Introduction: Trapeziectomy is a well established surgical procedure for the treatment of osteoarthritis of the carpo-metacarpal joint (CMCJ) o the thumb. The complications have been recognised in the past, but there has been limited literature describing the management and prognosis of long term complications following Trapeziectomy. Aim: The purpose of our study was to describe our experience in management and prognosis of patients with long term complications associated with Trapeziectomy with particular references to residual pain and sensory branch of radial nerve (SBRN) paraesthesia. Methods: 118 trapeziectomy procedures were performed in 103 patients for primary osteoarthritis of the CMCJ of thumb during the period of January 2000 – December 2005 at a single centre performed or supervised by a single surgeon (senior author). The data was obtained from the case notes retrospectively. The average follow up period was 12 months. The short term and long term complications and their management were recorded and analysed in detail. Results: Long term complication rate was 23.7% (28 cases) which included 15 patients (12.7 %) complaining of residual pain at the base of the thumb, 6 patients (5.1%) had symptoms related to superficial branch of radial nerve and 2 patients (1.7%) had FCR rupture. Steroid injection was more successful than physiotherapy or splinting in majority of the patients with residual pain. Superficial branch of radial nerve symptoms resolved with time. However persistent symptoms were treated suceesfully by desensitization therapy. Conclusion: Trapeziectomy is a fairly benign operation, but the complications are more than expected and the patients must be warned to expect long term complications. Most of the postoperative problems can be effectively managed non-operatively and the prognosis remains good in majority of the cases. Patients must be reassured to expect full recovery with time

We present the clinical and radiological outcome of a prospective series of 22 Buechel-Pappas Total Ankle Replacements (TAR) implanted in 19 patients with a mean follow-up of 9 years (range 6 to 13). The only published long term results of this prosthesis in the literature are from the originators' unit. Patients have been prospectively reviewed yearly since 1991. None was lost to follow-up. The primary diagnosis was rheumatoid arthritis in 11 and osteoarthritis in 8 patients. 12 patients were female. Mean patient age was 64 (range 39 to 81). At the time of review 4 patients (6 ankles) had died between 12 and 69 months post-operatively of unrelated causes with their prostheses in situ. One patient had a below knee amputation for chronic venous ulceration 11 years after a TAR which until that point had continued to function well. One patient with severe rheumatoid arthritis had the implant removed at 8 weeks for deep infection. Another patient with rheumatoid arthritis had the TAR revised to a tibio-talar-calcaneal fusion 59 months post-operatively for talar avascular necrosis. One patient has pain from impingement and another patient with rheumatoid arthritis has intermittent pain at 8 years following her TAR. Every other implant continues to function well. The New Jersey LCS ankle assessment scores increased from a mean of 35 pre-operatively to 82 post-operatively. The increases were largely due to pain relief and improved function with the pre-operative range of motion being preserved. These scores have been maintained in the long term. No surviving implant is radiologically loose. Our results suggest that the Buechel-Pappas TAR offers good clinical and radiological long-term results to patients with often disabling ankle arthritis

Primary total hip arthroplasty in patients with osteoarthrosis secondary to developmental hip dysplasia is often more complex due to anterolateral acetabular bone deficiency. Femoral head (shelf) autograft provides a non-immunogenic, osteoconductive lateral support with the potential for enhanced bone stock should revision surgery be required. The technique has been shown in other series to give reliable early results but may be complicated by graft revascularisation and collapse. As yet, no study has assessed shelf grafts long term or quantified the need for further bone graft at revision surgery. This study aims to assess initial graft union rate; quantify long term graft resorption and; quantify the need for further bone graft in the patients requiring revision surgery. A retrospective analysis of a single surgeon's series of 31 THR in 25 patients was conducted. Post-operative, biplanar radiographic analysis was performed at 3 and 6 months and annually thereafter for a mean of 14 years (range 8-18). Grafts were assessed for union, resorption and displacement. Intra-operative necessity for bone graft at revision surgery was recorded. Union, osseous 93%, fibrous 7%. No grafts displaced. In 71% less than one-third of the graft resorbed, in 29% one-third to one-half resorbed and in no grafts did greater than a half resorb. Of 10 patients revised, 2 required bone graft for inadequate bone stock. Femoral head autograft allows effective acetabular coverage with excellent rates of union, minimal graft resorption in the long term and improves bone stock in revision surgery

We aimed to assess the long term results of patients who underwent Autologous Chondrocyte Implantation (ACI) for osteochondral lesions of the talus. Between 1998 and 2006, 28 patients underwent ACI for osteochondral lesions of the talus. All these patients were prospectively reviewed and assessed for long term results. Outcomes were assessed using satisfaction scores, Mazur ankle score and the AOFAS score, and Lysholm knee score for donor site morbidity. The 28 patients who underwent the procedure included 18 males and 10 females. Follow up ranged from 1–9 years. In all patients, there was an improvement in the Mazur and AOFAS ankle scores and the Lysholm scores showed minimal donor site morbidity. Improvement in ankle score was independent of age and gender. The better the pre-op score the less the difference in post-op ankle scores. Patients were unlikely to benefit with pre-op ankle scores over 75. The mid to long term results of ACIs in the treatment of localised, contained cartilage defects of the talus are encouraging and prove that it is a satisfactory treatment modality for symptomatic osteochondral lesions of the talus. Complications are limited. However, in view of limited number of patients, a multi-centre randomised controlled study is required for further assessment

Introduction The Buechel-Pappas Total Ankle Replacement (BP TAR) has been used in Cornwall since 1991. The early results were presented to the Foot Society in 1997. The only published long term results of this pros-thesis are from the designer’s unit. Method We present the clinical and radiological outcome of a prospective series of 22 BP TARs implanted in 19 patients with a mean follow-up of 9 years (range 6–13). The primary diagnosis was rheumatoid arthritis (RA) in 11 and osteoarthritis in eight patients. Twelve patients were female. Mean patient age was 64 years (range 39–81). Patients were reviewed at yearly intervals. None were lost to follow-up. Results At the time of review, four patients (six ankles) had died between 12 and 69 months post-operatively of unrelated causes with their prostheses in situ. One patient had a below knee amputation for chronic venous ulceration, 11 years after a BP TAR which was functioning well. One patient with severe RA had the implant removed at 8 weeks for deep infection. A second patient with RA had the TAR revised to a tibiotalocalcaneal fusion 59 months post-operatively for talar avascular necrosis. One patient has pain from impingement and another patient with RA has intermittent pain at 8 years following TAR. Every other implant remains asymptomatic. The New Jersey LCS ankle assessment scores increased from a mean of 35 pre-operatively to 82 post-operatively. The increases were largely due to pain relief and improved function with the pre-operative range of motion being preserved. These scores have been maintained in the long term. No surviving implant is radiologically loose. Conclusion Our results suggest that the BP TAR offers good clinical and radiological long-term results to patients with often disabling ankle arthritis

A reduced range of movement post total knee replacement (TKR) surgery is a well recognised problem. Manipulation under anaesthesia (MUA) is a commonly performed procedure in the stiff post operative TKR. Long term results have been variable in the literature. We prospectively followed up 48 patients since 1996 from one centre, over an average of 7.5 years, (range 1 to 10 years) and report on the long term results. The mean time to MUA post TKR was 12.3 weeks (range 3 to 48). Pre MUA, the mean flexion was 53°. The mean immediate passive flexion post MUA was 97°, an improvement of 44° (Range 10° to 90°, CI < 0.05). By one year, the mean flexion was 87°, improvement of 34°, (range −15° to 70°, CI< 0.05). At ten years the mean flexion was 86°. We found no difference between those knees manipulated before or after 12 weeks. In addition there was no difference found in those knees which had a pre TKR flexion of greater or less than 90°. There were no complications as a result of MUA. However, one patient was eventually revised at two years secondary to low grade infection. Our findings show that MUA is safe and effective method at improving the range of motion in a stiff post operative TKR. The improvement is maintained in the long term irrespective of time to MUA and range of motion pre TKR

Starting in 1977 a new cemented stem made of titanium alloy (with vanadium) was designed regarding some principle: rectangular shape, smooth surface covered with thin layer of titanium oxide, filling the medullar cavity. As a consequence: a thin layer of cement. It was designed with a collar. Initial Cementing technique used dough cement, vent tube and finger packing; then we applied cement retractor low viscosity cement and sometimes Harris Syringe. At the moment we went back to initial technique plus a cement retractor made of polyethylene. Many papers looked at long term follow up results depicting about 98 to 100 percent survivors at 10 years and 95 to 98% at 20 years (Hernigou, Hamadouche, Nizard, El Kaim). Clinical as well as radiological results are available. Radiological results depicted some radiolucent lines that appeared at the very long term. They could be related to friction between the stem and the cement. As advocated by Robin Ling, he called “French paradox” the fact that if a cemented prosthesis is smooth and fills the medullary cavity, long term excellent results could be expected. This was the case with stainless steel Kerboull shape, the Ling design (Exeter)and the Ceraver design. The majority of these stems were implanted with an all alumina bearing system. And in some occasion, when revision had to be performed, the stem was left in place (108 cases over 132 revisions). Our experience over more than 5000 stems implanted is outstanding (see figure 1: aspect after 30 years). Discussion other experience with cemented titanium stem were bad (Sarmiento, Fare). We suspect that this was related either to the small size of this flexible material, or to the roughness of its surface. If one uses titanium cemented stem it must be large enough and extra smooth

The authors offer their personal experience with long term results on 71 patients (72 allografts) operated between 1961 and 1990. 23 were large osteoarticular grafts, 28 intercalary grafts and 20 fibular grafts. We used one composite hip endoprosthesis in 1988 after 16cm proximal femur resection due to Ewing sarcoma in a 10 year old girl. From the 23 osteoarticular grafts 14 (60%) are long term survivals including one after fracture salvage. Six had to be removed due to infection. From the 28 intercalary grafts 16 (57%) are surviving over 15 years. Infection occurred in 6 patients with chemotherapy. Two of them had intra-arterial CDDP and one additional radiation. All of the proximal humerus allograft had complete resorption of the proximal head within 3 years. The diaphyseal reconstructions with additional cancellous autografts incorporated within 3 years. The patient with the composite stem had two cup revisions, but the stem is doing well and we observed only a mild osteolysis at the proximal part of the graft between the 2nd and 5th year that remains stable. Fractures of the graft can be salvaged in most cases. Infection leads to the removal of the graft in almost all cases. Factors influencing the survival, remodeling and complications of the grafts are discussed. The regime of cryopreservation, fixation and loading of the graft influence these factors together with the use of autologous bone chips around the allograft-host junction as well as the application of chemotherapy or radiation. Fracture of the graft can be salvaged in most cases in contrary to infection that remains the most severe complication that can occur at any time period. Even with the improvement of tumor endoprostheses the use of allografts remains an optional solution especially in young patients

Background: Short-term cure rates of two stage revision for infection after TKR are approximately 90%. Little is known about the long-term reinfection-free survival or the mechanical durability of the reimplanted prostheses. The purpose of the study is to evaluate the mid to long term results of this technique with regards to persistence of infection, clinical and radiographic results. The hypothesis is that the success rate of the technique is maintained through long term follow-up, with a low rate of recurrent infection and mechanical implant failure. Methods: from January 1990 to august 2002, 124 two stage revision TKR for infection were performed at Our Institution with mean follow-up of 9,8 years (5 to 17,5). The clinical results were evaluated with SF12, WOMAC, and KSCRS performed preoperatively and postoperatively at 5 and 10 years. A radiographic analysis was performed using x-rays of the last available follow-up. Results: the WOMAC and KSCRS significantly improved at the 5 years follow-up decreasing slightly at 10 years. The SF12 postoperative variation was not significant. The radiographic results showed possible loosening of the tibial or femoral components on 17% and 12% of patients respectively. There were 17 reoperations, 10 of which for persistent infection (85% of survival at 10 years). Discusssion and conclusion: we are encouraged by the rate of eradication of infection at 10 or more years in these difficult cases. The long term clinical and radiographic results are satisfactory. The study supports the sustained use of this technique for infected total knee arthroplasties

Introduction: There is still debate on the effect of operative treatment on severe displaced intra-articular fractures of the os calcis. Operatively treatment consists of open reduction or percutanious screw fixation, with conflicting results. Although the results of either operative treatment are published, little is known about the long term results of non-surgical treatment of these difficult fractures. Patients and Methods: We analyzed the data of 35 patients with an intra-articular fracture of the oc calcis which were treated with a plaster cast between 1994 and 2006. All radiographs of the fracture and the radiograph at the latest follow-up were analyzed. All patients which could be traced were invited for a clinical examination and a radiograph. A Foot Function Index-score (FFI) and AOFAS score were recorded as clinical outcome. A regression analysis was performed with the clinical outcome (AOFAS score and FFI) as outcome and age, gender, Bohler’s and Gissane’s angles, trauma mechanism and type of fracture as predictors. Results: After a median follow-up of 10 years the mean AOFAS score was 75.8 (range29–100) and the FFI was 22.9 (range 0–71). In the regression analysis we found that none of the predictors could predict the outcome. Even the Bohler’s and Gisae angle did not predict the clinical outcome. Although there was a strong correlation between the Bohler’s angle on the lateral radiograph and the occurrence of degenerative changes in the long term follow-up, both Bohler’s angle and the degenerative changes did not correlate with the clinical measures. Conclusion: Although Bohler’s angle is a strong predictor for degenerative changes after a calcaneal fracture, both Bohler’s angle and the degenerative changes on the radiograph were not correlated with the clinical outcome

Introduction: Between 1990 and 2000 we reconstructed 123 hips in 110 patients using impaction bone grafting with frozen, morsellised irradiated femoral heads and cemented sockets. This review presents the medium to long term survivorship of irradiated allograft in acetabular reconstruction in our cohort of patients. Patients and Methods: Patients were reviewed in out-patients. Radiographs were examined for union, lucency and component migration. The mean age at revision with allograft was 64.3 years (26 to 97). 86 hips (70%) in 74 patients were reviewed both clinically and radiologically. At the time of review 28 patients (29 hips) had died and 5 patients (5 hips) were lost to follow up. Of those patients who had died 18 hips had been followed up to a mean of 66 months (12–145). A further 3 hips were unable to attend for clinical review but had accurate implant-allograft survivorship data. Their data were included in survivorship analysis to the time of last clinical review. Results: There have been 19 revisions; 9 for infection, 7 for aseptic loosening and 3 for dislocation. In surviving acetabular reconstructions, union of the graft had occurred in 64 out of 67 hips (95.5%). Radiolucent lines at the bone cement interface were seen in 12 hips (17.9%; 9 in a single DeLee zone and 3 in multiple zones) but none were considered loose. Migration of the acetabular component greater than 5mm was seen in 3 hips (4.5%). Survivorship analysis using revision as an end point for all indications at 10 years was 83.3% (95% C.I. 68 to 89%) and 71.3% (95% C.I. 58 to 84%) at 15 years. Conclusion: Acetabular reconstruction using irradiated allograft and a cemented cup is an effective reliable technique with good results in the medium to long term comparable to series using non irradiated freshly frozen bone

In Far East, including Japan and the Middle East, daily activities are frequently carried out on the floor. Deep flexion of the knee joint is therefore very important in these societies. Some patients who underwent total knee arthroplasty (TKA) in these countries often perform deep flexion activity, such as squatting, cross-leg sitting and kneeling. However it is still unknown that deep flexion activity affects long term durability after TKA. The purpose of this study was to examine the correlation between deep flexion and long term durability. Between December 1989 and May 1997, 507 total knee arthroplasties were carried out in 371 patients using the Bi-Surface Knee System (Japan Medical Material, Osaka, Japan) at two institutions and routine rehabilitation program continued for one to two months after TKA. One patient who underwent simultaneous bilateral TKA was excluded because of pulmonary embolism within one month. The other 505 knees (370 patients) were divided into two groups according to the range of flexion after our routine rehabilitation program; one group (Group A: 207 knees) consisted of more than 135 degrees flexion knees and the other group (Group B: 298 knees) consists of less than 135 degrees flexion knees. Patients whose follow-up period was less than 10 years were excluded from this clinical evaluation. Range of flexion was measured preoperatively, at the time after routine rehabilitation program, and at the latest follow-up. Knee function was evaluated on the basis of Knee Society knee score and functional score preoperatively and at the latest follow-up. Kaplan-Meier survivorship analysis was performed with revision for any operation as the end point. In Group A, the mean preoperative range of flexion was 133.0±16.3 degrees, and at the time after routine rehabilitation program, this improved to 139.7±5.1 degrees. This angle maintained to 136.2±14.3 at the latest follow-up. In Group B, the mean preoperative range of flexion was 111.6±20.4 degrees, and at the time after routine rehabilitation program, this improved to 114.5±13.6 degrees. This angle maintained to 118.2±17.8 at the latest follow-up. The Knee Society knee score and functional score was improved from 43.0±16.9 points and 39.0±20.2 points preoperatively to 95.1±5.8 points and 51.8±21.2 points at the latest follow-up, respectively in Group A. The Knee Society knee score and functional score was improved from 37.1±16.7 points and 31.9±18.4 points preoperatively to 92.5±8.7 points and 53.1±26.1 points at the latest follow-up, respectively in Group B. Kaplan-Meier survivorship at 10-year was 95.5% in Group A and 96.2% in Group B with any operation as the end point. The survivorship between Group A and Group B was not statistically significant. Good range of flexion was maintained and Knee society score was excellent after a long time follow-up for the patients who achieved deep flexion after TKA. Deep flexion was proved not to affect long term durability in this Bi-Surface Knee System

Compartment syndrome is a devastating complication of limb trauma requiring prompt decompression by means of fasciotomy; however to date little is known about the long term morbidity directly related to the fasciotomy procedure. This is a retrospective study from June 2001 to July 2008 of all patients undergoing fasciotomy in a tertiary referral centre following trauma to a limb. In total this comprised of 66 patients and of these one had since died and five were uncontactable. Therefore 60 patients were surveyed, 48 of whom underwent lower limb fasciotomy and 12 underwent upper limb fasciotomy. Patients were subjected to a phone survey with end points including weakness, parasthaesia and dysasthaesia which had persisted for more than one year post-op. The results were then correlated with time to fasciotomy, site of fasciotomy, initial post-op complications and Methods: of closure. 42 out of 60 patients (70%) reported persistent symptoms. Of these 20 (33%) reported that their symptoms limited them severely either occupationally or socially. Lower morbidity was seen in the upper versus the lower limb fasciotomy group, with decreased incidence of persistent severe symptoms (16.7% versus 35%). Twelve patients had early post-op complications (seven wound infections, 1 cardiac arrest, 2 amputations, 2 haematomas requiring evacuation). Amongst those with post-op complications, 10 out of 12 had persistent symptoms with severe symptoms seen in 80%. In terms of Methods: of closure, 39 patients had delayed primary closure, six were allowed to heal by secondary intention and 15 patients underwent skin grafting. All patients who underwent skin graft were symptomatic at the time of survey with 80% being severely symptomatic. Meanwhile of the patients allowed to heal by seconday intention 83% were asymptomatic. Mean time to closure of fasciotomy was four days. In those patients who were closed in three days or less, 47% were asymptomatic with 23% mildly symptomatic. In the group closed between 8–14 days 37% were symptomatic while all patients closed after 14 days were severely symptomatic. These results demonstrate significant morbidity associated with the fasciotomy procedure. Incidence was highest amongst those undergoing leg or thigh fasciotomy, those who had early post-op complications, those who were closed late and those who were closed with split/ full thickness skin graft. This was most dramatic in those who underwent skin grafting, a vast majority of whom were severely symptomatic. Long term sequelae were lowest in those with upper limb fasciotomies, those undergoing early primary closure and those that were allowed to heal by secondary intention

Previously ankylosed or surgically arthrodesed hip joints can be converted successfully to a Total Hip Replacement (THR) in order to improve patient mobility and function. We present a long term prospective cohort study of cementless revisions of previously ankylosed hips. Sixteen hips (15 patients) with a mean age of 52 years (range 16 to 75) had ankylosed hips for a mean of 36 years (range 3.5 to 65 years). They all received a cement-less THR between August 1988 and January 2003 and were prospectively followed-up for a mean of 11 years (range 5.0 to 19 years). Two patients died during the study period of unrelated causes and none were lost to follow-up. All patients showed improved mobility and function following the conversion of their ankylosed hips. The Harris Hip Score improved from a pre-operative mean value of 70 (Standard Error of Mean (SEM) 3.4) to a post-operative value of 83 (SEM 4.4) at the latest review, which was statistically significant (p < 0.05). There was one acetabular cup revision at 5 years post implantation for aseptic loosening. At a mean of 11 years post THR, all other femoral and acetabular components remained clinically and radiographically well fixed. One patient with systemic ankylosing spondylitis and spontaneous bilateral bony hip ankylosis developed the unusual complication of Paget’s disease of the Left hemipelvis and proximal femur two years after successful bilateral THR surgery. His symptoms resolved following medical therapy for Paget’s disease. We conclude that a previously ankylosed hip can be effectively converted to a cementless total hip replacement with good long term results

This study describes the long term clinical and patient reported outcomes following simple dislocation of the elbow. We identified all adult patients treated at our trauma centre for a simple dislocation of the elbow over 10 years. 140 patients were identified and 110 (79%) patients were reviewed at a mean of 88 (95% CI 80–96) months after injury. This included clinical examination, the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, an Oxford Elbow questionnaire and a patient satisfaction questionnaire. Patients reported long-term residual deficits in range of movement. The mean DASH score was 6.5 (95% CI 4 to 9). The mean Oxford Elbow score was 43.5 (95% CI 42.2 to 44.8). The mean satisfaction score was 85.6 (95% CI 82.2 to 89). Sixty-two patients (56%) reported persistent subjective stiffness of the elbow. Nine (8%) reported subjective instability and 68 (62%) complained of continued pain. The DASH, Oxford Elbow and satisfaction scores all showed good correlation with absolute range of movement in the injured elbow. After multivariate analysis, a larger elbow flexion contracture and female gender were both independent predictors of worse DASH scores. Poorer Oxford Elbow scores and overall satisfaction ratings were predicted by reduced flexion-extension arc of movement. Patients report good long term functional outcomes after simple dislocations of the elbow. These are not entirely benign injuries. There is a high rate of residual pain and stiffness. Functional instability is less common and does not often limit activities

Introduction: The treatment of stage 3 hallux rigidus is controversial. Cheilectomy, fusion and total joint replacement have all been advocated. No consensus is agreed on the best optimal management. We present our results of a ceramic on ceramic MOJE metatarsophalangeal (MTP) joint replacement. Aim: To find out the medium to long term outcome following MOJE MTP joint replacement. Material and Methods: A sample of 95 patients was identified, between January 1999 to July 2006 from our data base who underwent MOJE metatarsophalangeal joint replacement. We divided these patients into three groups. First group had screw fit ceramic MOJE joint replacement; second group Mark 1 ceramic on ceramic press fit MOJE joint replacement and third group Mark 2. Indications of the surgery were osteoarthritis (primary or secondary), osteochondral defects, inflammatory arthropahty, previous infections and previously failed surgery. The outcome was analysed clinically, radiologically and functionally (using AOFAS and QALY scoring system). Results: This study shows that the early results are promising but the medium and long term results show early radiological loosing. The significance of this is not known but based on these results we would advice caution on the use of these implants and further long term studies are required

Objective: To evaluate the clinical and radiological outcome of an intra-articular bone-patellar tendon-bone (B-PT-B) anterior cruciate ligament reconstruction in combination with an extra-articular tenodesis (Lemaire procedure), at very long term follow-up. Methods: Out of a total of 148 patients, 100 were available for clinical and/or radiological evaluation in 2006. The minimum follow-up is 21 years with a mean of 24.5 years. Outcome parameters included objective (IKDC) and subjective (KOOS) clinical scores, and radiographs (standing, TELOS). Results: 84% of the patients were very satisfied or satisfied. The objective IKDC classification was: A=17%, B=41%, C=34%, D=8%. In 2006, 27% had narrowing < 50% (C) and 27% had narrowing > 50% (D). Onset of osteoarthritis correlated with medial meniscus status and medial femoral chondral defects. Knees with a preserved (healthy or sutured) medial meniscus had a significantly (p< 0.05) better radiological outcome. 24% had narrowing < 50% (C) and 12% had narrowing > 50% (D). Risk factors for osteoarthritis were: medial meniscectomy, residual laxity, age at intervention and femoral chondral defects. Conclusion: The outcome of anterior cruciate ligament reconstruction using a B-PT-B in combination with extra-articular tenodesis is satisfactory in the very long term, in knees with a preserved medial meniscus and normal cartilage

We aimed to review the outcome of Agility total ankle replacements carried out in our institution between 2002 and 2006. Follow-up consisted of clinical and radiological review pre-operatively, then at 6 weeks, 6 and 12 months, and annually until 10 years post op. Clinical review included the American Orthopaedic Foot and Ankle Score, satisfaction and pain scores. Case notes were reviewed to determine intra and post-operative complications. 30 arthroplasties were performed in 30 consecutive patients. Pre-operative diagnosis was rheumatoid arthritis(16), primary osteoarthritis(12) and post-traumatic osteoarthritis(2). After a mean follow up of 6.2 years (1.4–10.1), 4 patients had died, and 22 out of the remaining 24 were available for follow-up. Intra operative complications included lateral malleoli fracture(3) and superficial peroneal nerve injury(2). Post operative complications included 1 early death, but this was not related to the surgical procedure. Two patients developed deep infections of the prosthesis. One underwent removal of the implant; the other is on long term oral antibiotic therapy. One patient had delayed union of the syndesmosis and six patients had non-union. On clinical assessment, patients' AOFAS scores improved from mean 40.4 pre-op to 83.5 post-op (p< 0.001). Radiological assessment of the tibial component revealed 25 (93%) patients had lucency in at least one zone in the AP radiograph. We found a relatively high level of re-surgery and complications following Agility total ankle replacement. A 7% revision rate is much higher than would be tolerated in knee or hip arthroplasty, but compares favourably to other studies of TAR. Despite radiological features which suggest loosening, the high rate of re-surgery and complications; patients are generally satisfied with the procedure, reporting lower levels of pain and improved function. Overall we feel that the Agility ankle is an acceptable alternative to ankle arthrodesis, however patients need to be warned of the risk of re-surgery

Aims: Evaluation of: 1/ type and incidence of pelvic ring injuries, 2/ type and incidence of associated injuries, 3/ type of pelvic ring injuries pathomechanism, 4/ influence of pelvic ring injuries on trauma severity score, 5/ analysis of clinical long term results. Material and methods: Retrospective evaluation of 257 patients with pelvic ring injuries treated between 1989–2003 had been made. Mean patients age was: 65 y.o. (Range: 32–61 y.o.). Mean follow-up time: 57,5 months (range: 18–192 m.). All patients were treated no operatively: bed-rest, hamaque suspension, and skeletal traction. Analysis of pelvic injuries was made by Tiles classification. Evaluation of pelvic injuries pathomechanism was made by Young-Burgess classification. Clinical end results were evaluated by Iowa Pelvic Score. In polytraumatized patients trauma severity was evaluated by AIS and ISS. Results: Incidence of pelvic injury in hospitalized patients was 1,3%. In study group there were following pelvic injury types: type A – 14 %, type B – 77 % and type C – 9%. Pathomechanisms of pelvic injuries in study group were following: type LC – 61%, type APC – 30%, type VS – 2%, type CMI – 7%. Long term clinical results in Iowa pelvic Score were for pelvic ring injuries: type A – 92 p., type B – 86 p., type C – 67 p. Mean value of ISS index in patients with pelvic ring injuries was 23p, mean value of ISS index in patients without pelvic ring injuries was 19p. Conclusions: 1/ pelvic ring injuries in standard orthopedic and traumatic department are rare, 2/ pelvic ring injuries are frequent in polytraumatized patients, 3/ type C according to Tile’s classification is the most frequent type of pelvic ring injury, 4/ type LC according to Young-Burgess classification is the most frequent type of pelvic ring injury pathomechanism, 5/ incidence of pelvic ring injury in polytraumatized patient increases ISS index, 6/ long term clinical results suggested that most pelvic ring injuries can be successfully treated nonoperatively

Previously ankylosed or surgically arthrodesed hip joints can be converted successfully to a total hip replacement (THR) in order to improve patient mobility and function. We present a long term prospective cohort study of cementless revisions of previously ankylosed hips. Sixteen hips (15 patients) with a mean age of 52 years (range 16 to 75) had ankylosed hips for a mean of 36 years (range 3.5 to 65 years). They all received a cementless THR between August 1988 and January 2003 and were prospectively followed-up for a mean of 11 years (range 5.0 to 19 years). Two patients died during the study period of unrelated causes and none were lost to follow-up. All patients showed improved mobility and function following the conversion of their ankylosed hips. The Harris Hip Score improved from a pre-operative mean value of 70 (Standard Error of Mean (SEM) 3.4) to a post-operative value of 83 (SEM 4.4) at the latest review, which was statistically significant (p < 0.05). There was one acetabular cup revision at 5 years post implantation for aseptic loosening. At a mean of 11 years post THR, all other femoral and acetabular components remained clinically and radiographically well fixed. One patient with systemic ankylosing spondylitis and spontaneous bilateral bony hip ankylosis developed the unusual complication of Paget’s disease of the left hemipelvis and proximal femur two years after successful bilateral THR surgery. His symptoms resolved following medical therapy for Paget’s disease. We conclude that a previously ankylosed hip can be effectively converted to a cementless total hip replacement with good long term results