Background

Focal resurfacing can treat localised articular damage of the knee not appropriate for arthroplasty or biological repair. Independent results on these implants are limited. We previously published early results showing significantly improved Knee Injury & Osteoarthritis Outcome Score (KOOS4) without complication or re-operation, demonstrating this system gives good analgesia and functional improvement in selected patients. We present long-term follow-up of these patients.

Introduction: The Thrust Plate Prosthesis (TPP) is a neck preserving femoral component in total hip arthroplasty (THA), allowing direct load transfer to the medial cortex of the femoral neck. We present an evaluation of its use in young patients with hip arthritis.

Methods: A consecutive series of patients were reviewed at a minimum of 5 years after THA using the TPP. Harris Hip Score (HHS) and Oxford Hip Score (OHS) were recorded pre-operatively and at the last clinical review. Radiographic analysis was performed and patient satisfaction levels and complications were recorded.

Results: Between 1996 and 2000 we implanted 41 prostheses in 38 consecutive patients (3 bilateral). The mean age at time of surgery was 56 years (41–67) and the mean length of follow up was 71 months. The HHS improved from a mean of 42 points pre-operatively to 88 points at the last clinical review and the mean OHS also improved from 40 points to 18 points. 83% of patients expressed that they were ‘very satisfied’ with the procedure. Three cases have since required revision surgery secondary to peri-prosthetic fracture, early deep infection and aseptic loosening (1 case each). Only one other case has radiological evidence of loosening or poor cortical contact with the collar of the TPP. Two patients have experienced sub-luxation or dislocation of the prosthesis. Eight patients suffer discomfort when lying on the operated side.

Discussion: These are the first results of the TPP from the United Kingdom. Whilst many of these young patients treated with the TPP show excellent improvement in clinical outcome scores and a high level of patient satisfaction, the complication rate gives some concern. We support the selective use of the TPP to treat young patients with hip osteoarthritis.

We report a prospective trial of 66 patients with intraarticular fractures of the calcaneum. All fractures were assessed by CT. Patients with displaced fractures were randomised to receive either conservative (n = 31) or operative treatment (n = 25). Undisplaced fractures (n = 10) were treated conservatively. Operation involved open reduction of the posterior subtalar joint, and fixation with Kirschner wires. All 66 patients were reviewed at a minimum of one year (mean 23 months). After conservative treatment the undisplaced fractures had slightly better results than the displaced fractures. There was no significant difference in outcome between the operatively and the conservatively treated displaced fractures. We have also documented prospectively the natural history of the injury, which is of use in assessing prognosis for both clinical and medicolegal purposes.

We treated 39 knees with chronic deficiency of the anterior cruciate ligament by reconstruction using the ABC carbon and polyester prosthetic ligament; 31 (79.5%) were reviewed at an average follow-up of 34 months. There had been four complete failures requiring revision. The remaining 27 were studied in detail. On the Lysholm rating, only 11 knees (41%) had good results with a score of over 76. The mean anterior drawer movement was reduced from 7.6 mm before operation to 5.8 mm at review. The mean difference from the opposite uninjured knee was 3.9 mm before operation, 1 mm (in 21 patients) at mean follow-up of 7.4 months and 2.5 mm (in 27 patients) at 34 months, indicating progressive loss of effect. In our opinion the results are unsatisfactory: we do not recommend the use of this prosthetic ligament.