Introduction: We report the clinical and radiological results of 137 AES Total Ankle Replacements (TAR)(Biomet, Europe) over a 4-year period.

Methods: 134 patients underwent 137 Total Ankle Replacements. There were 47 females and 87 males. Three patients underwent bilateral procedures. The mean age of the patients was 64 years (48–78). The main indication for surgery was post-traumatic arthritis other indications included primary arthritis, inflammatory arthritis, haemophilia, haemochromatosis, polio, cavo-varus deformity and revision of a loose STAR. The pre-op coronal deformity ranged from 20 degrees varus to 40 degrees valgus. The same surgeon performed all operations. All patients had a clinical and radiological follow-up at 3, 6 and 12 months then annually, thereafter.

Results: At a mean time to follow up of 18 months the mean AOFAS Hindfoot Score was 79. Excluding those patients with other joint disorders the stratified AOFAS score increases to 81. Four patients experienced postoperative talar subsidence and 8 patients had gaps or lysis around the tibial bone implant interface. Three patients developed soft tissue complications, two of which had to have a split skin graft and one of these developed a deep infection. The third patient required a fascio cutaneous local flap. Thirteen patients required a further procedure for postoperative edge loading. No implant has been revised to date. Two patients feel no better off since surgery and one patient feels worse off. The remainder rate their surgery as good or excellent.

Discussion: The early results of the AES TAR are encouraging. Careful management of the soft tissues and correct soft tissue balancing are important. In our series we have modified the surgical technique so less talar bone is resected.

Conclusion: We feel the AES TAR provides encouraging early results.

Aim: To assess the safety and efficiency of bilateral simultaneous total knee replacement surgery using a retrospective notes based review.

Methods: We performed a retrospective case note review of a series of 112 bilateral simultaneous knee replacements performed over a five year period in a district general hospital. (224 joints – 142 total joints, 82 unicompartmental). The procedures were all performed by a consultant knee surgeon operating alongside a knee fellow. Patients were only offered bilateral procedures if in ASA class I/II. (any borderline candidates were referred for anaesthetic assessment). Results were obtained for a number of parameters to assess the safety of this technique by measuring rates of both minor and major complications. Data was also gathered to assess the efficiency of the technique – measuring both tourniquet times and length of stay.

Results: Over the period of five years there were no deaths or major complications reported. There were three cases of DVT (2.6%) and one case of PE (0.9%). There were three cases of superficial wound infection (2.6%), one of joint infection (0.9%) and one of aseptic loosening (0.9%). Average tourniquet time was 76 minutes with an average length of stay of 8.6 nights.

Conclusion: Bilateral simultaneous knee replacement is a valuable technique which offers the patient a single operation and recovery period, and return to normal life. In addition, the complication rates are acceptable, unlike several studies looking at bilateral procedures performed back to back. It also offers an excellent training opportunity for the 2^nd surgeon to operate under close supervision. In an increasingly time pressured health service we believe this procedure is an efficient and safe technique when used in suitable patients.

The aim of the study was to compared the various treatments of femoral diaphyseal fractures in children. The endpoints being length of hospital stay, clinical and functional outcome. The prospective part of the study started with the appointment of a dedicated children’s orthopaedic surgeon in 1999. Prior to this in patient traction was the main treatment. Now early hip spicas for the under 5 year old, Nancy nails for the over fives and external fixation for polytrauma are the treatments of choice.

Anyone under the age of fifteen sustaining a traumatic femoral diaphyseal fracture was included in the study. In both groups’ details of the injury, demographic details, other injuries sustained, treatment performed and length of hospital stay were recorded. In the prospective group clinical and radiographic assessments were made at three months and one year. The range of movement of the affected limb was measured and compared to the unaffected side.

There were 47 fractures in the retrospective group and 16 fractures in the prospective. In the retrospective group 94% were treated with traction, and in the prospective group the treatments were, early hip spicas 44%, external fixator 31% and flexible nails 19%. The mean hospital stay was 31 nights in the retrospective group and 16 in the prospective group. In the retrospective group 17% had a mal-union greater than ten degrees, and at three months in the prospective group this was 46%. Clinical follow up at three months in the prospective groups, they all had a full range of movement, and only two had any pain.

The use of varied treatments result in shorter hospital stay which allows children home earlier and reduces the demand on hospital beds. The children returned to normal function with a good range of movement using these modern treatments.