Aim of this study was to compare the postoperative range of motion of three types of total knee replacements.

They were 72 posterior cruciate ligament retaining knee prostheses (group I), 61 postero-stabilized (group II), 52 ultracongruent plates (group III). Inclusion criteria were primary arthritis with varus deformity inferior to 15 degrees (°), no previous surgery on the knee, body mass index inferior to 35, preoperative flexion superior to 110°. All prostheses were performed with the same ancillary with one unique surgeon (DH). Recovery and analgesia protocols were similar in the three groups. Mobility was measured using a goniometer.

Continuous data were tested for normal distribution using Kolmogorov-Smirnov test. Normally distributed data were analyzed with two tailed t-tests, whereas non-parametric data were analyzed with Mann-Whitney U test. Statistical significance was set at p < 0.05.

At 2 years follow-up, the group I demonstrated a mean flexion of 121.8° in preoperative period and 110.3° in postoperative period. They were respectively of 121.3 and 122.2° in the group II. Regarding group III, they were 121.6 °preoperatively and 118.4° postoperatively.

Results were significant (p< 0.05) between groups I and II, and groups I and III.

No statistic correlation was found between need of mobilisation under general anesthesia (p> 0.05), flexum (p> 0.05), knee score (p> 0.05), patient satisfaction depending on type of prostheses (p> 0.05).

Posterior cruciate ligament removal tends to offer a best postoperative flexion without significant influence on the knee score or patient satisfaction.

The anterior supine intermuscular (ASI) approach enables total hip arthroplasty (THA) without dissection of muscles or insertions. This could be beneficial in patient recovery and satisfaction. Study-aim was to assess the learning-curve for the ASI-approach and show short-term results.

Two surgeons performed uncemented THA on 23 (17 and six respectively) consecutive patients. The Taperloc stem, Recap-cup and Magnum head (Biomet, Warsaw, USA) were used. THA was performed without the use of a traction-table. Data was gathered till 3 months follow-up.

Average patient age was 61 years (36–74), ASA-classification was two (one-four). There was a decrease in surgical time from 140 at the beginning to 80 minutes at the end of our series. Average blood-loss was 788 ml. Three patients received erythrocyte-transfusion. Minor non-orthopaedic complications all resolved within 48 hours. Average length of stay was five-and-a-half days. Functional score-lists showed improvement comparing pre-operative scores with scores on 12 weeks follow-up: Harris-Hip-Score from 56 to 94, Oxford-Hip-Score from 43 to 19, Hip-disability-and-Osteoarthritis-Outcome-Score from 109 to 18. On six weeks follow-up 65% and on 12 weeks 100% of patients showed unaided mobilisation. At follow-up we saw one superficial wound-infection, one partial non-disabling sartorius-lesion, one paraesthesia and one transient anaesthesia of the lateral femoral cutaneous nerve area.

ASI-approach for uncemented THA showed good results and rapid patient-mobilisation. This may in part be due to the non-dissecting of muscles or insertions, thus non-compromising the propriocepsis. Off course tissue-damage occurs, though this is likely to be of a fast reversible nature. There were no serious adverse events. We saw a rapid decline in session-duration suggesting a moderate learning-curve. Further research will have to prove the beneficiality of the ASI-approach.

Radiographic evidence of migration of the femoral stem component after THA is the most important diagnostic sign of femoral implant loosening. Early detection of stem subsidence may help in deciding to perform revision surgery before severe bone destruction has occurred, at a moment when standard clinical and radiological follow-up may still be reassuring.

The aim of this study was to identify the most appropriate bone and prosthetic landmarks to study subsidence and to determine the accuracy of the Imagika® method as compared to the ‘gold standard’ EBRA-FCA® software.

256 THA in 242 patients (102 men, 140 women) with a median age of 63.8 years (range: 36–85) received 4 different cementless or cemented prosthetic stem designs. They were followed for 10.6 years (range: 6–16). CLS® stems were used in 56 patients, MS-30® in 76, Elite® in 50 and Osteal® in 74.

4 specific analysis models were created in the Imagika® software in order to evaluate several possible landmarks on the proximal femur and on the stem, and to evaluate the possibility of using a correction factor to improve the comparability of successive x-rays taken under non standardised conditions. The most accurate prosthetic landmarks were the prosthesis shoulder in CLS® and MS-30® stems and the lateral aspect of the collar in Elite® and Osteal® stems. The best bone landmark was the top of the greater trochanter in all cases.

For the whole series, the annual linear subsidence rates were 0.049+/−0.014 mm with EBRA-FCA® and 0.052+/−0.012 mm with Imagika® respectively (P = 9E-7). Migration values in the 4 different groups were respectively 0.06 +/− 0.01 mm/yr and 0.05 +/− 0.01 mm/yr in the CLS® group (P = 4.6E-6), 0.02 +/− 0.002 mm/yr and 0.06 +/− 0.09 mm/yr in the MS-30® group (P = 6.8E-4), 0.06 +/− 0.002 mm/yr and 0.04 +/− 0.003 mm/yr in the Elite® group (P = 4.2E-5), and 0.05 +/− 0.005 mm/yr and 0.06 +/− 0.004 mm/yr in the Osteal® group (P = 7.4E-7). The different prosthetic designs did not show significant differences concerning migration values when studied according both methods.

Thanks to a correction factor, the Imagika® method uses all the radiographs when EBRA-FCA® rejects incomparable radiographs.

The Imagika® method is more users friendly and provides excellent reliability thanks to an automatic edge detection device.

Since no significant difference was observed between EBRA-FCA® and Imagika® methods whatever the prosthetic stem design studied, our results authorise us to apply these analysis models within the Imagika® software to all THAs to follow their radiographic evolution and to possibly predict the clinical evolution.