We have reviewed 70 Harris-Galante uncemented acetabular components implanted as hybrid hip replacements with cemented stems between 1991 and 1995 in 53 patients whose mean age was 40 years (19 to 49). The mean follow-up was for 13.6 years (12 to 16) with no loss to follow-up. We assessed the patients both clinically and radiologically.

The mean Oxford hip score was 20 (12 to 46) and the mean Harris hip score 81 (37 to 100) at the final review. Radiologically, 27 hips (39%) had femoral osteolysis, 13 (19%) acetabular osteolysis, and 31 (44%) radiolucent lines around the acetabular component. Kaplan-Meier survival curves were constructed for the outcomes of revision of the acetabular component, revision of the component and polyethylene liner, and impending revision for progressive osteolysis.

The cumulative survival for revision of the acetabular component was 94% (95% confidence interval 88.4 to 99.7), for the component and liner 84% (95% confidence interval 74.5 to 93.5) and for impending revision 55.3% (95% confidence interval 40.6 to 70) at 16 years.

Uncemented acetabular components with polyethylene liners undergo silent lysis and merit regular long-term radiological review.

Purpose: Trochlea dysplasia is a developmental condition characterized by an abnormally flat or dome shaped trochlea. This predisposes to recurrent patella instability. This study prospectively reviews the early results of patients undergoing a trochleoplasty procedure which corrects the dysplastic anatomical abnormality.

Patients and Methods: All patients were recruited from the senior author’s (JDJE) specialist knee clinic following the standard patellofemoral assessment. Patients were seen pre-operatively to collect epidemiological data, ensure completion of patient reported assessment forms and document clinical examination findings and investigations. Duration of instability and previous procedures performed for patella instability were recorded. Multiple patient-reported outcome measures were recorded. Outcome score assessments and clinical examinations were repeated post-operatively, along with a patient satisfaction questionnaire. All operations were carried out by the senior author with supplementary procedures based on pre-operative assessment.

Results: 22 patients had a minimum of 12 months follow-up. The average age was 21 years and the average duration of instability symptoms (pre-trochleoplasty) was 7 years. There were 16 females and 6 males. Mean follow up was 18 months. Patients reported improvement in outcome when the pre and post-operative scores were compared (mean scores of Oxford 34 to 41, WOMAC 23 to 15, Kujula 62 to 79, IKDC 62 to 81, and Lysholm 57 to 77). The patient satisfaction questionnaire revealed just one patient not satisfied with the procedure despite good patient reported outcome scores. The majority of patients perceived improvement due to the surgery and agreed they would recommend the procedure to others despite some residual symptoms. Recurrent instability after trochleoplasty was rare (one subluxation) and range of movement was uniformly excellent.

Conclusion: Early results of this trochleoplasty for patients with trochlea dysplasia and symptomatic recurrent patella instability are encouraging.

Trochlear dysplasia is a developmental condition characterised by an abnormally flat or dome-shaped trochlea and is an important contributory factor to patellofemoral instability and recurrent dislocation. We studied prospectively a series of 54 consecutive patients (59 knees) with patellofemoral instability secondary to trochlear dysplasia, who were treated by a trochleoplasty by a single surgeon between June 2002 and June 2007.

Pre- and post-operative scores were assessed by the patients and a satisfaction questionnaire was completed.

Of the 54 patients (59 knees) in the series, 39 (44 knees) were female and 15 (15 knees) were male. Their mean age at surgery was 21 years and 6 months (14 years 4 months to 33 years 11 months). In 40 patients (42 knees) the mean follow-up was for 24 months (12 to 58). One patient was unable to attend for follow-up. An analysis of the results of those patients followed up for at least 12 months showed a statistically significant improvement in outcome (p < 0.001 for all scores). Overall, 50 patients (92.6%) were satisfied with the outcome of their procedure.

The early results of trochleoplasty are encouraging in this challenging group of patients.

Purpose: To assess the outcome of customised hinged knee replacements when used to salvage catastrophically failed knee replacements in elderly patients.

Methods: Since 1993, 30 of the 280 (10.7%) revision knee replacements at the Avon Orthopaedic Centre, Bristol have used Endo customised hinged knee pros-theses (21 rotating, 9 fixed) for salvage of limb threatening situations in elderly patients. All were prospectively recorded and regularly reviewed. The average age was 75 years with a predominance of females. Surgical indications were 22 periprosthetic fractures (with or without aseptic loosening), 5 massive aseptic osteolyses, and 3 deep infections.

Results: The mean length of postoperative hospital stay was just 14.6 days and all patients were discharged walking with aids. At follow up (mean 3.0 years, range 0.5–9.3 years) 9 patients had died with their prostheses in situ and functioning. 2 had undergone amputation for recurrent sepsis and 2 had received further surgery for septic problems. 2 patients required further surgery for prosthetic disarticulation and one patient had successful on table vascular repair. 25 patients had mid or long term follow up. Their mean American Knee Scores (AKS) were 69.8 for knee and 35.6 for function (maximum 100), with a mean total knee flexion of 83 degrees. Mean Oxford knee scores (OKS) and WOMAC scores (both scored between 12 and 60 with low score indicating less difficulties) were 34.0 and 30.5 respectively.

Conclusions: Customised hinge revision knee replacements gave extremely rapid rehabilitation and hospital discharge which justified the high prosthetic cost. Complications were high but at mid and long-term review, no prostheses had failed from an aseptic cause and most of the knees of this challenging group were providing both stability and flex