Introduction: Nonunion is a relatively common complication seen in orthopaedic practice. The treatment of nonunion has traditionally been revision fixation with autogenic bone grafting. Here we present our results of nonunion treatment using Osteogenic Protein -1 (OP1) and allograft paste.

Material and Methods: Forty Eight Patients with resistant nonunion including atropic, hypertrophic and infected nonunion were treated with a composite of osteogenic protein-1 and allograft paste. The series consisted of 28 males and twenty females. Average age was 54 years. The average duration of preoperative symptoms was 26 months (range 4 to 52). 28 of 48 patients had an average of three prior failed surgical attempts at union (range 1 to 6). There were thirty seven atrophic, four hypertrophic and seven infected nonunions (bone transport docking site nonunion).18 patients in the series had previous autogenic cancellous bone grafting to the fracture site for attempted union. 39 patients had revision internal fixation with application of OP-1 and allograft paste to the nonunion site. Average healing time was 6.5 months (Range 3.5–19). Three patients in this series had OP-1 insertion twice, one patient simultaneously had autogenic cancellous bone grafting with OP-1.

Results: Average follow-up was 16 months (range 4 to 38). Functional and radiological outcome was excellent in 33 patients, good in five patients and fair in three. 3 cases were ongoing. Three patients went on to non-union requiring revision surgery and are under review. One patient died during follow-up.

Conclusion: Results in our series indicate OP-1 (BMP-7) implanted with Opteform allograft paste are as effective as autogenic cancellous bone grafting in treating resistant bone nonunions.

Introduction: The treatment of isolated medial compartment osteoarthritis (OA) in the young or physically active patient is a challenging problem for the orthopaedic surgeon.

The rationale for high tibial osteotomy (HTO) in medial compartment OA with varus deformity is to correct varus malalignment and to redistribute load to the non-diseased lateral compartment of the knee. Here we present our early to mid-term clinical and radiological findings.

Methods: Between October 2005 and April 2007 9 patients underwent HTO and TSF application. Pre-operative OA grade was recorded using the Ahlbäck classification. Radiographs were used to calculate the pre and post operative measurements for the tibiofemoral angle, the mechanical axis deviation and the tibial slope. Correction planning was carried out using the Spatialframe software package. All operations were performed by a single experienced consultant orthopaedic surgeon specialising in Ilizarov and limb reconstruction surgery. Pre and post-operative Oxford knee scores were collected for each patient.

Results: Median follow-up was 19 months (range 15–35). Median age at operation was 49 years (range 37–59). On preoperative radiographic examination eight knees were Ahlbäck grade 1 and one knee was Ahlbäck grade 2. The median time spent in the frame was 18 weeks (range 12–37). The median total angle of correction according to correction program given was 14 degrees (range 10–22) and the median duration of correction was 18 days (range 14–36) with 6 patients requiring an additional correction program.

2 patients subsequently underwent matrix induced autologous chondrocyte implant (MACI) for osteochondral defects.

In the primary OA group we found an improvement in mean Oxford knee score after HTO from 28.3 to 37.8/48 post-operatively. 1 patient was non-compliant with the correction and required a total knee replacement (TKR) for continued pain at 36 weeks post frame removal. 1 patient required fibular osteotomy during their correction.

6 (67%) of the 9 patients had a documented pin site infection. The median Otterburn grade was 3 (range 0–4). There were no cases of chronic bone infection.

Conclusions: High tibial osteotomy performed with the Taylor spatial frame presents a viable treatment option in active patients with early medial compartment OA. With TKR as an end point the survival rate of HTO for treatment of OA was 88.9% at a median of 19 months follow-up. Our results also indicate successful use of the technique in combination with MACI.

Previous studies have demonstrated the benefits of arthroscopic arthrolysis in relieving pain and improving motion in arthritic elbows, but none have reported the specific functional recovery. This study aims to review the functional outcome and patient satisfaction in a series of patients who underwent arthroscopic elbow arthrolysis for intrinsic stiffness, pain and arthritis not suitable for arthroplasty. Twenty six patients who underwent arthroscopic arthrolysis over a three year period were included. All patients were manual workers or strength athletes. All had pain and stiffness secondary to primary or secondary arthritis, with or without loose bodies. Pre- and post-operative evaluation included the Elbow Functional Assessment score, patient satisfaction and return to work and sports. The mean follow up period was 22 months. Function improved significantly in 87% with overall improvement in the Elbow Functional Assessment score from a preoperative score of 48 to a postoperative score of 84 (p< 0.05). All except three patients returned to their desired level of activity by 3 months postoperatively. Pain improved in 91%, mechanical symptoms in 80%, stiffness in all except one. The arc of elbow movement improved from 106° to 124° with a mean gain in elbow extension of 13°. Mayo elbow performance index also significantly improved postoperatively. Overall, 87% patients were very satisfied with the outcome. We conclude that the arthroscopic arthrolysis improves elbow function and returns patients to their desired level of activity, as well as improving range of motion and pain in patients with intrinsic elbow stiffness and pain.