Aims: To compare objective and subjective methods of assessment of outcome following total knee replacement. Methods: A retrospective review of 560 consecutive total knee replacements, performed under the care of a single surgeon, between January 1990 and January 2000, on 456 patients, was carried out. Minimum follow-up was two years. The patients were assessed using two postal questionnaires, a clinical interview and examination and a radiological investigation. The results from each assessment were entered into a database and evaluated. Results: The results from the postal and direct questionnaires were comparable. These results correlated well with clinical and radiographic evaluation. A simply worded questionnaire was found to be more user- friendly than a complex questionnaire. Questions about specific daily activities were less user-friendly than questions about general function. Conclusions: A simple postal questionnaire provides an accurate reflection of outcome after total knee arthroplasty. This has significant implications with regard to cost and clinical time when planning follow-up after knee replacement.

One hundred consecutive closed fractures of the adult tibial shaft treated by closed methods were surveyed prospectively in order to observe their natural history. The fractures were analysed with regards to speed of healing and the influence of age, sex, causal force, radiological morphology and concurrent fibular fracture. At 20 weeks 19 fractures had not yet united, but 15 of these had united by 30 weeks with conservative treatment alone. The remaining four cases were operated upon because no further progress in healing was anticipated. These findings suggest that, with regard to healing, open reduction and internal fixation is rarely justified in closed adult tibial shaft fractures.

Total knee replacements were performed on three patients with Parkinson's disease. The rehabilitation of all three was, however, hampered by inhibition of the extensor mechanism, hamstring rigidity and poor muscular co-ordination. Medical treatment of the disease did not help. None of the patients became mobile, and all three gradually weakened and died. We suggest that, at least in some patients with Parkinson's disease, knee replacement is contra-indicated.