Nuclear magnetic resonance imaging (MRI) was used to study the normal knee. As well as revealing bone quality, MRI provided useful information on intra-articular and extra-articular soft tissues. Midsagittal views gave clear images of the cruciate ligaments, and of the patellar and quadriceps tendons. Parasagittal views were the best for delineating the menisci which, like ligaments and tendons, are of low intensity; the semimembranosus tendon and its insertion to the proximal tibia were also seen clearly in these views. The cruciate ligaments and menisci, though visible in the coronal view also, were better seen in the sagittal view. Axial views provided information on the structure of the patella, its cartilage, the patellofemoral joint and posterior soft-tissue structures

We report a prospective case-controlled study which compared the outcome of knee replacement in seriously deformed and slightly deformed knees. There were 51 knees with varus or valgus deformity greater than 20 degrees matched for age, gender, disease, type of prosthesis and time of operation with a control group in which the alignment of the leg was within 5 degrees of normal. The clinical outcome at a mean 5.5 years was similar in the two groups. Some deformity persisted in 14 patients in the first group, 13 of whom were initially in valgus. These patients had a significantly poorer mean clinical outcome. Lateral dislocation or subluxation of the patella was found in four knees, all of which had had valgus deformity of 30 degrees or more

The Fulkerson osteotomy has proved to be a reliable treatment for subluxation of the patella due to malalignment. Aggressive rehabilitation in the early postoperative period is unwise since the proximal tibia is weakened by the oblique osteotomy. Early weight-bearing and unrestricted activity have caused fractures in a few patients. Even late in the postoperative period the osteotomy may adversely influence the biomechanical properties of the proximal tibia. We describe two athletes who sustained a fracture of the proximal tibia, during recreational activities, six months after a Fulkerson osteotomy. Both had been bearing full weight for about ten weeks without complaint. Bony healing of the osteotomy had been demonstrated on plain radiographs at ten and at 12 weeks. After a Fulkerson osteotomy, jogging and activities which impose considerable impact force should be discouraged for at least nine to 12 months

1. An operation to re-establish the continuity of the bone after resection of tumours of the lower end of the femur or upper end of the tibia is described. 2. Sound bony union may be obtained, allowing walking with weight bearing after three to four months. 3. The combination of a massive tibial or femoral graft (Juvara procedure) with an intramedullary nail, a massive homogenous graft, and fixation of the patella to the autograft to accelerate its revascularisation. has given constant and rapid bony union in five cases. 4. This possibility gives real value to wide resection in the treatment of severe cases of giant-cell tumours. especially those that are recurrent. osteolytic or suspect of malignancy. 5. Its value in the treatment of sarcoma cannot be assessed in so short a series

We report retrospective and prospective studies to identify the causes of fracture of the femoral neck associated with femoral shaft nailing on the same side. Of a total of 14 neck fractures in a series of 152 shaft nailings, eight were not visible on the initial pelvic radiographs. We used CT scans before and after operation, and fluoroscopy during the procedure in our prospective series, and reviewed abdominal CT scans retrospectively with the window set to bone level. Six of the eight undisplaced fractures were shown to have been present before operation, but two were iatrogenic. We recommend the preoperative use of CT scans of the femoral neck in high-risk patients such as those with associated fractures of the acetabulum, the distal femur or the patella. Early diagnosis will allow better general management and early fixation of the neck fracture

Aims

It has been suggested that mobile-bearing total knee arthroplasty (TKA) might lead to better outcomes by accommodating some femorotibial rotational mismatch, thereby reducing contact stresses and polyethylene wear. The aim of this study was to determine whether there is a difference between fixed- and mobile-bearing versions of a contemporary TKA with respect to durability, range of movement (ROM) and function, ten years postoperatively.

Objectives

The Attune total knee arthroplasty (TKA) has been used in over 600 000 patients worldwide. Registry data show good clinical outcome; however, concerns over the cement-tibial interface have been reported. We used retrieval analysis to give further insight into this controversial topic.

Aims

The Precice intramedullary limb-lengthening system has demonstrated significant benefits over external fixation lengthening methods, leading to a paradigm shift in limb lengthening. This study compares outcomes following antegrade and retrograde femoral lengthening in both adolescent and adult patients.

The Ilizarov apparatus was used to carry out opening-wedge callotasis of the proximal tibia in ten patients who had suffered premature asymmetrical closure of the proximal tibial physis and subsequent genu recurvatum. In four knees, the genu recurvatum was entirely due to osseous deformity, whereas in six it was associated with capsuloligamentous abnormality. Preoperatively, the angle of recurvatum averaged 19.6° (15 to 26), the angle of tilt of the tibial plateau, 76.6° (62 to 90), and the ipsilateral limb shortening, 2.7 cm (0.5 to 8.7). The average time for correction was 49 days (23 to 85). The average duration of external fixation was 150 days (88 to 210). Three patients suffered complications including patella infera, pin-track infection and transient peroneal nerve palsy. At a mean follow-up of 4.4 years, all patients, except one, had achieved an excellent or good radiological and functional outcome

Pain in front of the knee is common in athletes and is often called patellofemoral arthralgia, but it is difficult to prove that the pain arises in that joint. Thermograms of 30 athletes clinically considered to have patellofemoral arthralgia were compared with those of a similar number of unaffected athletes matched for age and sex. A comparison was also made with thermograms of two older groups of 30 patients with knee involvement from either rheumatoid arthritis or osteoarthritis. Twenty-eight of the athletes with patellofemoral arthralgia had a diagnostic pattern on thermography. The anterior knee view showed a rise in temperature on the medial side of the patella and the medialis knee view showed that this temperature rise radiated from the patellar insertion of the vastus medialis into the muscle itself. The possible aetiological role of quadriceps muscle imbalance in athletes with patellofemoral arthralgia is discussed in relation to these findings

A 14-year-old girl with a congenitally deformed and shortened right leg and foot is described. The patient could not bear weight on the deformed limb and had to hop on the left leg. The deformed foot faced backwards and had nine toes. The right leg was shorter than the left by 26 centimetres. Radiologically, the lower end of the right femur was ill-developed and there was no knee joint. There were two fibulae and the tibia and the patella were absent. A through-knee disarticulation was done and a prosthesis fitted later. The amputated leg and foot were dissected. Many of the muscles in the leg and foot were duplicated. There were two calcanei, one talus, one navicular, two cuboids and four cuneiforms. Ther were nine metatarsals, and all the toes had three phalanges except for one which had two

This is a preliminary report of the results of knee joint replacements using the Liverpool Mark II knee joint system which consists of a bicondylar prosthesis and a set of stereotactic instruments. The prosthesis has been developed from Gunston's concept, and the special instruments ensure its accurate insertion through meniscectomy-type incisions placed on either side of the patella. Particular features of the prosthesis are near-normal articulation, and the simplicity of the operation. Sixty-two knee replacements were implanted in forty-two patients between the spring of 1974 and January 1977. After the operation fifty-six knees were painless and four others produced only slight pain. Full extension was obtained in fifty-eight knees, and none showed a valgus or varus deformity. Collateral laxity was absent in all knees. There were two failures. These early results are most encouraging

1. The technique of the intra-articular surgery employed by the late Mr K. H. Pridie for osteoarthritis of the knee is described. 2. The results of sixty-two operations in sixty patients are analysed. The results in forty-eight knees (77 per cent) were pleasing to the patient. Forty knees (64 per cent) were rated as good at review. 3. The operation is most suitable for relatively active healthy people whose disability warrants a comparatively painful operation and lengthy rehabilitation. 4. The operation was most successful for relieving pain and improving stability. Functional improvement was less. 5. Results were remarkably permanent. The knees showed little tendency towards further deterioration. 6. Most of the bad results were associated with removal of the patella. A possible technical reason for this has been discussed

1. Twelve children are described in whom gradual limitation of knee flexion developed, without previous injury or inflammation. 2. Clinical and histological investigation showed progressive fibrous degeneration of the vastus intermedius and rectus femoris. 3. As the patella showed signs of retarded development a particular form of myodysplasia, probably congenital, may be supposed. 4. Conservative treatment always failed to stop the progress of this disease. 5. Surgical treatment (Bennett's method or an elongation of the ligamental apparatus of the intermedius muscle) was carried out in ten cases and gave good permanent results. Flexion remained possible only to the extent obtained at operation; rehabilitation gave no further improvement. 6. In the opinion of the author, these cases occur more often than is generally believed, but they are recorded under a different diagnosis and consequently are not submitted to rational treatment

We present a prospective review of the outcome of 76 Lubinus patellofemoral arthroplasties carried out in 59 patients between 1989 and 1995. At a mean follow-up of 7.5 years, 62 knees in the 48 patients were reviewed; 11 patients (14 knees) had died. None was lost to follow-up. The clinical outcome using the Bristol Knee Scoring system was satisfactory in 45% of the cases. Maltracking of the patella, resulting in lateral tilt, subluxation and polyethylene wear, was the most common complication (32%). Revision surgery was carried out in 21 knees (28%) giving a cumulative survival rate of 65% (confidence interval (CI) 49 to 77) at eight years. The survival rate for revision and moderate pain was 48% (CI 36 to 59) at six years. Progression of arthritis was seen in seven cases (9%). In five of these (6.5%), the symptoms were severe enough to need revision surgery. Due to the high proportion of unsatisfactory results, we have discontinued the use of this prosthesis

Aims

The treatment of patients with allergies to metal in total joint arthroplasty is an ongoing debate. Possibilities include the use of hypoallergenic prostheses, as well as the use of standard cobalt-chromium (CoCr) alloy. This non-designer study was performed to evaluate the clinical outcome and survival rates of unicondylar knee arthroplasty (UKA) using a standard CoCr alloy in patients reporting signs of a hypersensitivity to metal.

We measured the pressure distribution across the tibiofemoral and patellofemoral joints during total knee arthroplasty (TKA) using Fuji pressure-sensitive film (Prescale) in 51 patients (63 joints) comparing the results with those in 21 patients in whom Prescale was not used. We classified the stress-distribution patterns in the tibiofemoral joints into four types: normal, varus-valgus instability, rotational malalignment, and a combination of instability and malrotation. The medial ligaments were then released according to the information obtained from these patterns. The conformity ratio of the contact area between repeated trials was 87.0%. Pressure distribution across the patellofemoral joints was also considered. There was a significant decrease in the mean valgus stress angle in the Prescale group compared with the control group (p < 0.01). Release of the lateral retinaculum according to the results showed no significant differences in subluxation of the patella between the released group and the group which did not appear to need this procedure

Aims

Early implant migration measured with radiostereometric analysis (RSA) has been proposed as a useful predictor of long-term fixation of tibial components in total knee arthroplasty. Evaluation of actual long-term fixation is of interest for cemented components, as well as for cementless fixation, which may offer long-term advantages once osseointegration has occurred. The objective of this study was to compare the long-term migration with one- and two-year migration to evaluate the predictive ability of short-term migration data and to compare migration and inducible displacement between cemented and cementless (porous metal monoblock) components at least ten years postoperatively.

We have investigated those factors which influence the range of movement after total knee arthroplasty, including sex, age, preoperative diagnosis and preoperative flexion deformity and flexion range. We also compared cemented and cementless tibial fixation, the influence of collateral ligament and lateral parapatellar releases and of replacement of the patella, and of the period of postoperative immobilisation. We reviewed 516 Johnson-Elloy (Accord) knee arthroplasties performed between 1982 and 1989, with a minimum follow-up of 12 months. The most important factors in the range of flexion achieved after arthroplasty are the diagnosis and the preoperative range of flexion. In patients with osteoarthritis there was a mean loss of flexion; in rheumatoid arthritis there was a mean gain. In both groups, the stiffer knees gained motion and the more mobile knees lost it. Post-operative range of motion was not influenced significantly by cement fixation, collateral ligament or patellar retinacular releases, prolonged immobilisation or patellar replacement

We reviewed 40 cementless Porous Coated Anatomic knee replacements in 34 consecutive patients. The average follow-up was 12.9 months (range 6 to 36 months). At review, loose beads were identified in 23 knees, in 11 on the femoral side and in 16 on the tibial side (in five knees on both sides). One loose bead was adjacent to the patella. In four knees there were intra-articular beads. Radiolucent lines at the interface between bone and prosthesis were seen in 19 knees, in six on the femoral side and in 16 on the tibial side (in three knees on both sides). In relation to the tibial component loose beads were associated with a radiolucent line in all except one case. Progressive loosening with an increasing number of loose beads was seen in three knees. At this early stage of follow-up there was no correlation between the clinical results and the presence of loose beads