Introduction. The authors performed a short term prospective study of unicompartmental knee replacement (UKR) associated to patella-femoral arthroplasty (PFA) for the treatment of bicompartmental symptomatic knee arthritis. At the latest follow-up all the implants were matched to a similar computer assisted Total Knee Replacements (CAS-TKR) group implanted for the same indications. Hypothesis of the study was that this bicompartimental implants could achieve comparable outcomes to TKR with a more conservative surgery and a higher joint function. Materials and Methods. 19 cases of anteriomedial (12) or anterolateral (7) arthritis in 19 stable knees were prospectively involved in the study. All the knees underwent to a selective reconstruction using simultaneously both UKR and PFR using the same surgical technique. All bicompartmental implants were performed by the same surgeon. Surgical time, hospital staying and all intra and post operative complications were registered. At a minimum follow-up of 20 months, every single case was marched to a similar case where had been implanted a computer assisted cruciate retaining TKR. Criteria of matching were: sex, age, pre-operative range of motion and arthritis grade. In both the groups all the cases were assessed clinically using WOMAC, KKS and GIUM scores. All the knees were radiologically investigated using the same radiological protocol. Results. Intra operatively we did not registered any complication. No revision in both groups. The mean surgical time was 86 minutes (range: 78–121) in UKR+PFR group and 81 minutes (range: 71–112) in CAS-TKR group. There were no statistical significant differences in the hospital stay. No statistically significant difference was seen for the Knee Society, Functional and GIUM scores between the 2 groups. Statistically significant better WOMAC Function/Stiffness indexes were registered for the UKR+PFR group. CAS-TKR implants achieved a statistically better aligned mechanical axes. Conclusions. The results of this prospective short term prospective study suggest that UKR+PFR implant is a viable option for bicompartmental anteromedial arthritis at least as well as TKR but maintaining an higher level of function

MOXIMED KineSpring® Knee Implant System is an Orthopaedic device designed for younger or highly active patients with osteoarthritis. The device is placed under the skin, is attached to the tibia and femur, and contains springs which help limit some of the forces that are transmitted through the knee during activities such as walking or running and thereby relieve pain that may be experienced by patients with early arthritis of the knee. The aim of this study is to determine the long term safety and efficacy of the KineSpring knee implant system. This is a prospective case series involving two centres in Glasgow. 29 patients (mean age of 45.1 years and range 18-65 years) were recruited into the study between 2011 and 2016. The Primary outcome measure was Oxford knee score (OKS) at 2, 5 and 10 years post-operatively. Secondary outcome measures include device related complications and survival, patient reported functional outcome measures, patient satisfaction, pain levels and change in radiographic classification of osteoarthritis. At 2-year follow-up, 7 implants were removed (74.1% survival). Complications include deep infection, requiring removal in 1 patient, 2 implant failures requiring removal and one spring breakage. In comparison to pre-operative measures there was an improvement in the pain (3.58 vs. 5.20, p=0.02), stiffness (4.16 vs. 4.47, p=0.6) and OKS (32.4 vs. 36.9, p=0.03). The KineSpring improves overall pain, stiffness and functional outcome at 2 years following surgery, however there was a high rate of removal and further long-term follow up analysis is required regarding its effectiveness

High tibial osteotomy (HTO) is a common procedure for treating medial compartment knee arthritis. The main goal is to reduce knee pain by transferring weight-bearing loads to the relatively unaffected lateral compartment and thus delaying the need of total knee replacement (TKR) by slowing or stopping destruction of medial compartment. Between 2002 and 2010, 34 HTO's were carried out in 32 patients (Mean age 44.2). Results were reviewed in 23 patients with an average follow-up of 10.2 years (range 6–14 years). Oxford knee score (OKS) assessment was carried out on those patients. Of the remaining 11 patients, one was excluded, 2 were lost to follow-up, and 2 had died. Five cases had TKR at an average 8.8 years since having HTO. OKS results revealed nine cases (39.1percnt;) scored (40–48) which indicate satisfactory joint function and don't require treatment. Three cases (13percnt;) scored (30–39) indicating mild to moderate arthritis. Six cases (26.1percnt;), scored (20–29) indicating moderate to severe arthritis. Five cases (21.8percnt;) scored (0–19) indicating severe arthritis. Only five patients (14.7percnt;) had TKR (6–14) years after there HTO. The majority of cases had an OKS suggesting satisfactory joint function. Even those with scores suggesting moderate to severe arthritis were able to function normally for more than 6 years. The successful outcome of HTO can be maintained for more than 6–16 years. We conclude that HTO should be recommended for the treatment of medial compartment arthritis of the knee in young and active patients for symptomatic improvement and maintenance of activity levels

Aims

The aim of this study was to assess the feasibility of conducting a full-scale, appropriately powered, randomized controlled trial (RCT) comparing internal fracture fixation and distal femoral replacement (DFR) for distal femoral fractures in older patients.

Although the use of constrained cemented arthroplasty to treat distal femoral fractures in elderly patients has some practical advantages over the use of techniques of fixation, concerns as to a high rate of loosening after implantation of these prostheses has raised doubts about their use. We evaluated the results of hinged total knee replacement in the treatment of 54 fractures in 52 patients with a mean age of 82 years (55 to 98), who were socially dependent and poorly mobile.

Within the first year after implantation 22 of the 54 patients had died, six had undergone a further operation and two required a revision of the prosthesis. The subsequent rate of further surgery and revision was low.

A constrained knee prosthesis offers a useful alternative treatment to internal fixation in selected elderly patients with these fractures, and has a high probability of surviving as long as the patient into whom it has been implanted.