Methods

There were 106 men and 94 women (mean age 65 years; 22 - 85). 69 patients had inflammatory arthritis and 131 osteo-arthritis. 27 patients (13 B-P, 14 STAR) had a pre-operative varus/valgus deformity greater than or equal to 20 degrees. Mean follow-up was 48 months (36-72).

We describe the results of a randomised, prospective study of 200 ankle replacements carried out between March 2000 and July 2003 at a single centre to compare the Buechel-Pappas (BP) and the Scandinavian Total Ankle Replacement (STAR) implant with a minimum follow-up of 36 months. The two prostheses were similar in design consisting of three components with a meniscal polyethylene bearing which was highly congruent on its planar tibial surface and on its curved talar surface. However, the designs were markedly different with respect to the geometry of the articular surface of the talus and its overall shape.

A total of 16 ankles (18%) was revised, of which 12 were from the BP group and four of the STAR group. The six-year survivorship of the BP design was 79% (95% confidence interval (CI) 63.4 to 88.5 and of the STAR 95% (95% CI 87.2 to 98.1). The difference did not reach statistical significance (p = 0.09). However, varus or valgus deformity before surgery did have a significant effect) (p = 0.02) on survivorship in both groups, with the likelihood of revision being directly proportional to the size of the angular deformity. Our findings support previous studies which suggested that total ankle replacement should be undertaken with extreme caution in the presence of marked varus or valgus deformity.

Aim: To þnd out morbidity, mortality and functional outcome in socially independent patients with displaced subcapital hip fracture, treated by primary total hip replacement.

Patients And Methods: 51 patients with displaced sub-capital fracture treated by THR at a single hospital. Average age 74 year at the time of fracture. All patients were socially independent and mentally alert. Functional outcome was assessed using patient assessed site-speciþc Oxford hip score, a generic score- SF12, and patient satisfaction. This study had a mean follow up of 33 months (Range20–54).

Results: 2% recurrent dislocation rate with 4% revision rate. 6% 1 year mortality. Median oxford hip score 16.5. Oxford hip score correlated well with both SF12 and patient satisfaction.

Conclusion: This study reports acceptable morbidity and mortality following THRoperation in select patients with displaced hip fracture. Functional outcome following THR in fracture patients found similar to that in osteoarthritic patients.

Objectives: (i) To compare and correlate outcome in Sanders Type 2 Os Calcis fractures using two disease-specific scores (Kerr-Atkin score & American Orthopaedic Foot and Ankle society score) and a general quality of life score (short form 36 health status questionnaire). (ii) To compare results of operative with non operative treatment, in this group of patients.

Design: Retrospective study using a combination of case notes, plain x-rays and CT scan films review along with current clinical assessment.

Patients: 30 patients with 32 fractures of Os Calcis (Sanders type 2) were identified. These patients were treated during 1994–1997 with mean follow up of 40 months.

Intervention: 16 patients were treated by open reduction and internal fixation using a lateral approach. The remaining 14 patients were managed non operatively. Treatment modality was decided by consultant preference.

Outcome measurements: Kerr-Atkin score, AOFAS score, SF36.

Results: We found an extremely significant correlation (p,.001, Spearman) between the two disease specific scores. AOFAS score showed a stronger correlation with physical component summary score (PCS) of the SF36 than the Kerr-Atkin score.

The age of the patient had little impact on the Kerr-Atkins score but a large effect on PCS. Conversely the pre-op Bohlers angle, a measure of fracture severity, had a large effect on the Kerr-Atkins score but little impact on the PCS. The AOFAS was responsive to both these predictors: 41% of the variance in AOFAS score was explained by Bohlers angle and the age of the patient.

We did not find any significant difference in outcome between operative and non-operatively treated patients.

Conclusion: The AOFAS score was found superior in assessment of outcome for Sanders type 2 fractures, though the Kerr-Atkin score also performed well.

This study does not demonstrate any significant advantage of operative treatment in Sanders type 2 fractures of the Os Calcis.