In 1999, we developed a technique for biological reconstruction after excision of a bone tumour, which involved using autografts of the bone containing the tumour treated with liquid nitrogen. We have previously reported the use of this technique in 28 patients at a mean follow up of 27 months (10 to 54).

In this study, we included 72 patients who underwent reconstruction using this technique. A total of 33 patients died and three were lost to follow-up, at a mean of 23 months (2 to 56) post-operatively, leaving 36 patients available for a assessment at a mean of 101 months 16 to 163) post-operatively. The methods of reconstruction included an osteo-articular graft in 16, an intercalary in 13 and, a composite graft with prosthesis in seven.

Post-operative function was excellent in 26 patients (72.2%), good in seven (19.4%), and fair in three (8.3%) according to the functional evaluation system of Enneking. No recurrent tumour occurred within the grafts. The autografts survived in 29 patients (80.6%), and the rates of survival at five and ten years were 86.1% and 80.6 %, respectively. Seven of 16 osteo-articular grafts (44%) failed because of fracture or infection, but all the composite and intercalary grafts survived.

The long-term outcomes of frozen autografting, particularly using composite and intercalary grafts, are satisfactory and thus represent a good method of treatment for patients with a sarcoma of bone or soft tissue.

Cite this article: Bone Joint J 2014;96-B:555–61.

Aims: The concept of balancing ßexion and extension gap during total knee arthroplasty (TKA) is reported to be crucial. However, difþculties in 1)deþning the ideal distraction force to create a gap, and 2)equalizing ßexion and extension gap are often encountered during TKA for rheumatoid arthritis (RA). This study was performed to analyze these difþculties biomechanically in vivo. Methods: 35 knee at randomly selected TKA for RA were studied as follows. After soft tissue balancing, distraction force for both gaps was applied by ligament balancer. Force was gradually increased with recording the length of the gap created by consecutive force, in order to obtain load-elongation curve for each case. Results: Load-elongation curve showed various patterns, indicating soft tissues including ligamentous structure has been altered its biomechanical property due to the variety of rheumatoid pathology. If ideal force for extension gap was determined at the point when low stiffness changes to high stiffness in the curve, it would be about 120–200N. This force differed reasonably in each case. However, measured ßexion gap curve hardly reached this force in more than 60% of the35 knee, presumably due to functional loss of posterior structures. Interestingly, this phenomenon was often unpredictable at examination before the operation. Conclusions: Ideal tension for þlling the gap with implant seems to be different in each case from load-elongation curve analysis. From this study, we raise question to the concept of equal ßexion and extension gap. This concept, although sounds attractive, is often difþcult to obtain in rheumatoid knee. This observation may suggest which type of TKA (þxed or mobile) is safer for replacing the rheumatoid knee.

We investigated the clinical outcome of a reconstructive procedure of the medial patellofemoral ligament for the treatment of habitual or recurrent dislocation of the patella in four children (6 knees), with a minimum follow-up of four years. The technique involves transfer of the tendon of semitendinosus to the patella using the posterior one-third of the femoral insertion of the medial collateral ligament as a pulley.

There was no recurrence of dislocation after surgery. The mean Kujala score at follow-up was 96.3 points. Radiological assessment showed that the congruence angle, the tilt angle and the lateral shift radio were restored to normal. The lateral and medial stress shift ratios and the Insall-Salvati ratio remained abnormal.

We conclude that this technique can be recommended for the treatment of habitual or recurrent patellar dislocation in children, although hypermobility and patella alta are not fully corrected.