Purpose: Removal of intra-articular foreign bodies (FB) constitues a major indication for elbow arthroscopy. The purpose of our study was to evalute our experience with arthroscopic treatment of elbow osteochondromatosis.

Material and methods: Between September 1988 and June 2001 we performed elbow arthroscopy in 25 active patients (15 manual workers, 8 athletes including 2 high-level) who presented intra-articular FB osteochon-dromatosis of the elbow. Male gender predominated (n=22). Mean age at intervention was 42 years (17–68). The right (n=21) and dominant (n=24) side predominated. The mean clinical course before arthroscopy was two years. Seven patients had had upper limb trauma (five with elbow injury) a mean 60 months (6–144) before arthroscopy. Clinical assessment before arthroscopy and at last follow-up (mean follow-up 60 months, 8–138) included pain score (visual analogue scale), the notion of blocking and joint effusion and joint motion, as well as index of functional impairment during occupational and recreational activities and a subjective satisfaction index. Standard x-rays and arthroscan were obtained before arthroscopy to identify and evaluate intra-articular foreign bodies. Cartilage damage and presence of synovial anomalies were evaluated on the preoperative scan and during the intervention. Arthros-copy was performed according to the same procedure in all cases: lateral decubitus, arm cuff, anterior expoloration (anteromedial and anterolateral access). Standard x-rays were also obtained after arthroscopy and at last follow-up.

Results: FB were found and extracted in all cases. Cartilage injury was associated in 14 cases. Synovectomy was performed systematically in case of synovitis, a macroscopic synovial anomaly, or to extract a FB trapped in the synovial (n=18). Osteophytes were shaved in 12 cases. The post-arthroscopic period was uneventful with no complications (vascular, nervous, infectious). Clinical improvement was significant and sustained and the occupational and recreational function indexes improved. The subjective satisfaction index remained high five years after arthroscopy. We did not have any clinical recurence (blockage) or radiographically detectable anomaly at last follow-up. Less favourable results (persistent pain) were obtained in patients who had cartilage injury.

Discussion: Arthroscopy appears to be a safe treatment with long-term efficacy for osteochondromatosis of the elbow. Long-term prognosis is influenced most by presence of cartilage injury.

Purpose: We report aseptic complications observed in a retrospective series of 130 total knee arthroplasties using first generation Miller-Galante implants at 6.6 months mean follow-up.

Material and methods: Mean age of the patients at surgery was 65.4 years (35–82). One third of the patients was considered to be obese (BI > 30). The principal cause was primary degenerative joint disease (85%). Most of the implants were implanted without cement except for the first 9 prostheses (hybrid). Mean IKS score was 47.3 (12–70) preoperatively and 74.3 (30–99.5) postoperatively with 70% excellent or good results.

Results: The principal aseptic complications in this series were related to the patella (17%): loosening, fracture, dislocation, necrosis and metallosis. These complications were sometimes associated. Use of a metal-backed patellar insert was correlated with the development of certain patellar complications. The rate of aseptic loosening was 3.4% for the tibia, 1.7% for the femur. There was no statistically significant factor predictive of loosening (alignment, laxity, wear were not significant). Wear of the tibial component polyethylene predominated in the medial femorotibial compartment and was strongly correlated with varus and/or frontal laxity (p = 0.01). Images of bone rarefaction in the distal femur were observed in 61% of the cases. Their intensity was variable; stress shielding or osteolytic mechanisms appeared to be involved. Three revision procedures were required to treated clinically invalidating instability: one frontal laxity corrected by implantation of a thicker polyethylene tibial insert and two important sagittal laxities treated by posterior stabilised prostheses. Other aseptic complications were: stiffness requiring arthrolysis (n=1), unexplained painful prosthesis (n=1) and reflex dystrophy (n=1). These complications led to revision in 15% of the cases. Patient characteristics and mode of fixation were similar in patients with and without complications.

Discussion: These observations point out the multifactorial nature of failure of total knee arthroplasty, most often related to a complication of technical errors and implant properties. Nevertheless, patella-related complications was just one of the principal causes of the problems encountered with the Miller-Galante first-generation prosthesis, particularly the metal-backed insert, leading several teams to abandon this implant.