The long-term clinical and radiological results of 63 uncemented Low Contact Stress (LCS) total knee replacements in 47 patients with rheumatoid arthritis were reviewed. The average age at the time of surgery was 69 years (53–81). At a mean follow up of 22 years (20–25), 12 patients (17 knees) were alive, 27 (36 knees) had died, and 8 patients (10 knees) were lost to follow-up.

Revision was necessary in seven patients (7 knees) (11.1%) at mean 12.1 years following surgery. Four revisions were performed due to meniscal bearing wear, two for collapse of the tibial component, and one for aseptic loosening. Evidence of post-operative infection occurred in two knees (3.2%) within 6 weeks of surgery but resolved with antibiotics. Within the group of deceased patients, five had undergone revision (included in total revisions) but otherwise the primary implant remained in vivo.

For all living patients, the mean Oxford Knee Score (/48) was 30.2 (16–41) at latest follow up at mean 19.5 years (15–24.7) following surgery. Mean active flexion was 105 degrees (90–150) at this time point.

Our recorded survival rate of the uncemented LCS total knee replacements in patients with rheumatoid arthritis was therefore 88.9% at mean 22 years, or worst-case survival of 73.0% if patients lost to follow-up were considered failures. From a review of the literature and as far as we are aware, this study represents the longest follow up of any uncemented knee arthroplasty performed in a cohort of patients with rheumatoid arthritis.

Anterior knee pain following primary total knee replacement (TKR) is a common problem with average reported rates in the literature of approximately 10%. Symptoms are frequently attributed to the patellofemoral joint, and the treatment of the patella during total knee replacement is controversial.

There is no article in the literature that the authors know of that has specifically evaluated the effect of patella rim cautery on TKR outcome. This is a denervation technique that has historically been employed, with no evidence base. A prospective comparative cohort study was performed to compare the outcome scores of patients who underwent circumferential patella rim cautery, with those who did not.

Patients who had undergone a primary TKR were identified from the unit's arthroplasty database. Two cohorts, who were age and gender matched, were established. None of the patients had their patella resurfaced, but all had a patellaplasty. The Low Contact Stress TKR (Depuy International) was used in all cases.

The effect of circumferential patella rim cautery on the Oxford Knee Score (OKS) and the more anterior knee pain specific Patellar Score (PS) a minimum of 2 years post surgery was evaluated. Previous reports have suggested that a change of 5 points in the OKS represents a clinical difference. A sample size calculation based on an effect size of 5 points with 80% power and a p-value of 0.05 would require a minimum of 76 patients in each group.

There were 94 patients who had undergone patellaplasty only, and 98 patients who had supplementary circumferential patella rim cautery during their primary TKR. The mean OKS were 34.61 and 33.29 respectively (p=0.41), while the PS scores were 21.03 and 20.87 (p=0.87).

No statistically significant differences were noted between the groups for either outcome score. Patella rim cauterisation is unnecessary in primary TKR.

Introduction: It has been shown in several studies that cytokine (IL-6, TNF-alpha, IL-10, IL-8 etc) concentrations in the peripheral blood are associated with inflammatory activity and surgical trauma. These exhibit more rapid rise and quicker return-to-normal values than either the CRP or the ESR (few hours to few days) and have also been found to be better predictors of postoperative infection compared to CRP/ESR in some studies. Threshold levels of IL-6 after joint replacement surgery have been determined, but levels of other potentially useful cytokines (TNF-alpha, IL-8, IL-10 etc) are not yet known.

Aim: We sought to measure the serum levels of 25 different cytokines before and after hip/knee replacement surgery and identify those associated with postoperative inflammation.

Method: Peripheral venous blood samples were collected from 80 patients undergoing hip/knee replacement. Each patient had one preoperative and three postoperative (total four) blood samples. Samples were stored at −70 degree before being analysed by laser chromatography.

Results: Three out of the 25 cytokines we measured had a significant relationship with postoperative inflammation. The relationship of these three cytokines with a single case of deep infection in our study appeared to be of clinical significance.

Conclusion: It may be possible to use the serum levels of these three cytokines to diagnose periprosthetic infections in the early postoperative period when the CRP and ESR are elevated.

Introduction: A retrospective review was conducted on individuals who have undergone Mitchell osteotomy for mild to moderate hallux valgus deformity. Hallux valgus leads to altered load bearing function of the foot and correction of deformity might result in shortening of the first metatarsal. Transfer metatarsalgia is one of the common postoperative complication. This study aims to look at the restoration of load bearing function of the foot post deformity correction.

Methods: Patients with preoperative intermetatarsal angle of less than 14 degrees were included. Clinical records and radiographs were reviewed. Clinical evaluation done with AOFAS scores and plantar pressures recorded using musgrave system. The foot was divided into 7 regions: first metatarsal head, 2nd & 3rd metatarsal heads, 4th & 5th metatarsal heads, midfoot, heel, hallux and lesser toes. Average pressure, peak pressure distribution and contact time of all seven regions were analysed. A control group of 15 individuals with twenty normal feet were included for comparison. Statistical analysis was done with analysis of variance of the means and Pearson correlation tests.

Results: Seventeen mitchell osteotomy was performed on 13 patients with follow up ranging from 14 to 66 months, a mean of 34 months. Most of our study group were females with an age range of 25 to 71 years, a mean of 53 years. The mean postoperative AOFAS scores were 87 and a median of 90 out of 100. Pedobarograph findings: Statistically significant reduced average pressure, peak pressure and contact time were noted under hallux when compared to the normal control group. The peak pressures were reduced at all forefoot regions but statistically insignificant. Otherwise, the pressure distribution, contact time and center of pressure progression were similar to the normal feet. On analysis of correlation between the parameters observed, reduced pressure distribution under first metatarsal head lead to increased pressures under 4th, 5th metatarsal heads and lesser toes. Significant correlation found between the pressure distribution under hallux and the AOFAS scores, which reveals the outcome of procedure, depends on the load bearing characteristics of hallux and not the first MT head.

Conclusion: Mitchell osteotomy restores the load bearing function of the feet to near normal except hallux, which may affect the outcome of the procedure.

Introduction Hallux valgus (HV) leads to altered load-bearing function of the foot but there is no adequate evidence to show the restoration of load bearing function post-deformity correction where transfer metatarsalgia is the common complication. This study describes a retrospective review conducted on individuals who have undergone Mitchell and Scarf osteotomy for severe HV deformity.

Method Clinical records and radiographs were reviewed. Clinical evaluation was done using American Orthopaedic Foot and Ankle Society (AOFAS) scores and plantar pressures recorded using the Musgrave system analysing the average pressure, peak pressure distribution and contact time of the various regions of foot during the gait cycle. A control group of 15 individuals with 20 normal feet was included for comparison. Statistical analysis was carried out using ANOVA and correlation tests.

Results Twenty-two Mitchell and 22 Scarf osteotomies were performed on 28 patients with follow up ranging from 13 to 62 months. The average postoperative AOFAS scores following Mitchell and Scarf osteotomy were 74 and 84 respectively.

Pedobarograph findings: Post-Mitchell osteotomy, an insufficiency of hallux was seen, which overloads the second and third metatarsal heads. Post-Scarf osteotomy resulted in reduced peak pressures under first, second and third metatarsal heads and hallux with reduced push off during late stance phase. More pressure is transferred through heel, midfoot and lateral metatarsal heads. The centre of pressure progression is central in both the study groups. The outcome of the procedure depends on the load bearing characteristics of hallux and not the first metatarsal head.

Conclusion Mitchell osteotomy leads to abnormal load bearing characteristics of the forefoot with an unfavourable outcome. However, the Scarf procedure does not restore the load bearing characteristics to normal. A prospective study may be more valuable.

Introduction and Aims: The aim of this paper was to assess the 10 to 15-year clinical and radiographic results of uncemented LCS meniscal-bearing total knee replacements used to revise failed uni-compartmental knee replacements.

Method: Eleven (5 M: 6 F) cementless LCS meniscal-bearing total knee replacements were implanted in patients who had failed uni-compartmental knee replacements for medial compartment osteoarthritis. Mean time interval between the uni-compartmental knee replacement and the LCS total knee replacement was 18 months (12–72 months). Minimum follow-up of all patients reviewed was 10 years (mean 12.9 years). Average age of patients at the time of surgery was 60.1 years (47–74 years). Clinical and radiographic analysis was performed. American knee society pain and function scores were determined and Kaplan-Meier survivorship analysis was conducted. Failure was defined as revision due to any cause.

Results: At the time of the 10 to 15-year follow-up, all 11 patients were alive and were all reviewed. Four patients (three males, one female) had a revision of their LCS total knee replacement. The average time to revision of the LCS total knee replacement was 26 months (1–60 months). The average knee society pain and function scores were 80 and 45 at the final follow-up evaluation. The average range of movement was 95 degrees (80–100 degrees). The survival rate of 60% (95 % confidence interval) was noted at 12 years.

Conclusion: After 10 to 14 years of follow-up, the cementless LCS meniscal bearing total knee replacement for a previously failed uni-compartmental knee replacement was found to have a 37% revision rate.

Rockers are applied to lower limb casts to assist walking but there is little information on their biomechanical effects. The performances of 10 commercially available rockers were compared. They were applied to a below-knee cast worn by a normal subject who was also tested walking in the cast alone. Gait analysis was used to evaluate kinematic and kinetic data. The design of rocker had no effect upon the kinematics of walking. However, using new criteria for kinetic assessment of rocker function (tibial floor angular velocity and centre of pressure progression), most designs had a deleterious effect on the biomechanics of gait. Only two rockers approached the ideal kinetic criteria.