Patients affected by haemophilia commonly have recurrent intra-articular bleeding which leads to progressive destruction and instability of joints. Severe arthropathy of the elbow is complicated by pain, stiffness and loss of function which can be debilitating. Conservative measures such as analgesics, physiotherapy and orthotics are commonly used in the management of these patients. Surgery is considered when conservative measures fail to control the symptoms. Total elbow replacement is now increasingly performed with the advances made in factor replacement therapy and evolution of better implants and techniques of total elbow arthroplasty. The pathogenesis, clinical features and radiological changes of haemophilic arthropathy of the elbow are described in this review article.

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We present the results of clinical evaluation and patient-based outcomes after Ilizarov surgery in resistant clubfeet (grade D clubfeet, Dimeglio-Bensahel system). This is a retrospective study of 26 resistant clubfeet in 23 children who were managed by the Ilizarov technique. The average age of the patients at the time of the operation was 9 years and the average follow-up period was 47 months. A calcaneal or mid-foot osteotomy followed by bony distraction was undertaken in nine feet and a soft-tissue distraction, with or without soft-tissue release, was undertaken in 17 feet. Clinical evaluation of the degree of correction of the deformity and functional evaluation, using patient-based questionnaires, were used in assessing the outcome in these patients. Patient-based outcomes give useful information about the functional status following surgery, complementing the objective assessment by the surgeon. Clinical evaluation revealed stiff, plantigrade feet in nine patients and a recurrent deformity after initial correction in the remaining 14 patients. The patient-based outcomes were good to excellent in 52% for satisfaction, 57% for cosmesis, 48% for walking and 73% for teasing (made fun of because of the shape of foot), showing that the functional results were better in these patients in spite of a poor surgical outcome.

This retrospective study evaluated the short-term functional outcome of patellofemoral arthroplasty using patient-based outcome measures. The study cohort included 17 patients who underwent patellofemoral arthroplasty (14 unilateral and 3 bilateral) between 1996 and 2005. Mean patient age was 56 years (range, 43-65 years), and mean follow-up was 52.5 months (range, 24-84 months). Clinical and radiographic assessment was performed using the Hospital for Special Surgery (HSS) knee score. Functional assessment was performed using the Short Form-36 (SF-36) and the Knee Injury and Osteoarthritis Outcome Score (KOOS). Mean HSS knee score was 64 (range, 51-79) preoperatively and 90 (range, 71-100) postoperatively. Mean postoperative SF-36 scores were compared with normative data compiled by the British Omnibus Survey in 1992. Scores for physical and social functioning, role limitation due to physical and emotional problems, and pain were poorer compared with mental health and energy/vitality. Mean postoperative scores for the 5 KOOS subscales ranged from 51% to 72%. These findings indicate patient-based outcome measures should be used routinely for functional assessment of patients undergoing patellofemoral arthroplasty.