Orthopaedic surgeons and their patients continue to seek better functional outcomes after total knee replacement, but TKA designs claim characteristic kinematic performance that is rarely assessed in patients.

The objectives of this investigation is to determine the in vivo kinematics in knees with Cruciate Retaining TKA using Patient Specific Technology during activities of daily living and to compare the findings with previous studies of kinematics of other CR TKA designs.

Four knees were operated by Triathlon CR TKA using Patient Specific Technology and a fluoroscopic measurement technique has been used to provide detailed three-dimensional kinematic assessment of knee arthroplasty function during three motor tasks. 3D fluoroscopic analysis was performed at 4-month follow-up.

The range of flexion was 90°(range 5°–95°) during chair-rising, 80°(range 0°–80°) during step up and 100° (range 0°–100°) during leg extension. The corresponding average external rotation of the femur on the tibial base-plate was 7.6° (range +4.3°; +11.9°), 9.5° (+4.0°; 13.5°) and 11.6° (+4.5°; +16.1°). The mean antero-posterior translations between femoral and tibial components during the three motor tasks were +4.7 (−3.7; +1.0), +6.4 (−3.8; +2.6) and +8,4 (−4.9; +3.5) mm on the medial compartment, and −2.5 (−7.1; −9.6), −3.6 (−6.1; −9.7), −2.6 (−7.7; −10.3) mm on the lateral compartment, respectively, with the medial condyle moving progressively anterior with flexion, and the medial condyle moving progressively posterior with flexion.

We compared Triathlon CR PSI TKA results from this study with Genesis II CR TKA, with Duracon CR TKA, with Triathlon CR TKA and with the healthy knee kinematics. The results of this study showed no screw home mechanism. The internal rotation of the tibia with knee flexion is close to normal, better than Genesis II, Duracon and Triathlon CR TKA operated with standard surgery.

The medial condyle is characterized by the same pattern of the other implants, with a paradoxical anterior translation of 5 mm.

The lateral condyle shows a posterior rollback better than Triathlon CR operated with standard surgery.

For the first time is demonstrated that the surgical technique can modify the tibio-femoral kinematics.

The aim of this study is to present guidelines for treatment of acquired adult flat foot (AAFF) and review the results of a series of patients consecutively treated. 180 patients (215 feet), mean age 54? 12 years affected by AAFF were evaluated clinically, radiographically and by MRI to chose the adequate surgical strategy. Tibialis posterior dysfunctions grade 1 were treated by tenolysis and tendon repair (48 cases), grade 2 by removal of degenerated tissue and tendon augmentation (41 cases), grade 3 by flexor digitorum longus tendon transfer (23 cases); in these cases subtalar pronation without arthritis was corrected by addictional procedures consisting of either calcaneal osteotomy (66 cases), subtalar athroereisis (25 cases) or Evans procedure (21 cases) in case of severe midfoot abduction. Subtalar arthrodesis (82 cases) or triple arthrodesis (21 cases) were performed in case of subtalar arthritis isolated or associated with midtarsal arthritis respectively. Postoperatively plastercast without weight-bearing for 4 weeks followed by walking boot for 4 weeks was advised. All patients were followed up to 5 years. Before surgery the mean AOFAS score was 48+\−11, while it was 89+\−10 at follow-up (p< 0.005). Mean heel valgus deviation at rest was 15°+\−5° preoperatively and 8°+\−4° at follow-up (p< 0.005). Mean angulation of Meary’s line at talonavicular joint level was 165°+\−12° preoperatively and 175°+\6 at follow-up. Surgical strategy in AAFF should include adequate treatment of tibialis posterior disfunction and osteotomies for correction of the skeletal deformities if joints are arthritis free; arthrodesis should be considered in case of severe joint degeneration

Introduction: Facioscapulohumeral muscular dystrophy (FSHD) is the third most common hereditary disease of the muscle after Duchenne and myotonic dystrophy. FSHD consists in an atrophic myopathy with predominant involvement of the face, upper arms, and shoulder muscles. FSHD compromises the muscles of the scapu-lothoracic joint, and usually spares muscles of the scapu-lohumeral joint. Consequently, when the patient tries to abduct or foreword flex the shoulder, the contraction of the relatively preserved scapulo-humeral muscles produces an abnormal rotation of the scapula, that is not hold to the chest wall because of the insufficiency of the scapulo-thoracic muscles, resulting in a winged scapula and in a limited arm motion. The aim of this study is to describe an original scapulopexy and report the long term results obtained in 9 patients affected by FSHD.

Material and methods: Nine patients (4 male and 5 female) affected by winged scapula in FSHD were observed and selected. Average age at surgery was 25 years (range 13–39). Surgery consisted in scapulopexy of both sides in the same surgical time. Through a skin incision on its medial border the scapula was exposed and positioned over the chest. The 5th to the 8th ribs were exposed in the part below the scapula. The position of the scapula over the chest was fixed by 4 doubled metal wires to the 5th, 6th, 7th and 8th rib. Each wire was passed anteriorly to the rib, and into a hole performed 1.5 cm from the medial border of the scapula. By tightening the wires, the scapula was fixed firmly over the chest. A figure of eight dressing that holds the shoulders back was applied immediately after surgery and maintained for six weeks.

Results: The average surgical time was 65 minute for each single procedure. One patient experienced an unilateral pneumothorax the day after operation, which resolved spontaneously in 48 hours. Average follow up was 11 years (range 3–15). All patients experienced a complete resolution of the winged scapula and an improvement of range of motion of the shoulder compared to the pre operative conditions. Average pre-operative abduction was 68 and post-operative was 85. Average pre-operative flexion was 78 and post-operative 112.

Discussion: This technique is easy and quick to perform, does not require grafts, reduces post surgical complications such as pneumothorax or haemothorax, and ensures good results even at considerable follow-up.

Introduction: Neck hyperextension (NH) is defined as a progressive increase of lordosis associated with a limitation in flexion of the cervical spine, which ultimately results in an inability to approximate the chin to the sternum. NH may occur in relation to several myopathies. It is characterized by a general weakness and contractures of the axial muscles which produces a progressive increase of lordosis associated with a limitation in flexion of the cervical spine, that forces the patient to assume awkward compensatory postures to maintain balance and level vision. This study reports on operative complications, the degree of correction, the achievement of a solid arthrodesis, the maintenance of the correction and the clinical assessment of 7 patients.

Material and methods: Seven patients affected by various myophaties and NH were included. The mean age was 16.5 years (10–28 years). All underwent surgery, in which the paravertebral muscles were detached from the spinous processes and then transversally sectioned in order to bilaterally expose the laminas of vertebrae C2 to C7. The space between C1–C2 appeared mobile, while the spinous processes from C2 to C7 were close together and thus allowed only a very limited motion in between them. Ligamenti interspinosus and nuchae were detached and the facet joints from C2 to C7 were enlarged by capsulotomy. With a spreader rongeur, the interspinous spaces at each level were gently opened. Cortical cancellous autologue graft were shaped into wedges. After careful opening of each interspinous space, the bone wedges were driven between the spinous processes to maintain the achieved correction. The average follow-up time was 10.4 years (2.4–16.5 years).

Results: No major surgical complications occurred. At follow-up, the average angle between C2–C7 in neutral position had decreased (p = 0.016) from 50.7 (40–70) to 21.4 (2–50). The range of motion in the C1–C2 joint remained unaffected, while it decreased in C2–C7 (p = 0.016) from 33.5 (15–64) to 1.8 (0–8). In all cases, a solid arthrodesis was achieved.

Discussion and conclusion: The follow-up showed significant clinical improvement of posture in all patients. Our study has shown surgical treatment of NH to be an effective method within the whole series of seven patients, achieving both good immediate and good long-term results.