Introduction: The proximal femoral nail antirotation (PFNA) system is a cephalomedullary device originally designed to contend with the challenge of unstable tro-chanteric femoral fractures with the novel helical blade component aimed at limiting femoral head limiting cutout. We demonstrate its use in a variety of cases.

Methods: This is a prospective study of 370 consecutive patients treated with short and long PFNA systems at a single center with 1-year follow-up. The device was used for unstable trochanteric femoral fractures (AO-classification 31. A.2 and A.3), prophylactic and definitive fixation of pathological fractures and high energy femoral fractures for a wide age range (19–101 years). Clinical outcome involved assessment of general mobility & function, operative and post-operative parameters & complications. Radiological outcome involved assessment of blade tip-apex distance, nail tip-femoral scar distance and distal locking configurations.

Results: 17% died within the follow-up period. 72% achieved their pre-trauma mobility status and nearly all fractures healed within 6 months including those in over 85 years. Of 18 problematic cases, serious complications included deep infection, loss of proximal reduction, ipsilateral femoral shaft fracture and periprosthetic supra-condylar fracture. There were no cases of acetabular penetration or blade cut-out. Short PFNA was associated with the majority of femoral shaft fractures and the only significant finding regarding instrumentation.

Discussion: This study supports long PFNA design theory demonstrating adequate purchase in the femoral head-neck zone, shown by lack of cut-out. Positive results have been demonstrated in a variety of cases making it a useful option in fractures in all ages and indications alongside unstable trochanteric configurations.

Total Knee Replacement (TKR) is one of the commonest and successful orthopaedic operations performed in the UK with good long term results. The Natural knee (Sulzer – Centerpulse ) is one of the various types of prostheses available. This implant is unique because of the trochlear notch over the anterior surface of the femoral prosthesis that allows natural tracking of the patella and an asymmetric anatomical tibial component. To our knowledge there are no studies reviewing outcome of Natural Knee Replacement from the UK.

We reviewed 177 consecutive TKRs in 147 patients including 30 bilateral simultaneous or staged procedures using Natural Total Knee prosthesis performed during 1994 to 1998, with a minimum of five years follow up. All these surgeries were performed at a single NHS District General Hospital by different grades of surgeons including consultants and trainees.

12 patients died and 10 were lost to follow up. 155 knees were available for final follow up and evaluation. We carried out an outcome related to patient satisfaction using Oxford Knee questionnaire system. We compared the preoperative and post operative scoring using the questionnaire and found an improvement of the score after the procedure. The average improvement in scores before and after surgery was 30 (20 pre op to 50 post op). Out of 155 knees evaluated, 143 knees (92%) were happy with the results while the rest did not have satisfaction with surgery. Complications included anterior knee pain in 12, DVT in 40 , non fatal pulmonary embolism in 2, wound infection in 3, stiffness in 8 of which 5 needed manipulation under anaesthesia, there were 2 revisions of which one knee was done for infection and one for a loose femoral component.

Our results suggest that the five year follow-up results of this prosthesis are at par with other commonly used knee replacement prostheses in the UK.