Introduction

We reports the accuracy of direct Magnetic Resonance Arthrography (MRA) in detecting Triangular Fibrocartilage Complex (TFCC), Scapho-Lunate Ligament (SLL) and Luno-Triquetral Ligament (LTL) tears using wrist arthroscopy as the gold standard.

Long-term follow up after replacement arthroplasty has become established as a “Gold Standard”, providing information that can aid optimisation in future prosthetic design and use. In less mainstream joint replacements however, the evidence for use of prostheses, and in particular long-term outcome, is scarce.

A cohort of 71 patients (93 implants) was reviewed in 1997 having had a De la Caffinière prosthesis implanted between 1980 and 1989. The conclusions of the study included the findings that the replacement was generally well regarded by recipients, pain was improved and survivorship was comparable with data from the best hip replacements.

Ethical permission was obtained to review the same cohort ten years on (16 – 26 years post-op). Similar outcome measures were employed as in the original study but in addition formal grip strength measurements were taken, along with newer outcome scores including the DASH (Disability of arm, shoulder and hand) and EQ-5D (a European quality of life measure). Radiographs allowed assessment of radiological failure using the criteria from the original study.

We found a significant mortality rate in the interim period since the original review (27 patients, 36 implants). A further 8 implants in 8 patients had been removed and were not clinically reviewed as per patients’ wishes. However, 39 implants in 26 patients were available for follow up at a mean 19 years (SD 6.3) leaving a “lost to follow up” rate of 10 patients (10 implants). Survivorship at 26 years was 73.9% (95% CI 61.2, 86.6) with the end-point as revision. Our data also demonstrated continued patient satisfaction without pain, satisfactory power and thumb mobility.

Such information may be used to counsel future patients requiring surgery that there is a functional alternative to excision arthroplasty (trapeziectomy).

Aims: Anterior knee pain is a common complaint of mixed aetiology, and in many cases no demonstrable cause is identified. For patients with persistant anterior knee pain, tibial tubercle transfer (TTT) can be a surgical option. The aim of this study is to assess the effectiveness of TTT for chronic anterior knee pain resistant to conservative treatment. Method: All patients with arthroscopically proven Chondromalacia patellae (CMP) without clinical evidence of patella instability, who have failed to respond to conservative treatment such as physiotherapy were included in the trial. They underwent TTT with a modified Fulkerson technique and then routine post-operative care with a cricket pad splint for 2–4 weeks. Pre and post-operative scores were obtained using a Kujala patello-femoral score, a visual analogue score for pain and a patient satisfaction score. The Outerbridge grading was used to score the severity of CMP at arthroscopy. Results: There were 50 TTT’s followed up (7 staged bilaterals) with a mean follow up of 32.4 months (5–88 months). There were significant improvement in the pre-operative and post-operative Kujala (p> 0.001) and visual analogue pain scores (p> 0.001). Of the 50 TTT’s 70% had an excellent or good result and 30% a fair or poor result. Moreover 76% claimed that they would have the same operation again for their condition. There was no significant correlation between Outerbridge grading and post-operative outcome. Complications include late anterior knee pain (10 cases), superficial wound infection (1 case), non-union of osteotomy (1 case) and tuberosity fracture (1 case). Conclusion: Anteromedial tibial tubercle transfer is a reliable and effective treatment for peristant anterior knee pain.

Introduction: We report a series of 90 patients enrolled in a prospective study of Dynesys stabilisation reviewed at 12 to 30 months.

The procedure involves, at each segment, cephalad and caudad pedicle screws connected with a polycarbourethane spacer and polyethylene cord. It achieves load relief and controlled flexion. Since 1996, 7000 procedures have been undertaken globally.

Method: Indications are analogous to consideration for fusion. Entry criteria included 1) Unresolved and unacceptable lumbar back pain despite protracted conservative management and 2) Definite pathology where symptoms could be abolished by anaesthetising the target segments.

Where root compression was present, a midline approach and posterior screw placement was used in conjunction with open decompression. With back pain alone a bilateral Wiltse approach and posterolateral placement was used.

All patients were assessed pre and post surgery with SF36, Oswestry Disability Index and pain analogue scores and modified Zung. Standing radiographs were obtained post surgery and at review. Follow up was at 6, 12, 24 and 52 weeks in addition to this review.

Results: Follow up was 100%. 89 patients survived. Mobilisation was achieved on day 1 and discharge usually by day 2.Based on the above outcome measures and patient satisfaction good to excellent results were achieved in 74%(66/89). Screw loosening or breakage occurred in 8%, and was associated with a poor result.

Discussion: Dynesys flexible stabilisation offers a simple alternative to fusion with less potential for adjacent ‘Domino’ failure. It differs from tension ligament systems such as Graf. At this stage the results appear at least as good as a comparable cohort of fusion patients.

The present series is early, but gives grounds for encouragement. Screw loosening and failure are technical problems detracting from the result and require further development.

We are continuing to use the technique.

Introduction: Treatment of discitis using conventional methods can be prolonged and unrewarding. Patients can have prolonged pain and persistently elevated Inflammatory markers. We propose a new method of treatment of severe cases, and present two cases where this method has successfully been used.

Method: Once discitis has been diagnosed clinically and radiologically, a percutaneous discectomy of the infected level is performed. Matter is sent for microbiological analysis. An epidural catheter is then left in the infected disc space cavity. This is then used to administer appropriate antibiotics directly into the infected cavity. After one week the patient is converted on to intravenous antibiotics, for a further two weeks, then a prolonged course of oral antibiotics.

Discussion: Discitis can be a difficult and unrewarding condition to treat. This novel method appears to be a new and effective mode of treatment, for both acute and chronic infections, although it does require further evaluation.

INTRODUCTION: We report a series of 90 patients enrolled in a prospective study of Dynesys stabilisation reviewed at 12 to 30 months.

The procedure involves, at each segment, cephalad and caudad pedicle screws connected with a polycarbo-urethane spacer and polyethylene cord. It achieves load relief and controlled flexion. Since 1996, 7000 procedures have been undertaken globally.

METHOD: Indications are analogous to consideration for fusion. Entry criteria included (1) unresolved and unacceptable lumbar back pain despite protracted conservative management and (2) definite pathology where symptoms could be abolished by anaesthetising the target segments.

Where root compression was present, a midline approach and posterior screw placement was used in conjunction with open decompression. With back pain alone a bilateral Wiltse approach and posterolateral placement was used.

All patients were assessed pre- and post-surgery with SF36, Oswestry Disability Index and pain analogue scores and Modified Zung. Standing radiographs were obtained post- surgery and at review. Follow-up was at six, 12, 24 and 52 weeks in addition to this review.

RESULTS: Follow-up was 100%. 89 patients survived. Mobilisation was achieved on day 1 and discharge usually by day 2. Based on the above outcome measures and patient satisfaction good to excellent results were achieved in 74% (66/89). Screw loosening or breakage occurred in 8%, and was associated with a poor result.

DISCUSSION: Dynesys flexible stabilisation offers a simple alternative to fusion with less potential for adjacent ‘Domino’ failure. It differs from tension ligament systems such as Graf. At this stage the results appear at least as good as a comparable cohort of fusion patients.

The present series is early, but gives grounds for encouragement. Screw loosening and failure are technical problems detracting from the result and require further development.

We are continuing to use the technique.

INTRODUCTION: Treatment of discitis using conventional methods can be prolonged and unrewarding. Patients can have prolonged pain and persistently elevated Inflammatory markers. We propose a new method of treatment of severe cases, and present two cases where this method has successfully been used.

METHOD: Once discitis has been diagnosed clinically and radiologically, a percutaneous discectomy of the infected level is performed. Matter is sent for microbiological analysis. An epidural catheter is then left in the infected disc space cavity. This is then used to administer appropriate antibiotics directly into the infected cavity. After one week the patient is converted on to intravenous antibiotics, for a further two weeks, then a prolonged course of oral antibiotics.

DISCUSSION: Discitis can be a difficult and unrewarding condition to treat. This novel method appears to be a new and effective mode of treatment, for both acute and chronic infections, although it does require further evaluation.