The 22 year survivorship of metal on metal hip resurfacing arthroplasty (RSA) is reported to be 94.3% with expert surgeons, in males with head sizes greater than 48mm. The 2023 National Joint Registry (NJR) report estimates survivorship of all RSA at 19 years to be 85%. This estimate includes all designs, head sizes and females. Our aim was to estimate the survivorship of RSA currently available for implantation (males only, head size >48mm, MatOrtho Adept or Smith and Nephew Birmingham Hip Resurfacing (BHR)) in those under 55 years, performed by all surgeons, compared to conventional THR. We performed a retrospective analysis of the NJR. We included all males under 55 years who had undergone BHR or Adept RSA with head size greater than 48mm. Propensity score matching was used to produce two comparable groups of patients for RSA or conventional THR. We matched in a 3:1 ratio (THR:RSA) using sex, ASA, BMI group, age at primary procedure, surgeon volume, diagnosis and surgeon grade as covariates. The primary analysis was survivorship at 18 years. Time-to-revision was assessed using Kaplan-Meier curves. Cox's proportional hazard models were used to investigate between group differences. 4839 RSA were available for analysis. After matching the RSA and THR groups were well balanced in terms of covariates. Survivorship at 18 years was 93.7% (95% CI 89.9,96.2) in the RSA group and 93.9% (90.5,96.0) in the THR group. Despite these similar estimates the adjusted hazard ratio was 1.40 (95% CI 1.18, 1.67 p<0.001) in favour of THR. Survivorship of the currently available RSA in males under 55 was 93.7% at 18 years, however THR survivorship was superior to RSA. These results, generalisable to UK practice, should be set against perceived benefits in functional status offered in RSA when counselling patients

Abstract. Introduction. With respect to survivorship following total knee arthroplasty (TKA), joint registries consistently demonstrate higher revision rates for both sexes in those less than 55 years. The current study analyses the survivorship of 500 cementless TKAs performed in this age group in a high-volume primary joint unit where cementless TKA has traditionally been used for the majority of patients. Methods. This was a retrospective review of 500 consecutive TKAs performed in patients under the age of 55 between March 1994 and April 2017. The primary outcome measure for the study was all-cause revision. Secondary outcome measures included clinical, functional and radiological outcomes. Results. The all-cause revision rate was 1.6% (n=8) at a median of 55.7 months. Four were revised for infection, 2 for stiffness, 1 for aseptic loosening of the tibial component and 1 patella was resurfaced for anterior knee pain. The aseptic revision rate was 0.8% (n=4). Twenty-seven (5.4%) patients underwent a manipulation under anaesthetic (MUA). Including those who underwent MUA, 6.8% (n=34) underwent other non-revision procedures. Conclusion. Survivorship in our unit in this young patient cohort was excellent with an aseptic revision rate of 0.8% at 59.7 months using a fully cementless construct. The MUA rate was higher than expected

Introduction: The purpose of this study was to assess the efficacy and complications associated with revision hip arthroplasty undertaken in patients under the age group of 55 years. Methods: A review of our institutions revision hip database showed that 430 revision hip arthroplasties undertaken over the past 9 years had a minimum follow up of 2 years. Of this 84 (56 female, 38 male) patients were under 55 years of age (range 2 to 8 years). The index procedures were preformed at an average age of 46 years (range 15 years to 54 years). The single major etiology of failure was aseptic loosening (74%), followed by infection (8%) and recurrent dislocation (7%). In majority of cases uncemented implants were used at revision surgery (91% femoral stem, 100% acetabular cups). Bone grafts were necessary in 39% of cases. Results: There was 1% incidence of DVT requiring treatment and 1% incidence of deep infection requiring a further revision hip surgery. There were no cases of dislocation in this series. At final follow up satisfactory progress was noted in all cases with a significant improvement in Harris hip score (p < 0.05). Discussion: In conclusion, revision of hip arthroplasty in patients below 55 years is associated with improvement in function and patient satisfaction. They perform better than older cohorts but not as good as primary THRs. The complication profile is comparable in the two groups

Purpose. To identify the modes of failure after total knee arthroplasty (TKA) in patients ≤ 55 years of age and to compare with those ≥ 56 years of age in patients who underwent revision TKA. Materials and Methods. We retrospectively reviewed 256 revision TKAs among patients who underwent TKA for knee osteoarthritis between January 1992 and December 2012. The causes of TKA failure were analyzed and compared between those ≤ 55 years of age and those ≥ 56 years of age. The age at the time of primary surgery was ≤ 55 years in 30 patients (31 knees) and ≥ 56 years in 210 patients (225 knees). Results. A total of 453 TKAs were performed in ≤ 55-year-old patients between 1992 and 2012. Of these, 31 cases (7%) were revised. Their mean age was 50.6 years (range, 40 to 55 years) at primary surgery and the interval from primary TKA to revision was 8.6 years (range, 1 to 17 years). In the ≤ 55 years of age group, the most common modes of TKA failure was polyethylene wear in 14 cases (45%) followed by infection in 8 cases (26%) and component loosening in 5 cases (17%). The other conditions led to TKA failure were stiffness, periprosthetic fracture, malalignment, and osteolysis in one case each (3%). Of the 11,363 TKAs that were performed in ≥ 56-year-old patients, 225 cases (2%) required a revision. The mean interval between the operations was 5.3 years (range, 0.1 to 18 years). The major modes of failure of primary TKA include polyethylene wear in 99 cases (44%), infection in 91 cases (40%), and component loosening in 26 cases (12%). In both groups, the most common cause of failure was polyethylene wear, which was followed by infection and component loosening. There were relatively lower infection rate and higher loosening rate in patients ≤ 55 years of age, but the difference was not statistically significant (p > 0.05). The mean interval between the operations was shorter in the ≥ 56 years of age group (5.3 years; range, 0.1 to 18 years) than in the younger patient group (8.6 years; range, 1 to 17 years), but there was no notable intergroup difference (p > 0.05). Conclusion. The main modes of failure after TKA in patients ≤ 55 years of age were polyethylene wear, infection and loosening, and there was no significant difference in the modes of failure after TKA between the two groups

Risk of revision following total knee replacement is relatively high in patients under 55 years of age, but little is reported regarding non-revision outcomes. This study aims to identify predictors of dissatisfaction following TKR in patients younger than 55 years of age. We assessed 177 TKRs (157 consecutive patients) from 2008 to 2013. Data was collected on age, sex, implant, indication, BMI, social deprivation, range of motion, and prior knee surgery in addition to Oxford Knee Score (OKS) and SF-12 score. Postoperative data included knee range of motion, complications, and OKS, SF-12 score and satisfaction measures at one year. Overall, 24.9% of patients (44/177) were unsure or dissatisfied with their TKR. Significant predictors of dissatisfaction on univariable analysis (p<0.05) included: Kellgren-Lawrence grade 1/2 osteoarthritis; indication; poor preoperative OKS; postoperative complications; and poor improvements in OKS and pain component score (PCS) of the SF-12. Odds ratios for dissatisfaction by indication compared to primary OA: OA with previous meniscectomy 2.86; OA in multiply operated knee 2.94; OA with other knee surgery 1.7; OA with BMI>40kgm-2 2; OA post-fracture 3.3; and inflammatory arthropathy 0.23. Multivariable analysis showed poor preoperative OKS, poor improvement in OKS and postoperative stiffness, particularly flexion of <90°, independently predicted dissatisfaction (p<0.005). Patients coming to TKR when under 55 years of age differ from the ‘average’ arthroplasty population, often having complex knee histories and indications for surgery, and an elevated risk of dissatisfaction

Abstract. Introduction. Isolated patellofemoral osteoarthritis accounts for 10% of knee osteoarthritis. Many of these will not require arthroplasty solutions, but for those who are sufficiently symptomatic, patellofemoral joint (PFJ) replacement has been shown to be an effective procedure. The National Joint Registry (NJR) has shown a higher revision rate for this operation, particularly in younger patients (males <55 years 13.3% failure at 5 years, females 9.6%). The aim of this study is to report on the medium-term outcome of the Avon patellofemoral joint arthroplasty in patients under 55 from a non-design centre. There is no other published case series on this young patient cohort. Methodology. 50 Avon PFJ replacements (Stryker, Kalamazoo USA) were undertaken in 46 patients under 55 years old (range 35 – 54, mean 48.8) between 2010 and 2022 for end-stage isolated PFJ arthritis shown on Xray and MRI scan. The outcome measure was all-cause revision rate. This was assessed by review of clinical notes, imaging and NJR data. Results. The mean follow up was 5.8 years (range 6 months to 12.9 years). Only one patient had a revision procedure (for progressive osteoarthritis) which was 3 years after the primary procedure. This patient has had no further surgery. The implant survival rate was 97.2% at 5 years and 97.2% at 10 years. Conclusion. This study shows that patellofemoral joint replacement with the Avon prosthesis can give a satisfactory revision rate in the medium term in patients under 55 if carefully selected

The increasing number of total hip arthroplasty (THA) used in young patients will inevitably lead to more revision procedures at younger ages, especially since the outcome of primary THA in young patients is already inferior compared to older patients. However, these data are lacking in literature. The aim of this study was to determine the survival of both acetabular and femoral components placed during primary and revision hip arthroplasty in patients under 55 years using Dutch Arthroplasty Register (LROI) data. All primary THA registered in the LROI between 2007–2018 in patients under 55 years were selected (n=25,682). Subsequent cup- and stem revision procedures were included. Kaplan-Meier survival analyses were used to estimate the survival probability of primary and revised cup- and stem components. Mean follow-up of primary cups and stems was 5.8 years (SD 3.2) and 5.9 years (SD 3.2), respectively. In total, 659 cup revision procedures and 532 stem revision procedures were registered. Most common reason for cup revision was acetabular loosening (n=163), most common reason for stem revision was femoral loosening (n=202). Primary cup survival for any reason at 10 years follow-up was 96.1% (95%CI: 95.7–96.4). For primary stems, 10 year survival for any reason was 97.1% (95%CI: 96.7–97.3). Mean follow-up of all revision procedures was 4.1 years (SD 2.9). Out of 659 cup revisions, 113 cup re-revisions were registered. Survival of revised cups, with end-point cup re-revision for any reason was 82.2% (95%CI: 78.8–85.1) at 5 years follow-up. Out of 532 stem revisions, 89 stem re-revisions were registered. For revised stems, survival at 5 year follow-up, with endpoint stem re-revision for any reason was 82.0% (95%CI: 78.2–85.2). The outcome of revised acetabular and femoral components is worrisome, with a survival of 82% at 5 years follow-up. This information is valuable to provide realistic expectations for these young patients at time of primary THA

Surgical management of younger patients requiring primary total hip arthroplasty remains challenging due to their activity level, physical demands and the need for longevity of implanted components. There is a debate regarding the most suitable means of component fixation in this difficult group. We undertook a retrospective review of a sequential group of patients who underwent uncemented primary total hip arthroplasty, were 55 years or younger at the time of surgery, and who were currently a minimum of 5 years post operation. From January 2004 to December 2006 we performed 86 primary uncemented THRs in 71 young adults. The ages ranged from 18 to 55 years with a mean of 42.9 years at the time of operation. At last review, 8 patients (9 hips) had died from unrelated causes, and 16 patients (19 hips) were lost before completing 5 years of follow-up. Complications included 1 peri-operative mortality, 10 intra-operative femoral calcar fractures, 1 revision for sepsis, 1 dislocation and 1 DVT. At a minimum of 5 years post operation there were no revisions for aseptic loosening. Uncemented primary total hip arthroplasty in patients 55 years or younger yields good results at a minimum of 5 years. NO DISCLOSURES

Introduction: The functional outcome and survivorship of knee arthroplasty in young patients remains a concern. The aim of this study is to assess patient reported outcomes of knee arthroplasty surgery in osteoarthritic patients age 55 years old or younger in a generalist setting. Patients and methods: All patients 55 years old or younger at the time of index arthroplasty were identified from the Trent arthroplasty register. Demographic data was available for all patients. A self-administered questionnaire was mailed to patients. This questionnaire included an Oxford Knee Score along with questions relating to employment, leisure activities and the patient expectations of their surgery. Results: 242 patients 55 years old or younger had a knee arthroplasty in the study period (male:female 1:1). 208 patients had a total knee arthroplasty. The remaining had a unicompartmental knee replacement. Mean age of patients for the total knee arthroplasty group was 51 years (range 37–55) and that for the unicompartmental group was 50 years (range 37–55). The average length of follow up for the total knee arthroplasty group was 33.3 months (range 12–57) and that for the unicom-partmental group was 29.3 months (range 16–45). The average Oxford knee score at follow up was comparable between the two groups; 31.8 (range 12–57) for the total knee arthroplasty group and 32.0 (range 13–54) for the unicompartmental group. 77% of patients in the total knee arthroplasty group and 71% of patients in the uni-compartmental group reported that the pain relief was better or just as they expected following the operation. Conclusion: Knee arthroplasty remains a satisfactory procedure in young patients under the age of 55 years. There is no significant difference in Oxford knee scores between patients that have total knee replacement or unicompart-mental knee replacement. Pain relief is better or just as expected in the majority of patients in both groups

The five year results of 8187 primary total knee replacements undertaken for osteoarthritis in patients under the age of 55 years are presented. The casese were submitted to the Australian Orthopaedic Association National Joint Replacement Registry in the period 1st September 1999 to 31st December 2006. This represents 6.3% of the 130,377 primary knee replacements recorded by the registry for this period. The five year cumulative revision rate for patients under the age of 55 years was 8.0% (95% CI: 7.2 to 8.9). We compared the results to outcomes of older patients aged over 70 years at the time of surgery. The younger patients have a significantly higher risk of revision in the first five years (hazard ratio of 2.9; 95% CI= 2.59 to 3.26; p< 0.0001). Gender, mode of fixation, the use of cruciate retention or substitution prostheses or patella resurfacing did not significantly affect the rate of revision in those patients aged 55 years or less. Survival of fixed bearing implants was significantly better than that of mobile bearings. The most common reason for revision in this group was loosening (32.3%). Total knee replacement in patients under the age of 55 years is associated with a much higher risk of revision in the first five years. A decision to proceed with total knee replacement in this age group should be accompanied by a careful explanation of this significantly increased risk compared to knee replacement in older individuals

Purpose: To determine current practice in knee Arthroplasty surgery for osteoarthritis in young patients for the population registered on the Trent and Wales Arthroplasty Database. Is there a ‘gold standard’? If there is what is it?. Method: The Trent Arthroplasty Audit Group collects prospective data on all knee Arthroplasty surgery performed in Trent Region and North and West Wales (population 6.2 million). In 2000/2001 7% of knee arthroplasties were performed on osteoarthritic patients aged 55 years or less. We analysed the database to reach the following results. Results: In 2000/01 208 arthroplasties were performed in this group of patients. The youngest patient was 36 yrs. Seventy per cent of the patients were aged between 50 and 55 years. 114 were female. 27 had a unicompartmental knee replacement, mobile bearing in 25. Where the patient had a condylar knee replacent a mobile bearing design was implanted in 10 knees. A PCL sacrificing implant was used in 36% of cases. The patella was resurfaced in 31%. An uncemented prosthesis was used in 19 knees. An 8mm tibial insert was implanted in 32 cases and an insert of less than 10mm in a further eight cases. The surgery was performed by a Consultant in 65% of cases. A Consultant assisted in a further 14% of cases. The arthroplasty was the first surgical procedure to the knee in 38% of cases. The arthroplasty followed arthroscopic procedures in a further 41% of cases. Conclusions: The surgeons of the Trent Arthroplasty Audit Group are offering knee Arthroplasty to their patients at an earlier stage. Surgeons don’t appear to change their surgical practice or choice of implant when operating on young osteoarthritic patients. Given that we have previously shown that 20% of these patients are disappointed by the pain relief and 38% by their level of function what should we recommend?

Purpose: Anterior Cruciate Ligament (ACL) deficiency can result in symptomatic instability of the knee resulting in subsequent functional instability regardless of the patient’s age. We reviewed a single surgeon database of 908 ACL reconstructions (ACLR’s) carried out in the last 20 years. 14 patients were identified who were 55 years or over at the time of ACLR (mean age: 60 years, range: 55–75 years). Patients were evaluated clinically and with clinical outcome scoring and KT-1000 arthrometry assessment. One patient had died but the other 13 patients were available to attend for follow-up at an average of 9.7 years post-ACLR. One patient had undergone total knee replacement. For the remainder: the most recent mean Lysholm score was 76 - improving from 35 pre-ACLR (p< 0.05); KT-1000 testing at 30 degrees flexion with 30lbs force demonstrated a side-to-side difference > 2mm in only one knee; only the same knee demonstrated a pivot shift. The most recent mean Tegner score was 3.10. Conclusion: Anterior cruciate ligament reconstruction with autograft in the over-55 patient with minimal arthrosis is a safe procedure that returns stability to the knee and allows for return to a reasonable level of activity over the medium to long-term in the majority of cases

Introduction: Following previously gratifying results in older patients the study aims to quantify the outcomes and identify any contraindications in patient selection for patello-femoral replacements using the Avon pros-thesis in patients under 55 years old. Method: We present early outcome results for a prospective cohort study of patients under 55 years of age.110 knees in 86 patients (median age 47years, range 25–54) have been treated with Avon patello-femoral replacement (88 in females and 22 in males). Diagnoses included lateral facet OA (59 knees), patella dislocation (36 knees), trochlear dysplasia (39 knees) and post patellectomy instability (7 knees). 108 knees had undergone previous surgery. 14 knees required additional intra-operative procedures (including 11 lateral releases and 2 patella realignments). All patients were assessed pre-operatively using the Oxford, Bristol and WOMAC scores. Results: No knees have been lost to follow-up. 82 knees have post operative scores available (mean follow-up 27 months). 8 have been revised (6 due to progression of OA). The mean Oxford, Bristol and WOMAC scores all improved: 18 to 32, 56 to 83 and 39 to 25 respectively. Asymptomatic deterioration of the tibio femoral joint is seen in some cases of primary OA but not with trochlear dysplasia. 21 knees required post-operative additional procedures including 6 lateral releases, 3 patella realignments and 5 revisions. Equally good results were seen when comparing patients with the 3 main diagnoses. Trochlear dysplasia is strongly predicted by young age at onset of symptoms and patellar dislocation. Conclusion: Many of this type of patient, with disabling symptoms, wish to “live now”. The short-term improvements are frequently dramatic. Comparison of underlying pathologies has not identified groups that are performing less well to suggest restricting current indications. As yet there is no suggestion of prosthetic failure. Revision has presented little difficulty since minimal bone is resected primarily

Since 1996 over 400 isolated patellofemoral replacements using the Avon prosthesis have been undertaken in Bristol. As a result of the usually gratifying outcomes seen in patients over 55 years old, the indications for this surgery were soon extended to include the many younger patients who have severely disabling patellofemoral disease. We present results from a prospective cohort study of patients under 55 years of age at the time of surgery. 110 knees in 86 patients (median age 47 years, range 24–54) have been treated with Avon patellofemoral replacement (88 in females and 22 in males). Diagnoses included lateral facet OA (59 knees), patella dislocation (25 knees), trochlear dysplasia (41 knees) and post patellectomy instability (7 knees). 79 knees had undergone previous surgery. 17 knees required additional intra-operative procedures including 11 lateral releases and 2 patella realignments. All patients were assessed pre-operatively and at regular intervals using the Oxford, Bristol and WOMAC scores. All knees were scored preoperative and only one knee has been lost to follow-up due to the patient’s death, which was unrelated to surgery. Post-operative Oxford knee scores have been obtained for 106 knees with follow-up between 8 months and 8 years (mean follow-up 24 months). The mean Oxford score improved from 18 preoperatively to 31 at latest review. Bristol and WOMAC scores showed similar improvements. 16 knees required post-operative additional procedures including 6 lateral releases, 3 patella realignments and 11 revisions. Of the revisions 5 were for progression of tibiofemoral OA but none of these were knees with trochlear dysplasia. Equally good mean scores were seen when comparing patients with the 3 main underlying pathologies (trochlear dysplasia, patellar dislocation and lateral facet OA). At least 37% of the patients studied had pre-existing trochlear dysplasia and the majority of these patients report onset of symptoms, often patellar dislocation, in the first three decades of life. More than 90% of patients were overweight or obese according to their BMI at the time of surgery. Many of this type of patient, with disabling symptoms, wish to “live now”. The short-term improvements are frequently dramatic. As yet there is no suggestion of prosthetic failure. Revision presents little difficulty since minimal bone is resected in the primary proceedure. Radiological deterioration of the tibio femoral joint is seen in some cases of primary OA but not with trochlear dysplasia

Orthopaedics has been earmarked as one of the specialties that could make significant savings in the National Health Service. A large number of young adults are receiving total hip replacements and there has been a trend towards using uncemented implants. We describe the clinical and functional results at minimum 19 year follow up of cemented total hip replacements in patients under the age of fifty-five in our health region between 1990 and 1997. 104 cemented THRs performed in 100 patients under 55 years were included in this study. The follow-up data had been collected prospectively in the University database. 88.46% hips showed good to excellent results at final follow-up with a mean Harris hip score of 87.9±8.64. Revision was performed in 2 hips (1.92%), one for aseptic acetabular loosening and the other for late haematogenous infection. Probable radiological loosening was seen in 14 acetabular components (14.89%) and 4 femoral components (4.25%) at final follow-up. The mean rate of acetabular wear was 0.12mm/year and was not influenced by gender or diagnosis. The mean follow-up was 21.68±2.11 years (range 19 to 26 years) and the survivorship at 19 years was 98.07%. The GIRFT report looked at the economic aspect of implant selection and found that the cost of uncemented implants was almost double that of the cemented implants. Savings of atleast £10 million a year can be made if cemented implants were used. We recommend that in a publically funded health system like the NHS, cemented implants can be used in patients under 55 with good long term functional outcomes and large savings in the healthcare costs

Purpose: To clinically and radiologically evaluate medium term outcome of a patient cohort age 55 years or older at the time of medial opening wedge high tibial osteotomy (MOWHTO). Methods: Between January 1997 and January 2003, 60 patients (52 males) underwent 66 MOWHTOs. Following a systematic chart review 56 returned for follow up. Outcomes measures were KOOS, LEFS, SF-12, Cincinnati, Tegner scores, a new activity score and physical examination. Routine knee and long leg standing radiographs were compared to pre and early postoperative radiographs. Results: Thirteen patients were not assessed further, 6 (7 MOWHTOs) had undergone total knee arthroplasty (TKA), 3 had passed away and 4 were lost to follow up. Thus the probability of survival (not converting MOWHTO to TKA) was 0.966 at 3 years, 0.927 at 4 years and 0.878 at 5 years. Quality of life, functional status and general health of the remaining 47 patients (52 HTOs) with a mean age of 62 years (55–75) at the time of surgery were assessed. At a mean follow up of 62 months (26–98), on the author’s activity score, 83% performed at least one high impact activity at moderate to high intensity an average of 4–7 times weekly and 6% did not participate in any sport. Average participation in activities/sports was 3 per person at a participation level of 4.6 (Tegner). The mean Cincinnati score was 75% (SD=23, 14–95%). Mean scores for the KOOS and LEFS were 66% (SD=22,7–99%) and 49 (SD=18, 5–80) respectively. The mean physical component score of the SF-12 was 42 (SD=11, 21.7–60.4) and the mean mental component score, 54 (SD=11, 26–68). Seventy–two percent were fully weight bearing by 3 months. There were 6 revisions performed for a combination of delayed and non-unions. Conclusions: MOWHTO remains a viable alternative for patients over the age of 55 with knee osteoarthritis and varus malalignment who would otherwise be candidates for arthroplasty and particularly for those wishing to maintain or regain a high level of activity

Purpose: Alumina resistance to wear is now well established. In the eighties, improvement in manufacturing processes and implant design led to a significant reduction in the risk of fracture but failure of acetabular fixation remained a cause leading to revision. The purpose of this work was to present our results with a consecutive series of press-fit cementless metal backed alumina-alumina THA implanted between 1990 and 1992 in patients aged less than 55 years. Material and methods: The series included 62 patients and 71 hips. Mean age at surgery was 46 years (range 21 – 54). A cemented titanium femoral stem with a 32-mm alumina head was implanted with a press-fit metal-backed cup with an alumina insert. Three patients (4 hips) died. Four hips required revision for infection (n=1), unexplained pain (n=1), fracture of the alumina head (n=1), and aseptic cup loosening (n=1). At nine years the survival rate was 93.7% taking revision for all cause as the end point and 98.4% taking revision for aseptic loosening as the end point. Results: Fifty patients (57 hips) were reviewed with at least five years follow-up (mean 8 years, range 6–11 years). According to the Postel-Merle d’Aubigné score, functional outcome was excellent or very good in 96% of the patients. A minimal partial lucent line was observed around 38% of the cups, mainly in zone III and one cup exhibited a complete line measuring < 1 mm. Isolated osteolysis of the femur was observed in one hip. There was no case with acetabular osteolysis or implant migration. Discussion: Combining a cemented stem with a pressfit metal backed cup has provided very satisfactory mid-term results in these active patients. Use of a press-fit hemispheric cup has been found to be a reliable fixation method for alumina cups and improves results of Al-AL THA significantly. In light of the excellent resistance of the alumina cups against wear, these results can be expected to continue for a long period

Purpose: To clinically evaluate the medium term outcome of a patient cohort age 55 years or older at the time of medial opening wedge high tibial osteotomy (MOWHTO). Methods: Between January 1997 and January 2003, 60 patients (52 males) underwent 66 MOWHTOs. Following a systematic chart review 56 returned for follow up. Outcomes measures were KOOS, LEFS, SF-12, Cincinnati, Tegner scores, a new activity score and physical examination. Routine knee and long leg standing radiographs were compared to pre and early postoperative radiographs. Results: Thirteen patients were not assessed further, 6 (7 MOWHTOs) had undergone total knee arthroplasty (TKA), 3 had passed away and 4 were lost to follow up. Thus the probability of survival (not converting MOWHTO to TKA) was 0.966 at 3 years, 0.927 at 4 years and 0.878 at 5 years. Quality of life, functional status and general health of the remaining 47 patients (52 HTOs) with a mean age of 62 years (55–75) at the time of surgery were assessed. At a mean follow up of 62 months (26–98), on the author’s activity score, 83% performed at least one high impact activity at moderate to high intensity an average of 4–7 times per week and 6% did not participate in any sport. Average participation in activities/sports was 3 per person at a participation level of 4.6 (Tegner). The mean Cincinnati score was 75% (SD=23, 14–95%). Mean scores for the KOOS and LEFS were 66% (SD=22, 7–99%) and 49 (SD=18, 5–80) respectively. Seventy–two percent were fully weight bearing by 3 months. There were 6 revisions for a combination of delayed and non-unions. Conclusions: MOWHTO remains a viable alternative for patients over the age of 55 with knee osteoarthritis and varus malalignment who would otherwise be candidates for arthroplasty and particularly for those wishing to maintain or regain a high level of activity

Bony tumours of the foot account for approximately 3% of all osseous tumours. However, literature regarding os calcis tumours comprises individual case reports, short case series or literature reviews, with the last large case series in 1973.

We retrospectively reviewed the medical notes and imaging for all patients with calcaneal tumours recorded in the Scottish Bone Tumour Registry since the 1940's. Demographics, presentation, investigation, histology, management and outcome were reviewed.

38 calcaneal tumours were identified. Male to female ratio 2:1, mean age at presentation 30 with heel pain and swelling, average length of symptoms 9 months. 4 cases present with pathological fracture. 24 tumours benign including 6 unicameral bone cysts, 3 chondroblastoma, 3 PVNS with calcaneal erosion, and a wide variety of individual lesions. 13 malignant tumours comprising 6 osteosarcoma, 5 chondrosarcoma and 2 Ewings sarcoma. 1 metastatic carcinoma.

Tumours of the calcaneus frequently are delayed in diagnosis due to their rarity and lack of clinician familiarity. They are more common in men and have a 1 in 3 risk of malignancy, covering a wide variety of lesions. Outcome is dependent on early diagnosis, timely surgery and most importantly neo-adjuvant chemotherapy. Diagnosis is often made on plain radiograph but MRI is the gold standard.

We present the largest case series of calcaneal tumours, from our experience with the Scottish Bone Tumour Registry. Despite their rarity clinicians should maintain a high index of suspicion as accurate and timely diagnosis is important to management and outcome.

Introduction

Bony tumours of the foot account for approximately 3% of all osseous tumours. However, literature regarding os calcis and talar tumours comprises individual case reports, short case series or literature reviews with no recent large series.