Aims: Anterior knee pain is a common complaint of mixed aetiology, and in many cases no demonstrable cause is identified. For patients with persistant anterior knee pain, tibial tubercle transfer (TTT) can be a surgical option. The aim of this study is to assess the effectiveness of TTT for chronic anterior knee pain resistant to conservative treatment. Method: All patients with arthroscopically proven Chondromalacia patellae (CMP) without clinical evidence of patella instability, who have failed to respond to conservative treatment such as physiotherapy were included in the trial. They underwent TTT with a modified Fulkerson technique and then routine post-operative care with a cricket pad splint for 2–4 weeks. Pre and post-operative scores were obtained using a Kujala patello-femoral score, a visual analogue score for pain and a patient satisfaction score. The Outerbridge grading was used to score the severity of CMP at arthroscopy. Results: There were 50 TTT’s followed up (7 staged bilaterals) with a mean follow up of 32.4 months (5–88 months). There were significant improvement in the pre-operative and post-operative Kujala (p> 0.001) and visual analogue pain scores (p> 0.001). Of the 50 TTT’s 70% had an excellent or good result and 30% a fair or poor result. Moreover 76% claimed that they would have the same operation again for their condition. There was no significant correlation between Outerbridge grading and post-operative outcome. Complications include late anterior knee pain (10 cases), superficial wound infection (1 case), non-union of osteotomy (1 case) and tuberosity fracture (1 case). Conclusion: Anteromedial tibial tubercle transfer is a reliable and effective treatment for peristant anterior knee pain.

Aims: Thirty-three patients with condylar fractures of the middle and proximal phalanges were treated with internal fixation using self-tapping titanium lag screws. The results were studied prospectively and prognostic factors identified. Methods: The age range was 14–45 (mean 26 years). Five patients presented at more than five weeks post injury. Four patients had bicondylar fractures. The surgical technique, which utilises a lateral approach, is outlined. All surgery was performed by the senior author (DS), semi-electively, within five days of presentation. Patients were seen in the 4th postoperative day for mobilisation and protective splintage. Results: The results were satisfactory in the majority of cases. 21 patients had achieved a full range of movement when reviewed at six weeks and further eight at 12 weeks. The remainder were left with a flexion contracture of 10–35 degrees (mean 26). All patients achieved full flexion. All fractures healed and there was no loss of fixation. Conclusions: Internal fixation using a single lag screw through a lateral approach restores joint congruity, facilitates union and provides fixation stable enough to allow early mobilisation. Bicondylar and proximal phalangeal fractures had a poorer prognosis. Fractures presenting even at eight weeks can be taken down and reduced. Delay in fixation does not appear to influence the long-term outcome.

Aims: The 98% 10 year survivorship of the cemented AGC TKR is regarded as gold standard.(1) The authors attributed their excellent results to the flat on flat design and the compression moulded polyethylene rather than the cement. The aim of this trial is to determine if the type of fixation also influences outcome. Method: Participants were randomly allocated to either a cemented or cementless hydroxyapatite coated AGC prosthesis. All patients were assessed with the Hospital for Special Surgery Score (HSS) and radiographs pre-operatively and then post-operatively at six weeks, six months, one year and annually. Results: 223 knees were studied with a mean follow up of 39 months (max 8 years) Both groups were well matched for age and sex. There were no significant differences between the two groups in post-operative HSS scores or in improvement of HSS scores. There has been no observable migration in either group. There were 15 radiolucenies (< 2mm) in the cemented and 1 in the HA group. A common finding in the HAC group was a radiodense line around the uncoated stem of the tibial prosthesis which is of no clinical significance. There has been 1 case requiring revision, which was from the HAC group. In addition 2 patella buttons were revised following traumatic separation. Conclusion: The early results are equally good for both groups with no significant difference in outcome or complication rate between cemented and HA coated fixation.

Introduction: The search for a gold standard uncemented hip prosthesis with long term results matching cemented Charnley implants continues. It has been suggested that biological fixation would reduce the incidence of aseptic loosening caused by cement and polyethylene particles. The ABG (Howmedica) is a titanium alloy stem with an anatomic design and a modular head option of vitallium or ceramic. The cup is hemispherical and is fully coated with hydroxyapatite while the stem is proximally coated for metaphyseal fixation. We present a prospective series of 100 Consecutive patients with an immediate term follow up.

Methods: 100 patients who had an ABG prosthesis inserted between 1991 & 1996 were included in the study. All patients were operated upon by the senior author or under his direct supervision. Patients underwent a preoperative assessment including a detailed history, measurement of range of motion, Postel Merle D’Aubigne scoring and ADL assessment. Clinical and radiological review was Conducted at 3 months, 6 months, 1 year and then at yearly intervals. At each visit Patients were questioned regarding the presence of any thigh pain and Complications. All patients were clinically evaluated, Postel Merle D’Aubigne Score was obtained and ADL status assessed. AP and lateral radiographs were Taken and studied. Polyethylene wear was measured by using the Livermore Method. The Kaplan- Meier method was used to explore the survival pattern of the implants.

Results: The mean age of the patients was 52 years (range 23–72). Follow up ranged from 3 To 8 years (mean 5 years ). The mean preoperative Postel Merle D’Aubigne score Was 7 ( range 0–14) and mean score at final follow-up was 17.7(range 15–18).

Only 4 patients complained of thigh pain and most had dramatic and lasting improvement of the ADL status. Complications included 3 dislocations and 2 Superficial infections. Non progressive lucencies were noted in 6 stems and 2 cups. No stems were loose and one patient had a loose cup and is awaiting surgery. A high rate of superior polethylene wear of 0.2mm/year was identified in a Number of patients yet the survivorship was 99% after an average 5 year follow up.

Conclusion: Our results demonstrate the efficacy and excellent medium term outcome of the ABG prosthesis. A higher rate of complications in the first 2 years reiterates the lesson that every surgeon has to complete a learning curve before being technically comfortable with a new prosthesis. Of concern was the high rate of superior polyethylene wear although this did not effect the survivorship.