Patellar resurfacing in total knee arthroplasty remains controversial. We report the medium term results of patients who had Scorpio total knee replacement for osteoarthritis between January 2002 and September 2004. A retrospective review of 118 patients was undertaken. All patients during the first half of this time period had no resurfacing of the patella, and all patients in the later half of this period underwent resurfacing of the patella. The mean follow-up in the non-resurfaced group was 30 months and the mean follow-up in the resurfaced group was 17 months. The two groups were similar in age, gender and the grade of the surgeon. Knee society clinical rating score, patient satisfaction, anterior knee pain, patellofemoral questionnaires, patellofemoral revision rates and success in returning to normal daily activities were noted.

There was a significant difference between the two groups in the patellar revision rates, anterior knee pain and Euroquol scores. The incidence of anterior knee pain in the patella non-resurfaced group was 23%, compared to 6% in the resurfaced group [p<0.05]. The rate of revision in the non-resurfaced group was 11% compared to 0% in the resurfaced group [p=0.03]. The mean Euroquol score in the resurfaced group was 86.44 compared to 80.35 [p=0.04]. Knee Society score, patient satisfaction, symptoms of patellar apprehension and knee instability, return to pre-op functional level, ability to kneel, use of a walking aid, presence of limp and satisfaction with operation as not statistically different between the two groups.

In view of the statistically significant difference in the incidence of anterior knee pain and the rate of revision in the group of patients without patellar resurfacing, the authors suggest that retaining the patellar surface may not be a viable option. Although an appropriate design for the femoral prosthetic trochlea is an important factor, a good surgical technique with patellar resurfacing is more likely to result in predictable satisfactory results. We feel that high contact pressures between the non-resurfaced patellae and the prosthetic femoral trochlea can be generated after a total knee replacement when the patella is not resurfaced, and can thus result in patients having anterior knee pain.

Background: The Bankart repair remains a safe and effective method for repairing instability in shoulder injuries. We report the results of a large series of patients treated using this technique.

Materials and Methods: We retrospectively reviewed 136 consecutively treated patients with either anterior, antero-inferior or multidirectional shoulder instability over a 7-year period from 1999–2006 with a minimum of 2-year follow-up. All patients underwent open bankart repair through a deltopectoral approach, performed by a single surgeon. A thorough chart review was performed and patients were evaluated according to the Oxford Instability Score (OIS), the level of sport returned to, the influence of pre-operative physiotherapy and the incidence of redislocation.

Results: Of the 136 identified patients, 108 (79%) responded to the questionnaire. Of the responders, there were 95 males and 13 women. The average age was 24 years (range 14–72). Ninety-one patients had confirmed dislocations whereas 17 suffered from subluxations. The majority of patients had either anterior or antero-inferior instability, whereas four (3.7%) had multidirectional deficits. The average time to surgery from the index instability incident ranged from 3 months to 10 years. The average OIS was 23 which corresponded to a good result. There was no significance found in the OIS in relation to the age of the patient or pre-operative physiotherapy. Significant associations with a better outcome included: delay to surgery greater than 12 months; and the absence of multidirectional instability. Of those who actively participated in sport, 75% returned to the same level of non-contact sport where only 47% returned to a similar level in collision sports. Eight patients (7.4%) experienced re-dislocation post open repair and 3 (2.8%) reported feelings of subluxation.

Conclusions: Open bankart repair +/− capsulorrhaphy remains the gold standard for treatment of patients with shoulder instability. While our rate of success, in terms of re-dislocation, is equivalent to international norms, we found that a delay to surgery may be associated with a better outcome. Furthermore, the use of the Oxford Instability Score enables accurate and easy determination of the success of the operation.