Patients with skeletal dysplasia are prone to developing advanced degenerative knee disease requiring total knee replacement (TKR) at a younger age than the general population. TKR in this unique group of patients is a technically demanding procedure due to the bone deformity, flexion contracture, generalised hypotonia and ligamentous laxity. We set out to retrospectively review the outcome of 11 TKR's performed in eight patients with skeletal dysplasia at our institution using the SMILES custom-made rotating-hinge total knee system. There were 3 males and 5 females with mean age 57 years (range, 41–79 years), mean height 138 cm (range, 122–155 cm) and mean weight 56 kg (range, 40–102 kg). Preoperative diagnoses included achondroplasia, spondyloepiphyseal dysplasia, pseudoachondroplasia, multiple epiphyseal dysplasia, morquio syndrome, diastrophic dysplasia and Larson's Syndrome. Patients were followed clinically and radiographically for a mean of 7 years (range, 3–11.5 years). Knee pain and function improved in all 11 joints. Mean Knee Society clinical and function scores improved from 24 (range, 14–36) and 20 points (range, 5–40) preoperatively to 68 (range, 28–80) and 50 points (range, 22–74) respectively at final follow-up. Four complications were recorded (36%), including a patellar fracture following a fall, a tibial periprosthetic fracture, persistent anterior knee pain and a femoral component revision for aseptic loosening. Our results suggest that custom rotating-hinge TKR in patients with skeletal dysplasia is effective at relieving pain, optimising movement and improving function. It compensates for bony deformity and ligament deficiency and reduces the need for corrective osteotomy. Patellofemoral joint complications are frequent and functional outcome is worse than primary TKR in the general population. Submission endorsed by Mr Peter Calder, Consultant Orthopaedic Surgeon and Society member

Purpose. The correction obtained in the coronal plane knee deformity using guided growth was assessed in children with sick physes (Height<1SD of the normal children) to define the limits of this technique in sick physis. Methods. We retrospectively assessed deformity correction following guided growth using 8 plates in children with coronal plane deformity and metabolically abnormal physis- renal rickets in 6 and bone dysplasias (multiple epiphyseal dyspasia, spondyloepiphyseal dysplasia, metaphyseal dysplasia, mesomelic dysplasia, chondrodysplasia punctata) in 10 children aged 2 to 14 years. Lateral distal femoral angle(LDFA) and medial proximal tibia(MPTA) angles were serially assessed after eight plate application as a day care procedure. We noted correction achieved rate of correction, complications and additional surgical procedures. Fischer's exact test and multiple regression analysis was done to assess the effect of modifiers. Results. Sixteen children mean aged 7.8 years (2–14 years) with 9 boys and seven girls were followed for a mean of 16.125 months. Deviations from normal MPTA(n=6) were a mean of 11.82(range 8.4–16.9) and from normal LDFA(n=15) a mean of 13.96 (range 5.7–35.1). Mean rate of correction was 0.8°(range 0.1–2.65) per month in dysplasia group and 1.09°(range 0.5–1.6)per month. Complete correction was achieved in 2 out of 6 in renal and 4 out of 10 in dysplasia group. Complication included backing out of screw (1), suboptimal screw placement (2) in dysplasia group and stiffness of the knee (1). Multiple regression analysis found sex, severity of deformity >15° and duration of follow up to be not significant, however, age less than 6 years had a significantly higher chance of deformity correction(P=0.001). Conclusion. The rate of deformity correction with eight plates for guided growth is very variable even within the same patient in dysplasia group, chondrodyspalsia and SED having very slow correction rates. The deformities however correct completely before the age of 6 years irrespective of etiology. Bone dysplasias and metabolic causes require further study to understand their growth pattern and possibilities of relapse

Aims

The aim of this study was to present the first retrieval analysis findings of PRECICE STRYDE intermedullary nails removed from patients, providing useful information in the post-market surveillance of these recently introduced devices.

Aims

Computer hexapod assisted orthopaedic surgery (CHAOS), is a method to achieve the intra-operative correction of long bone deformities using a hexapod external fixator before definitive internal fixation with minimally invasive stabilisation techniques.

The aims of this study were to determine the reliability of this method in a consecutive case series of patients undergoing femoral deformity correction, with a minimum six-month follow-up, to assess the complications and to define the ideal group of patients for whom this treatment is appropriate.