Twenty knees, in which a total of 32 previous operations had been performed, were arthrodesed by the Charnley compression technique combined with intramedullary nailing. Patients with previous infection were excluded from the series, but three neuropathic knees were included. Bony union was evident after an average of six months in all but one patient who died three months after operation. One patient developed deep infection that resolved after removing the nail. The combined technique is simple and only limited bone resection is needed; it gives immediate stability and relief of pain with minimal morbidity

The Stanmore hinged total knee replacement was introduced in 1969 for severe destructive arthropathy of the knee, and the results of one hundred consecutive operations are presented after an average interval of two and a half years. Insertion of the prosthesis relieved pain in 94 per cent, improved the range of movement in 67 per cent, invariably restored stability and corrected valgus or varus deformity. Gross flexion contractures were improved but not always fully corrected. Serious complications were few, though of three cases of deep infection two came to amputation and one to fibrous ankylosis. There were no mechanical failures of components of the prosthesis

Between 1969 and 1985 26 patients with destructive lesions of the distal humerus were treated by endoprosthetic replacement; each implant was custom-made and incorporated part of the distal humerus or the entire bone as well as a hinged total elbow replacement. Recurrence occurred in three of the patients with tumours, and three prostheses were removed because of deep infection in patients with previously compound injuries of the elbow. Another three loosened without infection, but none needed revision or removal and no amputations resulted. Other complications included nerve palsies, but the only deaths were from metastases. A useful range of elbow movement, with a stable arm and good hand function, was achieved in every patient

Aims

To compare results of institutional preferences with regard to treatment of soft tissues in the setting of open tibial shaft fractures.

Over a 16-year period, 135 custom-made distal femoral prostheses, based on a fully constrained Stanmore-type knee replacement, were used in the treatment of primary malignant or aggressive benign tumours. Survivorship analysis showed a cumulative success rate of 72% at five years and 64% at seven years. Intact prostheses in 91% of the surviving patients gave good or excellent functional results. Deep infection was the major complication, occurring in 6.8% of cases; clinical aseptic loosening occurred in 6.0%. Revision surgery was carried out for loosening and infection, and the early results are encouraging. We conclude that prosthetic replacement of the distal femur can meet the objectives of limb salvage surgery

Aims

This study aimed to compare the effect of antibiotic-loaded bone cement (ALBC) versus plain bone cement (PBC) on revision rates for periprosthetic joint infection (PJI) and all-cause revisions following primary elective total hip arthroplasty (THA) and total knee arthroplasty (TKA).

We used calcium-phosphate cement combined with minimal internal fixation to treat 49 fractures of the lateral tibial plateau. There were 25 split depression fractures, 22 pure depression fractures and two bicondylar fractures. Anatomical reduction was obtained in 38 fractures, satisfactory reduction in nine and imperfect reduction in two. Of 44 patients reviewed at one year, 33 were rated as having an excellent reduction. Functional outcome as measured by the Rasmussen score was good or excellent at six months in 92% (44/48) of patients and in 95% (42/44) at one year. Eight (16%) showed some loss of reduction of the plateau. In seven of these the loss of reduction was slight (< 3 mm) and no action was taken. One patient with a deep infection had gross loss of reduction and a poor functional outcome. Calcium-phosphate cement is a useful alternative to bone grafting for the treatment of fractures of the tibial plateau

We reviewed 15 patients with an arthrodesis of the elbow using an AO compression-plate technique, after an average follow-up of 24 months. The most common indication was an open, infected high-energy injury with associated bone loss. Arthrodesis was successful in all but one patient in whom severe deep infection necessitated amputation. Eight patients were treated with the metal partly exposed in an infected wound. After removal of the metal, all wounds healed secondarily and none had clinical or radiographic signs of sepsis at latest review. Compression-plate arthrodesis of the elbow is a generally applicable method that can be used even in cases of severe bone loss. There appears to be greater certainty of union than with other techniques, and no increased risk of subsequent fracture

Fifteen patients with rheumatoid arthritis had 19 elbow arthroplasties with the Wadsworth type of surface replacement prosthesis. After a follow-up period averaging 30 months, 11 patients with 15 elbow arthroplasties were entirely satisfied with their freedom from pain and range of movement. Radiologically, however, the humeral component was loose in 10 of the 19 elbows and the ulnar component in 5. Two patients had reoperation, one to remove a prosthesis for early deep infection and one to exchange a humeral component which was loose. The risk of mechanical loosening is reduced by accurate positioning of the humeral component, but there is a high potential for failure. Changes in the design of the prosthesis and better instrumentation for alignment of the components are desirable. Prosthetic replacement of the elbow should still be regarded as experimental

The results are reported of an audit of allografts collected in the first 18 months of the Leicester Bone Bank. We retrieved 161 femoral heads at primary arthroplasty of which 103 were implanted into 59 patients. There were deep infections in two recipients and wound infections in five. In two of these cases, culture of the femoral head at implantation was positive but the organisms grown were not those which caused the clinical infection. We retrieved 22 large allografts from six cadavers. Four of these were contaminated at retrieval and required irradiation for sterilisation. There has been one clinical infection in the nine large allografts implanted so far. We recommend that all bone banks undertake prospective audit to ensure that high standards are maintained and wastage minimised

The Ring plastic-on-metal total hip replacement was introduced with the intention of combining the advantages of the cemented low-friction arthroplasty with those of a cementless system. Fourteen hundred and eighty-eight of these procedures have been reviewed. The results of a two to seven-year follow-up, and of a group which has completed at least five years are presented. There was an excellent clinical result in 93% of the whole series, and in 87% of the five-year group. When graded on the Charnley scale there was an average score of 5.86 for pain, 5.96 for function and 5.9 for range of movement, which compares favourably with cemented replacements. The deep infection rate was zero, and the revision rate 1.5% for the whole series. Erosive problems occurred with the smaller acetabular components and the reasons are discussed. The ease and success of exchange have been maintained

In fifty-six patients with ankylosing spondylitis three types of arthroplasty had been performed in ninety-nine hips. Forty-one of the patients were men and fifteen were women, their average age at operation being forty-two years. Primary pseudarthrosis produced well-satisfied patients, but only a fair result in five hips, whereas cup arthroplasty resulted in a poor outcome for eight hips, all of which needed revision. Total replacement of eighty-six hips, however, led to 73 per cent being graded as good or excellent up to ten years later. The main complications were deep infection of five hips, para-articular ossification around nine hips (six leading to bony ankylosis), and fibrous ankylosis of six hips

Distal radial fractures are common in children. Recent outcome studies have cast doubt on the success of treatment by closed reduction and application of plaster. The most important risk factor for poor outcome is translation of the fracture. If a distal radial fracture is displaced by more than half the diameter of the bone at the fracture site it should be classified as high risk. We performed percutaneous Kirschner-wire pinning on 157 such high-risk distal radial fractures in children under 16 years of age. The predicted early and late failure rate was reduced from 60% to 14% and only 1.5% of patients had significant limitation of forearm movement of more than 15 degrees in the final assessment at a mean of 31 months after operation. There were no cases of early physeal closure or deep infection

Aims

For paediatric and adolescent patients with growth potential, preservation of the physiological joint by transepiphyseal resection (TER) of the femur confers definite advantages over arthroplasty procedures. We hypothesized that the extent of the tumour and changes in its extent after neoadjuvant chemotherapy are essential factors in the selection of this procedure, and can be assessed with MRI. The oncological and functional outcomes of the procedure were reviewed to confirm its safety and efficacy.

We have reviewed at an average period of ten years the results of 71 consecutive primary arthroplasties with the Insall-Burstein total condylar knee prosthesis in patients with rheumatoid arthritis. Their mean age at surgery was 52 years (24 to 72). At follow-up the overall results (Hospital for Special Surgery knee rating score) were excellent or good in 77%, fair in 11% and poor in 11%. There was residual pain in only 5% of patients with prostheses in situ; 58% could walk more than 500 m, and the median range of motion was 108 degrees. Eight knees had been revised. Five underwent arthrodesis because of deep infection and three needed revision arthroplasty for mechanical loosening. The crude survival rate of the arthroplasties was 89%. The presence of radiolucency around the tibial component correlated significantly with the severity of residual pain

During the years 1971 to 1975, 378 Charnley low-friction arthroplasties of the hip were performed on 278 patients with rheumatoid arthritis. The average age at operation was thirty-nine years. The follow-up time ranged from one to six years (mean two and a half years). Forty per cent of patients were receiving steroids at the time of operation. The most common complications were loosening of the prosthesis (3.4%), perforation of the femoral cortex and fracture. Deep infection occurred in 0.7%, dislocation in 0.7%, and thromboembolic episodes in 1.3%. Ninety-five per cent of patients were free of pain at follow-up compared to 84% who were severely handicapped by pain before operation. In addition, the increased mobility in 98.5% of patients and their improved independence makes hip replacement a recommendable procedure in these patients

Aims

The purpose of this study was to: review the efficacy of the induced membrane technique (IMT), also known as the Masquelet technique; and investigate the relationship between patient factors and technique variations on the outcomes of the IMT.