Objective: To review the results of the Avon patellofemoral arthroplasty at 5 to 8 years.

Methods: The Avon patellofemoral arthroplasty was introduced in clinical practice in September 1996. We present a prospective cohort review of all patients treated in the first three years. Patients were evaluated using the Bristol knee score (BSK), the Melbourne patella score (MPS) and the Oxford knee score (OKS).

Results: 109 patellofemoral arthroplasties were performed in 92 patients between September 1996 and November 1999. The median age was 68 years (range 46 to 86 years). Nine patients (12 knees) died and two patients (two knees) were unfit for follow-up. Ten knees in 9 patients were lost to follow-up giving a follow-up rate of 89%. The mean period of follow-up was 5.6 years.

The median pain score rose from 15/40 pre-operatively to 40 points at eight years. The median (MPS) rose from 10/30 points pre-operatively to 25 points at eight years. The median (OKS) rose from 18/48 pre-operatively to 38 at eight years. 87% of knees had mild or no pain at eight years. There were no cases of failure of the prosthesis itself. All 15 revisions resulted from progression of arthrititis in the tibio-femoral joint. The five-year survival rate for all causes with 86 cases at risk was 96%.

Conclusions: The results show that this type of arthroplasty can give predictable pain relief and excellent functional improvement in patients with isolated patello-femoral arthritis. Disease progression is the main reason for revision to total knee replacement and great care is required in assessing the indications for this procedure.

We report the mid-term results of a new patellofemoral arthroplasty for established isolated patellofemoral arthritis. We have reviewed the experience of 109 consecutive patellofemoral resurfacing arthroplasties in 85 patients who were followed up for at least five years.

The five-year survival rate, with revision as the endpoint, was 95.8% (95% confidence interval 91.8% to 99.8%). There were no cases of loosening of the prosthesis. At five years the median Bristol pain score improved from 15 of 40 points (interquartile range 5 to 20) pre-operatively, to 35 (interquartile range 20 to 40), the median Melbourne score from 10 of 30 points (interquartile range 6 to 15) to 25 (interquartile range 20 to 29), and the median Oxford score from 18 of 48 points (interquartile range 13 to 24) to 39 (interquartile range 24 to 45). Successful results, judged on a Bristol pain score of at least 20 at five years, occurred in 80% (66) of knees. The main complication was radiological progression of arthritis, which occurred in 25 patients (28%) and emphasises the importance of the careful selection of patients. These results give increased confidence in the use of patellofemoral arthroplasty.

Claims for personal injury after whiplash injury cost the economy of the United Kingdom more than £3 billion per year, yet only very few patients have radiologically demonstrable pathology. Those sustaining fractures of the cervical spine have been subjected to greater force and may reasonably be expected to have worse symptoms than those with whiplash injuries.

Using the neck disability index as the outcome measure, we compared pain and functional disability in four groups of patients who had suffered injury to the cervical spine. After a mean follow-up of 3.5 years, patients who had sustained fractures of the cervical spine had significantly lower levels of pain and disability than those who had received whiplash injuries and were pursuing compensation (p < 0.01), but had similar levels to those whiplash sufferers who had settled litigation or had never sought compensation.

Functional recovery after neck injury was unrelated to the physical insult. The increased morbidity in whiplash patients is likely to be psychological and is associated with litigation.

Purpose: To compare the ten-year survivorship results of an established total and medial compartment knee replacement performed in a single centre over an eighteen year period.

Method: Since 1978 knee replacements have been prospectively recorded in Bristol on a database. Regular clinical and radiological review has been undertaken every two or three years up to twenty years. 408 medial St Georg Unicompartmental replacements and 531 Kinematic total knee replacements have been subject to survivorship analysis using three failure end points. One - revision or removal of the implant. Two – revision or removal and moderate or severe pain. Three – the worst case including all patients lost to follow-up.

Results: The follow-up rate was 97% in both groups. 212 patients (562 knees) died and 31 patients (35 knees) were lost to follow-up. At ten years 25 medial Sled and 20 Kinematic knee arthroplasties had been revised. There was no significant difference (p > 0.05) in the number of good and excellent results. The mean range of movement at the last follow-up was 109 degrees for the medial Sled and 100 degrees for the Kinematic (p< 0.01). 94% of the medial Sled patients obtained a range of movement equal to or greater than 90 degrees whereas only 84% of Kinematic patients obtained this range (p < 0.05).

The ten-year survivorship figures were similar for both groups. Revision as the end point was 87.5% for the medial Sled and 89.6% for the Kinematic knees. When moderate and severe pain was considered in addition to revision ten-year survivorship was 79.4% in both groups. The worst case survivorship was also 74% in both groups.

Conclusion: The ten-year survivorship results of a fixed bearing, non-congruous, Unicompartmental arthroplasty are as good as those of a total knee replacement when performed in a single centre by two consultant surgeons and a variety of trainees. The advantages of a more rapid recovery and better quality result are offset by an easier though slightly higher revision rate.

We have studied the long-term outcome of 408 primary medial St George Sled unicompartmental arthroplasties of the knee and 531 primary Kinematic total knee arthroplasties using survivorship analysis. The operations were performed by a number of surgeons under the supervision of two consultants at one orthopaedic centre. Prospective clinical assessment was carried out before and at 2, 5, 8, 10, 12 and 15 years after operation. Failure was defined as follows: revision or removal of the implant; the presence of moderate or severe pain; or ‘worst-case’ with all patients lost to follow-up.

Cumulative survival rates at ten years were calculated using life tables. The follow-up rate was 97%. At ten years, 25 medial sled arthroplasties and 20 Kinematic knee arthroplasties had been revised. With revision or removal as the survivorship endpoint at ten years there was a success rate of 87.5% for the medial sled and 89.6% for the Kinematic knee arthroplasty. When moderate or severe pain was included these rates became 79.4% for both arthroplasties. There was no statistically significant (p > 0.05) difference between the rates of survival for the two arthroplasties using either of the endpoint criteria.

Good or excellent results were recorded for 77.9% of the medial sled knees and 75.1% for the Kinematic knees. The former had 93.8% of cases with a final range of movement in excess of 90° compared with 83.7% for the Kinematic knees (p < 0.01). We conclude that at a single orthopaedic centre in the UK, the St Georg Sled medial compartment arthroplasty for appropriate specific indications offers predictable survivorship at ten years which is comparable with that of the Kinematic total knee arthroplasty.