loosening after 8 years follow-up in a patient aged 92. -for Constant score < 30 at 10 years: 58 % overall. The punctual survivorship rate was significantly different in function of the aetiology, at 6 years ; but this was no longer the case after 7 years. Discussion. According to revision of the prosthesis, there is a clear rupture in the survivorship curve about 3 years after insertion in aetiologies other than MCTA. This suggests that Grammont inverted total shoulder arthroplasty is not appropriate in these aetiologies (particularly in cases of rheumatoid arthritis). According to Constant score < 30, there is a clear rupture in the survivorship curve about 7 years after insertion specially in MCTA cases. This suggests that inverted protheses should be used only in cases with severe handicap and only in patients aged over 75

We report the results of cementless total hip arthroplasty using the Bi-metric titanium femoral stem at a minimum follow up of 10 years and a mean of 12.2 years (range 10–17). 64 hips (43 male/21 female) were implanted consecutively into 54 patients between 1988 and 1995. The mean age at operation was 54.3 years (range 42–65). All patients had a Bi-metric uncemented stem (Biomet UK). The first 13 patients received a metal backed screw in acetabular cup (TTAP-ST, Biomet UK) with the remainder receiving metal backed pressfit cups (Universal, Biomet UK). All patients were followed up annually and assessed using the Hip Society Score (HSS; max 40 points) to record pain, function and mobility. Survivorship was calculated using the Kaplan-Meier method. 57 hips were followed up for a minimum of ten years. There were 4 deaths (6 hips) before completion of follow up and 1 patient was lost to follow up. Using revision for any reason as the end point of the study; survivorship for the total hips at 10 years was 89.5% (95% confidence interval: 78.1–96.1%) with a mean Hip Society Score of 34.9 (range 20–40) compared to 14.5 (range 8–24) pre-operatively (p< 0.01 student t test). Survivorship for the femoral stem in isolation was 100% at 10 years (95% CI 93.7–100%) and there continues to be no revisions to date at a mean follow up of 12.2 years. The screw fix cup performed poorly with 3 acetabular revisions (including 1 liner change) before the 10 year follow up, a failure rate of 23.1%. There has sub-sequently been a further 4 acetabular revisions. Ten year survivorship for the pressfit cup is 93.5% (95% CI 82.0–98.8%) with 3 revisions (including 2 liner changes) at ten years. There has subsequently been one further acetabular revision and 9 further liner changes (29.5% failure rate). There have been no recorded infections and no instances of thigh pain. Radiographs at ten years showed all the femoral stems were stable with no evidence of migration. Two stems had small radiolucent lines at the bone-implant interface but no signs of loosening. One stem had an area of osteolysis in Gruen zone 7 but didn’t require revision. Rates of osteolysis were extremely low given the large amounts of particulate debris in the hip from the worn acetabular liners. In conclusion, although neither cup has proved to be particularly successful the Bi-metric stem has performed well at 10 year follow up and continues to do so. This is inspite of the fact they were implanted into a young and active group of patients

Introduction: The collarless polished tapered stem (CPT) is a double tapered cemented femoral component designed for primary hip replacement and as a revision stem for impaction bone grafting. We report the outcome at a minimum of 10 years (mean 11 years 1 month). Methods and patients: Of 191 consecutive primary hip replacements in 174 patients, implanted using contemporary cementing techniques, 63 patients died before 10 years (68 hips). None of these stems had been revised or had radiological signs of failure at their last follow-up. Only 1 patient (2 hips) was lost to radiological follow-up, hence complete radiological data was available on 121 hips and clinical follow-up on 123 hips. The fate of all the hips is known. Results: Survivorship with revision of the femoral component for aseptic loosening as the endpoint was 100%. The Harris hip scores were good or excellent in 75% of the patients with a mean of 86 (from 39). All the stems subsided vertically within the cement mantle at a mean rate of 0.18mm per year, stabilising to a mean total of 1.95mm (0.21–24mm) after a mean of 11 years 1 month. Unlike Exeter stems there was no change in the alignment of the stems. There was excellent preservation of proximal bone and an extremely low (< 2%) incidence of loosening at the cement bone interface. Discussion: The study confirms that the CPT subsides within the cement mantle, but without failing. It performs at least as well as the best stems currently available

The collarless polished tapered stem (CPT) is a double tapered, cemented femoral component designed for primary hip replacement and as a revision stem for impaction bone grafting. We report outcome at a minimum of 10 years (mean 11 years 1 month). Of 191 consecutive primary hip replacements in 174 patients, implanted using contemporary cementing techniques, 63 patients died before 10 years (68 hips). None of these stems had been revised or had radiological signs of failure at their last follow-up. Only one patient (two hips) was lost to radiological follow-up, hence complete radiological data was available on 121 hips and clinical follow-up on 123 hips. The fate of all the hips is known. Survivorship with revision of the femoral component for aseptic loosening as the endpoint was 100%. The Harris hip scores were good or excellent in 75% of the patients with a mean of 86. All the stems subsided vertically within the cement mantle at a mean rate of 0.18mm per year, stabilising to a mean total of 1.95 mm (0.21–24 mm) after a mean of 11 years 1 month. Unlike Exeter stems there was no change in the alignment of the stems. There was excellent preservation of proximal bone and an extremely low (< 2%) incidence of loosening at the cement bone interface. The study confirms that the CPT subsides within the cement mantle, but without failing. It performs at-least as well as the best stems currently available

Introduction and Aims: Problem: Patellar resurfacing in TKA remains controversial. Purpose: To evaluate the results of resurfacing/non-resurfacing of the patella in a randomised controlled clinical trial at a minimum of 10 years of follow-up. Method: One hundred knees (90 patients) with osteoarthritis were enrolled in a prospective randomised controlled double-blinded trial using the same posterior cruciate retaining total knee replacement. Patients were randomised to resurfacing or non-resurfacing of the patella. Evaluations were performed pre-operatively and yearly to a minimum of 10 years (range 10.1–11.5 years) postoperatively. Disease-specific (Knee Society Clinical Rating System), functional (stair climbing, knee flexion/extension torques, patellar examination) outcomes were measured. Patient satisfaction, anterior knee pain, and patellofemoral questionnaires were completed. Intra-operative grading of the articular cartilage was performed. Results: No patients were lost to follow-up; 46 knees remained alive. Nine revisions (9/90–10%) were performed – 7/48 (15%) in the non-resurfaced and 2/42 (5%) in the resurfaced group. Three knees in the non-resurfaced group were revised to a resurfaced patella for anterior knee pain. One resurfaced patella was complicated by AVN and fracture, requiring revision. No significant difference was found between the groups regarding revision rates, KSCR score, functional, satisfaction, anterior knee pain, patellofemoral, and radiographic outcomes. Intraoperative cartilage quality was not a predictor of outcome. Conclusions: This study represents the longest follow-up to date of a randomised controlled clinical trial to examine patellar resurfacing in TKA. The results showed no significant difference between the groups for all outcome measures at a minimum of 10 years

Purpose of the study: Total knee arthroplasty (TKA) is considered to be an effective treatment for degenerative knee joint disease when the functional impairment and the pain fail to respond to medical treatment. The success of TKA is determined by the degree of pain relief, functional recovery, and implant survival. For many years, those advocating or not preservation of the posterior cruciate ligament (PCL) have animated lively debates. Although a consensus has not been reached, posterior stabilised prostheses and prostheses with a mobile plateau are commonly implanted. The purpose of our study was to compare the outcomes obtained with fixed plateau TKA with preservation of the PCL with those obtained with other prostheses with or without sacrifice of the PCL with a fixed or mobile plateau. Material and methods: This was a prospective study in a single centre including a homogenous consecutive series of 12 TKA (cemented EUROP) with a fixed plateau and preservation of the PCL implanted from 1994 to 1996 in 117 patients aged 73 years on average. The International Knee Society scores were used for the clinical and radiographic assessment at ten years. Results: At ten years follow-up, 23 patients had died, 14 were lost to follow-up and 80 (82 knees) were evaluated clinically and 43 (45 knees) radiographically. The IKS knee score varied from 31 points (0–60) preoperatively to 88 points (30–98) postoperatively at last follow-up. The IKS function score was 40 points (0–90) preoperatively and 80 (25–100) at last follow-up. Lucent lines were noted for 59% of the condyles and 60% of the tibial plateaus. The lucencies were mainly located in the anterior and posterior zones of the femur (zones 1 and 4) and medially on the tibia (zones 1 and2). Two prostheses were revised at 8 and 11 years for loosening. The overall survival was 98.8% at ten years using the Kaplan-Meier method. Discussion: The clinical and radiological outcomes of prostheses with fixed plateaus and preserving the PCL in our series with one revision at 10 years were very satisfactory. Our results are comparable with earlier reports in the literature with or without sacrifice of the PCL with a fixed or mobile plateau. Conclusion: Longer term follow-up will be needed to confirm these results beyond ten years

Early stabilisation after an anterior cruciate ligament (ACL) rupture reduces future meniscal injury. We may therefore expect protection of articular cartilage from ACL reconstruction, but this has yet to be shown. Our aim wasto determine the effect of meniscal injury on the long term risk of osteoarthritis (OA) following ACL reconstruction using Single Photon Emission Computed Tomography (SPECT, a 3 dimensional radionuclide scan). We studied a prospective series of 31 patients (mean age at injury of 29 years) who had bone-patellar tendon-bone ACL reconstruction for unstable, ACL deficient knees. Mean follow-up was 10 years (range 9-13). Patients were separated into two groups according to the status of their menisci at the time of ACL reconstruction, those with intact menisci in group 1 (n=15) and those who required partial meniscectomy in group 2 (n=16). The contra-lateral normal knee was used as a control. All knees were clinically stable with high clinical scores (mean Lysholm score 93 and mean Tegner activity score 6). In group 1 (intact menisci) only one patient (7%) had clinical symptoms of OA and was the only patient with increased uptake on SPECT compatible with early OA. In group 2 (partial meniscectomy), two had clinical symptoms of osteoarthritis, and five patients (32%) had increased uptake on SPECT compatible with early OA. None of the control knees had early OA on SPECT. The prevalence of OA 10 years post ACL reconstruction, using the most sensitive investigation available, is very low in patients who had intact menisci (7%), but increases 5 fold (32%) if a meniscal tear was present. We recommend early ACL reconstruction to preserve the menisci to minimise the long term risk of OA

A monobloc porous tantalum acetabular cup with a 28mm internal diameter was employed in 397 primary total hip replacements between August 1997 and December 2003. All patients were personally examined at yearly intervals for 3 years following surgery and at 2 year intervals thereafter. Thirty-one patients were known to have died and 69 hips were lost to follow up less than three years following implantation, leaving 297 hips (81%) available for review up to 10 years following implantation. The mean age at surgery was 66.2 years, with 12% of patients aged 80 years or older. 58% of the patients were female and 42% male. 82% of the patients had osteoarthritis. Clinical and radiographic data were analyzed for patients followed for a minimum of 3 years. Mean follow up was 5.4 years. The mean preoperative Harris hip score was 31, increasing to 89 at last follow up. The most common complication was dislocation. Eleven patients had dislocations in the early postoperative period: 4 required closed and 2 open reduction, and five required revision of the acetabular component for recurrent instability. Three patients (4 hips) with severe rheumatoid arthritis developed late instability and required acetabular revision. Four patients had a femoral fracture, 2 of which healed with slight settling and 1 of which required open reduction, subsequently became infected and required removal of the prosthesis. There was 1 superficial and 2 additional deep infections, one of which required component removal. Two patients had a fracture of the greater trochanter and required internal fixation. Four femoral components loosened, of which 3 were revised, all without involvement of the acetabular component. There were 3 transient sciatic nerve palsies; one resolved completely and two partially, although all 3 were lost to follow before 3 years. The porous tantalum monobloc acetabular components performed remarkably well at up to ten years following implantation. There were no instances of clinical or radiographic loosening, no osteolysis and no measurable wear visible on postoperative radiographs. The highly porous tantalum achieved reliable bony ingrowth in all cases. We hypothesize that the direct compression molding of the polyethylene into the porous tantalum substrate eliminated the backside wear and the flexion of the polyethylene liner that occurs in modular cups

Background: Femoro-patellar arthritis (FPA) is less frequent than femoro-tibial arthritis, but still a challenging problem for orthopaedic surgeons. Several treatment have been described from lateral retinaculum release to TKR, with special features to patellar prosthesis. The purpose of this study was to evaluate a large consecutive series of femoro-patellar prosthesis (FPP), to learn about the late outcome, complications and performance. Material and Methods: Between 1992 and 2004, 60 prosthesis were performed by one of the authors in 55 patients with a mean age of 59 years; 44 were femal and 13 male, 5 had bilateral prosthesis. 62% had essential arthritis with trochlear dysplasia. 78% were graded Iwano III or IV. Resurfacing cemented Themis. ®. prosthesis was used in all cases, with a lateral approach associated with a tibial tubercle osteotomy to achieve correct aligment of extensor mechanism. None patient was lost to follow-up. Results: Mean follow-up was 10 years (46–218 months). During the study, 12 prosthesis were converted to TKR because of femoro-tibial arthritis; but the mean delay between FPP and TKR was 12 years. At revision, 48 FPP were evaluated by an independent examinator. IKS score raised from 106 to 157, knee score from 57 to 89 and function score from 49 to 78. Pain, ability to walk and to climb stairs were improved. Radiography did not demonstrate radio-lucent lines, wear or loosening. 95% had correct aligment of patellar button, without tilting. Survival rates of FPP were 89% at 10 years and 82% at 15 years. Conclusion: Resurfacing FPP is a reliable procedure offering good clinical performance and outcomes. The authors recommend the use of FPP for isolated FPA, without knee diformity, in association with tibial tubercle osteotomy

The modern generation of hip resurfacing arthroplasties was developed in the early 1990's with one of the original designs being the McMinn Resurfacing Total Hip System. This was a hybrid metal on metal prosthesis, with a smooth hydroxyapetite coated press fit mono block cobalt chrome shell with a cemented femoral component. Although no longer produced in this form, lessons may be learned from this original series of components. With metal on metal resurfacing arthroplasty now facing criticisms and concerns with regard function, bone preservation capability and soft tissue issues such as ‘pseudotumors’, it is the aim of this long-term study to assess the outcome and survival of an original series of resurfacing arthroplasties. 27 resurfacing arthroplasties were performed in 25 consecutive patients between June 1994 and November 1996. 16 right hips and 11 left were performed in 14 female patients and 11 male patients. The average age at the time of surgery was 50.5 years (SD 7.9, range 30-63). All surgeries were performed by a single surgeon using a posterior lateral approach. Following the initial early care, each patient received bi-annual follow up along with open access to the clinic with any concerns or complications. A retrospective review of the case notes was conducted and outcome scores retrieved from a prospectively updated database. Radiographs were analyzed and a Kaplan Meier survival chart was constructed for the group. At latest review 3 patients have died (5yrs, 8yrs and 13.8yrs) and 1 patient has been lost to follow up (5yrs). 7 resurfacings have required revision, all due to acetabular loosening, at a mean follow up of 7 years 11months (SD 2.03years, range 4-10). Metallosis was documented in 4 of the revision cases, however no extensive soft tissue inflammation or ‘pseudotumor’ identified. The mean follow up of the remaining 16 hips is 12years and 10months (SD 12.8months, Range 10.4yrs-14.0 years). The Kaplan Meier survival at a minimum follow up of 10 years is 75.8% (95% CI 0.67-0.95). Mean Oxford hip scores at latest follow up was 20.6 (SD 8.8, range 12-38). There was no significant difference between cup inclination angles for the surviving cohort and those who required a revision procedure with mean cup inclinations of 52.5 (SD 5.5, range 45-60) and 58 degrees respectively (SD 9.1, range 50-70)(p=0.255). This original series of hip resurfacings, with up to 14 years follow up, shows a survival of 76% at the minimum follow up of 10 years. All failures were due to loosening of the smooth backed acetabulum, which with a modern porous coating, failure may have been avoided or delayed. Despite high inclinations angles no soft tissue reactions were identified within this series. No femoral failures were identified suggesting unlike much literature focus, long-term failure may not be related to the femoral head or neck

Introduction: Spinal deformities (scoliosis, kyphosis or kyphoscoliosis) in children under 10 years of age result from congenital, neuromuscular and idiopathic etiologies. The progression of the deformity is affected by its nature, location and age of onset. Spinal arthrodesis is the procedure of choice in patients with progressive deformities. The use of instrumentation facilitates curve correction and arthrodesis rates. Pediatric spinal surgery is technically demanding, and is still considered controversial. The advent of reduced size spinal instrumentation allowed surgeons to expand their use to pediatric patients. The use of spinal instrumentation in children with various spinal deformities has not been well documented. Objective: To assess the safety and efficacy of spinal arthrodesis in young patients with progressive spinal deformities. Patients and Methods: We retrospectively reviewed the medical charts and radiographs of 25 patients younger than 10 years of age who underwent corrective surgery for various spinal deformities. Radiographic outcome, fusion rates and complication were compared between instrumented and non instrumented patients. Results: At two years of follow up instrumented corrective procedures resulted in superior correction compared to non-instrumented patients and in solid arthrodesis in all. Complications were infrequent. Conclusions: The use of reduced size spinal instrumentation in young patients with progressive spinal deformities is safe and effective. Curve correction, length of bracing and fusion rates are all in favour of instrumentation, wile complication rates are acceptable. The use of spinal instrumentation in young patients requires expertise and patience

Purpose: The modern generation of hip resurfacing arthroplasties was developed in the early 1990’s with one of the original designs being the McMinn Resurfacing Total Hip System. This was a hybrid metal on metal prosthesis, with a smooth hydroxyapetite coated press fit mono block cobalt chrome shell with a cemented femoral component. Although no longer produced in this form, lessons may be learned from this original series of components. With metal on metal resurfacing arthroplasty now facing criticisms and concerns with regard function, bone preservation capability and soft tissue issues such as ‘pseudotumors’, it is the aim of this long-term study to assess the outcome and survival of an original series of resurfacing arthroplasties. Method: 27 resurfacing arthroplasties were performed in 25 consecutive patients between June 1994 and November 1996. 16 right hips and 11 left were performed in 14 female patients and 11 male patients. The average age at the time of surgery was 50.5 years (SD 7.9, range 30–63). All surgeries were performed by a single surgeon using a posterior lateral approach. Following the initial early care, each patient received bi-annual follow up along with open access to the clinic with any concerns or complications. A retrospective review of the case notes was conducted and outcome scores retrieved from a prospectively updated database. Radiographs were analyzed and a Kaplan Meier survival chart was constructed for the group. Results: At latest review 3 patients have died (5yrs, 8yrs and 13.8yrs) and 1 patient has been lost to follow up (5yrs). 7 resurfacings have required revision, all due to acetabular loosening, at a mean follow up of 7 years 11months (SD 2.03years, range 4–10). Metallosis was documented in 4 of the revision cases, however no extensive soft tissue inflammation or ‘pseudotumor’ identified. The mean follow up of the remaining 16 hips is 12years and 10months (SD 12.8months, Range 10.4yrs-14.0 years). The Kaplan Meier survival at a minimum follow up of 10 years is 75.8% (95% CI 0.67–0.95). Mean Oxford hip scores at latest follow up was 20.6 (SD 8.8, range 12–38). There was no significant difference between cup inclination angles for the surviving cohort and those who required a revision procedure with mean cup inclinations of 52.5 (SD 5.5, range 45–60) and 58 degrees respectively (SD 9.1, range 50–70)(p=0.255). Conclusion: This original series of hip resurfacings, with up to 14 years follow up, shows a survival of 76% at the minimum follow up of 10 years. All failures were due to loosening of the smooth backed acetabulum, which with a modern porous coating, failure may have been avoided or delayed. Despite high inclinations angles no soft tissue reactions were identified within this series. No femoral failures were identified suggesting unlike much literature focus, long-term failure may not be related to the femoral head or neck

BACKGROUND: The purpose of this study was to evaluate the long term results of meniscal transplantation in a consecutive series of younger patients treated for pain in the tibiofemoral compartment following a previous meniscectomy. METHODS: One hundred and thirty eight (138) menisci were implanted into one hundred and thirty-five (135) patients over a sixteen year period. Seventy five (75) knees also had an associated osteotomy, and eleven (11) had a ligament reconstruction. The clinical outcome using pain and functional knee scores and failure rate of all transplants was evaluated at a mean 10.2 years (2–16 years) postoperatively. RESULTS: One hundred and twenty (120) patients with one hundred and twenty three (123) meniscal grafts were available for final follow up. Fifteen (15) patients were lost to follow up. Seventy five percent (75%) of patients had an improvement in pain knee score and seventy one percent (71 %) of patients had an improvement in functional knee score. Twenty patients (16.6%) underwent a total knee replacement at a mean interval of 9.3 years after the meniscal transplant. Patients with isolated meniscal transplantation had the most improved clinical outcome. Patients with concomitant knee osteotomy and knee ligament reconstruction procedures also had improved knee function without an increase the rate of complications. CONCLUSIONS: The long-term results of meniscal transplantation are encouraging in terms of reducing knee pain and increasing function at a mean follow up of 10.2 years. Patients with isolated meniscal transplantation have improved outcomes

The C-Stem in its design as a triple tapered stem, is the logical development of the original Charnley flat-back polished stem. The concept, design and the surgical technique cater for a limited slip of the stem within the cement mantle transferring the load more proximally. Five thousand two hundred and thirty three primary procedures using a C-stem have been carried out since 1993. We reviewed all 621 cases that had their total hip arthroplasty before 1998. Sixty nine patients (70 hips) had died and 101 hips had not reached a ten-year clinical and radiological follow-up and had not been revised. Thirty-two hips had been revised before 10 years, none were revised for aseptic stem loosening and no stems. The indications for revision were Infection in 4, dislocation in 3, aseptic cup loosening in 24 and unexplained pain in 1. The remaining 418 hips had a mean follow-up of 12 years (range 10–15 years). There were 216 women and 173 men, and 34 patients had bilateral LFAs. The patients' mean age at surgery was 53 years (range 16–83 years). Thirty four hips had been revised at the time of review. The reasons for revision were infection in 5, dislocation in 2, aseptic cup loosening in 24 and 1 for neuralgia paraesthetica where the stem was well fixed. Two hips were revised for stem fracture. There were no revisions for stem loosening but 2 stems were revised for fracture - both with a defective cement mantle proximally. The clinical results are very encouraging and they support the concept of the Charnley cemented low friction arthroplasty, but place a demand on the understanding of the technique and its execution at surgery

Triple-tapered cemented polished C-Stem has evolved from the study of long-term results of the Charnley low-frictional torque arthroplasty when the first fractured stem and then proximal strain shielding of the femur and stem loosening were identified as the continuation of the same process: lack or loss of proximal stem support. The C-Stem, by the concept, design and the surgical technique, caters for a limited slip of the stem within the cement mantle transferring the load more proximally. With a follow-up past 10 years and 3299 primary procedures there have been no revisions for aseptic stem loosening and no stem is radiologically loose. Four hundred and forty eight patients had 500 LFAs using the C-Stem with the longest follow-up: 256 women and 192 men; 52 patients had bilateral LFAs. The patients’ mean age at surgery was 55.5 years (range 17–89 years) and at a mean follow-up of 5.2 years. There was an overall improvement in the clinical outcome graded according to d’Aubigne and Postel for pain, function and movement from 3.1, 2.9 and 2.8 to 5.9, 5.7 and 5.5 respectively. A good quality proximal femur had been maintained in 56.8% and improved in 21.8%. The results are encouraging and support the concept but place a demand on the understanding of the technique and its execution at surgery

Aims: To evaluate the morphologic changes in the patellar tendon 10 years after harvesting its central third for reconstruction of the anterior cruciate ligament, and examine the association between the morphologic changes and the occurrence of anterior knee pain of the patients. Methods: Thirty-one patients who had undergone an anterior cruciate ligament reconstruction using central-third bone-patellar tendon-bone autograft with a closure of the patellar tendon defect were included in this study. An ultrasonographic and Power Doppler examination was performed at a mean follow-up of 10 years. Results: Ultrasonography of the harvested patellar tendon showed intratendinous calcification in 9 patients, hypoechoic lesion in 20 patients, hyperechoic lesion in one patient, and peritendinous changes in one patient. No abnormality was visible in the contralateral (normal) patellar tendons of the 31 patients. The harvested patellar tendon was significantly thicker than the contralateral patellar tendon both at the proximal third (p=0.017) and at the distal third (p=0.020) of the tendon. Patellar osteophytes were more common in patients with anterior knee pain than without it (p=0.05). Conclusions: Sonographic morphologic changes of the patellar tendon were common 10 years after the harvesting procedure. Also, the harvested patellar tendon was significantly thicker than the normal patellar tendon

Long-term regular haemodialysis for chronic renal failure is associated with amyloidosis. In this condition excess amounts of the unexcretable plasma protein beta-microglobulin are laid down in tendons, joints and bones. Amyloidosis presents with various musculoskeletal disorders only after several years of dialysis. We reviewed 83 patients who had been dialysed for at least 10 years. The commonest complaint was severe joint pain in the absence of radiological changes of arthritis (41%), the shoulders usually being the most affected (33%). Carpal tunnel syndrome had developed in 26 patients, and was bilateral in 14 of them; at operation the presence of amyloid was confirmed. Six of these patients had recurrent symptoms after a further two to three years and required another decompression. Other manifestations of amyloidosis included trigger finger, flexor tendon contracture, spontaneous tendon rupture and pathological fracture through amyloid bone cysts. The frequency of symptoms was proportional to the duration of dialysis: all 13 patients on dialysis for over 20 years were affected. Symptoms developed earlier in older patients

Aims: The aim of this study was to evaluate the long-term results of osteoarticular allografts operated during the years 1973–1992. Materials: 33 osteoarticular allograft operations were performed because of malignant (14) and benign tumors (19). The mean follow-up time was 15 years. Eight patients were excluded because of death (5) and amputation (3). Results: 25 (76%) of the grafts survived more than 10 years. 18 were whole-joint grafts and 7 hemi-joint grafts. 13 grafts situated in proximal tibia, 11 in distal femur and one in distal tibia. So far three cases have been converted to arthroplasty and two to arthrodesis. 20 grafts are still functioning. 19 of them are excellent or good according to Mankin score. Whole-joint and hemi-joint allografts were clinically equally good. Clear degeneration is seen in every joint and during the time the range of motion tends to decrease because of osteoarthrosis but clinically the patients were surprising painless. Conclusions: The operation is demanding and may cause a large variety of complications, for instance infection, non-union, fatigue fracture, nerve palsy and joint instability. On the other hand, the graft may provide weight-bearing bone that will incorporate biologically into the host skeleton and function almost as a normal joint for years. As prosthesis solutions have also problems and tend to fail with time, osteoarticular allografts should be taken to serious consideration when the first operation method is chosen

Metal on metal hip resurfacing is increasing in popularity for the young, active patient. We present the results of a consecutive series from a single surgeon over a ten year period; 295 hip resurfacings (McMinn and Cormet; Corin, Cirencester, UK) with a minimum follow up of 2 years and a mean follow up of 4 years. There were 173 males with a mean age of 53.4 years and 121 females with a mean age of 50.3 years. Forty-six patients underwent bilateral resurfacings. All resurfacings were performed through a posterior approach.

The aetiology in this group was primary OA in 75.9%, inflammatory arthritis in 6.1%, DDH in 6.1%, AVN in 4.7%, trauma in 4.7%, Perthes in 1.7% and SUFE in 0.7%. Patients were reviewed clinically and radiographically on an annual basis. Follow-up was available on 93% of patients. 94.2% of hips have survived and the mean Harris Hip Score is 87.5. Females had a higher failure rate (10.7%) than males (2.3%). There was no clear trend between patient age and failure rate. The highest failure rate (33.3%) was seen in patients with DDH whilst only 4.5% of patients with OA failed. One patient with AVN failed but no failures occurred in patients with inflammatory arthritis, trauma, Perthes or SUFE. Failures occurred due to cup loosening (2.0%), neck fractures (1.7%), head loosening (1.0%), head collapse (0.3%), infection (0.3%) and pain (0.3%). The five patients who suffered neck fractures were symptomatic within 3 months of surgery.

We remain cautiously optimistic about the medium term results of hip resurfacing. Careful patient selection is important and caution should be taken in females and patients with DDH

Purpose: We have used monoblock cryopreserved femoral heads for acetabular reconstruction without supporting material since 1985 for cemented total hip arthroplasty in patients with major acetabular defects. From 1985 to 1995, 140 reconstructions were performed. We present a prospective analysis of the clinical and radiological outcome at 10 years follow-up. Material and methods: Mean age of the population was 61 years. Most of the patients had had two prior interventions. According to the SOFCOT classification, the 140 defects were: grade II 50%, grade III 35% and grade IV 15%. The cryopreserved graft (femoral head bone bank) was used to reconstruct the acetabular defect. The graft was adapted to the size of the defect to fashion a congruent construct aimed at achieving primary stability. We did not use any supporting material in addition the primary osteosynthesis with one or two screws. A poly-ethylene cup was cemented in the graft. Most of the cement was applied onto the graft which was reamed to the size of the acetabulum. We retained a theoretical 6-year follow-up for review. All patients were seen for follow-up assessment using the Postel-Merle-d’Aubigné (PMA) clinical score and standard x-rays analysed according to the Oakeshott method. Kaplan-Meier survival curves were plotted taking change in status, revision for clinical failure as the endpoint. Results: Mean overall follow-up was 8.5 years; it was 10 years for patients with an implant still in situ. Eight patients (5.7%) lost to follow-up were included in the series retained for analysis at mean 5-year follow-up. Thirty-five patients died during the follow-up period (25%). These patients had been followed for a mean four years before their death. Radiologically, cup tilt was not significantly altered over time. Conversely, the centre of the cup, measured from the U line, was not modified in the patients who died or in the group of living patients without revision at last follow-up. It was modified in the group of failure group: mean 28 mm postoperatively in the failure group reaching 39 mm at time of failure (ANOVA < 10-3). We had 26 failures (18%) which occurred at six years (mean); there was a peak at two years and another at nine years. Mean Kaplan-Meier survival was 13.5 years (95CI 12.5–14). The PMA clinical score improved from 3/5/3 (11) pre-operatively to 5.3/5.6/4.3 (15.2) at last follow-up. Discussion: The overall results at 10 years in this series were globally satisfactory with a success rate above 70%. Failures were related to radiologically demonstrated graft compression with ascension of the centre of the cup measured from the U line. Comparing these results with data in the literature shows an improvement over the Harris series (7-year follow-up in a small group of 48 patients). Conclusion: This method of acetabular reconstruction reserved for major bony defects has provided a 73% rate of success at ten years

Purpose: The authors would like to report the outcome following evaluation of surgical treatment for acetabular fractures with more than 10 years follow-up. Materials and methods: 133 consecutive patients were evaluated with 10–16 years post surgery follow-up (mean 12 years). Mean age was 34 years (17 to 70 range) and male: female were 2:1. 90% of our cases were tertiary referrals. The follow-up assessments included AP pelvis and Judet view radiographs and clinical evaluation was performed with the Harris hip score, Modified Merle d’Aubigne score and the SF 36v2 health survey. Results: Fracture reduction was anatomical in 69% of the patients and in 31% it was non-anatomical. The reduction of the acetabular fractures was considered anatomical when all five lines on post-operative radiographs were corrected and the hip was congruent. Among our patients, 19% had excellent clinical results according to the modified Merle d’Aubigne Score and 58% according to the Harris Hip Score. A poor clinical outcome was identified in 18% of our patients according to the modified Merle d’Aubigne Score and 23% according to the Harris Hip Score. Radiographic evidence of osteoarthritis was in 35,8% of our patients (all grades of arthritis). 6 of our patients had neurological complications (sciatic nerve palsy) (3 pre-operatively, 2 post- operatively and in one patient there was a delayed sciatic nerve palsy secondary to haematoma). In 7 patients (8.6%) there was heterotopic ossification but in only three that was clinically a problem. Two patients developed intraoperatively pulmonary embolism. We had no post-operative deep vein thrombosis or pulmonary embolism. Conclusions: Our results compare favourably with those of previous published studies with shorter follow-up period. Anatomical fracture reduction is mandatory and improves the clinical outcome. Infection and avascular necrosis are associated with poor clinical outcome. Early surgical intervention for displaced acetabular fractures can improve the final outcome

Introduction: Cementless tapered straight stems of the first generation were introduced in 1979, those of the second generation in 1986. For further perfection SL-PLUS stems were introduced in early 1993. These were redesigned proximally and featured slimmer necks for a larger range of motion, a central trochanteric pull-out thread and a larger surface area in the proximal stem third. Method: Between 01/01/1993 and 31/03/1994 339 patients were implanted with these cementless new-generation stems. In the period under review no stems other than these, e.g. cemented implants or other implant systems, were used in primary THAs. Of the 339 patients, 218 were available for follow-up, 72 had died, 38 without revision surgery were contacted by phone and 11 were lost to follow-up. The underlying pathology was idiopathic degenerative joint disease (153 pts.), dysplastic OA (37 pts.), femoral head necrosis (12 pts.), posttraumatic OA (6 pts.) and OA of other origins (5 pts.). To evaluate changes in stem position, radiolucent lines, osseointegration and revision, clinical and monitor-controlled radiographic follow-ups were conducted at 10 years plus. Results: 5 patients were revised within the follow-up time because of: one aseptic loosening, one low-grade infection, two periprosthetic fractures, one traumatic subsidence. At the 10 year follow-ups (10,0 to 11,1, mean 10,2 years) the stem position was unchanged in all of the 213 patients. The stems had been implanted in proper anatomical alignment in 196 patients, in varus in 16 and in valgus in one patient. 93 patients showed no changes of the peri-implant bone. In 96 peri-implant bone apposition was recorded in one or more zones (Gruen). 20 patients presented with radiologic evidence of both peri-implant bone apposition and some atrophy. None of these patients showed abnormalities clinically (HHS: 95.2; 76–100). At the 10-year follow-ups 2 stems had worked loose. Another 2 patients presented with intertrochan-teric osteolyses with definite progression versus the 5-year follow-up. On analysis, radiolucent lines (RLs) were seen in zone 1 in 28.6% of cases, in zones 2 and 6 in 3.3%, in zones 3, 4 and 5 in 0.5% and in zone 7 in 22.1%. The Kaplan-Meier survival rate was 98.2% (CI 95.3 to 99.2) with revision of the stem for any reason as the end point (N = 339). Conclusion: The outcome of this quality control study showed the stem to be universally applicable in all primary THAs so that its continued use in the indications listed is well justified

Purpose: Prospective Observational Population Study to describe the incidence, demographics and pattern of spinal cord injury in British Columbia, Canada, for 10 years to 2004. Method: Systematic analysis of prospectively collected spine registry data (Vertebase) at Vancouver General Hospital, B.C., Canada from 1995–2004. Results: During the 10-year study period the 938 patients were admitted with a traumatic spinal cord injury. The Annual Population-Standardized Incidences ranged from 19.94 to 27.27 per million, with a median incidence of 23.34/million and with no significant change over the study period. The mean age was 39.7 years (34.73 in 1995 and 42.1 in 2004, p< 0.05) with a range of 16–92 years. 79.74 % were males. 48.2% of patients were AISA A on admission, of which 48% were quadraparetic. The most common levels of spinal cord injury were C5 (17.3%), C6 (10%), T1 (9.4%), T12 (5.8%). The Mean ASIA score was 50.22 with a range from 0–100. 19.8% of patients had a GCS£13. The mean ISS was 26.02, range of 0 – 75. Motor vehicle collisions and falls were responsible for 59% and 30% of admissions respectively. Mean length of in-hospital stay was 34 days, ranging from 1 – 275 days. In hospital mortality rate was 2.9%. ASIA Grade, Total Motor Score and anatomical level of injury all correlated directly with Length of stay (p< 0.0001). Conclusion: Acute Traumatic Spinal Cord Injury remains a major cause of significant morbidity among young males. The incidence appears to be increasing in the elderly. Modern multidisciplinary care has greatly reduced the associated acute mortality. Despite multiple prevention strategies the Annual Population-Standardized Incidence remained unchanged over the study period

Aim. Synovial sarcoma (SS) is a malignant soft tissue sarcoma with a poor prognosis because of late local recurrence and distant metastases. To our knowledge, no studies have minimum follow-up of 10 years that evaluate long-term outcomes for survivors. Method. Data on 62 patients who had been treated for SS from 1968 to 1999 were studied retrospectively in a multicenter study. The following parameters were examined for their potential prognostic value: age at diagnosis, sex, tumour site and size, histology, histological grade, fusion type (SYT-SSX1 vs. SYT-SSX2), and surgical margin status. Mean follow-up of living patients was 17.2 years, and of dead patients 7.7 years. Results. Mean age at diagnosis was 35.4 years (range, 6-82 years). Overall survival was 38.7%. The 5-year survival was 74.2%; 10-year survival was 61.2%; and 15-year survival was 46.5%. Fifteen patients (24%) died of disease after 10 years of follow-up. Local recurrence occurred after a mean of 3.6 years (range, 0.5-14.9 years), and metastases, at a mean of 5.7 years (range, 0.5-16.3 years). Only 4 patients (7%) were treated technically correctly. Factors associated with significantly worse prognosis included larger tumour size, metastases at the time of diagnosis, high-grade histology, trunk-related disease, and lack of wide resection as primary surgical treatment. Conclusion. In SS, metastases develop late with high mortality. Patients with SS should be followed for more than 10 years. There is a very high rate of incorrectly treated patients. Patients with suspicious lesions therefore should be sent to a referral center

We report the survival at ten years of 173 consecutive Birmingham Hip Resurfacing’s implanted between August 1997 and August 1998 at a single institution. Failure was defined as revision of either the acetabular or femoral component for any reason during the study period.

The survival at the end of ten years was 96.5% (95%c. i. 89.1 – 99.5%) The mean age of the patients at implantation was 50 years (range 15 – 75). There were 124 (72%) male cases and 49 (28%) female cases. 123 (71%) cases had the diagnosis of osteoarthritis, 9 osteonecrosis, 5 rheumatoid and 3 DDH. The posterior approach was used in 154 (89%) cases and anterolateral in 19 (11%). Cases were performed by 5 different surgeons.

There were 5 revisions, 9 unrelated deaths and 18 were lost to follow-up beyond 5 years. Two revisions occurred for infection (6 months and 2 years). A revision at 3.5 years for acetabular loosening and two further at 6.4 and 7.9 years due to avascular necrosis of the femoral head and collapse were performed. No other revisions are impending. The median pre-operative oxford hip score was 61% (IQR 48–73) and the median 10 year score was 7% (IQR 0–31) for 110 completed forms.

Further analysis of the total resurfacing database at this institution of 2775 cases was performed. Cox-proportional hazard analysis identified that component size and pre-operative diagnosis were significantly associated with failure. Although females may initially appear to have a greater risk of revision this is related to differences in the size and pre-operative diagnosis between the genders. This study confirms that hip resurfacing using a metal-on-metal bearing of known provenance can provide a solution in the medium term for the younger more active adult who requires surgical intervention for hip disease.

Purpose: There is no consensus whether the posterior cruciate ligament (PCL)should be preserved (CR) or sacrificed (CS) during primary total knee replacement (TKR). The purpose of this study was to compare the greater than 10 year survivorship and health related outcomes of CR and CS TKRs using a single implant system. Method: Between 1996 and 2000, 478 Genesis II Primary TKRs were inserted in 414 patients. Excluding those with a primary diagnosis other than osteoarthritis, body mass index greater then 40, history of prior patellectomy, fusion or osteotomy, 358 cases in 310 patients were included. 134 (37%) had a PCL preserving (CR) and 224 (63%) had a PCL sacrificing implant (CS). The two patient cohorts were compared for Kaplan-Meier survivorship, health-related outcomes (Knee Society scores, WOMAC, SF-12), range of motion (ROM) and radiographic loosening or wear. Results: Mean follow-up was 11.87±1.04 years for CR and 10.96±0.87 years for CS (p=0.001). Four cases were revised for infection. No significant differences were noted between the CR and CS Genesis II cohorts at 10 year Kaplan-Meier survivorship excluding infections (CR 0.984±0.011, CS 0.986±0.008, p=0.30). Overall revisions were two for CR (1.5%, no infections) and seven for CS (1.7%, four for infection; 1.3% excluding infections). Revision rates were not significantly different between groups including or excluding infections (p=0.493 and p=1.00 respectively). CS had significantly greater postoperative ROM than CR (CS=114.20±13.60, CR=111.35±12.38, p=0.024). At 10 years, no differences were observed in satisfaction, health-related outcomes or radiographic wear/loosening. Crepitus was reported more frequently in CS design. Conclusion: Most studies comparing PCL sacrificing (CS) versus retaining (CR) TKRs are short term. In this large, long term, single implant CR versus CS study, no differences were found in Kaplan-Meier survivorship, health-related outcomes or patient satisfaction. The CS design had more range of motion, but also a higher incidence of peripatellar crepitus than the CR design. We conclude that both CR and CS TKR designs can yield excellent long term clinical outcomes

Purpose: We report the 10 to 13 year results of the PFC knee system at our institution.

Method/Results: Between 1992 and 1995 97 PFC primary knee arthroplasties were performed consecutively in 82 patients. 32 patients have subsequently died (37 knees) and four (4 knees) are lost to follow-up. Clinical and radiological review of 46 patients (56 knees) was performed at a mean of 11.1 years post-operatively. Outcome was assessed using the Charnley modification of the Merle D’Aubigne score, with a median of 5 for pain and 4 for function. Radiological failure was defined as progressive radiolucency (1 case), lysis (1 case) or subsidence (1 case). Polyethylene wear was detectable in 10 cases, with > 50% in two. There was 100% survivorship with revision for aseptic loosening as an endpoint. There has been one revision for infection and one patella resurfacing, giving a 98% survivorship with no re-operation. In addition one periprosthetic fracture above a well fixed femoral component, required a supracondylar nail.

Conclusions: The PFC gives excellent outcome and survivorship at 13 years, regardless of the experience of the operating surgeon. This demonstrates that with careful training the PFC is a reliable knee replacement in the long-term for trainers and trainees alike.

Introduction. Total hip arthroplasties (THAs) in young patients are associated with high failure rates. We always use cemented total hip implants, however, in cases with acetabular bone stock loss we perform bone impaction grafting. Our purpose was to evaluate the outcome of 69 consecutive primary cemented total hips in patients younger than 30 years followed between 2 to 18 years. Methods. Between 1988 and 2004, 69 consecutive primary cemented THAs (mainly Exeters) were performed in 48 patients (32 women, 16 men) younger than thirty years. Average age at time of operation was 25 years (range, 16 to 29 years). Twenty-nine hips (42%) underwent acetabular bone impaction grafting because of acetabular bone loss. Mean follow-up was 10 years (range, 2 to 18 years). Revisions were determined, Harris Hip Score (HHS), and Oxford Hip Questionnaire Score (OHQS) were obtained and radiographs were analyzed. Survival was calculated using the Kaplan-Meier method. Results. No patients were lost to follow-up, but 3 patients (4 hips) died during follow-up, none of whom had underwent revision. Eight revisions were performed: 3 septic loosenings (6, 7, and 8 years post-operative) and 5 aseptic cup loosenings (2, 3, 4, 5, and 9 years post-operative). No stems were loose. The average HHS and OHQS at follow-up were 89 points (range, 55 to 100 points) and 19 points (range, 12 to 42 points), respectively. Using Kaplan-Meier analysis, the cumulative survival with revision for any reason as end point was 83% (95% CI, 69 - 92%) at 10 years. Excluding the infections, the survival rate was 90% (95% CI, 77 - 96%) with revision for aseptic loosening. The outcome of the patients who underwent acetabular bone impaction grafting was comparable to the primary cemented hips with a survival of 89% (95% CI, 62 - 97%) with revision for any reason as an end point. Excluding the infections, the survival rate was 95% (95% confidence interval, 72 - 99%) at ten years with revision for aseptic loosening as the end point. Conclusion. Primary cemented total hip arthroplasties in very young patients show satisfactory medium-term results, however, in cases with acetabular bone stock loss, a reconstruction with bone impaction grafting is advisable

We have reviewed 61 children treated for septic arthritis from 1972 to 1981. The diagnosis in all cases was confirmed by bacteriology or by radiographic changes. Routine arthrotomy was not performed, but most patients had a joint aspiration. The management and outcome are described. We suggest that arthrotomy should be selective rather than mandatory. Septic arthritis of the hip in infants requires arthrotomy, but in the older child an infected hip can be treated by aspiration if the duration of symptoms is less than four days; arthrotomy may be needed if there has been more delay. Infected joints other than the hip can be satisfactorily managed by aspiration.

Press-fit cups have given excellent clinico-radiographical results. This is a retrospective clinico-radiographical study about the long term performance of pure Titanium cementless modular press-fit cups (FitekTM) having, on the outer surface, an oriented multilayer titanium mesh (SulmeshTM) with 65% porosity (average pore size=400–640 micron). The cup was implanted after underreaming the acetabulum by 2 mm. In the cup’s equatorial area there are two “fins” originary designed to improve rotational stability but actually representing two excellent primary mechanical stabilizers. We have evaluated the first 100 consecutive cups implanted in 92 patients with an average FU of 9,7 years (range 9–11 years). All operations have ben performed by the two Senior Authors (PGM and RB). Regarding etiology, we had 43 Primary Arthritis, 37 Dysplastic Arthritis, 12 Osteonecrosis and 8 Post-traumatic Arthritis. results were evaluated with the Harris score. Radiographic evaluation was performed using AP and lateral x-rays pre-op. post-op and at the last follow-up. We had 86 Excellent, 10 Good, 2 Fair and 2 Poor. The 2 Poor results were 2 aseptic loosenings of the stem. The Mann-Whitney nonparametric U test and the Kruskal-Wallis test showed that the survival rate of the 100 analyzed cups, after a mean follow-up of 9.7 years, was 100% (end point: revision for any cause). Etiology was not statistically correlated with post-op score. Nevertheless, dysplastic patients showed inferior results compared to arthritic patients in different parameters, as pain, limp, Range Of Motion (p < 0.05), putting socks and shoes (p < 0.05). Our cups were intentionally implanted and radiographically appear in a fairly horizontal position (36.5° on average). In 6 cases we could calculate an eccentricity of the metal heads proving bidimensional linear wear of the liner (average 0.265 mm / year). At the last follow-up we had 3 femoral osteolysis, while in the acetabular side radiolucent lines were present in 14 % of the cases, never progressive. In no case we found a change of position of the cup. FitekTM cementless cups gave excellent results at 10 years with complete stability and osteo-integration. Excellent primary mechanical stability was given by the rough surface (SulmeshTM) and by the two “fins” in the equatorial area

Introduction: Anterior convex epiphysiodesis and posterior concave distraction has not been previously described in the literature for the treatment of thoracolumbar hemivertebrae. We describe our experience with long-term follow-up. Methods: Six consecutive patients with a mean age of 3.4 years were operated on using this technique. The levels of fusion extended two levels above and below the hemivertebra, while the instrumentation spanned the full length of the curve. Further concave distraction was carried out when there was evidence of loosening of the hooks. Results: The average follow-up was 10.8 years (range: eight to 14 years). The mean Cobb angle before surgery was 49 degrees, and at the latest follow-up was 26 degrees. There mean improvement in the scoliosis was 41%. In five of these cases, this correction was achieved immediately after surgery and did not significantly change despite repeated distraction. Conclusions: The addition of concave distraction provided better correction than convex epiphysiodesis alone. This method of treatment is recommended for patients with single fully segmented hemivertebrae located at the thoracolumbar junction associated with a significant deformity. This method is technically easier and safer than excision of the hemivertebra in the correction of such deformities

Aim: To compare the difference in periprosthetic bone density between cemented and uncemented total hip replacement at a minimum follow up of 10 years. Patients and methods: We looked at a cohort of 17 patients who have had bilateral total hip replacement with cemented Charnley total hip on one side and uncemented Furlong total hip on the other side between 1984 and 1994 (minimum follow up 10 years). Harris and Oxford hip scores were used to determine the function, SF 36 was used to measure quality of life and Dual energy X-Ray absorptiometry (DEXA) scan was used to quantify bone mineral density adjacent to the prosthesis. The results from the DEXA scan for cemented and the uncemented hips were analysed using Paired samples two tailed t-tests. To compare the Harris hip scores, a non-parametric Wilcoxon test was used. Pearson correlations were carried out to examine the relationship between the bone density measures (averaged for each zone) and the quality of life measures. Results: Bone mineral density was higher on the Furlong side in Gruen Zones 2, 3, 5 and 6 of the proximal femur and DeLee Charnley Zone 1 of the acetabulum. In all other zones there was no statistical difference. Comparison of Harris hip scores and Oxford hip scores showed no statistically significant difference between the two hips (p = 0.108). Age is negatively correlated with bone density in Gruen zones 6 and 7 and acetabular zones 2 and 3. Conclusion: Bone density is better preserved around the uncemented HAC coated stem compared to the Charnley cemented stem

Background. Metal on metal hip resurfacing has become popular worldwide for younger patients because of perceived advantages in function and ease of revision, due to bone conservation. Joint Registry data have shown increased risk of early failure, particularly in younger females. There have been few studies comparing the outcome of resurfacing to cemented total hip arthroplasty (THA). Methods. 715 Hip Resurfacings (HR) performed between 2000 and 2010 with up to 10 years follow-up were compared with 2210 Exeter cemented Total Hip Arthroplasties (THA) performed for all diagnoses during the same period within our region. Survivorship was recorded using revision for any cause as the end point. Harris Hip Scores were collected pre-operatively and at 1,3,5 and 7 year review. Prospective independent analysis was carried out using Kaplan Meier survivorship, and non-parametric testing to investigate the effect of age (under 55 and over 55) and gender on revision rate and Harris Hip Score. Results. Over the 10 year period survival of Exeter THA was better than HR overall. Revision rate 2% for THA and 7% for HR; P < 0.0001. There was no significant difference in risk of revision between THA and HR in males at any age. In females there was a significantly increased revision rate with HR. Under 55 Revision rates: THA 0%; HR 6.7%. 55 & over Revision rates: THA 1.3%, HR 5.9%, P < 0.0001. Harris Hip Scores were significantly better overall in the HR group. Sub-group analysis showed that Harris Hip Scores were not significantly different for males under 55. In all other groups (males over 55 and females under and over 55) Harris Hip Scores were better after HR compared with THA. Conclusions. In this series survivorship and functional scores for HR are at least as good as for THA in males. The increased risk of revision after HR in females should be weighed against advantages of bone conservation and better post-op hip scores

Study design: Long-term retrospective study of the low grade isthmic Spondylolisthesis treated by means of instrumented posterolateral fixation in adults. Objective: To evaluate clinical and functional survival of surgical treatment of the espondylolisthesis after minimum 10 years of follow-up. To study the radiologic behaviour of the fused and the adjacent level. Summary of background: It’s been suggested in many different series that posterolateral instrumented fusion is not always capable to improve the lumbar pain neither to stabilize a vertebral segment if the anterior column is not supported. The need to perform and interbody fusion in the surgical treatment of isthmic spondilolysthesis is still unknown. Material and method: From a total of 42 patients operated by low grade isthmic espondylolisthesis, it’s been obtained a clinic and radiological follow up in 31 patients, 19 females and 12 males. The average age at the moment of surgery was 34.9 years and in the last review was 46.5 years. The average follow up has been 11.8 years. Pain and functional disability was quantified by a visual analogical Scale (VAS) and the Oswestry Disability Index (ODI). Quality of life was assessed by the SF-36. The preoperative and postoperative percentage of slip and lumbosacral kyphosis was evaluated in serial radiographs at the fused level. The intervertebral disc height and dynamic behaviour was evaluated at the adjacent level. Results: Spondylolisthesis was present at L5 in 24 patients, L4 in 6 patients and at L3 in 1 patient. In the 87% of cases the fusion was one level and the 3% was two levels. The mean (range) anterior slip at postoperative was 21.9%, and 23.1% at the final follow up. The average angle for the lumbosacral kyphosis was 19.4° in the postoperative and 19.5° in the follow up. The Oswestry Disability Index scores average at follow up was 13,6. 75.8% of patients were considered with a minimum disability and 17.2% with a moderate disability. The 67.7% of the patients develop rewarded activities, the 25.6% develop domestic tasks and the 6.45% are in a disability situation. There was no statistically significant difference between the study population SF-36 scores and those of the general population, same age and gender, in any of the eight domains. Conclusions: Long-term clinical and radiographic outcomes after “in situ” posterolateral instrumented fusion of adult low-grade Spondylolisthesis were satisfactory. This study further confirms that such surgery is appropriate for these selected patients