Knee dislocations are a rare but serious cause of trauma. The aim of this study was to establish current demographics and injury patterns/associations in multi-ligament (MLI) knee injuries in the United Kingdom.

A National survey was sent out to trauma & orthopaedic trainees using the British Orthopaedic Trainees Association sources in 2018. Contributors were asked to retrospectively collect a data for a minimum of 5 cases of knee dislocation, or multi-ligament knee injury, between January 2014 and December 2016. Data was collected regarding injury patterns and surgical reconstructions.

73 cases were available for analysis across 11 acute care NHS Trusts. 77% were male. Mean age was 31.9 (SD 12.4; range 16–69). Mean Body Mass Index (BMI) was 28.3 (SD 7.0; range 19–52). Early (<3 weeks) reconstruction was performed in 53% with 9 (23%) patients under-going procedures for arthrofibrosis. Late (>12 weeks) reconstruction took place in 37% with one (3.7%) patient under-going arthroscopic arthrolysis. 4% had delayed surgery (3–12 weeks) and 5% had early intervention with delayed ACL reconstruction. For injuries involving 3 or more ligament injuries graft choices were ipsilateral hamstring (38%), bone-patella tendon-bone (20%), allograft (20%), contralateral hamstring (17%) and synthetic grafts in 18%.

Multi-ligament knee injuries are increasingly being managed early with definitive reconstructions. This is despite significant risk of arthrofibrosis with early surgery. Ipsilateral and contralateral hamstring grafts make up the bulk of graft choice however allograft (20%) and synthetic grafts (18%) remain popular.

Introduction

Tennis and Golfers elbows (TE, GE) are difficult conditions to treat. Ultrasound guided steroid injection (UGSI) is one of the treatment modalities in treating refractory TE and GE. We present our clinical experience and short to mid-term results of patients with TE and GE treated with UGSI.

To report the clinical, functional and radiological outcome of consecutive primary hip arthroplasties using large diameter (36mm and above) ceramic bearing couples. We believe this to be one of the first independent series.

We prospectively reviewed 519 consecutive primary THA using fully HAC coated acetabular shell and fully HAC coated stem (JRI Ltd) in 502 patients, with minimum follow-up of 32 months. A Biolox-Delta ceramic liner with an 18 deg taper and Biolox-Delta ceramic head (36mm and 40mm) were used in all cases, by 3 surgeons. None were lost to follow-up. Clinical outcome was measured using Harris, Charnley Oxford, EuroQol EQ-5D scores. Radiographs were systematically analysed for implant position, loosening, migration, osteolysis. Return to sports and hobbies were recorded.

Mean age was 64.9 yrs (11–82yrs). There were no dislocations. 50–62mm acetabular shells were used. 36 mm head was used in 92% of cases. No acetabular revisions were performed for aseptic loosening. Other re-operations were for infection (1), peri-prosthetic fractures (1). The mean Harris and Oxford scores were 95 (88–97) and 14.1 (12–33) respectively. Harris and Oxford scores were 95 (88–97) and 14.1 (12–33) respectively. The Charnley score was 5.7 (5–6) for pain, 5.8 (4–6) for movement and 5.9 (4–6) for mobility. There was a significant improvement in the range of movement of the hip. There was no migration of acetabular component. Acetabular radiolucencies were present around one shell. No acetabular liner wear was demonstrated in CT Scans. Mean inclination was 7.4deg(37–65). Mean EQ-5D description scores and health thermometer scores were 0.84 (0.71–0.92) and 88 (66–96). With an end point of definite or probable loosening, the probability of survival was 100%. Overall survival with removal or repeat revision of either component for any reason as the end point was 99.1%.

The results of this study show an excellent clinical and functional outcome and support the use of a fully coated prosthesis with ceramic bearing couples. We envisage monitoring and prospectively reporting the long-term outcome of this series of patients.

To discuss the rationale, selection criteria, indications, and results of using large diameter ceramic heads in revision hip arthroplasty.

We routinely use Biolox family of ceramic heads and acetabular liners in patients undergoing revision total hip replacements. We present our experience in using ceramic articular bearings over the last 20 years and the switch to larger diameter ceramic heads. We also present our rationale for using a large diameter ceramic head instead of a large metal head.

We reviewed a total of 689 revision arthroplasties over this time period and we report the outcome of large bearing couples with case examples in primary and revision scenarios. Furthermore we compared a subset of patients (110) with large diameter ceramic heads – Biolox Delta 36mm to patients who had metal on metal (large head 42 mm and above) bearing couples. The performance of the ceramic bearing couples will be discussed along with the functional outcome of these patients. We found no difference in the functional, clinical sports activities (UCLA and Tegner scores) between patients who had large metal bearing couples and large ceramic couples. Complication rate was less with the ceramic bearing revision arthroplasties, as was patient satisfaction.

Ceramic bearing couples have stood the test of time and have demonstrated an excellent long term wear properties. The recent introduction of the large diameter couples proves to be an excellent alternative if not the first choice in young, complex primary and revision case scenarios.

Introduction

Viscosupplementation is used widely to provide symptomatic relief to patients with knee OA. This study aimed to compare the efficacy and safety of the standard (3×2ml) and single (1×6ml) dosing regimens of hylan G-F 20.

We report the clinical and radiological outcome of consecutive primary hip arthroplasties using the JRI-Furlong Hydroxyapatite ceramic (HAC) coated acetabular components.

We reviewed 412 consecutive cementless primary THA using fully coated acetabular shell in 392 patients—with a minimum 12 to 18 year follow-up—performed at two institutions between 1986 and 1994. Twenty (22 THA) were lost prior to 12-year follow-up, leaving 372 patients (390 THA) available for study. Fully HAC coated stems were used in all patients. The clinical outcome was measured using Harris, Charnley and Oxford hip scores and the quality of life using EuroQol EQ-5D. Radiographs were systematically analysed for implant position, loosening, migration, osteolysis. Polythene wear was digitally measured. The radiographic stability of the acetabular component was determined by Enghs criteria.

The mean age was 74.4 years. The mean Harris and Oxford scores were 87 (78– 97) and 19.1 (12–33) respectively. The Charnley score was 5.6 (5-6) for pain, 5.2 (4–6) for movement and 5.3 (4–6) for mobility. Migration of acetabular component was seen in four hips. Acetabular radiolucencies were present in 54 hips (9.7%). The mean linear polythene wear was 0.06mm/year. Mean inclination was 48.4° (38–65).

Radiolucencies were present around 37 (6.6%) stems. Dislocation occurred in 10 patients (three recurrent). Re-operations were performed in nine patients (1.9%). Four acetabular revisions were performed for aseptic loosening. Other re-operations were for infection (three), periprosthetic fractures (one), cup malposition (one) and revision of worn liner (three). Mean EQ-5D description scores and health thermometer scores were 0.81 (0.71–0.89) and 86 (64–95). With an end point of definite or probable loosening, the probability of survival at 12 years was 97.1% for acetabular component. Overall survival at 12 years with removal or repeat revision of either component for any reason as the end point was 96.2%.

The results of this study support the continued use of a fully coated prosthesis and documents the durability of the HAC coated components. In our clinical experience, the Furlong prosthesis revealed encouraging radiographic stability over a long-term period.

Aim

To compare the clinical effectiveness, functional outcome and patient satisfaction following intra articular injection with Synvisc^¯ and Hyalgan^¯ in patients with osteoarthritis (OA) of the knee.