A reduced range of movement post total knee replacement (TKR) surgery is a well recognised problem. Manipulation under anaesthesia (MUA) is a commonly performed procedure in the stiff post operative TKR. Long term results have been variable in the literature.

We prospectively followed up 48 patients since 1996 from one centre, over an average of 7.5 years, (range 1 to 10 years) and report on the long term results.

The mean time to MUA post TKR was 12.3 weeks (range 3 to 48). Pre MUA, the mean flexion was 53°. The mean immediate passive flexion post MUA was 97°, an improvement of 44° (Range 10° to 90°, CI < 0.05). By one year, the mean flexion was 87°, improvement of 34°, (range −15° to 70°, CI< 0.05). At ten years the mean flexion was 86°.

We found no difference between those knees manipulated before or after 12 weeks. In addition there was no difference found in those knees which had a pre TKR flexion of greater or less than 90°. There were no complications as a result of MUA. However, one patient was eventually revised at two years secondary to low grade infection.

Our findings show that MUA is safe and effective method at improving the range of motion in a stiff post operative TKR. The improvement is maintained in the long term irrespective of time to MUA and range of motion pre TKR

Introduction We report the clinical and radiographic outcome of a consecutive series of 138 hydroxyapatite coated total knee replacements with a mean follow up of 11 years (10–13 years)

Method and Results These patients were entered into a prospective study. There were 74 females and 32 males. Indications for surgery were osteoarthritis in 131 knees, rheumatoid arthritis in 5 knees and pigmented villo-nodular synovitis in 2 knees. The mean age of the patient was 72.5 years at the time of surgery. All living patients (76 knees) were examined and X rayed. A current Hospital for Special Surgery knee score (mean 83 points) was obtained for comparison with the preoperative profile (mean 55 points).The knee status of deceased patients was known within the year of death. No patient was lost to follow up. Radiological evaluation, assessed according to the method described by the Knee Society, revealed no loosening in surviving patients, and there are no impending revisions. Seven prostheses have been revised, giving a cumulative survival rate of 93 percent at 13 years.

Discussion. We believe this to be the longest follow up report available for an hydroxyapatite coated knee replacement, and the first using the Insall Burstein knee. Results can thus be compared with the identical prosthesis using cemented fixation. Further modifications would be likely to improve reliability.

We have prospectively followed 100 consecutive HA coated knee replacements performed from 1990–1992. The prostheses was a cruciate sacrificing IB II, with HA coating on the femoral and tibial components. The average age at surgery was 72.5 years [32–92]. The indications for surgery was predominantly osteoarthritis [93 cases]. 3 knees required cemented tibial components at surgery and were excluded from the series. All knees were mobilised full weight bearing postoperatively.

Patients were reviewed annually with radiographic and clinical evaluation [Hospital for Special Surgery Knee score]. There was no loss to follow-up and at most recent review 48 people [60 knees] were alive. Of these, 47 knees had a final radiographic examination; the remaining knees were assessed clinically but did not attend hospital.

Using revision or need for revision as the endpoint for failure, 6 knees have been revised giving a 10 year survival of 92% [CI 0.96–0.76]. 3 tibial and 2 femoral components underwent aseptic loosening. 1 revision was for infection and 1 for technical errors.

Using pain as the endpoint for survival, 5 surviving knees [9.3%] complained of moderate or severe pain at rest or during exercise and could be regarded as failures.

There is a very low incidence of radiolucent lines at the prostheses-bone interface with 11 radiolucent zones of < 1mm under the tibial component [knee society radiological evaluation]. 72% of cases demonstrated evidence of bone-prostheses bonding with ‘spot welds’ or buttress formation.

Overall the survival at ten years is comparable with cemented fixation. We believe the evidence of bone-prostheses bonding and absence of radiolucent lines indicates that the surviving knees will continue to function well.

In a 10-year prospective study, 561 displaced subcapital fractures of the femoral neck in 546 patients were treated with the Hastings bipolar hemiarthroplasty. Within six months of their operations, 148 patients had died. In 322 hips followed up, 243 with adequate serial radiographs separated by more than one year, only 14 (5.6%) showed acetabular erosion. A group of 91 had been reviewed for between three and nine years (mean, 4 years 10 months) and of these, 95% had no pain or slight pain only. Comparison with an earlier series of conventional hemiarthroplasties reported from this institution showed that the clinical results were similar, but that the erosion rate had been halved.

The best treatment for a fractured neck of femur in an old person is considered by many to be replacement hemiarthroplasty which allows the patient to walk immediately on a stable, painless hip. The late results can be marred by acetabular erosion in which the metal head of the prosthesis erodes upwards into the acetabulum to give pain and disability. Here the trial of a new bipolar prosthesis with a dynamic self-aligning outer head is described in 161 fractured necks of femur. No acetabular erosion has been seen with its use over four years.