Between 29th May 2001 and 15th May 2003, 233 consecutive Preservation unicompartmental knee replacements (UKR) were performed. Of these, 30 were lateral UKRs (13%) performed in 12 men and 16 women (2 bilateral cases) with a mean age of 67 years (range 36 to 93 years). A metal-backed mobile bearing tibial component was used in 13 knees and an all-polyethylene fixed bearing tibial component in 17 knees. The patients were reviewed prospectively at 1 and 2 years. The 2 year results show no difference in range of motion or function between the mobile and fixed bearing versions of the Preservation knee when used on the lateral side. This is similar to the reported results on the medial side. There were 3 early revisions, all in the mobile bearing group. The incidence of revision has been reduced by the introduction of an improved cementing technique.

The aim of this study was to assess the results of bilateral total knee replacement (TKR) staged one week apart during one hospital admission and compare these results with those of bilateral sequential TKRs and bilateral TKRs performed in 2 separate admissions by a single surgeon using a single prosthesis. Between 5th November 1997 and 10th August 2004, 104 patients underwent bilateral LCS TKRs using the Anteroposterior glide (APG) tibial component. The patients were analysed in 3 groups. The patients in Group 1 underwent bilateral sequential TKR under the same anaesthetic. The patients in Group 2 underwent bilateral TKRs under 2 separate anaesthetics, 7 days apart, during the same admission. The patients in Group 3 underwent bilateral TKR under 2 separate admissions, essentially 2 unilateral TKRs. The patients in Group 1 had shorter operations (p< 0.0001) and shorter hospital stays (p< 0.0001). Patients in Group 2 had less blood loss (p=0.004) but were not transfused any less than the other groups. The complication rate was low and comparable in all groups. There were no in hospital or 30 day deaths in any of the groups. Those patients in Group 3 had worse AKS function scores (p=0.02) and those patients in Group 2 had a significantly better HSS score (p=0.02). There was no significant difference between the groups in terms of range of motion or the AKS Knee score. This study has confirmed a shorter operation and hospital stay when the bilateral TKRs are carried out under the same anaesthetic. These patients also bled the most postoperatively. There was little difference in terms of complications and clinical outcome at a mean follow up of 4 years. With appropriate patient selection, both same anaesthetic and same admission bilateral TKR are safe methods to treat bilateral arthritis.

The aim of this prospective cohort study is to compare the early results in a single surgeon series of the mobile and fixed bearing versions of the Preservation UKR for lateral OA. Lateral UKRs were only considered for patients with isolated lateral compartment osteoarthritis with a functioning anterior cruciate ligament. Mild patellofemoral osteoarthritis was not considered a contraindication. If there was any doubt over the condition of the medial compartment or patellofemoral joint, single photon emission computed tomography was performed. Significant uptake it the medial or patellofemoral joint was considered a contraindication. Patients were assessed preoperatively and at 1 and 2 years postoperatively with the American Knee Society Score (AKSS), Oxford Knee Score (OKS) and with anteroposterior, lateral and Rosenberg radiographs.

Between 29^th May 2001 and 15^th May 2003, the senior author (GK) performed 233 consecutive Preservation UKRs. Of these, 30 were lateral UKRs (13%) performed in 12 men and 16 women (2 bilateral cases) with a mean age of 67 years (range 36 to 93 years). A metal-backed mobile bearing tibial component was used in 13 knees and an all-polyethylene fixed bearing tibial component in 17 knees. Patients in the mobile bearing group were significantly younger (t test; p< 0.0001) and had better AKSS knee (Mann-Whitney U test; p=0.05) and AKSS function scores (Mann-Whitney U test; p=0.005). The patients were reviewed after a minimum of 2 years (range 2 to 3.4 years). There was no significant difference between the 2 groups. There had been 3 revisions in the mobile bearing group for tibial loosening and none in the fixed bearing group (chi squared test; not significant). There was 1 tibial periprosthetic fracture in the fixed bearing group. This study shows that the choice of bearing type makes little difference in clinical outcome or range of motion over the first 2 years when using the Preservation Knee. A similar good functional result was obtained with a fixed bearing despite the mobile bearing group being younger and having significantly better preoperative AKS knee and function scores. The 3 revisions for tibial loosening in the mobile bearing group are a concern. However, these results are short-term and there may be improved implant longevity in the long-term with mobile bearing tibial components due to reduced polyethylene wear.

The humerus is a common site for metastasis. Intramedullary nail fixation has been reported to be the best form of fixation for this disease but complications with this procedure have been reported. This study reports on the results of using a new humeral nail for the treatment of pathological fracture or impending fracture of the humerus. Twenty nine patients had 31 Austofix humeral nails, 25 for pathological fracture and 6 for impending fracture. Twenty-four nails were inserted anterograde and 7 retrograde. Cement augmentation was used in 4 patients. Adjuvant therapy was used in 26 patients. One patient was lost to follow-up. Fixation failed in six patients, two due to intra-operative fractures during retrograde insertion, one due to fracture through screw holes postoperatively, and three due to local progression of disease. Difficulties in locking the nail distally were encountered in an additional 3 patients. In conclusion, in the majority of patients, nailing of the humerus with metastatic disease resulted in a stable humerus. Retrograde nailing of the humerus was associated with an increased risk of intra-operative fracture. Adjuvant therapy cannot be relied upon to prevent loss of fixation due to local progression of disease. The longest possible nail should be inserted through the antegrade route and locked to minimise the risk of loss of fixation.