This study investigated the effects of arthroscopic release for the treatment of stiffness in total knee replacement (TKR) to compare the outcomes against the reported outcomes for more invasive procedures such as open release and revision. We prospectively followed all patients undergoing TKR between 1998 and 2008 at the lead author's institution where stiffness other than that for mechanical or infective reasons was treated arthroscopically. Nineteen knees from the author's series of 572 knee replacements and three knees from other units were treated and outcomes were recorded in terms of pre-operative and post-operative Oxford knee scores and range of motion. At arthroscopy each of the 22 knees displayed extensive scarring (particularly in the suprapatella pouch) that was debrided. The mean follow-up was 40 months (range 5 months to 10.5 years). The Oxford knee score improved from 42.6 (±7.5) prior to TKR to 36.3 (±8.5) after TKR and to 29.3 (±9.0) after arthroscopic arthrolysis. The mean maximum flexion declined from 107° prior to TKR to 64°. Arthroscopic arthrolysis improved mean maximum flexion to 105° on table and 93° at most recent follow-up. We recommend this technique as a reasonable option for the treatment of stiffness after knee replacement as it compares well with more invasive surgical options

Patellofemoral unicompartmental joint replacement is a controversial subject with a relatively small evidence base. Of the 50,000 total knee arthroplasties performed each year in the UK, approximately 10% are performed for predominantly patellofemoral arthritis. There are several patellofemoral unicompartmental prostheses on the market with the National Joint Registry recording 745 such prostheses used in 2007. Most evidence in favour of this procedure comes from experience with the Avon prosthesis (Stryker) predominantly from designer-surgeons. The FPV patellofemoral joint replacement (Wright Medical) has been in use in Europe for several years. The instruments have recently been redesigned and the device marketed in the UK. In 2007 the FPV had 5.9% market share (n=44). We present our early experience with the FPV patellofemoral joint replacement, which to our knowledge, is the first clinical outcome series for this prosthesis. 33 consecutive FPV joint replacements in 29 patients were performed between April 2007 and September 2009 for unicompartmental patellofemoral OA. All cases were performed or directly supervised by the senior author. Results are presented with a minimum follow-up of six months. Oxford and American Knee Society scores (AKSS) were obtained on all patients preoperatively and at subsequent outpatient visits. Mean preoperative AKSS knee score was 49.7 points and postoperative scores at 6 months and 1 year were 82.5 and 86.4 respectively. Mean Oxford score preoperatively was 30.4 (37%) and at 6 months and 1 year were 21.3 (56%) and 11.2 (77%) respectively. There were no complications related to the implant. One knee required a secondary open lateral release due to inadequate balancing at the index procedure. Further medium to long-term follow up data are required, but our initial experience with this device is encouraging