Purpose

Proper positioning of the components of a knee prosthesis for obtaining post-operative knee joint alignment is vital to obtain good and long term performance of a knee replacement. Although the reasons for failure of knee arthroplasty have not been studied in depth, the few studies that have been published claim that as much as 25% of knee replacement failures are related to malpositioning or malalignment [x].

The use of patient-matched cutting blocks is a recent development in orthopaedics. In contrast to the standard cutting blocks, they are designed to fit the individual anatomy based on 3D medical images. Thus, landmarks and reference axes can be identified with higher accuracy and precision. Moreover, stable positioning of the blocks with respect to the defined axes is easier to achieve. Both may contribute to better alignment of the components.

The objective of this study was to check the accuracy of femoral component orientation in a cadaver study using specimen-matched cutting blocks in six specimens; first for a bi-compartmental replacement, and then for a tri-compartmental replacement in the same specimen.

Background: Increased contact stress with a femoral resurfacing prosthesis implanted in the medial femoral condyle and a non-functional meniscus is of concern for potential deleterious effects on tibiofemoral contact mechanics.

Methods: Peak contact pressures were determined in seven fresh frozen human cadaveric specimens using a pressure sensitive sensor placed in the medial compartment above the menisci. A knee simulator was used to test each knee in static stance positions (5°/15°/30°/45°) and through 10 dynamic knee-flexion cycles (5°–45°) with single body weight ground reaction force (GRF) which was adjusted to the living body weight of the cadaver donor. All specimens were tested in three different conditions: Untreated knee (A); Flush implantation of a 20mm resurfacing prosthesis (HemiCAP^®) in the weight bearing area of the medial femoral condyle (B); Complete radial tear at the posterior horn of the medial meniscus with the femoral resurfacing device in place (C).

Results: On average, flush device implantation resulted in no statistically significant differences when compared to the untreated normal knee. The meniscal tear resulted in a significant increase of the mean maximum peak contact pressures by 63%, 57%, and 57% (all P ≤ 0.05) at 15°, 30° and 45° static stance positions and 78% (P ≤ 0.05) through the dynamic knee flexion cycle. No significant different maximum peak contact pressures were observed at 5° stance position.

Conclusion: Possible effects of reduced meniscal tissue and biomechanical integrity of the meniscus must be considered in an in-vivo application of the resurfacing device.

Objectives: The aim of this study was to examine the influence of different prosthesis designs (Deep-Dish (DD) vs. posterior stabilized (PS)) on the patello-femoral pressure. The femoro-patellar pressure depends among other things on the AP stability of the knee joint. The use of DD has been described to be equally applicable with a resected or deficient PCL.

Methods: Fresh frozen human knee specimens (n = 8, 7 male, 1 female) underwent testing in a kinematic device simulating an isokinetic knee extension cycle from 120° of flexion to full extension. Knee motion was driven by a hydraulic cylinder applying sufficient force to the quadriceps tendon to produce an extension moment of 31 Nm. The amount of patellofemoral contact pressure and its distribution was measured by means of a pressure sensitive film (Tekscan^®, Inc., Boston, USA). Patellar contact pressure was examined first after implantation of a cruciate retaining TKA (Genesis II, Smith& Nephew, Memphis, USA). An 11 mm polyethylene (PE) DD insert was tested before and after resection of the PCL. Finally, the femoral component of the CR TKA was removed and replaced by a posterior stabilized (PS) model repeating measurements with an 11 mm PE inlay. The patella was not resurfaced throughout the whole procedure. A paired sampled t-test was applied for comparison of means and considered significant at p ≤ 0.05.

Results: There was no statistical significant difference of patello-femoral peak and mean contact pressures of the DD inlay before and after resection of the PCL. After implantation of the PS TKA peak pressure was significantly lower (Mean: 6.12 ± 2.37 MPa, Range: 10.68 – 3.30 MPa) in comparison with the DD type (7.12 ± 2.53 MPa, 11.94 – 3.55 MPa; p < 0.01) with a preserved PCL. Also the mean contact pressure turned out to be lower with the PS design (p < 0.006; PS: 3.58 ± 1.25 MPa, 5.91 – 2.08 MPa, DD: 4.27 ± 1.34 MPa, 6.66 – 2.18 MPa). The contact area was also significantly smaller with the PS design (p < 0.03, PS: 140.84 ± 40.04 mm2, 188.47 – 65.10 sq mm, DD: 175.97 ± 24.46 sq mm, 222.56 – 142.56 sq mm).

After resection of the PCL differences in contact pressures and contact area between DD and PS failed to reach statistical significance although there was an obvious tendency towards lower pressures with the PS-design.

Conclusions: The results of this study suggest that a posterior stabilized TKA design reduces the retropatellar peak and mean pressure as well as the contact area in comparison with a deep-dish design when the PCL is preserved. The better reproducible rollback with a PS model could serve as a possible explanation. However, this difference is less pronounced when a DD inlay is applied after resection of the PCL. Nevertheless, a PS rather than a DD design is recommended in the PCL deficient knee.

Aim: Cementation of tibial implants in total knee arthroplasty is a gold-standard considering the high loosening rates of cementless implants. In contrast, only sparse data exist regarding unicondylar arthroplasty due to limited use. In this study, we compare cemented with cementless unicondylar knee arthroplasty and aim to define both clinical and radiological differences in treatment outcome.

Materials and Methods: In a retrospective study, 106 patients who had undergone a medial unicondylar replacement were examined after a mean postoperative period of 8 years. Of these, 42 patients (median age 81±7 years) had received a cemented and 64 (median age 73±7 years) a cementless knee arthroplasty by the same surgeon while 7 patients were deceased or could not be reached. Well-established clinical (VAS, HSS, KSS, UCLA, WOMAC) and quality of life (SF-36) scores were used to evaluate treatment outcome. X-rays were performed to evaluate periprosthetic loosening zones, according to Ewald’s criteria.

Results: The cementless patient group presented significantly better clinical scores (HSS, KSS, UCLA, WOMAC), except in the Visual Analogue Scale (VAS) for pain assessment. The quality of life was significantly better in the cementless group except in the subgroups concerning physical function, vitality and social role, which resembled normal population. Moreover, radiographic analysis using antero-posterior X-rays revealed significantly more and larger periprosthetic loosening areas in tibial zone 2 in the cementless group.

Conclusion: The inferior clinical results characterising the cemented group could be attributed to the higher mean age. Regarding the radiological loosening zones, we did not detect any differences in the techniques of fixation, although physical activity and mechanical stresses were higher in the cementless group.

Objective: Decreased quadriceps strength may contribute to anterior knee pain after total knee arthroplasty (TKA). The quadriceps force necessary to establish full extension is strongly dependent on the position and the relative length of the lever arms over the knee joint. The purpose of this in vitro study was to investigate the amount of quadriceps force required to extend the knee isokinetically after TKA in dependence of different prosthesis designs and the state of the posterior cruciate ligament (PCL).

Methods: Eight fresh frozen human knee specimens were tested in a kinematic device that simulated an isokinetic knee extension cycle from 120° of flexion to full extension. Knee motion was driven by a hydraulic cylinder applying sufficient force to the quadriceps tendon to produce an extension moment of 31 Nm. The quadriceps force was measured using a load cell attached to the quadriceps tendon after implantation of a cruciate retaining (CR) TKA (Genesis II, Smith& Nephew, Memphis, Tn, USA) applying a conventional and a highly conforming polyethylene (PE) inlay before and after resection of the PCL. Finally, the femoral component of the CR TKA was replaced by a posterior stabilized (PS) design and measurements were redone.

Results: No significant differences in the average quadriceps force were detected between the different PCL retaining inlays (CR, highly conforming) as long as the PCL was intact. However, after resection of the PCL, the required quadriceps force increased significantly for both designs (CR: 4.7%, p < 0.01, Highly conforming: 3.5%, p < 0.03). After implantation of the PS femoral component quad force decreased to its initial levels with forces significantly lower compared to the PCL deficient knees provided with a CR (−6.0%, p < 0.01) or highly conforming (−5.1%, p < 0.01) inlay. With a PS design average quadriceps extension force was not significantly different from cruciate retaining TKA inlays at an intact PCL.

Conclusions: The data of this in vitro study suggest that the quadriceps extension force is significantly higher for knees after cruciate retaining TKA with PCL deficiency, independent of the use of a CR or DD inlay. Thus, the integrity of the PCL should be secured in clinical practice when using a cruciate preserving TKA design.

Background: Isolated patellofemoral arthroplasty has gained new attention after recently published positive results. It is considered an intermediate treatment for the patient with isolated arthritis of the anterior compartment of the knee. Aim of this nationwide survey was to determine the current status of patellofemoral arthroplasty in Germany.

Methods: All German departments of orthopaedic surgery, traumatology and general surgery with a yearly performance of at least fifty knee arthroplasties were asked to complete a standardized questionnaire. In the first part, surgeons were asked general questions about their department size, case numbers of knee arthroplasties per year and non-endoprosthetic treatment of isolated patellofemoral disorders. If patellofemoral arthroplasty was conducted, parameters concerning age, gender, duration of complaints, indication for surgery, surgical approach, type of endoprosthesis used, additional surgical treatments and failures were evaluated in the second part. Furthermore we asked for the reasons if no isolated patellofemoral arthroplasty was performed.

Results: A total of 224 (30%) usable questionnaires were returned. Of 53420 knee arthroplasties performed per year, only 195 were isolated patellofemoral arthroplaties (0.37%). However, in 54 departments (24%), at least one isolated patellofemoral arthroplasty was performed with an average of 3.95 (1–20) procedures per year. The majority of patients were between 40 and 60 years old (40–60y: 56%; 20–40y: 8%, 60–80y: 35%, > 80y: 1%). Females were affected in 65% of patients. Etiology of isolated patellofemoral arthritis was believed to be idiopathic in 41% and traumatic in 8%. Patellofemoral dysplasia was held responsible in 47% and patellofemoral instability in 4% of cases. The main reason for failure and surgical revision was ongoing pain of the affected knee (40%). Negative attitude and disbelief towards the success of isolated patellofemoral arthroplasty were stated by the majority (62%) of non-users. A lack of appropriate indications was reported by 22% and missing know-how by 16%.

Conclusions: Isolated patellofemoral arthroplasty has only little significance among surgeons performing knee arthroplasty in Germany. Although promising results were reported in the literature, the majority of surgeons do not believe in the success of the procedure.

Introduction: Mobile bearing total knee arthroplasty (TKA) has been developed to theoretically provide a better, more physiological function of the knee and produce less polyethylene (PE) wear. The theoretical superiority of mobile bearing TKA’s over fixed bearing devices has not yet been proven in clinical studies.

The objective of the present study was to analyze in vivo the knee joint kinematics in the sagittal plane in a patient population that had received either a fixed or a mobile TKA in a prospective, randomized, patient- and observer-blinded, clinical study.

Methods: 31 patients were evaluated by means of fluoroscopy during unloaded flexion and extension against gravity, as well as during step-up and step-down with full weight bearing. In these 31 patients, 22 fixed bearing TKAs, 16 mobile-bearing TKAs and 19 natural knee joints were included.

All patients had been operated in a prospective, randomized, patient- and observer-blinded, clinical study, and had received either fixed or a mobile bearing, cruciate retaining Genesis II TKA for primary osteoarthritis.

Fluoroscopic radiographs were evaluated by measuring the „patella tendon angle” as a measure of antero-posterior translation as well as the “kinematic index” as a measure of reproducibility.

Results: During unloaded movement, fluoroscopic analysis did not show a significant difference between both types of prosthesis designs and the natural knee. In the weight-bearing movement, both types of TKA designs did not show the typically arched but a more linear patellar tendon angle curve, with a greater angle in extension and in flexion than the natural knees. This means that the femur glides anteriorly under load near extension and does not show the natural roll-back in flexion. In the mobile-bearing group, inter-individual deviations from the mean during weight-bearing movements were significantly less than in the fixed-bearing group.

Conclusions: In the present study, no functional advantage of mobile bearing TKA over fixed bearing devices could be found. Both TKA designs showed the typical kinematics of an anterior instability. Long-term follow-ups are necessary to elucidate the possible influence of lower PE wear on the incidence of aseptic loosenings.

Purpose: In the treatment of acetabular dysplasia in adolescents and adults the triple osteotomy according to Tonnis is a common procedure. This retrospective study were undertaken to evaluate the clinical and radiological results and quality of life after triple osteotomy according to Tonnis.

Material and Methods: In our retrospective study 43 patients (f=32, m=11) with acetabular dysplasia after triple osteotomy procedure with an average age of 21.8 years (SD=7.6) were evaluated. The average follow-up was 9.3 years (range 0.6–19.1 ys). For clinical evaluation, the Harris Hip Score was used. The pre- and postoperative x-rays in ap and faux profile plane were evaluated for the CE-, VCA-, AC-, ACM-angle and the acetabular index. Quality of life was evaluated by the SF-36-health questionnaire.

Results: 48,8% of our patients achieved excellent or good results in the Harris Hip Score and 65,1% of the patients considered the subjective postoperative result as excellent or good. The CE angle improved significantly from preoperatively 8.8 to postoperatively 34.5 degrees. The VCA angle according to Lequesne and Seze improved significantly from 30.7 to 50.9 and the AC angle from 10.2 to 19.5 degrees. The ACM angle decreased significantly from 53.3 to 56 degrees and the acetabular index increased from 33.4 to 37.3 postoperatively. Range of motion of the operated extremity decreased significantly for hip flexion and internal roation. SF-36-health questionnaire results of the patient group showed significant differences for the parameters physical function, bodily pain and emotional role compared to those of a healthy reference group of the same age.

Four patients showed a pseudarthrosis of the ischial or pubic bone. Three patients had persisting pain of the pseudarthrosis and needed another operative procedure. Hypaesthesia in the area of N. cutaneus femoris lateralis occurred in seven cases.

Conclusion: The results of the operative treatment of an acetabular dysplasia with a triple osteotomy procedure according to Tonnis showed a satisfactory outcome, even though significant functional deficits and deficits of quality of life could be demonstrated in middle and long term follow-up.

Aim: Investigations on human hyaline cartilage of late stage degenerative arthritis showed that the vascular derived endothelian growth factor (VEGF) seems to play a role in the development of degenerative arthritis. The current study was designed to evaluate the expression of VEGF on chondrocytes of hyaline cartilage in the time course of degenerative arthritis.

Methods: In twelve white new-zealand-rabbits the anterior cruciate ligament was resected to create an anterior instability of the knee. In twelve control rabbits only a sham operation without resection of the ACL was done. Another four animals have not been operated at all (0 weeks). Four animals of each group were sacrificed at three, six and twelve weeks each. After opening of the knee joint, the degenerative arthritis was macroscopically graded and the hyaline cartilage of the load bearing area was evaluated histologically according to Mankin and by immunostaining for VEGF.

Results: The macroscopic and histological grade of degenerative arthritis according to Mankin showed a positive linear correlation to the time after surgery. The scores of the control group were constant in the time course. In the cartilage of the untreated animals (0 weeks) an average of 12 percent (SD 2.6) VEGF-positive chondrocytes were found. After 3 weeks the trial group (17.6%; SD 5.7) as well as the control group showed a significant increase (16.2%; SD 4.7). After 6 weeks the value in the control group dropped to normal (11.5%; SD 5.9) and remained constant after 12 weeks (11.6%; SD 3.3). In the trial group the percentage of VEGF positive chondrocytes rose steadily (19.4%; SD 4.6 after 6 weeks; 21.3%; SD 5.4 after 12 weeks). There was a positive linear correlation between the percentage of VEGF positive cells and the Mankin score (r=0.767; p< 0.01) and the macroscopic score (r=0.518; p=0.02).

Conclusion: The current study shows for the first time an in-vivo increase of VEGF expression on chondrocytes in the time course of osteoarthritis, which is dependent on macroscopic and histological grades. Further studies are needed to evaluate whether this pattern applies to human beings and whether new treatment approaches could evolve from this knowledge.

Aim: Previous investigations have shown the vital role of chondrocyte CD44 in cartilage homeostasis and matrix attachment and indicated a participation of CD44v5 in the development of osteoarthritis. However, all reports dealt with late stage human osteoarthritis, as human specimens are only available at the time of surgery. Thus, little is known about the expression of CD44v5 in the time course of osteoarthritis. The current study was designed to evaluate the expression of CD44v5 on chondrocytes of hyaline cartilage in the time course of osteoarthritis.

Methods: In twelve white new-zealand-rabbits the anterior cruciate ligament was resected to create an anterior instability of the knee. In twelve control rabbits only a sham operation without resection of the ACL was done. Four animals of each group were sacrificed at three, six and twelve weeks each. After opening of the knee joint, osteoarthritis was macroscopically graded and hyaline cartilage of the load bearing area was evaluated histologically according to Mankin and by immunostaining for CD44v5.

Results: In the trial group, macroscopic and histological grades of OA showed a positive linear correlation to the time after surgery. Immunostaining showed an increased expression of CD44v5 in the control group after 3 and 6 weeks, which dropped to normal after twelve weeks. There was no difference between control and trial groups after 3 and 6 weeks, but after 12 weeks. We found a significant positive correlation between CD44v5-expression and macroscopic (r=0.294) and histological (r=0.314) grades of OA.

Conclusion: The current study shows in-vivo an increase of expression of the hyaluronan receptor CD44v5 in the time course of osteoarthritis. Further studies are needed to evaluate whether this pattern applies to human beings and whether new treatment approaches could evolve from this knowledge.

Introduction: Mobile bearing total knee arthroplasty (TKA) has been developed to theoretically provide better, more physiological function of the knee and produce less PE wear. The theoretical superiority of mobile bearing TKAs over fixed bearing devices has not yet been proven in clinical studies. The objective of the present study was to prospectively analyze clinical and functional outcomes of randomized fixed and mobile bearing total knee arthroplasty patients by means of gait analysis, electromyography and established clinical scores.

Methods: In a prospective, randomized, patient- and observer-blinded, clinical study, 33 patients (mean age 63 years) received a cruciate retaining Genesis II TKA for primary osteoarthritis. 16 patients received a mobile bearing and 17 patients a fixed bearing device. The day before surgery and 24 months postoperatively, established clinical (KSS, HSS, WOMAC, UCLA, VAS) and quality of life (SF-36) scores were used to compare both patient groups. Electromyography of standardized locations was measured with the MyoSystem 2000 and analyzed with Myoresearch software. Gait analysis was performed with a six camera motion analysis system and force platforms.

Results: Both groups showed significant improvements between pre- and postoperative evaluation in gait analysis and electromyography, but gait analysis results as well electromyography did not show any difference between both groups at follow-up. Clinical and quality of life results significantly improved from pre- to postoperative evaluation, but only the Knee Society Score showed a significant superiority of the mobile bearing group (mean 159.0; SD 27.7; range, 105–196) over the fixed bearing group (mean 134.4; SD 41; range, 56–198) (p=0.0022).

Conclusions: In the present study, no functional advantage of mobile bearing TKA over fixed bearing devices could be found, although the mobile bearing group had better clinical results. Thus, long-term clinical results and in-vivo wear analyses have to be followed, and more subtle functional analyses (e.g. fluoroscopy) have to be employed to finally judge over the theoretical advantage of mobile bearing TKAs.

Aim: Evaluation of clinical, electromyographic and gait analysis results after constrained revision total knee arthroplasty. Material and Methods: 14 patients (mean age 67 years, 54-78) were evaluated 28.5 months (range, 6.5 to 61.4 months) after revision arthroplasty using constrained total knee endoprostheses (Genesis, Blauth).

Clinical evaluation was carried out using HSS, Knee Society, Tegner Activity, and Patellar scores. A three-dimensional, quantitative gait analysis and simultaneous epicutaneous electromyographic recordings of 7 muscles surrounding the knee were carried out on all patients. 11 healthy volunteers (mean age 69 years, 60-75) served as control group.

Results: Patients achieved 68 points in HSS, 125 in Knee Society, 1.3 in Tegner, and 19.1 in Patellar scores. Compared to the controls, all patients showed minor functional results. Electromyographic amplitudes of 5 muscles of the operated leg were significantly decreased compared to the contralateral side as well as the control group. Besides maximum knee extension all gait analysis parameters differed significantly between patients and controls. On the other hand, operated and uninvolved patients’ legs differed only in maximum knee extension in gait analysis. Significant correlations between clinical scores and ground reaction forces as well as electromyo-graphic levels of the gastroc muscle were noticed.

Conclusion: Functional deficits may not be explained by revision arthroplasty alone, but already exist preoperatively. The gastroc muscle seems to play and especially important role, as its functional deviations are highly correlated with clinical scores. The shown results stress the demand for extensive pre- and postoperative rehabilitation to avoid or at least reduce functional deficits after revision total knee arthroplasty.

Aims: Comparison of the effectiveness of the injection of hyaluronic acid (Ostenil¨) and cortisone (Volon¨) into the facet joints in the treatment of facet joint syndrome. Methods: 60 patients suffering from low back pain due to degenerative arthritis of the facet joints were included in this randomized, controlled, double-blinded, clinical trial. 30 patients received intra-articular injections of hyaluronic acid (Ostenil¨) and 30 patients received intra-articular injections of 10mg triamcinolon-hexacetonid (Volon 10¨). The facet joints of the spinal segments L3/L4, L4/L5, and L5/S1 were injected bilaterally with computed tomography guidance in intervals of one week each. Clinical evaluation was carried out one week prior þrst injection, at the day of þrst injection, after one, two, and three weeks, and after three and six months. Clinical assessment was carried out using the visual analog scale for pain, the Roland Morris Questionnaire, and the Oswestry Disability Questionnaire. Quality of life was assessed using the SF-36 health questionnaire. Radiological assessment was done according to Kellgren. Results: Pain reduction was achieved faster in the Volon 10¨group. After three months the Ostenil¨group reached better pain reduction and this effect lasted for a longer period. The Roland Morris score, the Oswestry Disability Questionaire, as well as the Low Back Pain Outcome Score showed signiþcantly better results in the Ostenil¨group after 3 and 6 months follow-up. Conclusion: Even though no signiþcant difference was found in the short-term follow-up, the results in the Ostenil¨group were comparable to the Volon 10¨group, and were signiþcantly better in the long-term follow up. Thus the intra-articular injection of hyal-uronic acid (Ostenil¨) is an effective alternative in the treatment of low back pain caused by facet joint syndrome, avoiding the known side effects of cortisone.

Objective: The purpose of this study was to investigate whether radiographic scores correlate with histomorphological grading and expression of the hyaluronan receptor splice variant CD44v5 in osteoarthritic synovia, cartilage and synovial fluid. Methods: Synovia and cartilage specimens of 19 patients with osteoarthritis of the knee were histomorphologically evaluated with the Mankin’s score, and expression of CD44v5 was analyzed by immunohistochemistry. For radiographical scoring, weight-bearing radiographs of the knee joint were evaluated according to Kellgren and Ahlback. Levels of soluble CD44v5 in synovial fluids were determined by ELISA. Results: The mean radiological scores according to Kellgren and Ahlback were 3.79 and 3.21, respectively. Histomorphological evaluation of specimens revealed a mean grade of 5.53. There was no correlation between radiographical and histomorphological data. Expression of CD44v5 in synovia and cartilage samples was detected in about 50% of the patients and was restricted to latestage osteoarthritis. The immunohistochemical data obtained from synovia correlated significantly with radiological disease progression (p< 0.05). A highly significant correlation was evident between expression of CD44v5 in synovia and cartilage (p< 0.01). Synovial fluid levels of the soluble receptor form showed no correlation. Conclusion: Overall, this study emphasizes a combination of several independent parameters including radiography, histomorphology, and immunohistochemistry for accurate assessment of osteoarthritic disease progression. In this regard, CD44v5 may be a useful additional marker for late-stage osteoarthritis

Aims: In recent years more and more studies tried to evaluate possible inßuences of different growth factors on hyaline cartilage regeneration. In a rabbit model, HGF (hepatocyte growth factor) was proven to increase the amount of hyaline-like chondrocytes in a mixed þbrocartilaginous regenerate of small defects. The present study was undertaken to evaluate, whether intraarticular administration of hepatocyte growth factor inßuences the ingrowth of osteochondral grafts in a sheep model. Methods: Both knee joints of a sheep were opened surgically and osteochondral grafts were harvested and simultaneously transplanted to the contralateral compartment. The sheeps were divided into two groups. In one group hepatocyte growth factor was administered by intraarticular injections given three times a week for four weeks. The control group received isotonic sodium chloride injections. The animals were sacriþced after three months and the received knee joints were evaluated histologically. Results: Histological evaluation showed that the autologous osteochondral grafts were healed in at the level of the subchondral bone. A healing or ingrowth at the level of the cartilage could not be observed. Anyway, histological evaluation of the transplanted grafts according to Mankin showed, that the cartilage of the HGF group showed less signs of degeneration than the control group. In the HGF group less cloning of chondrocytes and less irregularities of the articular surface were observed. Conclusion: In conclusion, HGF positively inßuenced the structure of the transplanted osteochondral graft, but could not diminish the þssures in the marginal zone of the grafts.

Aims: Tibiotalar fusion is considered as gold standard for end-stage posttraumatic arthritis of the ankle. This study analyses the long-term results after talar joint fusions, especially the health related quality of life, correlated to the clinical and radiological results. Methods: We examined 16 males and 1 female patient, with 18 ankle fusions, clinically, radiographically and in regard of quality of life with the SF-36 Health Survey after a minimum follow-up period of 20 years (mean 23, range 20–33). Mean age at operation was 37 years (SD=8y), at follow up 61 years. Between injury and arthrodesis was an interval of six years in average. In eleven cases an external þxation was used. Results:. Subjectively 50% were not handicapped performing daily life activities and 44% were in the same job as at the time of injury. Out of 11 complications, the most frequent one was wound infection in seven cases (68%). On clinical examination þve feet were stiff at the forefoot. Eight patients had 25%, three had 50%, one had 75% and one the full range of motion. We found one valgus and seven varus deformities of the ankle. Following roentgenographic measurements with the MORREY as well as the TAKAKURA score, degenerative arthritis in the subtalar and Chopart joints was 2.7 (SD=0.77). The mean OMA score was 59.4 points, the visual analogue scale was 1.99, the radiologic score was 2.7 and the SF-36 revealed for physical functioning, emotional role functioning and bodily pain signiþcant deþcits. A signiþcant correlation was found between the OMA and the radiological score at 0.05, and between the clinical and the SF-36 score at 0.01. No correlation was found between the radiologic score and the SF-36 questionnaire. Conclusion: Ankle arthrodesis leads to deþcits in the functional outcome, to limitations in the activities of daily living and to roentgenographic changes in the adjoining joints. The clinical outcome and the SF-36 score correlate tightly.