Aims: Purpose of this study was to obtain long term follow-up in patients with Osteofibrous Dysplasia (OFD), in order to investigate natural history of the disease, late results of treatment, and potential risk of Adaman-tinoma development in this setting. Methods: A retrospective study of 48 patients with histologically proven OFD observed at our Institution between 1900 and 1997 was undertaken. Clinico-pathologic features of all cases were reviewed and found consistent with OFD. A clinical status update and current radiographs were obtained in all patients. A subgroup of 21 patients with minimum follow-up of 20 years (21 to 44 years, average 27) was analysed for functional result and adamantinoma development. Functional result according to MTS-ISOLS score correlated with surgical aggressiveness. Results: Best results were observed in patients that received a single biopsy or curettage; worse results were seen after multiple resections or osteotomies and associated with complications as infection or compartment syndrome. No patients had current symptoms or significant symptoms changes nor physical findings, radiographic clues or subsequent radiographic changes suggesting adamantinoma development. Conclusions: OFD is a benign condition; the natural history of the disease has minimal consequences in the adult life. Surgical treatment is usually not necessary and may actually worsen the result because of the potential for severe complications. The relationship with adamantinoma remains unclear, follow-up is suggested

Introduction: The purpose of this study was to evaluate the clinical and radiographic long term follow-up results of vascularized fibular grafting (VFG) as a joint preserving procedure for osteonecrosis of the femoral head (ONFH). Materials and Methods: Between October 1979 and December 1992, 97 hips in 89 patients with ONFH that had follow-up for at least 10 years (range: 10 years – 21 years) were evaluated. The mean age at the time of operation was 34 years. There were 49 hips with Ficat stage II radiographic changes and 48 hips with stage III disease. The disease was associated with consumption of alcohol in 19 hips, trauma in 17, and the use of steroids in 7. In the remaining 54 patients, the condition was idiopathic. Results: Overall satisfactory results, including excellent, good or improved by 10 points, were seen in 78 hips (80.4%) clinically, and 63 hips (64.9%) showed radiographic improvement or no change.†Radiographically, new bone formation and remodeling was found in 32 hips; and no further progression of necrosis in 31 hips while progression of collapse was found in 34 hips. There were only 9 conversions to total hip anthroplasty (THA) at the last follow-up. By Kaplan-Meier survivorship analyses, there was a significant lower rate of conversion to THA in patients who were less than 35 years. The probability of conversion to THA was not significantly related to etiology, radiologic stage, or location of involvement of the necrosis. Discussion: VFG not only has an excellent new bone formation and remodeling capacity, but also is one of the highly recommended joint preserving procedures in symptomatic ONFH in younger patients with early collapsed disease. Furthermore, femoral head replacement can be avoided or at least postponed in advanced stages of disease in the younger population

The purpose of this study was to evaluate trabecular bone response, at fifty-two week follow-up, to four different synthetic graft materials (CaSO4 and CaSO4 – HA/TCP composites) as compared to autograft in a canine defect model. The group with the highest HA/ TCP proportion had the greatest amount of residual graft material and total mineralized material. Increasing the proportion of HA/TCP reduces the rate of dissolution, and appears to have little effect on bone formation at long term follow-up. This study further suggests that a range of composites could be created to match the spectrum of resorption rates demanded by clinical applications. The purpose of this study was to evaluate trabecular bone response to four synthetic graft materials (CaSO4 and CaSO4 – HA/TCP composites) as compared to autograft in a canine defect model, at long term follow-up. Both 85% CaSO4 – 15% HA/TCP and 65% CaSO4 – 15% HA/TCP showed bone formation similar to autograft. The group with the highest proportion of HA/TCP lasted longer than the other formulations. The results suggest that increased HA/TCP proportions reduce the rates of dissolution, without compromising bone formation in the current model. Results suggests that a range of composites could be created to match the spectrum of resorption rates demanded by clinical applications. In this REB-approved RCT, bilateral humeral and femoral cylindrical defects were filled with one of four types of pellets with varying proportions of CaSO4 – HA/TCP, autograft bone, or left unfilled. After sacrifice at six, twelve, twenty-six or fifty-two weeks, defect sites were evaluated histologically for tissue and inflammatory response, area fractions of residual graft material, and bone ingrowth in the defects. The area of the defect occupied by residual graft material in the group with the highest percentage of HA/TCP was greater than in other composite groups (p< 0.0001). This group contained the greatest amount of total mineralized material (graft material + bone) (p< 0.03. The extent of new bone formation increased from twelve to twenty-six weeks (p< 0.0001). Both 85% CaSO4 – 15% HA/TCP and 65% CaSO4 – 15% HA/TCP showed bone formation similar to autograft. Funding: Research grant from Stryker Howmedica, Matwah, NJ

From January 2003 a long term follow-up project started for adult patients treated in our Centre for cancer in pediatric age, to evaluate late effects of therapy. For all patients a personalized follow-up was scheduled (time, function-tests, etc). We analyzed 24 cases of bone tumors: 14 osteosarcoma (OS) and 10 Ewing’s sarcoma (ES). Median age at diagnosis was 13 years (range 11–18) for OS patients, 11.6 years (range 6–18) for ES; 50% males in both groups. All patients were treated according current CNR/ISG-protocols: all OS cases underwent surgery; in 5/10 ES patients local treatment was surgery, in 5/10 radiotherapy; 7/24 received hematopoietic stem cells transplantation (HSCT). Median age at evaluation is respectively 26.5 years (range 18.7–34) and 23.5 (range 21.6–32); median follow-up is 13 years (range 6–22) and 13.7 (range 6.7–22.3). Cardiovascular function is normal in all OS cases; 3/10 ES patients developed asymptomatic ejection fraction reduction, currently not treated. One OS patient underwent bilateral thoracotomy and HSCT for multiple metastases at diagnosis and had a mild lung function alteration. One OS patient developed mild chronic kidney disease, one ES nephrolithiasis. Liver function is normal in all cases. Height velocity and final height are normal in 10/14 OS and 9/10 ES patients; in remaining 5/24 no growth hormone secretion deficit was found. One OS patient developed primitive hypothyroidism and one OS benign thyroid nodule with partial thyroidectomy; one patient multifocal papillary thyroid carcinoma with total thyroidectomy at 11 years from diagnosis of ES. Spermatogenesis deficit is a common find (5/7 OS and 5/5 ES male patients); one female treated with HSCT and radiotherapy for ES pelvic relapse has primitive hypogonadism. No other hypothalamo-hypophyseal-adrenocortical system hormones deficit was found. We reported no significant neuropsychological alterations nor employment problems: 20/24 patients have a job, 4/24 are students. Three OS females have children

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.

Purposes: To evaluate the effectiveness of Posterior Lumbar Interbody Fusion (PLIF) surgery in resolving back and back related leg pain and its effect on quality of life.

Methods: Two hundred and twenty six patients who met the inclusion criteria of degenerative disc disease, spondylolisthesis, disc herniation and postlaminec-tomy/postdiscectomy syndrome unresolved by conservative therapy were entered into the study. Patients were assessed using a self-administered questionnaire containing the Oswestry disability index (ODI) for back pain related disability, visual analogue scales (VAS) for back and leg pain severity (0 = none, 10 = worst imaginable pain) and the SF-36 general health questionnaire. Outcomes were assessed preoperatively and at a minimum of 2 years follow-up. Statistical significance was tested using a paired t-test after confirming normality of the data.

Results: Of the 226 patients,182 (99 females, 83 males; mean age at treatment, 45.3 years; age range 15 – 67 years) returned follow-up questionnaires (81% response). The mean duration of follow-up was 26.4 months (range 24 – 60 months). The ODI showed a statistically and clinically significant improvement between baseline (52.1) and follow-up (29.5), (22.6(17.8 to 27.5); P= 0.000). This represents a 43% improvement in functional ability. There was a statistically and clinically significant improvement between VAS back pain scores at baseline (7.7) and follow-up (3.9), (3.8 (3.1 to 4.4); P = 0.000 ). This represents a reduction of 49%. Similarly VAS leg pain at baseline (6.6) and follow-up (3.2) ,(3.4 (2.7 to 4.2); P = 0.000) showed a reduction of 52% which was also statistically and clinically significant. All dimensions of the SF-36 except role physical showed a statistically and clinically significant improvement.

Conclusion: The results show that in our series, there is a statistically and clinically significant improvement in pain, functional ability and quality of life after PLIF surgery in patients with chronic back and leg pain unresolved by conservative therapy.

Purposes: To evaluate the effectiveness of Posterior Lumbar Interbody Fusion (PLIF) surgery in resolving back and back related leg pain and its effect on quality of life.

Methods: Two hundred and twenty six patients who met the inclusion criteria of degenerative disc disease, spondylolisthesis, disc herniation and postlaminec-tomy/postdiscectomy syndrome unresolved by conservative therapy were entered into the study. Patients were assessed using a self-administered questionnaire containing the Oswestry disability index (ODI) for back pain related disability, visual analogue scales (VAS) for back and leg pain severity (0 = none, 10 = worst imaginable pain) and the SF-36 general health questionnaire. Outcomes were assessed preoperatively and at a minimum of 2 years follow-up. Statistical significance was tested using a paired t-test after confirming normality of the data.

Results: Of the 226 patients,182 (99 females, 83 males; mean age at treatment, 45.3 years; age range 15 – 67 years) returned follow-up questionnaires (81% response). The mean duration of follow-up was 26.4 months (range 24 – 60 months). The ODI showed a statistically and clinically significant improvement between baseline (52.1) and follow-up (29.5), (22.6(17.8 to 27.5); P= 0.000). This represents a 43% improvement in functional ability. There was a statistically and clinically significant improvement between VAS back pain scores at baseline (7.7) and follow-up (3.9), (3.8 (3.1 to 4.4); P = 0.000 ). This represents a reduction of 49%. Similarly VAS leg pain at baseline (6.6) and follow-up (3.2) ,(3.4 (2.7 to 4.2); P = 0.000) showed a reduction of 52% which was also statistically and clinically significant. All dimensions of the SF-36 except role physical showed a statistically and clinically significant improvement.

Conclusion: The results show that in our series, there is a statistically and clinically significant improvement in pain, functional ability and quality of life after PLIF surgery in patients with chronic back and leg pain unresolved by conservative therapy.

Introduction: Total Knee Replacement (TKR) is a routine and common orthopaedic operation. Approximately 600 TKRs are performed annually at Royal Bournemouth Hospital. Although contemporary advice is that these patients should have long-term follow-up, there is very little evidence to support this protocol that involves considerable resources. We have had a policy of early discharge from follow-up (6–12 weeks) for over 10 years.

Purposes of the study: To validate the efficacy of the policy of early discharge after total knee arthroplasty at 8–10 years post surgery and to identify whether this policy has made revision surgery more difficult or complex as a result of possible late presentation.

Methods: 798 consecutive patients who underwent primary Total and Unicompartmental knee arthroplasy at Royal Bournemouth Hospital during the period 1 April 1994 to 31 March 1996 were identified. Medical records and operative notes were analysed for all patients from this cohort who have had any further surgery on their index knee. The waiting lists were also checked to identify patients from this cohort waiting for further surgery.

Results: The mean age at index operation was 72 years (range 37 to 92 years). 39/798 patients (4.9%) have had revision surgery at 8–10 years follow-up. Many of the revisions were performed on patients with early problems and 15/39(38%) of the revisions were performed on patients who were rereferred to clinic. There was a 1.1% deep infection rate leading on to revision (9 knees).

8/39 of revisions were for resurfacing the patella (20%). One patient who had a complex patella fracture needing patellectomy later had further revision surgery for instability requiring posterior stabilised components. In no patient was the revision surgery compromised or made reconstructable due to delayed presentation. In total 3 patients required bone grafting of contained cavities and only 5 knees with aseptic loosening required revision implants with stems.

Conclusion: We do not accept the need for long-term follow-up of successful implants especially whilst using prostheses with a proven track record in elderly patients.

Objective: To assess whether Webb Morley Instrumentation had satisfactory long term results.

Design: A retrospective review of 52 patients who underwent fusion and instrumentation with Webb Morley Instrumentation between 1991–1997.

Subjects: 52 patients were reviewed, 32 patients with idiopathic scoliosis who underwent isolated anterior fusion, 19 patients with neuromuscular scoliosis who underwent anterior and posterior surgery.

Outcome measures: Preoperative and postoperative radiographs, ISIS scans, and patient review. The in-patient notes were assessed for duration of surgery, blood loss, hospital stay and complications. Correction of Cobb angle and union were assessed.

Results: In the idiopathic group Cobb angle improved by 57%, apical rotation by 36% and tilt angle by 56%. There were no major complications and all united. The implant has a tendency to kyphose the spine, and an average of 7 degrees of kyphosis was seen across the implant. In the neuromuscular group Cobb angle improved by 52%, apical rotation by 21% and tilt angle by 57%. There was one asymptomatic pseudarthrosis, two rod breakages and two posterior rod dissociations. Only one patient complained of significant back pain.

Conclusions: Webb Morley instrumentation offers results as good as most other anterior implant systems. The flexibility of the rods may be a relative advantage, with a high union rate. Although the implant tends to kyphose the spine this has not been a problem clinically at follow-up of 4-11 years. This may help in design of future implants.

Introduction: Many surgeons recommend surgical resection of symptomatic tarsal coalition. The success of this procedure in reducing symptoms has been well described in the literature, but long term results remain scarce. In 1967 Mitchell et al described a series of 41 resections of calcaneonavicular coalition with an average 6 year follow up. In 1990 Gonzalez et al described two groups who underwent a total of 75 resections of calcaneonavicular coalition by multiple surgeons. We describe the largest combined series of calcaneonavicular and talocalcaneal coalition resection with a minimum follow up of 3 years and a maximum of 12 years (average 9.5 years).

Methods: We retrospectively studied the clinical results of a consecutive series of 79 primary resections for tarsal coalition in 63 patients carried out by the senior author over a 12 year period. A standard resection procedure was performed in each case. Duration of symptoms, side of maximal symptoms, activity level, family history, peroneal spasm, and patient weight preoperatively was recorded retrospectively using medical records. Visual analogue pain scores, analgesia requirement, activity level, time to return to maximum activity, occupation, patient and parent satisfaction level, peroneal spasm, range of motion, AOFAS ankle-hindfoot score, and patient body mass index was recorded at follow up.

Results: At follow up the majority of patients had mild or no pain and did not require regular analgesia, had some limitation of recreational activities but not of daily activities, and had some stiffness. The majority of patients and parents were satisfied with the outcome.

Discussion: Resection of tarsal coalition is recommended when symptomatic but also is recommended bilaterally when present regardless of symptomatology of the lesser affected foot.

Purpose of this study is to examine the long-term follow-up in prosthesis reconstruction after proximal humerus resections.

Material and methods From February 1975 to December 1990, 144 patients have been operated for a musculoskeletal tumor of the shoulder girdle with resection and reconstruction using a modular cemented prosthesis. The MRS prosthesis is assembled in three parts with a ball shaped rotating head stitched to the glenoid and acromium. Seventy patients died and 3 patients were lost to follow-up: 71 achieved a follow-up more than 10 years (123–259, av 175 mo). Age ranged from 9 to 73 years (mean 29.7). The resection was intrarticular in 44 cases, in 12 more the glenoid was resected along with the proximal humerus (extrarticular resection) and in 15 cases we performed a Tikhoff –Lindberg procedure.

Infection occurred in 7 patients (10%) from 1 to 144 months (median 12 mo): in 6 patients prosthesis removal was needed to achieve healing.

Mechanical complications were present in 19 patients (27%): 15 (21%) had prosthetic head instability (5 surgically treated), 2 breakage of the prosthetic stem and 2 prosthetic disassembly.

Results: A detailed roentgen graphic analysis has been developed to better define the long-term course of the cement bone interface. Only 3 aseptic stem loosening were detected at 1, 3 and 11 years (after a supercondylar fracture occurred 8 months before). Eighteen patients were reoperated (25%); in 4 cases with minor surgery. Failure of the system occurred in 11 cases (15%).

Conclusion: The long durability of this cemented prosthesis has been demonstrated with very few cases of stem loosening in the early follow-up time. The problem of a good prosthetic head suture is still under concerning particularly in Tikhoff-Lindberg procedure.

Aim: The aim of the present study was to evaluate the functional results of the Latarjet procedure. Moreover we analysed the prevalence of glenohumeral OA after this intervention. Patients and Methods: Forty patients were included in the study. All the patients were clinically evaluated according to the system of Rowe, Duplay and Constant. X-ray evaluation was useful to detect bony lesions, to evaluate the position and the evolution of the graft, and according to the system of Samilson the grade of glenohumeral OA. Results: At follow-up none of the patients had recurrent dislocation. Only two patients reported occasional subluxation, and 1 case had a positive apprehension test. The average score for strenght according to the system of Constant was 16 points (min/max: 9/22) for the operated shoulder and 19 points (min/max: 12/24) for the uninvolved side. Pre-op radiographs demonstrated a bony lesion in 37 cases (90%): in 35 cases was discovered a lesion of the glenoid rim and in 36 shoulder was detected an Hill-Sachs lesion. In only one case was detected a Samilson grade 1 degeneration. Post-op radiographs showed a correct positioning of the coracoid graft in 32 cases, too lateral in 5 cases and too medial in 3 cases. Glenohumeral OA: 2 cases Samilson grade 2; 1 case Samilson grade 1. Conclusion: Our data confirm that Latarjet technique is an efficient procedure in chronic anterior shoulder instability in sportsmen so to allow to more than 80% of our patients to return to sport activities.

Introduction: The objective for this study was to assess the long term results for minor column allograft used in revision hip arthroplasty.

Methods: We prospectively included patients undergoing acetabular cup revision using minor column allograft with a minimum of 5 years follow-up. Minor column allograft was used in uncontained acetabular bone defects of sizes between 30% and 50% of the acetabulum. Acetabular failures requiring re-revisions at any time after surgery were included. Acetabular failure for any cause requiring re-revision surgery was used as end-point. Graft failure was considered when re-revision required the concurrent use of structural bone graft, metal augments or excision arthroplasty for any cause.

Results: There were 65 cases that met the study criteria. We included 5 deaths with a mean follow-up of 11.9 years (6.8–14.8) and 10 losses to follow-up after a mean follow-up of 11.7 years (5.3–17.4). Twenty eight acetabulum failed, with 14 occurring before 5 years at a mean of 1.8 years (0.1–4.8) and 14 occurring after 5 years at a mean of 12.2 years (5.6–23.2). Causes included aseptic loosening (23), infection (2), dislocation (1), graft non-union (1) and cup fracture (1). Fourteen grafts failed, with 8 occurring before 5 years at a mean of 1.2 years (0.5–4) and 6 occurring after 5 years at a mean of 11.3 years (6–23.2) after surgery. The mean improvement in modified Harris Hip Scores was 32.3 at 1 year and 32.6 at last follow-up assessment. The cup survivorship was 56.9 % and graft survivorship 78.5 % at a mean follow-up of 16.3 years (5.3–24.8).

Discussion: Metal augments have been used in revision arthroplasty for low demand patients but we recommend the use of minor column allografts in higher demand patients who are more likely to require further revision surgery.

This is a prospective study of 74 consecutive LCS total knee replacements of which 34 were meniscal-bearing and 40 rotating-platform total knee arthroplasties comparing functional and radiological outcome measures of the New Jersey total knee replacement.

The study is based on a cohort of 96 patients who were followed up over a period of 8.6 to 15.6 years (mean 11.8 years). 49 patients (64 knees) were living and 5 patients were lost to follow-up. At time of follow-up 37 patients were dead. The patients were aged 23 to 81 (mean 64.5) at the time of surgery.

The methods used include a pre- and post-operative New Jersey Orthopaedic Hospital Scoring Scale (NJOHSS). In addition the cohort were assessed postoperatively using the Knee Society Score (KSS) and the Knee Society Radiological Evaluation Form (KSREF).

The results of the study showed that there was a significant overall improvement in the NJOHSS (mean improvement = 22.4 points) with 81% of the cohort scoring ‘good to excellent’ post-operatively. When the two types of arthroplasty were compared there was no significant difference in improvement in the NJOHSS. However, both the ‘Post-op’ and ‘Function’ components of the post-operative KSS were greater in the rotating-platform total knee replacement. The comparison of the post-operative KSREF did not show any significant differences between the two types of arthroplasty.

Revision procedures were carried out in 3 patients with meniscal-bearing arthroplasty and 2 patients with rotating-platform arthroplasty. Of the Meniscal-bearing group two were for sepsis and one required liner exchange. Both of rotating-platform group were revised for aseptic loosening.

We therefore conclude that there was excellent long-term survival of the LCS knee arthroplasty in this cohort and there was no significant difference in functional outcomes for either knee replacement. We also note that there have been no revisions for aseptic loosening in the meniscal-bearing group to date.

Fifty-six patients, with a median fourteen years follow-up of isolated tibial shaft fracture treated with an IM nailing, underwent functional evaluation with SMFA and SF-36 questionnaires, as well as an injury specific questionnaire. Thirty-three also underwent clinical and radiological evaluation.

Overall, SF-36 scores (PCS 49.9, MCS 52.0) were near normal. Five (15.2%) had physical findings of venous stasis, while a third reported symptoms A third had at least mild OA on radiographs (knee-seven, ankle-eleven). A third of patients had a loss in ankle dorsiflexion, and more than half reported knee pain that was limiting to at least one activity.

We conducted a study to evaluate the long term functional outcomes and disabilities of patients with an isolated tibial shaft fracture treated with intramedullary nailing.

We identified two hundred and fifty eligible patients from the VGH Orthopaedic Trauma database between 1987 and 1992. A total of fifty-six patients agreed to participate. All were evaluated with the SF-36 and SMFA functional questionnaires, as well as an injury specific questionnaire focusing on knee pain, and symptoms of venous insufficiency. A sub-group of thirty-three patients were evaluated radiographically and by physical examination. We had a median follow-up of fourteen years, with a range from twelve to seventeen years.

The SF-36 scores (PCS 49.9, MCS 52.0) were comparable to population norms. Of the questionnaire group (n=56), fifteen denied knee pain with any activity, while twenty-nine had knee pain that was limiting to at least one type of activity. With respect to swelling, eighteen reported asymmetrical swelling affecting the injured limb. However, in the examination group, only five had objective evidence of venous stasis. Knee range of motion was essentially equivalent to the unaffected side, while thirteen patients had a restricted range of motion of the ankle. Radiographically, seven patients had at least mild OA of at least one knee compartment, while eleven had at least mild OA of the tibio-talar joint, despite near anatomic fracture healing.

At a median fourteen years following tibial nailing of isolated tibial fractures, patients function very well, but objective and subjective evaluation shows not insignificant sequellae.

The purpose of this paper was to assess the incidence of pelvic osteolysis following the use of a one piece all polyethylene titanium plasma spray backed acetabular component a mean of 9.6 years following implantation.

The radiographs of 86 hips followed for a mean of 9.6 years were reviewed. All had primary total hips using a titanium plasma spray backed all polyethylene uncemented acetabular component. Radiographs were assessed for osteolysis in the three zones described by DeLee and Charnley.

There was no osteolysis seen in any cup in any of the zones. There were no loose cups and no obvious cup migration.

This acetabular component shows superior performance compared with all two piece cups in terms of the development of periacetabular osteolysis. The use of two piece cups should be reconsidered.

Introduction: Distal femoral varus osteotomy (DFVO) has been advocated as the treatment of choice for lateral compartment osteoarthritis associated with a valgus knee in the young population in order to delay the need for total knee arthroplasty (TKA). The aim of this study was to evaluate the long-term results of DFVO for the valgus osteoarthritic knee.

Methods: A retrospective analysis was performed on 38consecutive patients (40 knees) who underwent a DFVO between 1984 and 2001. Two patients (2 knees) were lost to follow-up. Mean follow up was 123 months (range 39 to 245 months). Peri-operative documentation was evaluated for etiology, pre-operative functional and subjective impairment, intra-operative technical difficulties or complications, early and late post-operative complications and post-operative functional and subjective outcomes.

Results: At the time of the most recent follow-up, 24 knees had good or excellent result, 3 knees had a fair result and 3 had poor results. The remaining 8 knees were converted to a total knee arthroplasty. The mean Knee Society objective score improved from 18 (range, 0–74) to 87.2 (range, 50–100) and the mean Knee Society function score improved from 54 (range, 0–100) to 85.6 (range, 40–100). The ten-year survival rate of DFVO was 82% (95% confidence interval, 75%–89%) and the fifteen-year survival rate was 45% (95% confidence interval, 33%–57%).

Discussion: With proper patient selection, DFVO is a reliable procedure for the treatment of the valgus osteoarthritic knee. This procedure delays the need for further surgical procedures, such as TKA, with good results.

The purpose of this study was to assess the incidence of pelvic osteolysis following the use of a one piece all polyethylene acetabular component a mean of 9.6 years following implantation. The radiographs of 86 hips followed for a mean of 9.6 years were reviewed. All had had primary total hip arthroplasty using a titanium plasma spray backed all polyethylene acetabular component. Radiographs were assessed for pelvic osteolysis in the three zones described by Charnley and Delee. There was no osteolysis seen in any cup in any of the three zones. There were no loose cups and no obvious cup migration. This acetabular component shows superior performance compared with all two pieced components in terms of the development of pelvic osteolysis. The use of two-piece cups should be reviewed.

The present study sought to assess the clinical and radiological results and long-term joint impact of different techniques of lateral ankle ligament reconstruction.

The treatment of supracondylar humeral fractures in children continues to evolve. The currently fashionable treatment for displaced fractures is closed reduction and the insertion of at least two K-wires. This usually requires the patient to have a second surgery to remove the K-wires, and may result in significant scarring. The senior author has used the straight arm method to treat displaced supracondylar fractures. We have reviewed the long term results of seven children treated by the straight arm method. No patient had a scar, no patient had a cubitus varus and all children regained a full range of movement. This method offers excellent results with no risk of iatrogenic nerve injury, scarring, or second surgery.