Introduction

The Oxford Total Meniscal Knee (TMK by Biomet), is a total knee replacement with a multidirectional mobile bearing. As part of the evaluation of the TMK we compared our group of TMK knee replacements with an equivalent cohort of AGC total knee replacements.

Introduction

Debate continues regarding the relative advantages of ceramic-on-ceramic (CoC) and metal-on-polyethylene (MoP) articulations in total hip arthroplasty (THA). Perceived benefits of CoC include longevity, and low wear - in turn limiting the effects of particulate wear debris. However, CoC bearings cost significantly more, and concern remains over the risk of ceramic fracture; a complication not seen with MoP bearings, which are also cheaper.

Introduction: Debate continues regarding the optimal timing of surgery for patients requiring bilateral knee arthroplasty; we reviewed the costs, clinical and functional outcomes of 116 patients undergoing simultaneous or staged bilateral surgery using 3 different prostheses.

Method: Data were retrospectively collected from 116 consecutive patients undergoing 232 knee replacements over 10 years, either simultaneously or over 2 hospital admissions (staged). Post-operative complication rate, total cost of treatment (calculated from pros-theses, theatre time, days in hospital and number of clinic attendances) and functional (HSS) score at 1 year were the outcome measures.

Results: 54 patients underwent Oxford unicondylar knee replacements, 41 simultaneously, 13 staged; respective mean total costs were £9890 and £13,553 (p< 0.001). 42 patients were treated with AGC prostheses; 14 simultaneously, 28 staged, with respective total costs of £12,187 and £16,920 (p< 0.001). 10 TMK patients had simultaneous surgery (mean total cost £14,812), 10 were staged (£20,191); p< 0.001. For all 3 prostheses, there was no significant difference in complication rate or 1 year functional outcome between simultaneous and staged groups.

Discussion: Some authors advocate replacing both knees simultaneously as safe and cost-effective; others report significant increases in medical and surgical morbidity. Our series shows significant cost savings with no increase in complication rate.

Introduction: Periprosthetic fractures are an infrequent but increasingly prevalent problem and can be technically difficult to manage. Various techniques have been described to manage periprosthetic supracondylar fractures around a Total Knee Replacement (TKR) including, immobilisation, plate fixation, rush rods, LISS (less invasive stabilisation system) and retrograde nailing. The aim of this retrospective study was to evaluate the effectiveness of the retrograde intramedullary nail.

Methods: We identified all patients who underwent retrograde intramedullary nail for the treatment of periprosthetic femoral fractures between January 1999 and October 2005. Notes, x-rays and operation data were examined retrospectively. Outcomes were measured by radiological union, limb alignment, return to function, pain and complications.

Results: Of the 15 patients 2 died of coexisting medical problems during the follow-up period, but both with good fracture alignment. 13 united between 12 – 24 weeks (mean 15 weeks), 11 regained pre-injury function with alignment good in 12. 12 were pain free at follow-up, 2 patients required non-steroidal analgesia intermittently. There was one delayed union (53 weeks). There was one post operative complication where a patient with bilateral fractures required one night stay on ITU.

Conclusion: Intramedullary nailing of periprosthetic fractures around a TKR gave excellent functional results and 100% union in this series.

A new method to reconstruct major acetabular floor defects is described. It relies on the placement of special nails into each of the three bones of the hemipelvis. Curved lugs attached to the nails are coalesced using bone cement forming a platform onto which a standard acetabular prosthesis is located. Forty-seven cases are reported with a mean follow-up of 4.4 years (1 to 8). No loosening of an acetabular cup or migration of the device has occurred.

Thirteen elbows affected by severe haemophilic arthropathy and treated by silastic interposition arthroplasty were followed up for at least five years. The severity of pain, the frequency and severity of spontaneous haemorrhage and the range of movement were assessed before operation and at review. All patients were much improved and needed less factor replacement. Three elbows were revised, one for infection and two because of fragmentation of the silastic sheet. They regained good function following revision.