Results and longevity of total knee arthroplasty depend on the correction of axis of the lower limb and the stability of the prosthesis. Faithful to the principle of dependent cuts, our goal was to obtain two equal correlated, rectangular extension and flexion gaps using a ligament balancing tensor called CORES^® (Stryker^®).

Material and Methods: We retrospectively studied the results of a continuous series of 122 total knee arthroplasties (Jade^®, Stryker^®) implanted by only one operator, between December 1994 and 1997. The mean follow-up is 9,5 years. Tibial plateaus were slip and fixed, with or without conservation of the posterior cruciate ligament. Mean patient age at implantation was 71,2 years. 94% had osteoarthritis and 6% rheumatoid disease. The mean preoperative IKS score was 23,4 and the IKS function score was 42,6. 16% of knees were aligned normally, according to the IKS criteria, 24% presented valgus > 4°, and 60% presented varus > 3°. Patella was centred (AA’ distance < 3mm) in 65% of cases and not tilted (alpha angle< 5°) in 41% of cases. There were 22% antero-medial and 78% antero-lateral with ATT eversion approaches. All tibial and femoral components were cemented. Resurfacing patella was not the rule (5%). Clinical outcome was assessed with the IKS score and radiological outcome with the IKS criteria.

Results: There were no early complications. At follow up, the mean IKS knee score was 90 points with mean motion 109°. Mean IKS function was 85 points. 82% of the knees were aligned (HKA angle between 177° and 183°), 7% in varus, and 11% in valgus. Patella position was centered in 80% of cases, and tilted in 8%. No patellar dislocation was observed. Radiolucent lines were observed in 20% of the tibial components, without aseptic loosening. 3% of the femoral component presented radiolucent line, and one was symptomatic. Four TKA were removed at ten and eleven years, corresponding to three deep haematogenous infections and one aseptic loosening (a young man with haemophilic arthritis). Arthroplasty survival rate was 95% at 9,5 years (Kaplan-Meier method), considering all reasons for removal, and 99,4% for removal for aseptic loosening with 95% confidence interval.

Discussion: Since a well-balanced distribution of medial and lateral contact forces avoids overload of one compartment and thus premature wear, knee imbalance assessment is a key point in TKA. This method allows ongoing intraoperative assessment of the angular and rotational correction, bone defect, as well as bone resection levels.

Conclusion: To our knowledge, our study report the first results at 9,5 years of a TKA based on dependent femoral cuts using a ligament tensor. This confirms the durability and longevity of this model of prosthesis, and the accuracy of the method.

Purpose of the study: Analyze failures (recurrent anterior instability) and other complications (pain, stiffness) compromising the overall outcome after arthroscopic anterior shoulder stabilization.

Material and methods: We studied failures and complications in a consecutive inaugural series of 43 patients undergoing an arthroscopic Bankart procedure for chronic anterior shoulder instability. The procedure was performed with knitted resorbable threads on metallic anchors. Outcome was reviewed at mean 26 months (range 6–63 months). There were 19 recurrent dislocations, 12 recurrent subluxations, 4 cases of recurrent subluxation and dislocation and 6 cases of painful unstable shoulder. Mean patient age was 35.6 years (range 19–59 years). Thirty-two patients practiced sports, including 21 who practiced high-risk sports.

Results: One patient, a competition basketball player, presented recurrent traumatic dislocation due to a violent shock after premature resumption of sports activities five months after surgery. There were no recurrent dislocations among the subluxation cases. Pain persisted in three of the six painful unstable shoulders. Sixteen patients presented persistent apprehension but none complained of instability. Nine patients had a positive relocation test. Limited external rotation of less than 30% as observed in five patients and of 30–50% in two. Residual pain was observed in 14 patients (33%) (when carrying a heavy load with the arm hanging along the body, with fatigue, and for forced movements without warm-up in the morning). For four patients, pain occurred in the armed position. Seventeen patients (43%) interrupted their sports activity. The Duplay score showed 13 (30%) fair and poor objective overall results. Subjectively, only seven patients (15%) were only partially satisfied or dissatisfied.

Discussion: Analysis of failures and complications disclosed a discordance between the low rate of failure using the classical definition (recurrent dislocation or subluxation) and the high rate of fair or poor overall outcomes. Residual pain and non-resumption of sports activities appeared to be the major problems. These two factors were analyzed in detail to compare this series with data in the literature. It was found that non-resumption of sports activities is not always related to shoulder instability or apprehension and that pain is often related to associated injury (SLAP, cuff). Conversely, pain associated with a positive relocation test should be considered as a true recurrence, especially in a subject who was unable to resume sports activities.