35 patients with an infected total knee arthroplasty were operated with a two-stage revision protocol including the use of custom hand-made antibiotic loaded articulating spacers.

Spacers were built intraoperatively, without specific tools, regarless the defect being considered cavitary or segmentary.

Patients were allowed to walk with an orthosis. Range of motion (ROM) with the articulating spacer averaged 80° and after reimplantation 106.5°. All but two patients in our series were treated with a combination of antibiotics including rifampicin and the antibiotics used in the spacers constituted from 7.5% of its final weight.

Reimplantation was successfully performed in 33 out of 35 cases at an average time of 10.2 weeks, excluding a patient were we had to wait 2.5 years. An extended exposure at reimplantation was necessary in 21% of the patients (five “Q-snip” and two anterior tibial tuberosity osteotomies).

According to the Knee Society Score (KSS) the results were considered excellent or good in 27 patients (84.8%), and fair or poor in 6 patients (14.2%) out of the 33 reimplantated. No significant differences related to the micro-organism or the time elapsed until reimplantation, as compared for ROM and functional and clinical KSS were found but early infections had significant worst ROM than late or sub-acute infections. Intercondylar constrained designs had better functional, clinic KSS and ROM that posterostabilised designs or hinge designs without significant differences.

Our modified technique for custom made spacers can be applied in any surgical theatre with a minimum cost. Our results are comparable to those reported in the literature, demonstrating the consistency of the two-stage reimplantation protocol despite multiple modifications and different dosages of antibiotic used in the cement spacers.

Isolated patellofemoral osteoarthritis can be a disabling disease. When conservative treatment fails, surgical options can be unpredictable and may be considered too aggressive for middle-aged and active people. We analysed the clinical and radiological results of a new coronal osteotomy involving thinning of the patella in a selected group of patients with isolated patellofemoral osteoarthritis. Since 1991, 31 patients (35 knees) have been treated, of whom 34 were available for follow-up at a mean of 9.1 years. The Knee Society Score, the Patellar score and the Short-form-36 questionnaire were used for clinical evaluation. We also examined the radiological features to confirm bone consolidation and assess the progression of osteoarthritis. A significant improvement in the functional scores and radiological parameters was noted. All patients except one were satisfied with the operation. Radiological progression of the patellofemoral osteoarthritis was slowed but radiological femorotibial osteoarthritis progressed in 23 (65%) cases, with a total knee replacement becoming necessary in four cases without technical problems in resurfacing the patella. We compared the results with other forms of surgical treatment reported in the literature.

This treatment offers good clinical and radiological results, presenting an alternative method of managing patellofemoral osteoarthritis.

Introduction and Objectives: Our aim is to describe the versatility of the Becker flap in different pathological conditions of the hand as treated in a orthopaedic trauma centre.

Materials and Methods: The Becker flap surgical technique is described as it is used in our centre as a means for coverage of injuries of the soft tissues in the palmar region of the hand. The procedure is described in three patients. One of these was a salvage procedure for recurrent carpal tunnel syndrome. The second was performed after an acute infection of the hypothenal eminence. The third involved coverage of a hand following trauma with a loss of tissue.

Results: In spite of the varied aetiologies of these cases, coverage was complete in all three cases, and there was no vascular compromise of the flap, nor dehiscence of sutures or acute infections. The use of the cubital flap was sufficient to resolve these conditions. On follow up, overall functional results for the hands were good, and the aesthetic results were acceptable for both the hand and the donor site.

Discussion and Conclusions: The Becker flap represents a good option for coverage of palmar cutaneous defects of the hand. Its versatility in the field of orthopaedic trauma makes it a practical and efficacious flap for use in acute and delayed cases.