A painful osteoarthritic knee in a young patient presents a therapeutic dilemma. Non-operative modalities, such as physical therapy, modification of activities to limit those that involve impact, and anti-inflammatory medications often provide only limited and temporary benefit. Operative options include arthroscopic debridement, arthrodesis, proximal tibial osteotomy, and uni-compartmental or total knee replacement. Total knee replacement has generally been reserved for patients who are at least sixty years old because of the potential for numerous revision operations in the course of a lifetime.

Mobile bearing total knee arthroplasty systems is emerging as the next wave of development in knee joint prosthetic reconstruction. The mobile bearing allows very high conformity between articulating surfaces on both sides of the polyethylene insert. The forces involved in these highly conforming articulations are very low, well below the theoretical yield point of the polyethylene bearing surface. Because the bearing is mobile, the interface between components and bone is protected from excess shear stress, therefore protecting the fixation.

The main concern of this prospective study was to determine the clinical, radiographic and functional results of Rotaglide mobile-bearing total knee arthroplasty in young active patients who were fifty-nine years old or less at time of the arthroplasty. We evaluate medium-long term results and survivorship of 81 patients who have their total knee replacement implanted for at least 3 years in Birmingham Heartlands & Solihull Hospital (UK), using Rotaglide total knee replacement (Corin).

The average follow-up of 7.3 years was reported in this prospective study with range of 3 – 12 years. The average age at the primary operation was 50.7 years with range of 37 – 58 years. The knee scores are satisfactory with an average of 195.6 points using IKSS and 14.6 using OKS. The average postoperatively range of motion was 126.2 with range of 95 – 130 degree. The radiological assessment of the X-ray in AP and lateral views show that both the femoral and tibial components well aligned with no radiolucent lines.

We conclude from this prospective study that Rota-glide mobile-bearing total knee arthroplasty in patient 59 years or younger is a reliable procedure with excellent results at medium-long term follow-up, with an estimated survivorship of 98 percent at 12 years.

The loss of bone stock is the main challenge at revision hip surgery. Uncemented total hip replacements have tried to address this problem, but have failed in the past due to inadequate stabilisation. The use of hydroxyapatite to coat a prosthesis is an interesting new concept to limit bone loss and add stability to the prosthesis.

In this retrospective study we assessed the radiographs 117 hips, in 99 patients, where the Furlong hydroxyapatite ceramic coated cementless threaded acetabular cups were used as part of total hip replacement. The average age of the patients was 53.44 years and the average period of follow-up 71.96 months.

We found that the radiographic evidence of loosening was present in 3.42% (four hips). Although in 2.56% (three hips) the acetabular cups had moved from the position they had been put in originally, they did not show any features of loosening later. The bone stock in all 117 hips was well maintained. It is concluded that the early results of this hydroxyapatite coated prosthesis are very encouraging.

We report a prospective, randomised, controlled trial of the effect of either a non-steroidal anti-inflammatory drug (diclofenac sodium) or physiotherapy on the recovery of knee function after arthroscopy. At 42 days after surgery there was no significant benefit from either form of postoperative treatment compared with the control group. Complications attributable to the anti-inflammatory drug occurred in 9.6% of the patients so treated. Neither the routine administration of a non-steroidal anti-inflammatory agent nor routine physiotherapy is justified after arthroscopy of the knee.

Fifty-nine cases of trochanteric wire revision following hip arthroplasty with trochanteric osteotomy and reattachment were identified and their outcome was studied. Two were infected and were excluded. Five were revised for instability: four became stable while one continued to have persistent dislocation. Fifty-two were revised for pain, 36 by removal of the trochanteric wire and 16 by reattachment of the greater trochanter. Successful relief of pain was obtained in less than half the cases. There was no difference in the incidence of back pain, wiring technique, trochanteric advancement, previous surgery to the same hip, trochanteric size or the pattern of wire breakage in the successfully treated group and the unsuccessful group. Neither was the removal of intact wire from a united trochanter any more certain of relieving pain than removal of broken wire from an un-united trochanter. Six patients later required revision for loosening or infection. These results indicate the need for full radiological and haematological investigation before exploration of the greater trochanter. At exploration for pain the wires should simply be removed as we could show no successful union after late reattachment of the trochanter in the absence of instability.

Four cases of arterial damage resulting from closed posterior dislocation of the elbow are described. Two of these have been successfully treated by conservative methods and two by vein graft to the damaged artery. Sixteen previous cases are detailed and the management of this uncommon complication of dislocated elbow is discussed.