Purpose: This study was designed to establish the poly-ethylene wear rates in the Oxford medial unicompert-mental knee replacement.

Introduction: The Oxford meniscal bearing knee was introduced as a design to reduce polyethylene wear. There has been one previous retrieval study of the Oxford UKA, which reported very low wear rates in some specimens, but abnormal patterns of wear in others, including impingement. There has been no further investigation of these abnormal wear patterns.

Methods: Forty-seven bearings were retrieved from patients who had received a medial Oxford UKA for anteromedial osteoarthritis of the knee, none of which had previously been studied. Mean time to revision was 8.4 years (SD 4.1) and 20 had been implanted for over 10 years. The macroscopic pattern of polyethylene wear and the linear penetration (dial gauge measurement) was recorded for each bearing.

Results: The mean linear penetration rate (LPR) was 0.07mm/year. The patterns of wear fell into 4 categories, each with a different LPR; 1) No abnormal macroscopic appearance, n=16 (LPR = 0.01mm/year), 2) Abnormal macroscopic wear with extra-articular impingement, n=16 (LPR = 0.05mm/year), 3) Abnormal macroscopic wear with intra-articular impingement, n=6 (LPR = 0.10mm/year), 4) Abnormal macroscopic wear with impingement and signs of incongruous articulation, n=9 (LPR = 0.14mm/year). The differences in LPR were statistically significant (p< 0.05).

Conclusion: The results show that very low polyethylene wear rates are possible if the device functions normally. However if the bearing displays abnormal function (extra-articular, intra-articular impingement or incongruous articulation) wear rates increase significantly.

With medial unicompartmental osteoarthritis (OA) there is occasionally a full-thickness ulcer of the cartilage on the medial side of the lateral femoral condyle. It is not clear whether this should be considered a contraindication to unicompartmental knee replacement (UKR). The aim of this study was to determine why these ulcers occur, and whether they compromise the outcome of UKR.

Case studies of knees with medial OA suggest that cartilage lesions on the medial side of the lateral condyle are caused by impingement on the lateral tibial spine as a result of the varus deformity and tibial subluxation. Following UKR the varus and the subluxation are corrected, so that impingement is prevented and the damaged part of the lateral femoral condyle is not transmitting load. An illustrative case report is presented.

Out of 769 knees with OA of the medial compartment treated with the Oxford UKR, 59 (7.7%) had partial-thickness cartilage loss and 20 (2.6%) had a full-thickness cartilage deficit on the medial side of the lateral condyle. The mean Oxford Knee Score (OKS) at the last follow-up at a mean of four years was 41.9 (13 to 48) in those with partial-thickness cartilage loss and 41.0 (20 to 48) in those with full-thickness loss. In those with normal or superficially damaged cartilage the mean was 39.5 (5 to 48) and 39.7 (8 to 48), respectively. There were no statistically significant differences between the pre-operative OKS, the final review OKS or of change in the score in the various groups.

We conclude that in medial compartment OA, damage to the medial side of the lateral femoral condyle is caused by impingement on the tibial spine and should not be considered a contraindication to an Oxford UKR, even if there is extensive full-thickness ulceration of the cartilage.

Purpose: The relationship of pattern of injury to this region of the knee to the intraoperative finding of abnormal common peroneal nerve position and associated nerve palsy was studied.

Methods: 54 consecutive patients with posterolateral corner disruption requiring surgery were assessed prospectively by MRI, arthroscopic examination, and by operative display. The pattern of disruption, the status of the biceps tendon and any displacement of the common peroneal nerve were recorded.

Results: Of the 54 cases, there were 9 with CPN palsy, 18 were seen to have distal injuries (13 suffering a fibular head avulsion fracture and 5 biceps tendon avulsion with no fracture). There was a strong relationship (p< 0.001) between such distal posterolateral corner injury and abnormal position of the common peroneal nerve, as 16 of the 18 (90%) patients were seen to have abnormal nerve position. No proximal injury resulted in abnormal nerve position and only 1 was associated with CPN palsy. 7 of the 13 cases of fibular head fracture had CPN palsy, and 1 of the 5 distal soft tissue avulsions.

Conclusion: There is a strong association of distal soft tissue avulsion and fibular head fracture and CPN palsy in these injuries. Whenever such a distal injury is suspected, the surgeon operating in this region should expect an abnormal position of the common peroneal nerve and appreciate the increased risk of iatrogenic damage. Presumably since the CPN is intimately bound to the biceps tendon by deep fascia, proximal retraction of the biceps tendon results in displacement of the CPN to an abnormal position and accounts for the high incidence of nerve palsy.