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When clinical indications exist, we recommend simultaneous bilateral anterior cruciate ligament reconstruction as opposed to staged procedures because it is a safe, effective, and cost-effective option.

We compared the outcome of the cemented Thompson Parkridge Richards (TPR) ankle prosthesis with that of the cementless Scandinavian Total Ankle Replacement (STAR) ankle prosthesis in a demographically similar group of patients. These were 14 consecutive arthroplasties in 12 rheumatoid arthritis patients, all operated on by the same surgeon. The status of all patients, five years or more after surgery, is known. The mean follow-up periods for the TPR group and the STAR group are 7.2 and 5.4 years respectively. Four of the six TPR tibial components became radiographically loose within two years of surgery. Two of these have been converted to fusions. The STAR prostheses remain satisfactory both clinically and radiographically at five years.

Between 1992 and 1997, we undertook a prospective, targeted clinical and ultrasonographic hip screening programme to assess the relationship between ultrasonographic abnormalities of the hip and clinical limitation of hip abduction. A total of 5.9% (2 of 34) of neonatal dislocatable hips and 87.5% (7 of 8) of ‘late’ dislocated hips seen after the age of six months, presented with unilateral limitation of hip abduction. All major (Graf type III) and 44.5% of minor (Graf type II) dysplastic hips presented with this sign. Statistically, bilateral limitation of hip abduction was not a useful clinical indicator of underlying hip abnormality because of its poor sensitivity, but unilateral limitation of abduction of the hip was a highly specific (90%) and reasonably sensitive sign (70%). It was more sensitive than the neonatal Ortolani manoeuvre, which has been considered to be the method of choice. It was, however, not sensitive enough to be of value as a routine screening test in developmental dysplasia of the hip. We consider unilateral limitation of hip abduction to be an important clinical sign and its presence in an infant over the age of three to four months makes further investigation essential.