Current literature comparing the effect on body mass index (BMI) on the outcome of total hip replacements (THR) is inconclusive. To describe the effect of BMI on THR over the first five years.

We prospectively recruited 1,617 patients undergoing primary THR for osteoarthritis and followed them up at 5 years, recording, dislocations, revisions, deep and superficial infections, Harris Hip scores (HHS) and SF-36. A multivariate analysis was performed to identify if BMI is an independent predictor of adverse outcome.

148 (9%) patients had a BMI >35. 6.8% of patients with a BMI >35 had a dislocation by 5 year post op compared with 3.2%BMI 30–34.9, 2% BMI 25–29.9 and 1.5% BMI<25 (p=0.03) Superficial infections 14.2% BMI >35, 4.4% BMI <25. In SF 36 scores only Mental Health and change in health had no significant differences with an increase in BMI having a statistically significant decrease in all other SF scores. HHS had a mean improvement of 45.1 at five years with an expected loss of 0.302 HHS points (95% CI0.440–0.163) per 1 point BMI increase. There was no significant difference in deep infections, mortality <3 months, revision rates or length of stay.

The most significant risk in increasing BMI is the dislocation rate, possibly representing increased technical difficulty in larger patients. Whilst increasing BMI has a reduced HHS and SF16 score, the overall benefit is still positive.

We set out to demonstrate the 10-year survivorship of the PFC sigma TKA in a young patient group.

Demographic and clinical outcome data were collected prospectively at 6 months, 18 months, 3 years, 5 years and 8–10 years post surgery.

The data were analysed using Kaplan Meier survival statistics with end point being regarded as death or revision for any reason.

203 patients were found to be < 55 years at the time of surgery. Four patients required revision and four patients died. Another four patients moved away from the region and were excluded from the study.

A total of 224 knees in 199 patients (101 male and 98 females.) 168 patients had a diagnosis of Osteoarthritis and 28 with inflammatory arthritis. Average age 50.6 years range 28–55 years (median 51). Ten-year survivorship in terms of revision 98.2% at ten years 95% confidence interval.

Our results demonstrate that the PFC Sigma knee has an excellent survival rate in young patients over the first 10 years. TKR should not be withheld from patients on the basis of age.

Since 2008 the improvised explosive device has been responsible for a significant proportion of injuries sustained whilst on operational duty in Afghanistan. Vehicles have been developed and adapted to offer maximal protection to service personnel. As a result of the decrease in mortality, there has been an increase in the severity of injuries to the lower limb.

Hind-foot injuries are a difficult cohort of injuries to treat successfully. Those that are amenable to reconstruction carry a significant morbidity, which may result in either early or delayed amputation.

There has been a new injury pattern to the lower limb, not previously described in the medical literature. This pattern consists of a displaced intra-articular calcaneal fracture, distal third tibial fracture and midfoot injury within the same limb.

We believe the combination of the three injuries form the “unhappy triad of the ankle”. Each of the injuries is individually reconstructable, but the combination of all three primary amputation should be considered as part of the surgical options.

The DuPuy Sigma total knee arthroplasty (TKA) is a modification of the well-established Press Fit Condylar (PFC) TKA and is used extensively in the UK and worldwide. This study reports the first 10-year clinical and radiological follow-up data for the Sigma PFC.

A total of 235 consecutive Sigma TKAs were performed in 203 patients between October 1998 and October 1999, in our unit. Patients were seen at a specialist nurse-led clinic 1 week before admission and at 6 months, 18 months, 3 years, 5 years and 7-10 years after surgery. Data was recorded prospectively at each clinic visit.

Of 235 knees, 171 (147 patients) were alive at 10 years. Twelve were lost to follow up. Eight knees (3.4%) were revised; four for infection and four underwent isolated change of polyethylene insert. Ten-year survival with an end point of revision for any reason was 95.9%, and with an endpoint of revision for aseptic failure was 98.7%. The mean American Knee Society score was 62 at 8-10 years compared with 31 out of 100 pre-operatively.

Our results show that the PFC Sigma knee arthroplasty performs well over the first 10 years post-implantation.

The aim of this study was to compare the long-term outcome from total knee replacement (TKR) in young versus old patients in terms of pain and functional outcome.

We used our arthroplasty database, which recorded prospectively pain and American Knee Society scores at regular intervals over ten years after TKR. The procedures used a modern, cemented resurfacing type cruciate retaining prosthesis. A cohort of young patients (≤55 years) was identified. A control group of patients ≥ 56 was identified, matching for ASA, body mass index and underlying condition. Change over time was analysed using a factorial repeated measures ANOVA test, which allowed for investigation of difference between groups. 40 Knees in 26 patients were identified. 2 patients died prior to follow up, 2 were revised within the study period (1 for infection at 2 years and one for change of poly at 7 years) and a further 4 were lost to follow up. 7 knees could not be matched and were excluded. This left a study group of 24 young and 24 older knees. Pain scores (p=0.025) and American Knee Society “Knee” (p<0.001) and “Function” (p<0.001) scores changed significantly over time. There were however no statistical differences over the 10-year period in pain (p=0.436) and knee performance (0.618) but overall function was higher throughout the period in the younger group (=0.004).

We conclude that Knee replacement in younger patients produces similar outcomes in terms of pain and function compared with older patients and TKR should not be withheld purely on account of age.