Background and purpose There have been few reports of large series of ankle replacements. The aim of this study was to document and evaluate the early results of a nationwide series of total ankle replacements (TARs) performed using second-and third-generation implants.Methods Records of total ankle replacements performed between February 2000 and November 2005 were retrieved from the New Zealand National Joint Registry and retrospectively reviewed at a mean of 28 months after the primary procedure. At 6 months post surgery, patient scores were generated from questionnaires. Comparisons between patient scores and categorical variables were made using ANOVA. Regression analyses using Cox proportional-hazards modeling were performed to determine predictors of failure. A Kaplan-Meier survivorship curve was used to describe the rate of prosthetic survival.Results 202 total ankle replacements were performed in 183 patients. 14 prostheses (7%) failed. The overall cumulative 5-year failure-free rate was 86%. An unfavorable patient score at 6 months after the initial procedure turned out to be a good predictor of subsequent failure. The cumulative 5-year failure-free rate was 65% at 5 years for patients with an unfavorable score, and 95% for those who had a favorable patient score. Each 1-point increase in the patient score (i.e. poorer outcome) corresponded to a 5% relative increase in the risk of failure (p < 0.05). In addition, longer operative time for the primary procedure was found in the group of TARs that subsequently failed (p < 0.05).Interpretation The National Joint Registry appears to be a useful tool for monitoring the trends in TAR surgery.

Violence 1 team which included two upper-limb surgeons, a paraplegist and a hand therapist. The assessment variables included muscle charts (MRC scale), joint mobility, spasm, sensation, motivation and functional requirements. A retrospective review of muscle and sensation charts made it possible to classify 69 of the 84 hands that had had surgery (Table II) according to the international

We have reviewed the rate of revision of fully cemented, hybrid and uncemented primary total hip replacements (THRs) registered in the New Zealand Joint Registry between 1999 and December 2006 to determine whether there was any statistically significant difference in the early survival and reason for revision in these different types of fixation. The percentage rate of revision was calculated per 100 component years and compared with the reason for revision, the type of fixation and the age of the patients. Of the 42 665 primary THRs registered, 920 (2.16%) underwent revision requiring change of at least one component. Fully-cemented THRs had a lower rate of revision when considering all causes for failure (p < 0.001), but below the age of 65 years uncemented THRs had a lower rate (p < 0.01). The rate of revision of the acetabular component for aseptic loosening was less in the uncemented and hybrid groups compared with that in the fully cemented group (p < 0.001), and the rate of revision of cemented and uncemented femoral components was similar, except in patients over 75 years of age in whom revision of cemented femoral components was significantly less frequent (p < 0.02). Revision for infection was more common in patients aged below 65 years and in cemented and hybrid THRs compared with cementless THRs (p < 0.001). Dislocation was the most common cause of revision for all types of fixation and was more frequent in both uncemented acetabular groups (p < 0.001). The experience of the surgeon did not affect the findings. Although cemented THR had the lowest rate of revision for all causes in the short term (90 days), uncemented THR had the lowest rate of aseptic loosening in patients under 65 years of age and had rates comparable with international rates of aseptic loosening in those over 65 years.

There is increasing interest in measuring patient-reported outcomes as part of routine medical practice, particularly in fields like total joint replacement surgery, where pain relief, satisfaction, function, and health-related quality of life, as perceived by the patient, are primary outcomes. We review some well-known outcome instruments, measurement issues, and early experiences with large