A series of 100 consecutive osteoarthritic patients was randomised to undergo total knee replacement using a Miller-Galante II prosthesis, with or without a cemented polyethylene patellar component. Knee function was evaluated using the American Knee Society score, Western Ontario and McMaster University Osteoarthritis index, specific patellofemoral-related questions and radiographic evaluation until the fourth post-operative year, then via questionnaire until ten years post-operatively. A ten-point difference in the American Knee Society score between the two groups was considered a significant change in knee performance, with alpha and beta levels of 0.05. The mean age of the patients in the resurfaced group was 71 years (53 to 88) and in the non-resurfaced group was 73 years (54 to 86). After ten years 22 patients had died, seven were suffering from dementia, three declined further participation and ten were lost to follow-up. Two patients in the non-resurfaced group subsequently had their patellae resurfaced. In the resurfaced group one patient had an arthroscopic lateral release. There was no significant difference between the two treatment groups: both had a similar deterioration of scores with time, and no further patellofemoral complications were observed in either group. We are unable to recommend routine patellar resurfacing in osteoarthritic patients undergoing total knee replacement on the basis of our findings.

[1] Detection of biological patterns in structurally complex rivers is difficult but essential in the management of imperiled species. On the basis of the network dynamics hypothesis (NDH), we predicted that tributaries exert a strong influence on main stem morphology, mediated by tributary sediment inputs. We predicted that the likelihood that a tributary will affect main stem geomorphology depends on the ratio of the tributary basin area to the main stem basin area (T BA :M BA ). Although the results of this study do not indicate that T BA :M BA is a useful predictor of the presence of shallow alluviumdominated confluences (i.e., shoals) in the Etowah River, in Georgia, alluvial shoals were closer to tributary mouths than were other shoal types, indicating an association with tributaries. Shoals near large tributary confluences also contained a larger proportion of gravel and cobble bed sediments and were wider than adjacent, downstream shoals. These confluence-associated shoals may be ecologically different in that aquatic macrophyte occurrence is higher in wide shoals with coarse sediments, and several state and federally listed darters (Percidae) are associated with shoals and these aquatic macrophytes. Recognizing confluence-associated shoals as unique shoal types may aid researchers in understanding the distribution patterns of these aquatic organisms.

No abstract

No abstract