Aims

The aim of this study was to analyze the complications and outcomes of treatment in a series of previously untreated patients with a primary aneurysmal bone cyst (ABC) who had been treated by percutaneous sclerosant therapy using polidocanol.

We report the early results of a patello-femoral prosthesis with a more anatomical trochlear component than previously reported designs, and with a patella component, geometry and instrumentation that allows optimum tracking and coverage of the patella, prior to final fixation of the patella component.

The first 115 patello-femoral prostheses were implanted between April 2000 and October 2005, and were followed up in a Special Clinic by one observer, who was not the operating surgeon, using the Bristol Knee Score (BKS), and the Oxford Knee Score (OKS). 115 patello-femoral arthroplasties were performed in 86 patients, 28 bilateral procedures (24.3%). 20 (71%) of which were performed as a single procedure. There were 100 females and 15 males, a ratio of 6.6:1, with a mean age of 70.05 years. (range 57 – 79). There were 9 patients lost to follow up, giving a follow up rate of 89%. The mean period follow up was 36 months (range 12 – 78 months). The median OKS (maximum 12/60) was 40/60 pre-operatively (range 22-46) and 22/60 Post-operatively (range 12 – 38), and the BKS was 45 pre-operatively (range 35 – 65) and 85 post-operatively (range 55 – 100). The mean range of movement was 110° pre-operatively (range 90 – 120°), and 125° (range 90 – 130°) post-operatively.

There was 1 superficial wound infection. 2 knees were revised to total knee replacement for progression of arthritis. Four other patients had re-operations, 1 for bilateral subluxing patellae, 2 for soft tissue problems, 1 patient had a locked knee with displacement of the patella prosthesis, which was revised successfully.

Early results of the FPV prosthesis demonstrate, like other more recent designs, that there are fewer problems with mal alignment and mal tracking than with earlier prosthesis, giving 90% good or excellent results.

Aims: To establish the frequency of achieving the desired prosthesis position in an uncemented total hip replacement and the effect of the position on outcome. Methods: We reviewed the earliest and most recent available post-operative pelvic x-rays of 96 patients who had undergone a total hip replacement between March 1992 and December 1995. A press þt hydroxyapatite coated cup and stem were used in all cases (CSF & JRI respectively). We assessed the following parameters: Centre of rotation, off set, cup angle, leg length and insert wear. We then established the clinical outcome at 5–9 years of 88 patients using the MDP scoring systems and correlated this with the radiological study to establish the effect of prosthesis placement on the clinical outcome. Results: There was an acceptable centre of rotation in 53.6% of the patients, 44% of the patients had a cup angle of 40–49 degrees, 73% had an adequate off set and 71.7% had equal leg lengths. There was no correlation between the MDP and the centre of rotation, cup angle, off set or leg length. There was also no correlation between these parameters and wear of the liner. Conclusion: It is evident that the desired position of the prosthesis is not achieved in a signiþcant number of patients. This does not seem to correlate with the clinical outcome and wear. Extreme deviation from the anatomical position is likely to be detrimental.

The aim of this study was to assess the outcome of patients who underwent ElmslieTrillat antero-medial tibial tubercle transfer for treatment of persistent symptomatic anterior knee pain due to chondromalacia patellae.

We performed a prospective analysis of 23 patients who underwent Elmslie-Trillat antero-medial tibial tubercle transfers over a five year period for chronic anterior knee pain and an arthroscopic diagnosis of chondromalacia patellae. All patients who presented with anterior knee pain underwent an initial period of physiotherapy and all patients whose symptoms persisted following physiotherapy underwent arthroscopic assessment. Patients who continued to experience debilitating symptoms despite this initial treatment and who also had a diagnosis of chondromalacia patellae from arthroscopic assessment were listed for an Elmslie-Trillat tibial tubercle anteromedialisation. Patients who gave a history of instability or dislocation were excluded. The average age of patients undergoing surgery was 34 years (21–48 years) and the average time between arthroscopic diagnosis and surgery was 14 months. All patients who underwent surgery had pre and post operative KuJala patellofemoral scoring. The average pre-operative score was 54 (30–78) and post operative score 76 (46–100). The average post operative assessment was 25 months (6–62 months). Twenty one patients had improved post operative scores with one having a worse score and one score remaining unchanged following surgery. Nineteen patients felt that their symptoms had improved, three felt that there had been no change and one felt that they were worse after surgery. When asked if the improvement in symptoms had been worthwhile nineteen stated that they would undergo surgery again if in the same situation and four stated that they would not.

The treatment of symptomatic chondromalacia patellae remains a challenge. Although a more selective approach to individuals with anterior knee pain is widely advocated in the literature this study demonstrates that good results can still be achieved in patients treated empirically with a tibial tubercle anteromedialisation.

We compared magnetic resonance imaging (MRI) scans and plain antero-posterior (AP) and lateral radiographs of 100 randomly selected patients in order to detect segmental abnormalities of the lumbar spine. We started by identifying those who appeared to have a segmental defect of the lumbar spine on MRI scan. We then checked all 100 plain radiographs to detect the true rate of segmental abnormality. We detected 17 patients with a segmental abnormality that correlates well with other studies. We believe that MRI scanning alone is not sufficient to detect reliably all segmentation defects in the lumbar spine, and that a plain lateral and an AP x-ray is also required. Of those who do have a segmentation disorder we have identified a sub-group who are at risk of surgery at the wrong level, if the correct pre-operative work-up is not performed. The difficulty will occur when a segmental abnormality is present (as determined by plain radiographs) and it is missed by MRI scan, and plain films are not taken, and the correct level is determined by counting upwards from the lumbosacral take-off angle using the image intensifier in theatre. We believe that all patients undergoing nerve root decompression should have an AP and lateral plain film and an MRI scan as well as pre-operative image intensification in theatre. Although the number of patients that would be affected by this is small, the consequences of operating on the wrong level are well recognised and can be avoided by being aware of the potential problem and by adhering to the above recommendations.