The Oxford unicompartmental knee replacement (UKR) was introduced in 1976 with good results. Mobile bearings in the lateral compartment have been associated with unacceptably high bearing dislocation rates, due to greater movement between the lateral femoral condyle and tibia, and the lateral collateral ligament's laxity in flexion. The new domed implant is designed to counter this with a convex tibial prosthesis and a fully-congruent, bi-concave mobile bearing allowing a full range-of-movement (ROM), minimising dislocation risk and bearing wear.

We present complication rates and clinical outcomes for a consecutive series of our first 20 patients undergoing Oxford domed lateral UKR, between June 2006 and August 2009, with minimum 6-month follow-up. There was one unrelated death (31 months post-UKR) and one postop MI. We had no bearing dislocations, infections or loosening nor other complications. All patients had post-op Oxford Knee Scores; eleven had pre-op scores and demonstrated a significant improvement – mean pre-op 22.75 to post-op 35.45 (p=0.01). All achieved full extension with average ROM 116°, mean change in ROM was –2.6°(p=0.6).

This study adds to previous work in confirming a low level of complications with this new procedure (including the early learning curve), particularly bearing dislocation and demonstrates excellent functional outcomes.

The treatment of nonunion is challenging providing the surgeon with a variety of different surgical options in order to encourage and achieve bone consolidation. Despite excellent results presented in 2008 of 99% union rates, Judet Osteo-Periosteal Decortication does not seem to be popular at present with bone grafting and distraction osteo-modelling being the favoured option.

Retrospective analysis was performed from December 2002 to December 2008 of 46 cases of osteoperiosteal decortication(Judet technique) for failure of fracture union.

Union was successfully achieved in 39 of the 45 patients(85%) after a mean delay of 10.7 months(range 3-39 months). Thirty patients(65%) achieved union following the decortication procedure without subsequent operations. The mean number of procedures following decortication was 0.6(range 0-4) mostly being performed for metalwork failure. Metal work failure occurred in 13 cases(28%) with the majority occurring in decortications of the femur(n=11,85%). The femur was the location of all persistent non unions in the series. The nonunion scoring system(0-100,Calori et al 2008) means were noticeably worse for the persistent nonunion group(41.67, range 34-46) compared to the union group(29, range 4-52).

Osteoperiosteal decortication remains a highly effective surgical technique in the management of failed fracture union.

The Ganz trochanteric flip osteotomy has gained popularity in recent years as a surgical approach that can be used when performing debridement surgery and hip resurfacing. The advantages include preservation of blood supply to the femoral head, maintenance of abductor strength and exposure. Morbidity associated with the trochanteric osteotomy is however a problem.

We reviewed the complications associated with the trochanteric flip in 367 patients that had undergone hip resurfacing arthroplasty. Pain, either felt deep within the groin or from prominent screws heads laterally was a significant problem for 96 patients (26.1%) and necessitated screw removal under general anaesthesia at a mean time of 16 months postop. Of these, 14 patients (14.5%) continued to have pain, with 8 patients proceeding to revision surgery; 5 for refractory pain, 1 for aseptic loosening, 1 for aseptic lymphocyte dominated vasculitis associated lesion (ALVAL) and 1 for acetabular soft tissue impingement.

Trochanteric non-union, leading to further surgery, was diagnosed in 24 patients (6.5%) whom underwent reattachment at a mean time of 6 months postop. Within this group the majority of patients were male (16), with a mean age of 53.5 years (range 35 to 65). Trochanteric non-union was associated with smoking, diabetes, obesity, age and non-compliance. Following reattachment surgery, all patients went on to union.

In total 120 patients experienced complications associated with the trochanteric osteotomy that resulted in a need for further surgery, a re-operation rate of 32.6%. Pain from trochanteric screws appears to be the over whelming issue. Surgeons using the trochanteric flip should be aware of the morbidity associated with the approach and counsel patients accordingly pre-operatively. Patients presenting with ongoing pain following screw removal should be investigated extensively for serious underlying problems.