Introduction

Arthritic knees requiring total knee replacement may present with additional deformities located along the femur or tibia away from the articular region. These deformities may be congenital, developmental, associated with metabolic bone disease, or acquired as a result of malunited fractures or previous advocated for arthritic knee with ipsilateral extra-articular deformity.

Introduction. Leg length discrepancy (LLD) is a common sequalae of limb reconstruction procedures. The subsequent biomechanical compensation can be directly linked to degenerative arthritis, lower back pain, scoliosis and functional impairment. It becomes particularly problematic when >2cm, established as a clinical standard. This two-arm experimental study assesses how reliable an iPhone application is in the measurement of LLD at different distances in control and LLD patients. Materials and Methods. 42 participants were included in the study, divided evenly into 21 control and 21 LLD patients. A standardised measurement technique was used to obtain TMM and iPhone application measurements, taken at a distance of 0.25m, 0.50m and 0.75m. Results. The mean discrepancy of iPhone-based measurements in the control group was 1.57cm, 1.59cm and 2.19cm at 0.25m, 0.50m and 0.75m respectively. This compares to measurements in the LLD cohort with a mean discrepancy of 1.71cm, 1.85cm and 2.19cm. The overall mean discrepancy of iPhone data was 1.78cm in the control cohort compared to 1.92cm in the LLD cohort. Conclusions. Results suggest that the iPhone application can be used to identify clinically significant leg length discrepancies. At 0.75 metres anomalous results become more prevalent and the accuracy of the application appears to decline. The results also suggest the application is slightly more accurate in the control group, nevertheless, in distances up to 0.50 metres the mean discrepancy sits within the 2cm standard of clinically significant LLD

Introduction. Acetabular dysplasia is a common cause of osteoarthritis of the hip. Chiari pelvic osteotomy enables medialization of the center of the femoral head and improvement of coverage over the femoral head for hip dysplasia and prevents or delays progression of degenerative arthritis. We reviewed 104 patients after this augmentation procedure. Patients and methods. Between 1989 and 2000, 167 patients with developmental dysplasia of the hip had undergone the surgery at university hospital. Among them, 104 patients were able to be traced after surgery for more than 10 years. The mean follow-up period was 15.5 years. There were 96 women and 8 men with an average age of 34.3 years at surgery. The average angle of osteotomy was 6.6 degree craniad to the horizontal plane. Ratio of migration of the distal pelvis was 42%. Results. 8 hips were replaced by prosthesis. Setting total hip arthroplasty as an end point, 10-year, 15-year and 20-year survival rate was 99.0, 92.3 and 70.0% respectively. Patients with minimal grade of osteoarthritis at the time of osteotomy preserved 5.4 mm joint space on plain radiographs of last time follow-up. Patients with moderate or severe grade of osteoarthritis at the time of surgery had only 2.5 mm joint space at last. All patients with minimal grade of osteoarthritis could avoid total hip arthroplasty. Conclusion. Chiari pelvic osteotomy can prevent progression of degenerative arthritis in patients with minimal grade of osteoarthritis for more than 15 years

Introduction. Patient demand for a less invasive surgical approach reducing the trauma induced to the joint has resulted in the development of Minimally Invasive Surgery (MIS). Although the length of the surgical incision is appealing to patients, the changes are not purely cosmetic. The surgery should not violate the extensor mechanism in any way. Incisions into the quadriceps tendon or into the vastus medialis muscle make the approach less difficult but this violation will slow the recovery and affect the ROM of the knee. In Asian knees, authors found the variation of VMO, which is essential in early functional recovery in TKA patient, is so much, so new clinical test for MIS QS should be needed to show location relationship between the upper pole of the patella and the insertion of VMO itself to avoid unnecessary injury of VMO during TKA. Purpose. The purpose of this comparison study was to verify whether MIS QS TKA can be a more functional and better method in treatment of advanced degenerative arthritis comparing with mini MIS TKA. Methods. Group I: MIS QS group were 50 knees (69.3±9.7 years) and follow up period of that were 28.8± 0.4 months. Group II: mini quad split MIS TKA were 200 knees knees (67.4±5.6 years) and follow up period of that were 34.2± 0.6 months. We did clinical and radiological assessment. Results. The length of incision of group I was 9.32±0.96 cm and that of group II was 10.9±0.5 cm. In clinical assessment, the postoperative pain score of group I was 47.5±2.74 points and that of group II was 47.4±3.27 points. The postoperative knee score of group I was 94.5±5.16 points and that of group II was 93.9±5.94 points. The postoperative knee functional score of group I was 90±8.94 points and that of group II was 93.4±6.73 points. The postoperative range of motion of group I was 122±16.9 degrees and that of group II was 116±23.5 degrees. In radiological assessment, The postoperative tibiofemoral angles of group I was 5±2.6 degrees and that of group II was 5.4±2.7 degrees. The α and β angle of group I was 95±3.5, 88±3.4 degrees and that of group II was 96±2.5, 89±2.4 degrees. The γ and δ angle of group I was 5.17±4.12, 85±1.4 degrees and that of group II was 3.96±3.1, 86±1.8 degrees. Conclusions. There were no significant differences in functions between two groups. Both MIS QS and mini Quad split TKA are an effective and safe method in treatment of advanced degenerative arthritis

Total hip arthroplasty (THA) is one of the most successful and commonly performed surgical interventions worldwide. Based on registry data, at one-year post THA, implant survivorship is nearly 100% and patient satisfaction is 90%. A novel, porous coated acetabular implant was introduced in Europe and Australia in 2007. Several years after its introduction, warnings were issued for the system when used with metal-on-metal bearings due to adverse local tissue reaction, with one study reporting a 24% failure rate (Dramis et al. 2014). A subsequent 2018 study by Teoh et al. showed that the acetabular system had a survival rate of 98.9% at five years when used with conventional polyethylene or ceramic bearing surfaces. The current study was conducted to determine the safety and effectiveness of the acetabular system using standard highly-crosslinked polyethylene (XLPE) and ceramic liners at five-year follow-up. Our hypothesis was that the acetabular system would exhibit survivorship comparable to other acetabular components on the market at five-year follow-up. A prospective, non-randomized study was conducted from February 2009 to June 2017 at eight sites in Canada and the USA. One hundred fifty-five hips were enrolled and 148 hips analyzed after THA indicated for degenerative arthritis. At five-year follow-up, 103 subjects remained for final analysis. All patients received a zero, three, or multi-hole R3 acetabular shell with Stiktite porous coating (Smith & Nephew, Inc., Memphis, TN, USA). Standard THA surgical techniques were employed, with surgical approach and either of a XLPE or ceramic bearing surface chosen at the discretion of the surgeon. The primary outcome was revision at five-years post-op with secondary outcomes including the Harris Hip Score (HHS), Hip Disability and Osteoarthritis Outcome Score (HOOS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), radiographic analysis, and post-operative adverse events. Data and outcomes were analyzed using summary statistics with 95% confidence intervals, t-tests, and Wilcoxon Rank tests. At five-year follow-up the overall success rate was 97.14% (95% CI: 91.88–100). When analyzed by liner type, the success rate was 96.81% (95% CI: 90.96–99.34) for polyethylene (n=94) and 100% (95% CI: 71.51–100) for ceramic (n=11), with no significant difference between either liner type (p=1). There were three revisions during the study (1.9%), two for femoral stem revision post fracture, and one for deep infection. The HHS (51.36 pre-op, 94.50 five-year), all 5 HOOS sub-scales, and WOMAC (40.9 pre-op, 89.13 five-year) scores all significantly improved (p < 0 .001) over baseline scores at all follow-up points. One (0.7%) subject met the criteria for radiographic failure at one-year post-op but did not require revision. Six (1.8%) of the reported adverse events were considered related to the study device, including four cases of squeaking, one bursitis, and one femur fracture. Results from this five-year, multicenter, prospective study indicate good survivorship for this novel, porous coated acetabular system. The overall survivorship of 97.14% at five-year follow-up is comparable to that reported for similar acetabular components and aligns with previous analyses (Teoh et al. 2018)

Introduction. Cementless Total Knee Replacement (TKR) was introduced to improve the longevity of implant; but has yet to be widely adopted because of reports of higher earlier failures in some series. The cementless TKR design has evolved recently and we have been using cementless component – both femoral and tibial on our patients. The long follow-up for fully TKR has been scarce in the literature. The purpose of this study isto investigate the minimum of ten years clinical and radiographic result of cementless titanium component and cementless tantalum component in primary TKR. Material & method. From 2008 to 2010 317 TKR underwent primary total knee with cementless femoral component titanium based (Zimmer Nexgen) and cementless tantalum component monoblock tibial component, The surgery was performed mainly on younger patients - average age was 48 yrs old ranging from 26 yrs old to 62 yrs old. All surgeries were performed by single surgeon. All patients were followed clinically and radiographically for a minimum of 8 yrs. Mean 7.8 years and range from 7 to 9 years. The underlying diagnosis for majority of the cases were degenerative arthritis in 97 of the cases and rheumatoid arthritis on the 3%. Result. We have revised 6 cases − 3 cases were for sepsis. They were revised in 2 stages. And we also revised 5 cases for loosening of femoral component. The tibial component revision for aseptic loosening or osteolysis for an end point for survivorship was a 100% for the tibia monoblock design. There was no radiographic evidence of tibial component loosening or subsidence, or migration at the time of the latest follow-up for tibia monoblock. On the femoral part we documented 16 cases other than those 4 revision for osteolysis, where limited osteolysis happened in some area of the tibial component but it did not affect stability and those has been followed up for a longer term. There was interesting phenomena in some of those cases where bone growth happened around the anterior cortex where it sealed the component entirely. Knee society scores improved from 51 pre-operatively to 94 pre-operatively on the last clinical visit. We had 32 cases where the patientswere able to regain their full mobility flexion of over 150 degrees. Conclusion. Our data clearly shows that the cementless TKR has excellent result as compared to the cemented with a good survival ship at 10 years. The tantalum tibial component shows an excellent survivorship. The femoral component also present reasonably good result but we still faced a few cases of loosening. The functional outcome for the implant with the surgery was satisfactory. With this result we strongly recommend using the cementless implant in young patients. We believe that cementless tibial is totally safe at this point as well as the femoral cementless prosthesis. However, we expect some improvement with the outcome with the femoral component when using the tantalum

Purpose. The purpose of this study is to compare the mid-term outcomes between rotating platform(RP) and posterior cruciate substitute(PS) bearings in LCS-total knee arthroplasty (TKA). Methods. This is a prospective randomized matched-pairs case–control study of patients who underwent primary TKAs with a minimum 2 years follow-up. The inclusion criteria was degenerative arthritis, and exclusion criteria was arthritis other than degeneration, previous operations such as osteotomy, body mass index (BMI) over 30 kg/m. 2. The matching criteria were set as age, BMI, preoperative ROM, gender, and the Knee Society (KS) and Hospital for Special Surgery (HSS) scores. After 1:1 matching, 50 cases involved the LCS RP bearing system as group 1 and 50 cases involved LCS PS bearing system group as group 2. Clinical and radiographic outcomes were evaluated. Results. The overall survival was 100% at final follow up. There were no complications between groups, such as infection, dislocation of bearing. The postoperative ROM was 122.3° ± 9.3 in group 1, 121.2° ± 9.7 in group 2. The KSKS scores were 93.5±7.2 in group 1, 92.8±3.6 in group 2 at final follow up. The KSFS scores were 87.5±7.7 in group 1, 86.9±6.8 in group 2 at final follow up. The HSS scores were 93.1±8.8 in group 1, 91.7±6.1 in group 2 at final follow up. There was no statistical difference in Hospital for Special Surgery Scores (HSS), Knee Society Scores (KSS) score evaluations between groups. However, the improvement of KSS and HSS scores was faster in group 1, the final scores were achieved at 3 to 6 months in group 1, at 6 to 1 year in group 2. Moreover, the KSFS scores were improved continuously until 2 years follow up. The postoperative mechanical axis was found as 1.2° ± 1.2 in group 1, 0.9° ± 0.9 in group 2. There were no statistical differences between groups in radiological evaluations including radiolucent lines. Conclusion. This study demonstrated that the PS-LCS prosthesis could provide satisfactory performance compared with that of the RP-LCS prosthesis with minimum 2-year follow-up, however, there could be disadvantages in PS-LCS prosthesis due to more bone loss in box cut in femur

There is an increased incidence of dislocation, dysplasia, slipped epiphysis, Perthes’ disease, and avascular necrosis leading to degenerative arthritis which occurs in up to 28% of Down's syndrome patients. As the life expectancy for patients with Down's syndrome has increased, so has the presence of hip disease. Hip replacement has been shown to have good results in this population. Special considerations include a high risk of postoperative dislocation and leg length inequality which often require large head THR or dual mobility type reconstruction to reduce these risks. Numerous spine deformities including scoliosis and C1-2 subluxation need to be taken into account-anesthesia consult

There are a number of progressive conditions that afflict the hip and result in degenerative arthritis. Along the path of progression of the disease and prior to the development of arthritis, some of these conditions may be treatable by joint preservation procedures. Periacetabular osteotomy for developmental dysplasia of the hip (DDH), femoroacetabular osteoplasty for femoroacetabular impingement (FAI), and a variety of surgical procedures for management of early osteonecrosis of the femoral head are some examples of joint preservation of the hip. DDH is characterised by abnormal development of the acetabulum and the proximal femur that leads to suboptimal contact of the articular surfaces and the resultant increase in joint reaction forces. FAI is a condition characterised by an abnormal contact between the femoral neck and the acetabular rim. FAI is believed to exist when a triad of signs (abnormal alpha angle, labral tear, and chondral lesion) can be identified. The question that remains is whether joint preservation procedures are able to avert the need for arthroplasty or just an intervention along the natural path of progression of the hip disease. There is an interesting study that followed 628 infants born in a Navajo reservation, including 8 infants with severe dysplasia, for 35 years. None of the children with DDH had surgical treatment and all had developed severe arthritis in the interim. The latter study and a few other natural history studies have shown that the lack of administration of surgical treatment to patients with symptomatic DDH results in accelerated arthritis. The situation is not so clear with FAI. Some believe that FAI is a pre-arthritic condition and surgical treatment is only effective in addressing the symptoms and does not delay or defer an arthroplasty. While others believe that restoration of the normal mechanical environment to the hip of FAI patients, by removing the abnormal contact and repair of the labrum, is likely to change the natural history of the disease and at minimum delay the need for an arthroplasty. There is a need for natural history studies or case series to settle the latter controversy

Purpose. To compare and analyze the long term follow up clinical & radiological result after utilization of fixed-type & rotating-type implant for high flex both total knee replacement. Subject & Method. This paper targeted 45 patients, 90 cases that got high flex both total knee replacement with utilization of fixed-type implant(LPS-flex. ®). & rotating-type implant(P.F.C. ®. Sigma RP-F) for 1 patient by 1 operator(C.C.H) in our hospital from 2005.01 to 2006.11. Preoperative diagnoses were degenerative arthritis (43 patients, 86 cases), rheumatic arthritis (2 patients, 4 cases), mean age at the operation was 66.4 years old(54∼78), 3 men, 42 women, mean follow up period was 110.8months(97∼120). We compared and estimated Hospital for Special Surgery(HSS) score and Knee Society Score(KSS), Western Ontario and MacMaster Universities Osteoarthritis(WOMAC) score and mean range of motion of knee joint at pre-operation and last follow up for functional & clinical evaluation. And we compared and estimated change of femorotibial angle and radiolucency through erect AP & lateral x-ray at pre-, post-operation and last follow up using American Knee Society Roentgen Graphic Evaluation for radiological evaluation. Result. On the result of clinical and functional evaluation, it showed improving outcome in both group(fixed-type implant, rotating-type implant), and there was no statistically significant difference. Mean HSS score was increased from 43.0, 37.1(pre-operation) to 93.2, 92.1(last follow-up), mean KSS score was increased from 37.1, 37.2(pre-operation) to 88.8, 87.6(last follow-up), WOMAC score was also increased from 104.8, 104.4(pre-operation) to 126.1, 128.4(last follow-up). Mean joint range of motion was increased from 104.8, 104.4(pre-operation) to 126.1, 128.4(last follow-up), but there was no significant difference between 2 groups. The change of femorotibial angle was corrected from average introversion 8.2°(pre-operation) to extroversion 4.8°(post-operation) in fixed-type implant group, and average introversion 8.3°(pre-operation) to extroversion 4.8°(post-operation) in rotating-type implant group, and there was no significant difference between 2 groups. And in all cases, there was no change of radiolucency, loosening of implant, or osteolysis at the last follow-up. Conclusion. It showed good functional, clinical and radiological result on long term follow-up in both groups that got both total knee replacement with utilization of fixed-type implant and rotating-type implant for 1 patient, and there was no statistically significant difference between 2 groups. As a result, it is considered that the selection of implant will be up to the condition of patient and experience of operator and so on

Introduction. The range of motion (ROM) obtained after total knee arthroplasty (TKA) is an important measurement to evaluate the postoperative outcomes impacting other measures such as postoperative function and satisfaction. Flexion contracture is a recognized complication of TKA, which reduces ROM or stability and is a source of morbidity for patients. Objectives. The purpose of this study was to evaluate the influence of intra-operative soft tissue release on correction of flexion contracture in navigated TKA. Methods. This is prospective cohort study, 43 cases of primary navigation assisted TKA were included. The mean age was 68.3 ± 6.8 years. All patients were diagnosed with grade 4 degenerative arthritis in K-L grading system. The average preoperative mechanical axis deviation was 10.3° ± 5.3 and preoperative flexion contracture was 12.8° ± 4.8. All arthroplasties were performed using a medial parapatellar approach with patellar subluxation. First, medial release was performed, and posterior cruciate ligament was sacrificed. After all bone cutting was performed and femoral and tibial trials were inserted, removal of posterior femoral spur and capsular release were performed. The degree of correction of flexion contracture was evaluated and recorded with navigation. Results. After the medial soft tissue release, as a first step, the flexion contracture was recorded as 7.2° ± 4.3 and 4.1° ± 4.0 as varus. The second step, posterior cruciate ligament was sacrificed, the flexion contracture was recorded as 7.2° ± 4.4 and 5.5° ± 3.0 as varus. After posterior clearing procedure and capsular release, the flexion contracture was showed as 3.9° ± 1.2 and 1.4° ± 1.2 as varus. The final angles after cemented real implant were recorded as 3.3° ± 1.4 in flexion contracture, 0.9° ± 1.8 in varus. There were significant differences all steps except between medial release step and posterior cruciate sacrifice step and between posterior clearing step and final angle. Conclusions. The appropriate soft tissue balancing could correct flexion contracture intra-operatively. The medial release could correct the flexion contracture around 5° compared with preoperative flexion contracture, and posterior clearing procedure could improve further extension. However, the sacrifice of posterior cruciate ligament provided little effect on correction of the flexion contracture intra-operatively

Total hip arthroplasty (THA) is frequently performed as a salvage procedure for the acetabular fracture when posttraumatic osteoarthritis, posttraumatic avascular necrosis, or fixation failure with subluxation develop. Special considerations for this situation include previous surgical exposure with dense scar tissue, the type and location of implants, the location and amount of heterotopic ossification, indolent infection, previous sciatic nerve palsy, and the pathoanatomy of existing acetabular defect. These factors can influence the choice of surgical exposure and the reconstructive method. The outcomes of THA after acetabular fracture are generally less favorable than those of the nontraumatic degenerative arthritis. Reason for this high failure is the low mean age and the high activity level of the patient. Other important reasons for failure include the problem of acetabular bone deficiency and compromised bone quality. We evaluated the results of cementless THA in patient who had previous acetabular fracture. We also compared this result with those of patients with posttraumatic avascular necrosis of the femoral head. Forty-five consecutive cementless THAs were performed for the treatment of post-traumatic osteoarthritis after acetabular fracture between December 1993 and December 2008. Of these patients, 15 patients were died or lost to follow-up monitoring before the end of the minimum one year follow-up period. This left 30 patients (30 hips) as the subjects of our retrospective review. We evaluated the clinical and radiographic results of these patients and compared with the results of THA in patients with post-traumatic AVN of the femoral head which had without acetabular damage. Two hips required revision of the cup secondary to early migration of the acetabular cup (1 hip) and postoperative deep infection (1 hip). There was no significant difference in clinical and radiographic results between two groups except implanted acetabular component size and required bone graft (p<0.05). The Kaplan-Meier ten-year survival rate, with revision as the end-point, was 90% and 96.7% with loosening of acetabular component as the end-point. Our series suggested that compared with cemented components, uncemented sockets may improve the results of arthroplasty after previous acetabular fracture. In conclusion, cementless THA following acetabular fracture presents unique challenge to the surgeon, careful preoperative assessment and secure component fixation with proper bone grafting is essential to minimize problems

There is continuing debate among orthopedists regarding the appropriate treatment of femoral neck fractures, open reduction internal fixation (ORIF), Total hip arthroplasty (THA) or hemiarthroplasty. In 2003 310,000 patients were hospitalized for hip fracture in the United States and about one-third were treated with total hip arthroplasty. Worldwide, the total number of hip fractures is expected to surpass 6 million by the year 2050. In a survey distributed by the American Association of Hip and Knee Surgeons, and of the 381 members who responded, 85% preferred hemiarthroplasty, 2% preferred ORIF and 13% preferred THA. The decision to perform internal fixation, hemiarthroplasty, or THA is based on comminution of the fracture activity level and independence, bone quality, presence of rheumatoid or degenerative arthritis, and mental status. Evidence based practice indicates that in a young patient with good bone stock and a fracture with relatively low comminution an ORIF is the treatment of choice. If the patient has a comminuted fracture with poor bone quality, minimal DJD, no RA, and low activity demand a hemiarthroplasty is a reasonable choice. If the patient has a comminuted fracture with poor bone quality, DJD and high activity demand a total hip replacement is a reasonable choice

We present a series of 16 patients who have had a failed ankle arthroplasty converted to an ankle arthrodesis using a surgical technique of bone grafting with internal fixation. We describe our technique using tricortical autograft from the iliac crest to preserve length and an emphasis is placed on maintaining the malleoli and subtalar joint. A successful fusion was achieved in all cases with few complications. Our post operative AOFAS improved to a mean of 70 with good patient satisfaction and compares well to other published series. From this series and an extensive review of the literature we have found fusion rates following failed arthroplasty in patients with degenerative arthritis to be very high. In this group of patients a high fusion rate and good clinical result can be achieved when the principles of this surgical technique are adhered to. It would appear that a distinction should be made between treating patients with poor quality bone and more extensive bone loss, as is often the case with rheumatoid patients; and the patients with a non inflammatory arthropathy and better bone quality. The intramedullary nail would appear to be the preferred option in patients with inflammatory polyarthropathy where preservation of the subtalar joint is probably not of relevance as it is usually extensively involved in the disease process, and a higher rate of complications can be anticipated with internal fixation

Fracture of the acetabulum can lead to degenerative arthritis of the hip, avascular necrosis of the femoral head, or both. Total hip arthroplasty is a common form of surgical treatment when significant joint changes and pain are present. Ten patients with fracture acetabulum were treated in this study using metal on metal total hip arthoplasty. The initial fracture was posterior wall fracture in one patient, posterior column fracture in one patient, transverse fracture in 2 patients, fracture dislocation in 3 patients and fracture posterior wall and column in 3 patients. The indications of arthroplasty were secondry osteoarthritis after internal fixation or after conservative management or collapse of the femoral head. Arthroplasty was done after an average period of 1.8 years (range from 1 to 4 years). After a follow up period ranged from 3 to 7 years with a mean of 4.6 years, the Harris hip score was improved from a mean of 51 (range 20 to 65) to a mean of 92.5 (range 90 to 95). Infection occurred in one case and two stages revision was done. Another case developed loosening of the acetabular component and was revised using cementless cup fixed with screws and bone graft. Metal on metal THR after acetabular fracture are relatively uncomplicated and lead to a good outcome despite the difficulties faced during the procedure

Introduction. Total Knee Arthroplasty (TKA) is highly successful in treatment of end-stage degenerative arthritis of the knee. CT-based Patient-Specific Instrumentation (PSI) utilizes a CT scan of the lower extremity to create a three-dimensional model of the patient's anatomy, plan the surgery, and provide unique patient-specific resection blocks for the surgery. There are few published studies utilizing CT-PSI. The present study prospectively evaluates clinical, operative, and radiographic outcomes from 100 CT-based TKAs using this technology (MyKnee®, Medacta International S.A., Castel San Pietro, Switzerland). Materials and Methods. 100 consecutive eligible knees (94 patients) of the senior author underwent TKA using CT-based PSI technology. The primary outcome of the study was to compare the planned pre-operative femoral and proximal tibial resections to the actual intra-operative measured resections. Clinical outcomes included pre- and post-operative Knee Society Scores, Range-of-Motion (ROM, measured by goniometer), and complication data. Pre- and 6-week post-operative long-leg standing radiographs were obtained to assess HKA alignment. The femoral component angle (FCA) in the coronal plane, the tibial component angle (TCA), and posterior slope of the tibia were also assessed. Additionally, 10 patients were selected at random to undergo a post-operative CT scan for comparison to radiographic measurements. Results. 94 patients were enrolled representing 51 left and 49 right TKAs. Average follow up was 3.9 years (range 3.5 – 4.4 years). Average Knee Society Score (KSS) improved from 44.3 to 81.8 while KSS Function Score improved from 59.1 to 81.8 at 1 year. ROM arc of the patients was 110.5 (range 0–130) pre-operatively and was 111.3 (range 0–130) post-operatively. Two patients had a post-operative infection requiring surgical intervention. There were no thromboembolic complications and no revisions in study patients. No patient required a manipulation under anesthesia for post-operative stiffness. No intraoperative complications occurred nor were there any cases of abandoning the PSI blocks for standard technique. The actual bony resections achieved during surgery were strongly correlated to the planned resections of all 6 bone fragments measured. Each achieved statistical significance (p<0.001). Average post-operative alignment was 179.36° (range 175°–186°). Alignment was 180 ± 3° in 94% of patients post-operatively. Ten patients underwent a post-operative CT scan for HKA verification. The average post-operative HKA was 179.9° (range, 176.9°–180.9°) with a standard deviation of 1.31°. When comparing our pre-operative alignment by x-ray vs. CT, we found only 0.09° (p<0.001) average difference between them. Post-operatively, we continued to show very similar results showing x-ray HKA measurement of 180.1° vs. CT measurement of 179.9° (p<0.001). Discussion. The pre-operative CT reconstruction can accurately predict the intra-operative resection depths as demonstrated here. All 6 bony resections measured to within 1mm of the predicted value in the aggregate of our series. The restoration of mechanical axis to 179.9° as measured by CT scans demonstrates the efficacy of the blocks. Conclusion. The present study demonstrates efficacy in the use of CT-based PSI - showing that the planning can accurately predict bony resections, be used safely, and achieve precise radiographic outcomes. Consequently, we routinely support the use of CT-based PSI in TKA

Objective. A study was performed in a tertiary health care centre to evaluate outcomes of arthroplasty in Indian Population. Various factors which may affect knee flexion after surgery were also evaluated. Methods. 82 patients with 60 unilateral & 22 bilateral total knee arthroplasties were included in the study. Assessment was done as per knee society knee score and function score. A simple functional questionaire including ability to squat, ability to sit cross leg, kneel while prayers, ability to use Indian toilet was filled and patients were rated accordingly as fair, good and excellent. Results. Average improvement in knee score was from 22.88 to 91.23 and function score from 16.26 to 73.59. Average range of motion improved from 80.4 to 125 degrees. Preoperative range of motion predicted final range of motion. There was significant improvement in flexion contracture (Mean 15.3 to 1.19). There was trend of increase in range of motion with time with no further gain reported after 1 year. Age, Sex, diagnosis, BMI, tibio- femoral angle did not of affect the final outcome. A Comparison was made between total condylar prosthesis & posterior stabilized prosthesis with no significant differences of outcomes between the two. 65% were rated excellent, 30% rated good & 5% fair as per functional questionaire given to the patients. Conclusion. Cemented total knee Arthroplasty provides pain relief, correction of deformity & restoration of function in inflammatory and degenerative arthritis. There is need to develop new functional scoring system for Indian population as knee society function score does not correspond to routine functional milestones of daily living achieved after total knee arthroplasty in Indian population

Introduction. A better understanding of the rate of improvement associated with aTSA and rTSA is critical to establish accurate patient expectations for treatment to reduce pain and restore function; more realistic patient expectations pre-operatively may lead to greater patient satisfaction post-operatively. To this end, this study quantifies the rate of improvement in outcomes of aTSA and rTSA using 5 different scoring metrics for 1641 patients with one platform shoulder arthroplasty system. Methods. 1641 patients (mean age: 69.3yrs) were treated by 14 orthopaedic surgeons using one platform shoulder system (Exactech, Inc). 729 patients received aTSA (65.3yrs; 384F/345M) for treatment of degenerative arthritis and 912 patients received rTSA (72.5yrs; 593F/319M) for treatment of CTA/RCT/OA. Each patient was scored pre-operatively and at various follow-up intervals (3 months, 6months, annually, etc) using the SST, UCLA, ASES, Constant, and SPADI metrics; active abduction, active forward flexion, and active/passive external rotation were also measured. 4439 total follow-up reports were analyzed (1851 and 2588 rTSA). Improvements in outcome using each metric score were calculated and normalized on a 100 point scale. The rate of improvement was analyzed using a 40 point moving filter treadline and with a 3rd order polynomial treadline over the entire range of follow-up. Results. aTSA and rTSA outcomes with each scoring metric improved in the majority of patients, where less than 5% of reports had negative improvement in each metric after 6 months follow-up. (Figure 1) Similarly, motion improved in the majority of aTSA patients, where less than 8% of reports had negative improvement after 6 months follow-up. rTSA patients had a higher percentage of reports with negative improvement in motion after 6 months followup, where <12% of patients had negative improvement in active abduction and forward flexion while <20% patients had negative improvement in active external rotation. The pattern of improvement for each metric was similar for both aTSA and rTSA, where the SST metric demonstrated the largest improvement and the Constant metric demonstrated the smallest improvement for aTSA (Figure 2) and rTSA (Figure 3). Differences in improvement between aTSA and rTSA were observed, with rTSA associated with a larger magnitude of improvement in both the Constant score and active forward flexion and with aTSA associated with larger improvement in external rotation. Finally, full improvement was reached between 12 and 24 months for both aTSA and rTSA patients where the rate of improvement associated with rTSA patients was generally 30% larger than aTSA patients during the first 12 months. Discussion and Conclusions. This database analysis of over 1600 patients demonstrates the reliability of improvements in outcomes achieved with both aTSA and rTSA using a single platform shoulder system. Future work should attempt to better understand the impact of pre-operative diagnosis, patient age/gender/BMI, and also the role of rehabilitation on the rate of improvement with each prosthesis type; additional follow-up time is required to confirm these results

The carpometacarpal joint of the thumb is one of the most common locations of degenerative arthritis. Surgical options include trapezio-metacarpal fusion, replacement or resection arthroplasty with or without interposition. We report the medium term results of a Modified Thompson's suspensionplasty. The radial half of the APL tendon was looped around the FCR tendon to create the suspension. The remainder of the tendon is then used for interposition. We carried out a retrospective review of 50 patients (67 hands) who underwent this procedure from January 1999 to December 2005. There were 41 female (52 hands) and 9 male (15 hands). The average age at the time of surgery was 62 years (range 41 years – 79 years). The average follow up was 5.33 years (1-9 yrs). 22 patients also had a concurrent second procedure to the same thumb and a further three had a third procedure. The average PRWHE score was 25 (0 – 80) and the average DASH score was 40 (24 – 100). There were eight complications which included four persistent radial sided wrist pain. Two of these underwent tenotomy of FCR, whilst two responded to conservative measures. Two patients had symptoms related to scapho-trapezoid arthritis, which responded to an injection. One patient had superficial infection which settled with oral antibiotics, whilst another patient had early chronic regional pain syndrome. Overall the satisfaction rate was 90% with 48 patients (96%) willing to undergo the same procedure again. We conclude that the modified Thompson's suspensionplasty gives excellent medium term results

Introduction. Lower limb mal-alignment as a result of fracture malunion can result in knee degenerative arthritis or predispose to early arthroplasty failure due to the altered mechanical axis. The choice of corrective osteotomy is often determined by potential complications. Opening wedge osteotomy is associated with poor bone healing especially in adult diaphyseal bone. Distraction osteogenesis enables gradual deformity correction with the gap filled by regenerate bone. Bone formation however is formed less favourably in the diaphysis and metaphyseal osteotomy is advised. We present a consecutive series of adult tibial diaphyseal correction using the Taylor Spatial Frame utilising the method of distraction osteogenesis. Method. 15 adults, 11 male and 3 female, underwent tibial deformity correction. A mid diaphyseal osteotomy was made using minimal soft tissue dissection and an osteotome. The site was determined by the centre of rotation of angulation (CORA). After a 6 day latency period distraction was undertaken by the Taylor Spatial Frame. Patients were encouraged to fully weight bear throughout the treatment process. Following regenerate consolidation the frame was removed and a below knee weight bearing cast applied for 4 weeks. Result. A mean correction of 11 degrees (4∼19) was undertaken. Correction time was a mean 13.5 days (6∼22). All osteotomies consolidated and frame removal was after a mean 136 days (92–192). All patients had at least one superficial pin site infection which responded to oral antibiotics. There were no deep infections or significant complications. Conclusion. Deformity correction at the CORA produces realignment without translation. The Taylor Spatial Frame allows accurate virtual hinge placement and stable correction of adult bone. Concern over diaphyseal osteotomy in adult bone has been previously raised but our study confirms that tibial diaphyseal correction using distraction osteogenesis is successful with minimal morbidity and rapid return to function. We believe that this should be considered as the optimal technique when undertaking tibial diaphyseal deformity correction