This study examines the association between postoperative coronal tibiofemoral alignment and revision surgery in knee arthroplasty. We retrospectively reviewed the case notes and post-operative long-leg radiographs of 197 Kinemax knee arthroplasty with mean follow-up of 9 years (SD 2.2). They were divided into three groups: neutral, valgus and varus. Revision or decision to revise was used as a hard endpoint. There was no statistical difference among the three groups (p=0.78). We conclude that aseptic failure of a total knee is multifactorial. Coronal tibio-femoral alignment may not be as important a cause of failure as has been previously thought.Résumé Cette étude a pour but d'examiner l'alignement des éléments prothétiques dans la chirurgie de reprise de prothèse totale du genou. Nous avons de façon rétrospec-tive revu en 1997 une série de prothèses de type Kinemax avec un suivi moyen de 9 ans (SD 2.2). La population a été divisée en trois groupes : Neutre, Valgus et Varus. Pour les courbes de survie ont été utilisées comme référence la révision ou la décision de révision. Nous pouvons conclure que le descellement aseptique d'une prothèse totale du genou est multi factorielle. L'alignement tibio fémoral n'est pas une cause importante d'échec comme l'on pouvait le penser auparavant.

Purpose The short-term results of silastic implant of the first metatarsophalangeal joint (MTPJ) have been successful. However, reservations exist regarding long-term results. The aim of this study was to evaluate long-term outcome of silastic implant prosthesis in treatment of hallus rigidus. Methods This was a retrospective study, with 108 feet in 83 patients, operated upon between 1988 and 2003. Mean age at operation was 55 years (SD 8.1) with a follow-up period of 8.5 years. Outcome measures included the American Orthopaedic Foot and Ankle Scoring system(AOFAS), passive and active arc of motion. Patients' satisfaction was assessed using the visual analogue scale. All the patients had anteroposterior and oblique views and were assessed for loosening and osteolysis. Pedobarographic studies were performed using the Musgrave Footprint. Complications and revisions were recorded. Results The mean total AOFAS score was 77.5 (SD 13.4). Mean active and passive arc of motions were 36.8 degrees (SD 19.13) and 46.82 degrees (SD 17.19), respectively. Patient satisfaction showed mean VAS of 7.73 (SD 2.41). Prostheses were removed in three feet at three, five and seven years respectively because of persistent pain. Radiologically 25 feet (23 %) had osteolysis but were non progressive and didn't correlate with the functional outcome. ConclusionWe can conclude that silastic implant arthroplasty is an effective procedure in hallux rigidus management with satisfactory functional outcome and high patient satisfaction.

We present the outcomes in 38 consecutive patients who had total ankle replacement using the Ankle Evolution System with a minimum follow-up of four years. Pain and function were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) score and regular standardised anteroposterior and lateral weight-bearing radiographs were obtained. Patient satisfaction and complications were recorded and the survival of the implants was demonstrated by the Kaplan-Meier method. The mean follow-up was for 57.8 months (48 to 80). The cumulative survival rate at six years was 94.7% (95% confidence interval 80.3 to 98.7). The mean total AOFAS score was 88.1 (53 to 100). The mean score for pain was 35.8 (20 to 40). Ten patients presented with edge-loading of whom nine had corrective surgery. Two ankles were revised, one to an arthrodesis and the other to replace the tibial component. Nine patients showed radiological evidence of osteolysis. They had minimal non-progressive symptoms and further surgery was not undertaken. Nevertheless, the concerns about osteolysis led to the implant being withdrawn by the manufacturer. The medium-term results of the ankle evolution system ankle replacement are satisfactory with high patient satisfaction, but the rate of osteolysis is of some concern. The long-term benefit of this procedure has yet to be determined.

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