Arteriovenous fistula formation after a closed extremity fracture is rare. We present the case of an 11-year-old boy who developed an arteriovenous fistula between the anterior tibial artery and popliteal vein after closed fractures of the proximal tibia and fibula. The fractures were treated by closed reduction and casting. A fistula was diagnosed 12 weeks after the injury. It was treated by embolisation with coils. Subsequent angiography and ultrasonography confirmed patency of the popliteal vein and anterior and posterior tibial and peroneal arteries, with no residual shunting through the fistula. The fractures healed uneventfully and he returned to full unrestricted activities 21 weeks after his injury.

The purpose of this study was to analyse the twenty to twenty-five year outcomes of one hundred and ninetyfive cemented, matte finish, HD-2 THRs performed in one hundred and sixty-six patients with osteoarthritis of the hip by two surgeons.

The one hundred and ninety-five THRs (one hundred and sixty-six patients) were followed prospectively by clinical assessment using the Harris Hip Score (HHS) and radiographic analysis.

One hundred and forty-nine patients (90%) died with their implant still functioning or still had a successful implant at twenty to twenty-five years follow-up. Ten patients (6%) underwent a revision for aseptic loosening of the acetabular (n=2, 1.2%) or femoral (n=4, 2.4%) component, or both (n=4, 2.4%), that was related to wear-induced osteolysis. 7 (4.2%) patients (eight hips) were lost to follow-up. The mean HHS at the latest follow-up (twenty to twenty-five years) was 88±9. Radiographically, twenty-nine (85%) of the acetabular components were well fixed and four (12%) were probably or possibly loose. Two hips (6%) had probable or possible loosening of the femoral component. At twenty five years, the calculated cumulative survival rate (Kaplan-Meier method) revealed excellent results for revisions (83%±6, any cause) and aseptic loosening (86%±6, femoral component, 93%±3, acetabular component).

The surviving patients had a good mean follow-up and radiographic fixation, proving the exceptional long-term success of this implant.

Purpose: The young patient with hip arthritis remains one of the biggest challenges to arthroplasty surgeons. The difficulty of providing a long-lasting total hip arthroplasty (THA) has been clearly documented in the literature. The aim of this study was to assess the outcomes of uncemented THA’s performed in our unit in patients aged under 50.

Methods: In our unit information on all patients is recorded prospectively on an arthroplasty database. From this database we identified 273 uncemented THAs in 237 patients under the age of 50 performed in our unit between 1985 and 2000 with a minimum of 5 year follow up. Outcomes were assessed in terms of 10 and 15-year survival with revision for any reason as the endpoint. Hip scores at routine and most recent follow-up were also reviewed. All surviving implants were radiographically assessed for acetabular wear, component loosening and for the presence of osteolysis.

Results: The mean age of patients at the time of surgery was 41.1 years. 36 patients had bilateral THA. The overall 10 and 15 year survival was 88.7 ± 2.4% and 65.6 ± 4.8 % respectively. Femoral stem survival was significantly higher at 100 % and 98.4 ± 1.6% at 10 and 15 years. Acetabular component survival was 88.6 ± 2.5 % at 10 years and 65.9 ± 4.8 % at 15 years. In unrevised THA’s 56.9% had asymmetric polyethylene wear > 2mm. 2% had definite evidence of acetabular loosening. 25.5% had radiographic evidence of femoral cortical hypertrophy or spot-welds. The mean HHS pre–operatively, at 5 and 10-year follow-up was 46.4 ± 13, 90.7 ± 12.2 and 87.9 ± 14.7 respectively.

Conclusions: Uncemented THA is effective even in young active patients. The main challenges remain ace-tabular polyethylene wear and loosening. Femoral uncemented stems provide long-term functional fixation. Contemporary bearing surfaces in association with such stems may provide long lasting THA’s even in young active patients.

Introduction Reflex sympathetic dystrophy (RSD) as a complication of total knee arthroplasty (TKR) is rarely mentioned. The literature has been limited to 58 cases of RSD in TKR, a prevalence of 0.8% of all TKR done. No previous reports give a clear understanding as what to expect in the long term after the diagnosis of RSD post TKR has been made nor do they report the struggle that patients undergo to achieve their result.

Methods We report on 11 cases of RSD diagnosed post TKR, operated on by one of us from 1991 to 2001. All patients met diagnostic criteria for Complex Regional Pain Syndrome, Type 1. Specifically they exhibited slow post-operative recovery and delayed return of normal function. Flexion was limited and cutaneous hypersensitivity was present along with temperature changes in the limb. These patients were evaluated using general and disease specific outcome tools previously validated in the literature, the SF-36 and WOMAC scores. In addition they were evaluated clinically at minimum two years following resolution of symptoms.

Results We found that once appropriate treatment had been instituted, which in our case was manipulation under anaesthetic in the painfree phase of CRPS-I, the majority of our patients reported higher scores on the bodily pain section of SF-36 however these were still lower than age matched controls of pre-operative osteoarthritic patients as determined by WOMAC scores. In general, though patients had poorer SF-36 and WOMAC scores than primary uncomplicated TKR, they did significantly better than primary osteoarthritics without surgery.

Conclusions This would suggest that when appropriately managed, RSD after TKR does not hold the dire prognostic consequences as previously thought.