Introduction

Success of total hip replacement (THR) is closely linked to positioning of the acetabular component. Malalignment increases complication rates. Our aim was to describe the anteversion and inclination of the inherent acetabulum in arthritic hips and identify the number that fall out with the ‘safe zone’ of acetabular position described by Lewinnek et al. (anteversion 15±10 degrees; inclination 40±10 degrees).

Introduction

Soft tissue balancing is an important aspect of total knee replacement surgery. Traditionally sequential medial soft tissue release is performed for balancing in varus deformity. Its effects on kinematics and dynamic Femoro-Tibial-Mechanical-Angle (FTMA) have been described in extension and 90° flexion in coronal plane. However most studies have missed what happens when the knee flexes from 0 to 90 degrees This study is one of the first to describe its effects on knee kinematics throughout flexion. The aim was to look at deviation of FTMA in coronal plane with traditional sequential medial release with and without measured stress applied in varus and valgus at each point of measurement through the range of flexion.

Traditionally sequential medial soft tissue release is performed for balancing in total knee arthroplasty for varus knees. Its effects on kinematics have been described in extension and 90° flexion in coronal plane. This is the first study to describe its effects on kinematics throughout flexion. 12 cadaveric knees were studied using a computer navigation system to assess kinematics. Femoro-Tibial-Mechanical-Angle(FTMA) was studied in extension, 0°, 5°, 30°,45°,60°,90° and maximum flexion. Sequential medial release was performed in 7 steps, described by Luring et al(Ref). At each step FTMA was measured without and with stressing. A 10 Newton Meter moment arm was applied for varus and valgus stress. Most of the initial release steps had little effect on FTMA without force applied, especially in the initial 60° of flexion. Application of varus force demonstrated very small changes. Application of valgus force demonstrated little change in initial arc of flexion until step 5 was reached (Table 1). Our study concludes the present sequence of medial release may not be correct and should be further investigated to modify the sequence for soft tissue balancing in TKR surgery.

Aim: To evaluate and assess the validity and accuracy of various described ways of performing the McMurray’s test in the diagnosis of meniscal tears.

Material & Methods: Prospective study with patients divided into seven groups based on seven described ways of performing McMurray’s test. Twenty-five patients in each group, aged between 15 to 60 years-undergoing arthroscopy of knee for clinically suspected meniscal tear. Exclusion criteria were ACL tear on arthroscopy, radiological or arthroscopic evidence of osteoarthritis and patients within six weeks of injury.

All patients were assessed preoperatively with knee examined in one of seen different methods. EUA followed by arthroscopy. Clinical and arthroscopic findings were correlated and sensitivity and specificity were determined.

The study is ongoing with following results.

Conclusion: Accuracy of McMurrays test ranged between 0 to 95% in various studies. Factors determining outcome include patient selection difference in applying test and interpretation of results. McMur-rays original description included no varus or valgus stress and a click a was positive test. Other descriptions include varus or valgus stress and apart from click pain is also considered a positive test. Comparisons among results in literature are difficult with confusing results. Our study is incomplete but trends suggest Reider’s method may be the most accurate.