Abstract. Background. We know that tears of the Triangular fibrocartilage complex (TFCC) can cause DRUJ instability and ulnar sided wrist pain. This study shows the clinical result of patients who had arthroscopic transosseous repair of the TFCC tear with DRUJ instability. Arthroscopic repair of TFCC tear is a promising, minimally invasive surgical technique especially in patients with DRUJ instability. Materials and methods. Fifteen patients who underwent TFCC one tunnel repair form 2018–2021 were reviewed retrospectively in hospital. The proximal component of TFCC was repaired through arthroscopic one- tunnel transosseous suture technique. VAS score for pain, wrist range of motion, grip strength and post operative complications were evaluated and each patient was rated according to the DASH score. Results. The patients had a TFCC tear confirmed on MRI and was confirmed on arthroscopy by doing a hook test. The patients were followed up for 6 months. Twelve patients had normal stability of DRUJ and three patients showed mild laxity compared with the contralateral side. The mean VAS score reduced from 4.7 to 0.8 (P=0.001) and grip strength increased significantly. The quick DASH score (P=0.001)also showed significant functional improvement. No surgical related complications occurred. Conclusions. Arthroscopic one tunnel transosseous TFCC foveal repair can be an excellent and safe method for repair of TFCC tear with DRUJ instability. Its a good treatment option in terms of reliable pain relief, functional improvement and reestablishment of DRUJ stability

Introduction. Traditionally it has been thought that the use of a small diameter femoral head in conjunction with a posterior surgical approach would result in a high rate of dislocation. We present the results of a consecutive series of 350 total hip replacements performed using a 22mm femoral head and a standard posterior approach, with prospective data collection. Objective. To determine the outcome of total hip replacement using small diameter heads via a standard posterior approach. Methods. Between March 2000 and April 2005, 319 patients underwent 350 total hip replacements with a small diameter 22mm head under the care of four different consultants, using a standard posterior approach. All patients underwent annual clinical and radiological review. All of the femoral implants were cemented modular polished triple-tapered C-stems (Depuy Ltd.) and all of the acetabular components were cemented UHMW-polyethylene components with long posterior walls. Palacos-R cement (Heraeus GMBH) containing gentamicin was used in all cases, with a third generation cementing technique. A standard posterior approach was used in all cases, with direct repair of the short external rotators, but without the use of transosseous sutures. Results. There were 245 female and 105 male patients, with 198 right-sided operations, 152 left with 31 patients undergoing staged bilateral operations. The average age at the time of surgery was 69.2 years (range 25–92 years). Five patients (6 THRs0 were lost to follow-up and 101 patients (29%) died during the study. The average duration of follow-up for surviving patients is 128 months (108 – 169 months). Five acetabular components have been revised for aseptic loosening associated with a high wear rate, and 4 are currently loose. There were three peri-prosthetic femoral fractures treated by internal fixation, and two temporary nerve palsies. Four femoral components were revised at the time of revision of a loose acetabulum, but none were loose. There has been no aseptic loosening of any femoral components and there were no cases of deep infection. The average acetabular abduction angle was 43.2 degrees (30–62) and the average femoral offset was 46mm (35–54). Five patients suffered dislocations, 3 female and 2 male, 2 right-sided and 3 left. Average age was 70 (60–85), average offset was 44.6mm (40–48). Four occurred on a single occasion only and were stable on reduction and only one required further surgery for recurrent dislocations, with application of a PLAD. Extended, skirted femoral heads had been used in four of these cases, reducing the head/neck ratio (p<0.5). Conclusions. Total hip replacement using small diameter femoral heads and a posterior approach has provided excellent results and implant longevity, with a low complication rate. Dislocation occurred in five cases and was associated with the use of an extended head. When using a posterior surgical approach the use of extended heads should be avoided, with high offset stems and standard heads being used in preference in order to achieve the correct length and offset, whilst maintaining the maximum head/neck ratio

Introduction. Avulsion of abductors from hip is a debilitating complication after total hip arthroplasty performed through a trans-gluteal approach. It results in intractable pain, Trendelenberg limp and instability of the hip. Techniques described for repairing these abductor tears including direct trans osseous repairs, endoscopic repair techniques, Achilles tendon allograft, Gluteus Maximus and Vastus Lateralis muscle transfers. The aim of our study was to assess improvement in pain, limp and abductor strength in patients operated upon surgically for confirmed abductor avulsion using a modified trans osseous repair and augmentation of repair with a Graft Jacket allograft acellular human dermal matrix (Graft jacket; Wright Medical Technology, Arlington, TN). Patients and Methods. In this prospective study we include 18 consecutive patients with hip abductor avulsions following a primary total hip arthroplasty through Hardinge approach for osteoarthritis. All the patients presented with pain around lateral aspect of hip, walking with a significant Trendelenberg limp and used a crutch or a stick in the opposite hand. Diagnosis was made by clinical examination and confirmed by MRI scans. Surgical Technique. Surgical procedure was through lateral approach using the old scar to mobilise combined aponeurosis of the Gluteal Medius and Gluteus Minimus from the bony bed on the ilium to permit advancement onto the trochanter. The conjoint Gluteus Medius and Minimus insertion was affixed to the greater trochanter with No.5 non absorbable trans-osseous suture using a Krackow stitch through a series of transverse tunnels made in anterior aspect of greater trochanter. An on lay augmentation (Fig. 1) of the osseo-tendinous junction was performed using a Graft Jacket matrix of 4 × 7 cms in size after rehydration according to the manufacturer's instructions. Results. At mean follow up of 22 months (15–34 months), pain improved in all patients with mean VAS score improving from 8.25 to 2.33 (p value-0.05). All the patients had improvement in their abductor strength with MRC grade 4 out of 5 in 16 patients and 3 out of 5 in 2 patients. Trendelenberg sign disappeared in all but two. Mean Harris hip score improved from 34.05 to 81.26 (p value-0.001). All patients had improvement in gait except mild noticeable limp in two patients.13 patients did not use any walking aids and five felt more secure using a walking stick in the contralateral hand. The mean SF-36 Physical component score was 53.47 and Mental component score was 56.07. Conclusions. The procedure is safe and associated with high patient satisfaction, without the morbidity of tendon or muscle transfers. The Graft Jacket Matrix provides biological bridging between the hip abductors and its insertion into greater trochanter. It provides a biological scaffold for cellular and vascular in-growth and constructive tissue remodelling. The described procedure appears to enhance the mechanical strength of repaired tendon immediately following surgery. The Graft Jacket allograft matrix has already been used successfully in rotator cuff repairs of shoulder and has showed encouraging results. The early success of this new procedure warrants further study with more patients, longer follow-up and possibly histological study of retrieved specimens