Degree of early integration of titanium alloy implants into bone is an important predictor of long term implant success in arthroplasty. The correlation between observations on early cell adhesion and the ability of modified surfaces to affect osseointegration of implants in in vivo models is unclear. We hypothesised that observation of increased focal adhesion complexes in early cultures of osteoblasts would correlate with increased osseointegration of treated implants in an animal model. Longer term culture of rat osteoblasts for alkaline phosphatase activity indicated that cells cultured on the 9V treated surfaces were displaying greater alkaline phosphatase activity at 14 days. Bone nodule formation at 28 days demonstrated a trend towards smaller area of bone nodules on the surfaces treated at 9V then those treated at 3V and 5V. A rat model was employed for testing mechanical push-out strength of experimental implants and demonstrated a trend towards increased yield strength of the bone-implant interface for implants treated at 3V180s and 5V180s. Histomorphometry was performed and no statistically significant differences in percentage area of contact with mineralised bone matrix were seen, although there was a trend for greater mineralised matrix contact on the polished and 9V180s treated implants. Previous experiments demonstrated cells on the 9V treated surfaces were well spread and had significantly increased size and number of focal adhesions. This was regarded as indicating more successful cell adhesion. The above results demonstrate that this early trend disappeared in longer term culture did not persist in experiments in an animal model.

Background

Uncemented implants are an important part of the arthroplasty armamentarium. Risk of aseptic loosening and failure of these components is related to initial osseointegration - the formation of a seamless bone-implant interface without interposition of fibrous tissue.

This study was designed to evaluate the performance of a new patient specific interpositional knee device. Treatment of osteoarthritis is evolving, allowing surgical treatment options at an earlier stage. The interpositional knee device is a recently developed patient specific implant used for the treatment of mild to moderate uni-compartmental osteoarthritis. The benefits over traditional methods of surgical management are: it's less invasive, can be a day procedure and does not limit future options. Young Adults with early uni-compartmental arthritis are suitable. A MRI scan of the patient's knee is reviewed by local and US radiologists to decide if the patient is suitable for the implant. A bespoke implant is produced. Prior to insertion an arthroscopic procedure is undertaken to allow proper positioning of the implant.

We treated 27 patients with the iForma Conformis interpositional knee implant in South Wales at the Princess of Wales Hospital, Bridgend and the Royal Glamorgan Hospital, Llantrisant since November 2007. The pre- and post-operative WOMAC scores were recorded. The average age was 54.7 years, BMI 32; 10 females and 20 males. The average pre-operative WOMAC score was 42.2 improving to 62.9 post-operatively. 35 implants were used. 7 patients experienced post-operative problems. No dislocations were reported. Average follow-up was 12.6 months.

Our early experience suggests patient selection plays a role in the outcome following surgery. It indicates that this device is a viable and safe alternative to a uni-compartmental knee replacement.

The use of a quadrupled hamstring graft in ACL reconstruction is well established. There are many described techniques in securing graft fixation, the optimal method is not yet established. The aim of this study was to review the results of a single surgeon series using the above implants looking at functional outcome for the patient and implant survivorship.

Patients were recruited for the study who had completed 8 months of post-op rehabilitation following primary ACL reconstruction and that had received the same surgical technique using the same implants from one surgical team. Patients undergoing a revision procedure were excluded. All patients received the same post-operative rehabilitation. Those who met the inclusion criteria were contacted via a postal survey using the Lysholm and Tegner questionnaires.

In total 77 patients were eligible for inclusion, consisting of 10 females and 67 males with a mean age of 31 (range 16-56). A 77% survey return rate was achieved with average follow up of 25 months (range 9-44). The mean Lysholm score was 82.1, with 59% ranking their knee as good or excellent. On average patients dropped 1.8 levels on the Tegner activity rating from a pre-injury average of 7.5 to post rehabilitation average of 5.7. There was a 100% survivorship of implants with no revisions undertaken due to implant failure.

The study has shown that this cohort of patients has produced self reported outcomes analogous to findings in the current literature. No obvious problem with implants was observed. It has highlighted the multiple factors associated with the outcome of ACL reconstruction and demonstrates that the quadrupled HT graft using Bio-Intrafix and Rigidfix implants produces short to mid-term functional and activity levels in keeping with the literature standard.

Treatment of osteoarthritis is evolving, allowing more options of surgical intervention at an earlier stage. The interpositional knee device is a recently developed patient specific implant used for the treatment of uni-compartmental osteoarthritis. It is designed for use in mild to moderate osteo-arthritis only. The benefits it offers are, that it is less invasive than traditional methods, can be performed as a day procedure and does not limit future options.

Young adults with uni-compartmental arthritis are suitable for this implant. A MRI scan of the patient's knee is reviewed by radiologists to decide if the patient is suitable. A bespoke implant, based on the MRI data, is produced. Prior to insertion an arthroscopy is undertaken to allow proper positioning of the implant.

We have treated 26 patients with the iForma Conformis interpositional knee implant in South Wales at the Princess of Wales Hospital, Bridgend and the Royal Glamorgan Hospital, Llantrisant since November 2007. The pre- and post-operative WOMAC scores were recorded. Average age was 54.7 years, BMI 32; 9 females and 17 males. The average pre-operative WOMAC score was 42.2 with an improvement to 62.9. 33 implants were used (19 right, 14 left). 7 patients experienced post-operative problems (5 implants removed and 2 MUAs). No dislocations were reported. Average follow-up time was 12.6 months (range 6-26 months).

Our early experience suggests patient selection plays a vital role in the outcome of patients following surgery. It indicates that the interpositional knee device is a viable and safe alternative to a uni-compartmental knee replacement.

Introduction

Surgical treatment options for osteoarthritis of the first MTPJ include fusion, excision arthroplasty, interposition arthroplasty and replacement arthroplasty. ¹ Arthroplasty of the first MTPJ is not a treatment modality that is, as yet, widely accepted. ^2,3 although early results are promising.

The Toefit-plus (tm) first MTP joint arthroplasty is an uncemented modular hemi or total joint replacement. The aim of this study was to look at the short to medium term outcome of the Toefit-plus(tm) system, performed by a single surgeon in a district general hospital.

AIMS

To review the results of a single surgeon series using the above implants looking at functional outcome and implant survivorship.

Introduction

Venous Thromboembolism is a well documented complication of Total hip and total knee replacement, and NICE guidelines recommend use of pharmacological prophylaxis routinely after these procedures. Current practice in our department is use of mechanical prophylaxis routinely, and chemical prophylaxis in high risk cases only. Previous departmental audit has shown VTE rates to be lower than the national average, however medical and haematology audit has contradicted this, and suggested that practices should be revised to include chemical prophylaxis routinely. This study seeks to determine whether we are seeing the full extent of the problem and whether our practices should be revised accordingly.

Treatment of osteoarthritis is evolving, allowing surgical treatment options at an earlier stage. The interpositional knee device is a recently developed patient specific implant used for the treatment of mild to moderate uni-compartmental osteoarthritis. The benefits over traditional methods of surgical management are: it's less invasive, can be a day procedure and does not limit future options. Young Adults with early uni-compartmental arthritis are suitable. A MRI scan of the patient's knee is reviewed by radiologists to decide if the patient is suitable. A bespoke implant is produced. Prior to insertion an arthroscopy is undertaken to allow proper positioning.

We treated 27 patients with the iForma Conformis interpositional knee implant in South Wales at the Princess of Wales Hospital, Bridgend and the Royal Glamorgan Hospital, Llantrisant since November 2007. The pre- and post-operative WOMAC scores were recorded. The average age was 54.7 years, BMI 32; 10 females and 20 males. The average pre-operative WOMAC score was 42.2 improving to 62.9 post-operatively. 35 implants were used. 7 patients experienced post-operative problems. No dislocations were reported. Average follow-up was 12.6 months.

Our early experience suggests patient selection plays a role in the outcome following surgery. It indicates that this device is a viable and safe alternative to a uni-compartmental knee replacement.

Aim: To evaluate the effectiveness of all inside meniscal repair technique in treating bucket handle tears of the meniscus in the athletic population.

Method: From 2005–2008, 40 patients underwent meniscal repair for bucket handle tear of the meniscus, either as a primary procedure or combined with ACL reconstruction. All patients were contacted by clinical review, letter or telephone retrospectively. All patients were scored using the Tegner Knee score. All patients had been participating in sport at international level, semi professional level or club level. Failure was defined as a recurrence in symptoms necessitating reoperation and success as a return to competitive sport.

Results: There were 27 medial meniscal tears and 13 lateral, in 38 knees. The average age was 23 years (16–39). The average length of follow up was 1.5 years (0–2–3.1) years, and the average time from injury to surgery was 47 weeks. 9 patients were treated with fast fix (Smith and Nephew Endoscopy) and 31 Rapidloc (DePuy Mitek). There was an average of 2.85 sutures used. The overall cumulative survival rate at two years was 83.9% (4 Failures). All reoperations were preceded by a subsequent traumatic event to the knee resulting in a recurrence of symptoms. Time to return to sport in patients with associated ACL reconstruction was not affected by conincidental meniscal repair. Of the primary meniscal repairs the time to return to previous sport was less than 4 months.

Conclusion: This study shows that meniscal repair has a high success rate for sporting individuals with meniscal tears and has a high chance of the individual returning to competitive sports.

Background: goal of our study was to predict the size of intramedullary nail using forearm as reference. Intra-medullary nailing has become favoured treatment for femoral shaft fractures. An implant of the correct size is needed to achieve the desired results. Preoperative templating is useful and well established for trauma and elective surgery to ensure availablity of a suitable implant of correct size preoperatively. Various ways have been described to estimate the nail length. Most commonly used is to x-ray the other limb or directly measure the reamer under x-ray. However these methods involve use of x-rays and information is not well-timed. We describe a simple technique, which can be used to predict the length of femur and therefore have the intra medullary nail of appropriate length available.

METHOD: measurements were taken on 100 volunteers from the tip of olecranon to the tip of little finger and tip of greater trochanter to palpable joint line on the lateral side of the knee. Two observers took the measurements on both sides. We used an ordinary plastic tape measure for ease of use and reproducibility.

RESULTS: statistical analysis revealed a very strong correlation (with pearson correlation factor of 1) between the two lengths. Difference between the two means was 0.16 Mm.

CONCLUSION: forearm reference represents maximum nail length required. It provides a useful method of estimation of femoral length. It can be easily applied in clinical practice with a tape measure alone without resort to x-rays and other expensive and possibly harmful means.

The Unispacer knee system is a cobalt-chrome self-centring tibial hemiarthroplasty device for use in the treatment of isolated medial compartment osteoarthritis of the knee. The indications for use are similar to those for high tibial osteotomy, but insertion does not require bone cuts or component fixation, and does not compromise future knee replacement surgery. A prospective study of a consecutive series of 18 patients treated with the Unispacer between June 2003 and August 2004 was carried out to determine the early clinical results of this device. The mean age of the patients was 49 years (40 to 57). A total of eight patients (44%) required revision within two years. In two patients revision to a larger spacer was required, and in six conversion to either a unicompartmental or total knee replacement was needed. At the most recent review 12 patients (66.7%) had a Unispacer remaining in situ. The mean modified visual analogue score for these patients at a mean follow-up of 19 months (12 to 26) was 3.0 (0 to 11.5). The mean pain level was 30% that of the mean pre-operative level of 10. The early clinical results using this device have been disappointing.

This study demonstrates that use of the Unispacer in isolated medial compartment osteoarthritis is associated with a high rate of revision surgery and provides unpredictable relief of pain.

Introduction: Fractures of the neck of femur has a considaerable impact on the NHS and due to the elderly group of population it involves morbidity can be very costly. We assesed the outcome of trauma patients with these fractures after providing orthogeriatric care in our hospital.

Aim: 179 patients had been studied who had been managed in our hospital over a period of 18 months with hemiarthroplasty for displaced intracapsular fracture of the neck of femur. 104 patients had routine orthopaedic care and 75 patients had regular orthogeriatric care. All the complication were noted, analysed and compared with the national averages.

Methodology: This was a retrospective study-clincal notes of all patients who had hemiarthroplasty during the 18 month period were reviewed and a performa was completed.

Result: Total sample size was 179 patients(104 before and 75 after the introduction of orthogeriatric service) who had hemiartroplasty for the displaced intracapsular fracture of the neck of femur. The median length of stay being 16.5 days before and 20 days after. The medical complications before and after the introduction of this service were-Cardiac complication 4% before and 1% after, Chest infection 2% before and 1% after, DVT 2% before and 1% after. The Overall complication rate has been reduced from 41% to 18% and the one year mortality reduced from 16.34% to 12 with the introduction of orthogeriatric service.

Conclusion: We believe that the weekly ward round and a continued supervision by the orthogeriatric team is one of the factors in improving the outcome of geriatric trauma patients in terms of reduced morbidity and mortality.

Osteochondroma is the most common benign bone tumour. The risk of sarcomatous change in an isolated lesion is approximately 1%. We report a case of an isolated osteochondroma which appeared benign on clinical and plain radiographic examination but routine histological analysis revealed non-Hodgkin’s lymphoma in the underlying bone. This association has not previously been reported and the case emphasises the importance of routine histological analysis, even if a lesion appears benign.

Purpose: In this ongoing trial we are analysing the performance of both a fixed bearing total knee replacement and a mobile bearing total knee replacement using gait analysis and a patient-based questionnaire. We aim to find out if there is a difference in the functional performance of the two types of prosthesis.

Method: Patients are taken from the in-patient waiting list of three consultants and introduced to the trial if deemed suitable. Each patient is analysed once pre-operatively and on three occasions post-operatively (6 weeks, 3 months and 1 year) at the university gait analysis laboratory. At each visit various anthropological measurements are recorded and the patient fills in an “Activities of Daily Living” questionnaire. After calibration and measurement of the passive range of motion of both knees each patient has their gait analysed over a series of six walks using a standard 5 camera system with skin marker clusters, the kinematic data from this is supplemented with force-plate recordings and video analysis of each set of walks. Data is recorded for both of the patient’s knees. The staff in the gait analysis laboratory are blinded as to which prosthesis has been used for each patient in an effort to eliminate bias.

We present our methodology and some preliminary results.

Introduction: The natural history of bone bruises of the knee and their clinical significance remains unclear with only a few short term studies in the literature.

Aim: This study was designed to try and elucidate the long term outcome of bone bruises of the knee following trauma.

Materials and Methods: 60 patients with bone bruises identified in their knees by MRI scans following trauma were included in the study. All patients were reviewed in a research clinic with a minimum 5 year follow up. A detailed history including mechanism of injury, persistent symptoms and functional status was obtained. Clinical examination to identify intra-articular pathology was then undertaken. All patients had a repeat MRI scan of the knee. The relationship between the injury and the bone bruise, the effect of treatment if any and the long term outcome of such lesions was studied.

Results: 80% of the patients had a twisting injury with our without a hyperextension of valgus/varus force. 58% of our series had ACL injuries and 68% of the bone bruises were in the medial condyle. 72% of the patients did not return to their pre-accident status and had continuing symptoms although the majority of them did not have signs of clinical instability. There was MRI evidence of lasting sequelae of bone bruises in the majority of patients. Detailed results will be discussed.

Conclusions: bone bruises identified on MRI following trauma to the knee are significant lesions with the potential for long term sequelae.

Acute swelling of the hand is a common problem after trauma or surgery and is associated with both pain and loss of function. We describe a prospective study of 47 patients in which we assessed the effects of a pneumatic compression device (A-V impulse hand pump) on the swollen hand. The pump reduced swelling by increasing the velocity of venous return as demonstrated by Duplex scanning of the median cubital vein.

Continuous use of the pump for 48 hours gave a reduction of 78.6% in swelling of the injured hand compared with the opposite, uninjured side. Even when used intermittently, with the pump on for 12 hours out of 24, a statistically significant effect was seen.

There was a subjective reduction in pain and an objective improvement in function of the hand. Use of the pump resulted in a nearly normal hand by the time of discharge from hospital after, on average, 48 hours.

1. The surface of mature adult human articular cartilage from the knee has been studied by electron microscopy in eleven patients ranging in age from thirty-seven to eighty-three years. The ultrastructural appearance varies from person to person and often from area to area in the same specimen. These variations range from an intact surface to one showing overt fibrillation visible with the light microscope.

2. In areas where the articular surface appears intact the underlying superficial matrix consists of closely packed collagen fibres with only a small amount of interfibrillary ground substance. The collagen fibres show a predominantly tangential orientation in this region of the cartilage. Osmophilic lipidic bodies are sometimes seen in the matrix very close to the joint surface.

3. The appearances under the electron microscope are altered in what is interpreted as an early ultrastructural change in the development of cartilage fibrillation. In the affected areas the collagen fibres show abnormally wide separation by an excessive amount of interfibrillary matrix. Collagen fibres become directly exposed to the joint cavity, and the surface can also show accumulations of finely granular material and sometimes tuft-like projections containing collagen fibres and fine fibrils. At a slightly later stage shallow clefts and steeply sloping curves are apparent at the surface. It is suggested that these various alterations precede the development of overt fibrillation visible under the light microscope.

4. Electron micrographs occasionally show small "blisters" at the articular surface. Electron microscopy has not given evidence of shedding of cells into the joint cavity from non-fibrillated areas of adult human articular cartilage. Cells can, however, sometimes become exposed at the surface in fibrillated areas.