From 1970 to 1980 cemented metal-on-plastic total hip replacement was performed on 799 hips with primary osteoarthritis using one surgical technique. At the 10- to 20-year follow-up there had been 97 revisions for mechanical loosening. Univariate survivorship analysis showed that an increased risk of revision was associated with male gender, young age at primary THR, the Brunswik and Lubinus snap-fit prostheses with large femoral heads (as compared with the Charnley prosthesis), and varying experience of the surgeon. Multivariate statistical analysis showed a three-fold increased risk of revision for men (p < 0.0001), an increase in relative risk of 1.8 per 10 years younger at surgery (p < 0.0001), a fivefold increase in risk for the Brunswik prosthesis (p < 0.0001) and a twofold increase for the Lubinus prosthesis (p = 0.0067). Inexperience of the surgeon, however, was not validated as a risk factor. The study shows that the true risk factors for revision can be identified accurately by combining univariate survivorship and multivariate statistical analyses

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.

Aims

Commonly performed unicompartmental knee arthroplasty (UKA) is not designed for the lateral compartment. Additionally, the anatomical medial and lateral tibial plateaus have asymmetrical geometries, with a slightly dished medial plateau and a convex lateral plateau. Therefore, this study aims to investigate the native knee kinematics with respect to the tibial insert design corresponding to the lateral femoral component.

Aims

Postoperative rehabilitation regimens following ankle arthrodesis vary considerably. A systematic review was conducted to determine the evidence for weightbearing recommendations following ankle arthrodesis, and to compare outcomes between different regimens.

1. A series of 149 consecutive cases of flexor tendon grafting in the fingers and thumb is reviewed and the results are analysed. A description of the technique which has evolved from this experience is given. 2. Replacement of a divided flexor digitorum profundus in the presence of an intact sublimis tendon restored a useful range of movement in 80 per cent of cases. 3. Replacement of both flexor digitorum profundus and sublimis gave good results in 70 to 80 per cent of cases. 4. Replacement of a divided flexor pollicis longus tendon gave good results in 85 per cent of cases. 5. The particular tendon used for the graft did not materially influence the result, but there are special indications for the use of the different tendons. 6. The choice of splintage or of early movement after operation does not appear to have a significant bearing upon the result. 7. The most important factor in determining the result is probably a precise and gentle surgical technique and complete haemostasis. Minor differences in method are of little importance. The failures in this series were due more to faulty performance of the operation than to any other single factor

Aims

The aim of this study was to investigate whether clinical and radiological outcomes after intramedullary nailing of displaced fractures of the fifth metacarpal neck using a single thick Kirschner wire (K-wire) are noninferior to those of technically more demanding fixation with two thinner dual wires.

We used survival analysis to evaluate 113 consecutive semiconstrained total elbow arthroplasties (TEAs) in 95 patients at a maximum follow-up of 99 months. Our criteria for failure were mechanical malfunction, revision for any reason, and deep infection. The primary diagnosis was inflammatory arthritis in 86 elbows, post-traumatic arthritis in 6, supracondylar nonunion or fracture in 12, osteoarthritis in 2 and other causes in 3. Seven failures were due to deep infection, and five of these had a primary diagnosis of inflammatory arthritis. Eight failures were revised or had revision recommended for aseptic loosening, and six of these were in patients with post-traumatic arthritis or supracondylar nonunion. The cumulative survival for TEAs performed for post-traumatic arthritis, fractures or supracondylar nonunion was 73% at three years and 53% at five years, significantly worse than the cumulative three- and five-year survivals of 92% and 90%, respectively, for patients with inflammatory arthritis. TEA with a semiconstrained prosthesis appears to have a satisfactory survival in selected patients with arthritic disorders. The incidence of deep infection was reduced by improvements in surgical technique and postoperative management, and the routine use of antibiotic-impregnated cement. The incidence of aseptic loosening was low, except in patients with supracondylar nonunion or post-traumatic arthritis

1. The operation of spinal fusion combined with Harrington rod instrumentation is often accompanied by severe blood loss. Factors affecting the degree of blood loss are discussed with emphasis on the adverse effects of partial or complete obstruction of the inferior vena cava during operation. 2. A new scoliosis operating frame is described which is designed to encourage normal venous return during spinal fusion with the patient prone. In addition, it stabilises the patient during the procedure. 3. A standard anaesthetic technique and method of supporting the patient have been used in forty major corrective operations in thirty-eight consecutive cases of scoliosis in the past nine months. The measured blood loss at operation encountered in this series compares favourably with the quantities lost in a previously reported series of cases in which alternative methods of anaesthesia and of support for the patients were used. 4. All operations in both series were performed by the same surgeon (J. E. H.). Although further experience with the surgical technique has helped in reducing the blood loss in the later series, the same basic method of exposure and performance of the instrumentation and fusion has been used in all cases

Aims

It is not known whether change in patient-reported outcome measures (PROMs) over time can be predicted by factors present at surgery, or early follow-up. The aim of this study was to identify factors associated with changes in PROM status between two-year evaluation and medium-term follow-up.

Aims

In this randomized study, we aimed to compare quality of regenerate in monolateral versus circular frame fixation in 30 patients with infected nonunion of tibia.

Aims

The aim of this study was to assess the feasibility of conducting a full-scale, appropriately powered, randomized controlled trial (RCT) comparing internal fracture fixation and distal femoral replacement (DFR) for distal femoral fractures in older patients.

1. Cell differentiation around screws manufactured by two American and two Swiss companies and inserted into seventy femora in forty-one adult mongrel dogs has been observed over periods varying between two weeks and nine months. 2. This study reveals that, despite their excellent holding power, such screws are not everywhere in firm contact with the surrounding bone at the time of insertion. Indeed, only part of the thread surface facing the head of the screw touches the compact bone, all other surfaces being separated by a space up to 150 µ in thickness. 3. These spaces result both from the surgical technique employed and from the inaccurate measurements of drills, screws and taps. 4. Migrating cells invade these spaces during the first two weeks. In the absence of movement, these cells differentiate into osteogenic cells; movement leads to differentiation into fibroblasts, chondroblasts and osteoclasts, and failure of fixation ensues. In contrast, callus formation by osteogenic cells firmly anchors screws in four to five weeks, well before callus uniting the bone fragments has been established. 5. Extremities should be protected from undue stresses during those first few weeks after osteosynthesis, whatever the technique. 6. This study clearly demonstrates the importance oftesting screws in living bone to ascertain their holding power at all stages of fracture healing