We describe a lumbar facet syndrome in which disabling symptoms are associated with normal or near-normal plain radiographs. Local spinal fusion relieved symptoms in 12 patients; the excised facet joint surfaces showed some of the histological changes seen in chondromalacia patellae and in osteoarthritis of other large joints. The most frequent change was focal full-thickness cartilage necrosis or loss of cartilage with exposure of subchondral bone, but osteophyte formation was remarkably absent in all specimens. We suggest that there are both clinical and histological similarities between the facet arthrosis syndrome and chondromalacia patellae. Facet arthrosis may be a relatively important cause of intractable back pain in young and middle-aged adults

Aims. Open reduction and plate fixation (ORPF) for displaced proximal humerus fractures can achieve reliably good long-term outcomes. However, a minority of patients have persistent pain and stiffness after surgery and may benefit from open arthrolysis, subacromial decompression, and removal of metalwork (ADROM). The long-term results of ADROM remain unknown; we aimed to assess outcomes of patients undergoing this procedure for stiffness following ORPF, and assess predictors of poor outcome. Methods. Between 1998 and 2018, 424 consecutive patients were treated with primary ORPF for proximal humerus fracture. ADROM was offered to symptomatic patients with a healed fracture at six months postoperatively. Patients were followed up retrospectively with demographic data, fracture characteristics, and complications recorded. Active range of motion (aROM), Oxford Shoulder Score (OSS), and EuroQol five-dimension three-level questionnaire (EQ-5D-3L) were recorded preoperatively and postoperatively. Results. A total of 138 patients underwent ADROM; 111 patients were available for long-term follow-up at a mean of 10.9 years (range 1 to 20). Mean age was 50.8 years (18 to 75);79 (57.2%) were female. Mean time from primary ORPF to ADROM was 11.9 months (6 to 19). Five patients developed superficial wound infection; ten developed symptomatic osteonecrosis/post-traumatic arthrosis (ON/PTA); four underwent revision arthrolysis. Median OSS improved from 17 (interquartile range (IQR) 12.0 to 22.0) preoperatively to 40.0 (IQR 31.5 to 48.0) postoperatively, and 39.0 (IQR 31.5 to 46.5) at long-term follow-up (p < 0.001). Median EQ-5D-3L improved from 0.079 (IQR -0.057 to 0.215) to 0.691 (IQR 0.441 to 0.941) postoperatively, and 0.701 (IQR 0.570 to 0.832) at long-term follow-up (p < 0.001). We found that aROM improved in all planes (p < 0.001). Among the variables assessed on multivariable analysis, a manual occupation, worsening Charlson Comorbidity Index and increasing socioeconomic deprivation were most consistently predictive of worse patient-reported outcome scores. Patients who subsequently developed ON/PTA reported significantly worse one-year and late OSS. Conclusion. ADROM in patients with persistent symptomatic stiffness following ORPF can achieve excellent short- and long-term outcomes. More deprived patients, those in a manual occupation, and those with worsening comorbidities have worse outcomes following ADROM. Cite this article: Bone Joint J 2022;104-B(1):157–167

Hip joint preservation remains a preferred treatment option for hips with mechanically correctable pathologies prior to the development of significant secondary arthrosis. The pathologies most amenable to joint preservation are hip dysplasia and femoroacetabular impingement. These pathologies sometimes overlap. Untreated acetabular dysplasia of modest severity always leads to arthrosis if uncorrected. Acetabular dysplasia is best treated by periacetabular osteotomy, usually combined with arthrotomy for management of labral pathology and associated cam-impingement if present. Pre-operative variables associated with the best long-term outcomes include less secondary arthrosis, younger age, and concentric articular surfaces. The earlier PAO series show 20 year survivorship of 81% and 65% in Tonnis Grade 0 and 1 hips. Femoroacetabular impingement has become progressively recognised as perhaps the most common cause of secondary arthrosis. The etiology of impingement is multifactorial and includes both genetic factors and stresses experienced by the hip prior to cessation of growth. Cam impingement can be quantified by the alpha angle as measured on plain radiographs and radial MR sequences. Cam impingement can be treated by arthroscopic or open femoral head-neck osteochondroplasty. As with hip dysplasia, prognosis following treatment is correlated with the severity of pre-operative secondary arthrosis but unfortunately impinging hips more commonly have some degree of arthrosis pre-operatively whereas dysplastic hips can become symptomatic with instability in the absence of arthrosis. The scientific basis for the treatment of pincer impingement is less strong. Unlike cam impingement and hip dysplasia, pincer impingement pathology in the absence of coxa profunda has not been correlated with arthrosis and so rim trimming with labral refixation is probably performed more often than is clinically indicated. Overall, joint preserving surgery remains the preferred treatment for hips with mechanically correctable problems prior to the development of significant secondary arthrosis

Hip joint preservation remains a preferred treatment option for hips with mechanically correctable pathologies prior to the development of significant secondary arthrosis. The pathologies most amenable to joint preservation are hip dysplasia and femoroacetabular impingement. These pathologies sometimes overlap. Untreated acetabular dysplasia of modest severity always leads to arthrosis if uncorrected. Acetabular dysplasia is best treated by periacetabular osteotomy, usually combined with arthrotomy for management of labral pathology and associated cam-impingement if present. Preoperative variables associated with the best long-term outcomes include less secondary arthrosis, younger age, and concentric articular surfaces. Femoroacetabular impingement has become progressively recognised as perhaps the most common cause of secondary arthrosis. The etiology of impingement is multifactorial and includes both genetic factors and stresses experienced by the hip prior to cessation of growth. Cam impingement can be quantified by the alpha angle as measured on plain radiographs and radial MR sequences. Cam impingement can be treated by arthroscopic or open femoral head-neck osteochondroplasty. As with hip dysplasia, prognosis following treatment is correlated with the severity of preoperative secondary arthrosis but unfortunately impinging hips more commonly have some degree of arthrosis preop whereas dysplastic hips can become symptomic with instability in the absence of arthrosis. The scientific basis for the treatment of pincer impingement is less strong. Unlike cam impingement and hip dysplasia, pincer impingement pathology in the absence of coxa profunda has not been correlated with arthrosis and so rim trimming with labral refixation is probably performed more often than is clinically indicated. Overall, joint preserving surgery remains the preferred treatment for hips with mechanically correctible problems prior to the development of significant secondary arthrosis

Introduction. Cephalomedullary nailing (CMN) is commonly used for unstable pertrochanteric fracture. CMN is relatively safe method although various complications can potentially occur needing revision surgery. Commonly used salvage procedures such as renailing, hemiarthroplasty, conservative treatment or total hip arthroplasty (THA) are viable alternatives. The aim was to investigate the rate of THA after CMN and evaluate the performance on conversion total hip arthroplasty (cTHA) after failure of CMN. Method. Collected data included patients from two orthopedic centers. Data consisted of all cTHAs after CMN between 2014-2020 and primary cementless THA operations between 2013-2023. Primary THA operations were treated as a control group where Oxford Hip Score (OHS) was the main compared variable. Result. From 2398 proximal femoral hip procedures 1667 CMN procedures were included. Altogether 46/1667 (2.8%) CMNs later received THA. Indications for THA after CMN failure were 13 (28.3%) cut-outs, nine (19.6%) cut-throughs, eight (17.4%) nail breakages, seven (15.2%) post traumatic arthrosis, seven (15.2%) nonunions, one (2.2%) malunion and one (2.2%) collum screw withdrawal. Mean (SD) time to complication after CMN operation is 5.9 (6.8) months. Mean (SD) time from nail procedure to THA was 10.4 (12.0) months. Total complication rate for cTHA after CMN was 17.4%. Reported complications were infection with seven (15.2%) cases and one (2.2%) nerve damage. Mean (SD) time to cTHA complication was 3.6 (6.1) months. One-sample T-test showed OHS to be significantly better (P<.001) for primary cementless THA compared to cTHA after one year. Conclusion. Altogether 2.8% of CMN were converted to THA. Nearly half (47.8%) of the cTHA procedures were due to CMN cut-out or cut-through. OHS was significantly better in primary cementless THA compared to cTHA. Prosthetic joint infection was the most frequent complication related to cTHA

Hip joint preservation remains a preferred treatment option for hips with mechanically correctable pathologies prior to the development of significant secondary arthrosis. The pathologies most amenable to joint preservation are hip dysplasia and femoroacetabular impingement. These pathologies sometimes overlap. Untreated acetabular dysplasia of modest severity, if left uncorrected, always leads to arthrosis. Acetabular dysplasia is best treated by periacetabular osteotomy, usually combined with arthrotomy for management of labral pathology and associated cam-impingement if present. Pre-operative variables associated with the best long-term outcomes include less secondary arthrosis, younger age, and concentric articular surfaces. Femoroacetabular impingement has become progressively recognised as perhaps the most common cause of secondary arthrosis. The etiology of impingement is multifactorial and includes both genetic factors and stresses experienced by the hip prior to cessation of growth. Cam impingement can be quantified by the alpha angle as measured on plain radiographs and radial MR sequences. Further, significant cam impingement is clearly associated with the development of osteoarthrosis. Treatment can be performed either by arthroscopic or open femoral head-neck osteochondroplasty. As with hip dysplasia, prognosis following treatment is correlated with the severity of preoperative secondary arthrosis but unfortunately impinging hips more commonly have some degree of arthrosis preop whereas dysplastic hips can become symptomatic with instability in the absence of arthrosis. The scientific basis for the treatment of pincer impingement is less strong. Unlike cam impingement and hip dysplasia, pincer impingement pathology in the absence of coxa profunda has not been correlated with arthrosis and so rim trimming with labral refixation is probably performed more often than is clinically indicated. Similarly, caution should be exercised when considering rim-trimming for protrusion since high central contact pressures due to an enlarged acetabular notch are not corrected by rim trimming. Overall, joint preserving surgery remains the preferred treatment for hips with mechanically correctable problems prior to the development of significant secondary arthrosis

Surgical invention to preserve the native hip joint remains a preferred treatment option for hips in young patients with mechanically correctable pathologies prior to the development of significant secondary arthrosis. The two most common pathologies most amenable to joint preservation are hip dysplasia and femoroacetabular impingement. These pathologies sometimes overlap. Untreated acetabular dysplasia of modest severity, if left uncorrected, always leads to arthrosis. Acetabular dysplasia is best treated by periacetabular osteotomy, usually combined with arthrotomy for management of labral pathology and associated cam-impingement, if present. Correction of deformities on the femoral side is now less common and reserved for only the more severe combined femoral and acetabular dysplasias or the rare isolated femoral dysplasia. Pre-operative variables associated with the best long-term outcomes include less secondary arthrosis, younger age, and concentric articular surfaces. Femoroacetabular impingement has become progressively recognised as perhaps the most common cause of secondary arthrosis. The etiology of impingement is multifactorial and includes both genetic factors and stresses experienced by the hip prior to cessation of growth. Cam impingement can be quantified by the alpha angle as measured on plain radiographs and radial MR sequences. Further, significant cam impingement is clearly associated with the development of osteoarthrosis. Treatment can be performed either by arthroscopic or open femoral head-neck osteochondroplasty. As with hip dysplasia, prognosis following treatment is correlated with the severity of pre-operative secondary arthrosis but unfortunately impinging hips more commonly have some degree of arthrosis pre-op whereas dysplastic hips can become symptomatic with the onset of instability in the absence of significant secondary arthrosis. The scientific basis for the treatment of pincer impingement is less strong. Unlike cam impingement and hip dysplasia, pincer impingement pathology in the absence of coxa profunda has not been correlated with arthrosis and so rim trimming with labral refixation is probably performed more often than is clinically indicated. Similarly, caution should be exercised when considering rim-trimming for protrusion since high central contact pressures due to an enlarged acetabular notch are not corrected by rim trimming. Overall, joint preserving surgery remains the preferred treatment for hips with mechanically correctable problems prior to the development of significant secondary arthrosis

Aims. To evaluate the outcomes of terrible triad injuries (TTIs) in mid-term follow-up and determine whether surgical treatment of the radial head influences clinical and radiological outcomes. Methods. Follow-up assessment of 88 patients with TTI (48 women, 40 men; mean age 57 years (18 to 82)) was performed after a mean of 4.5 years (2.0 to 9.4). The Mayo Elbow Performance Score (MEPS), Oxford Elbow Score (OES), and Disabilities of the Arm, Shoulder and Hand (DASH) score were evaluated. Radiographs of all patients were analyzed. Fracture types included 13 Mason type I, 16 type II, and 59 type III. Surgical treatment consisted of open reduction and internal fixation (ORIF) in all type II and reconstructable type III fractures, while radial head arthroplasty (RHA) was performed if reconstruction was not possible. Results. At follow-up the mean MEPS was 87.1 (20 to 100); mean OES, 36.9 (6 to 48); and mean DASH score, 18.6 (0 to 90). Mean movement was 118° (30° to 150°) for extension to flexion and 162° (90° to 180°) for pronation to supination. The overall reoperation rate was 24%, with nine ORIF, ten RHA, and two patients without treatment to the radial head needing surgical revision. When treated with RHA, Mason type III fractures exhibited significantly inferior outcomes. Suboptimal results were also identified in patients with degenerative or heterotopic changes on their latest radiograph. In contrast, more favourable outcomes were detected in patients with successful radial head reconstruction after Mason type III fractures. Conclusion. Using a standardized protocol, sufficient elbow stability and good outcomes can be achieved in most TTIs. Although some bias in treatment allocation, with more severe injuries assigned to RHA, cannot be completely omitted, treatment of radial head fractures may have an independent effect on outcome, as patients subjected to RHA showed significantly inferior results compared to those subjected to reconstruction, in terms of elbow function, incidence of arthrosis, and postoperative complications. As RHA showed no apparent advantage in Mason type III injuries between the two treatment groups, we recommend reconstruction, providing stable fixation can be achieved. Cite this article: Bone Joint J 2020;102-B(12):1620–1628

Background and aims. Hallux rigidus in the metatarsophalangeal joint (MTPJ) can be treated with arthroplasty to reduce pain and enhance motion. Few studies have investigated the functionality and the survival of HemiCap arthroplasty. Primarily we aimed to examine the medium to long-term functionality and the degree of pain after surgery. Secondarily the failure and revision rate of HemiCap implants. Methods. A total of 106 patients were operated with HemiCap arthroplasty (n=114) from 2006 to 2014, median age 53 (16 to 80) years, 78 females, 37 dorsal flange (DF) implants. Patient charts were reviewed retrospectively to collect revision data. Pre operative Coughlin/Shurnas arthrosis degree, hallux valgus (HV), intermetatarsalintermetatarsal (IM) and Distal Metaphyseal Articular Angle (DMAA) angles was were measured. Pre- and post operative 3 weeks, 6 months, 1 and 2 year2-year pain levels of the first MTPJ by Visuel Analog Skala (VAS 1–10), American Orthopaedic Foot and Ankle Score (AOFAS 0 to 100 points) and, Range of Motion (ROM), were available for 51 patients. FortysevenForty-seven of the 70 available for reexamination partook in a cross sectional follow up where the Self-Reported Foot and Ankle Score (SEFAS 0–48 points) was added to the Patients Related Outcome Measures (PROMs). Statistics. Kaplan-Meier for survival analysis, adjusted for sex, radiological angles, degree of arthrosis and dorsal flange. Prospective PROMs and ROM compared by paired t-test. Results. At 3, 5 and 7 years we had an mean implant survival of 85%, 83% and 78%. Almost all were revised due to pain, one due to malalignment and one due to loosening of the Hemicap. Dorsal flange, gender, preoperative arthrosis degree, HV, IM or DMAA angles did not statistically influence the result. For those (n=23) that were re-examined, preoperative dorsal ROM changed from mean(sd) 21 (6) to 42 (18) degrees, VAS from 7 (2) to 2 (2) and AOFAS from 61 (11) to 87 (11) (p < 0.001). At mean 5 year follow up (n=47), mean (sd) dorsal ROM was 46 (17) degrees,. AOFAS was 84 (9), VAS 2 (1) and SEFAS 42 (6) points. The dorsal flange made no statistical significant difference for ROM or PROMs, but DF displayed 51 degrees of extension vs. 44 without (p=0.1). Periprostethic lucency (<2 mm) was observed in 27/47. Conclusions. In general, we saw an acceptable implant survival rate. We did not find any predictors that influenced implant failure and the design alterations with the dorsal flange are not evident clinically. Patients who were not revised had significantly less pain, greater ROM, and better overall foot and ankle conditions than preoperatively, but the data are biased by missing numbers and revisions

Purpose: Facet joint arthrosis is an entity that can have a key role in the etiology of low back pain, especially with hyperextension, and is a key component of surgical planning, especially when considering disc arthroplasty. Plain films and MRI are most commonly utilized as the initial imaging of choice for low back pain, but these methods may not truly allow an accurate assessment of facet arthosis. Our purpose was to observe the inter- and intraobserver reliability of utilizing CT and MRI to evaluate facet arthrosis, the inter- and intraobserver reliability of the facet grading system, and the agreement of surgeons as to when to perform disc arthroplasty after the lumbar facets are evaluated. Method: A power analysis was performed which showed we would need 6 reviewers and 43 images to have 80% power to show excellent reliability. 102 CT and the corresponding MRI images of lumbar facets were obtained from patients who were to undergo lumbar spine surgery of any type. 10 spine surgeons and 3 spine fellows reviewed the randomized images at 2 time points, 3 months apart, graded the facet arthosis as well as indicated whether they would chose to perform a disc arthroplasty based on the amount of facet arthrosis. Both interobserver and intraobserver kappa values were calculated by result comparison between observers at the two time points and between CT and MRI images from the same patient. Results: interobserver reliability for MRI was 0.21 and 0.07(fair to slight agreement), and for CT was 0.33 and 0.27(fair agreement), for the spine surgeons and spine fellows respectively. The mean intraobserver reliability for MRI was 0.36 and 0.26 (fair agreement) and for CT was 0.52 and 0.51 (moderate agreement). The kappa value for agreement of whether to perform a disc arthroplasty after grading the facet arthrosis utilizing MRI was 0.22 (fair agreement) and utilizing CT was 0.33 (fair agreement) among the senior spine surgeons. Conclusion: The existing grading system for facet arthrosis and of whether to perform a disc arthroplasty utilizing the grading system has at best only fair agreement. CT is more reliable for grading facet arthrosis

Rotational acetabular osteotomy (RAO) is a circumacetabular osteotomy of the acetabulum designed to correct the dysplastic hip. In this procedure, the femoral head is covered with the articular cartilage of the acetabulum and the forces of weight-bearing are distributed more evenly. The purpose of this study was to determine whether RAO is effective in delaying the onset of arthrosis in patients with painful hip dysplasia. We determined the outcome of 20 female patients in whom RAO was performed between 1975 and 1984; all were aged 20 to 29 years at the time of surgery. The pre-operative centre-edge angle of Wiberg was 0 or negative with proximal subluxation of the femoral head. Of these, 10 were lost to follow-up before the age of 42. In these patients, however, radiographs showed no signs of arthrosis at the last follow-up. The remaining 10 patients were examined 15 to 25 years after surgery, when they were 42 to 47 years old. Radiographs revealed findings of arthrosis in only two of them who had had the secondary acetabulum before surgery. To evaluate the efficacy of preventive medicine, it is necessary to compare the results of intervention with the natural course of the disease. Wiberg reported on the natural history of seven female patients with severe hip dysplasia in 1939. When these patients were 13 to 34 years old, radiographs demonstrated no sign of arthrosis and the centre-edge angle was equal to or less than 12 degrees with proximal subluxation of the femoral head. These hips deteriorated to advanced arthrosis by the age of 42 years. Thus the outcome of our patients was significantly better than the natural course. In conclusion, our study suggests that RAO is effective in delaying the onset of arthrosis in patients with painful hip dysplasia

Arthrosis of the hip joint can be a significant source of pain and dysfunction. While hip replacement surgery has emerged as the gold standard for the treatment of end stage coxarthrosis, there are several non-arthroplasty management options that can help patients with mild and moderate hip arthritis. Therefore, the purpose of this paper is to review early prophylactic interventions that may help defer or avoid hip arthroplasty. Nonoperative management for the symptomatic hip involves minimizing joint inflammation and maximizing joint mobility through intra-articular joint injections and exercise therapy. While weight loss, activity modifications, and low impact exercises is generally recommended for patients with arthritis, the effects of these modalities on joint strength and mobility are highly variable. Intra-articular steroid injections tended to offer reliable short-term pain relief (3–4 weeks) but provided unreliable long-term efficacy. Additionally, injections of hyaluronic acid do not appear to provide improved pain relief compared to other modalities. Finally, platelet rich plasma injections do not perform better than HA injections for patients with moderate hip joint arthrosis. Primary hip joint arthrosis is rare, and therefore treatment such as peri-acetabular osteotomies, surgical dislocations, and hip arthroscopy and related procedures are aimed to minimise symptoms but potentially aim to alter the natural history of hip diseases. The state of the articular cartilage at the time of surgery is critical to the success or failure of any joint preservation procedures. Lech et al. reported in a series of dysplastic patients undergoing periacetabular osteotomies that one third of hips survived 30 years without progression of arthritis or conversion to THA. Similarly, surgical dislocation of the hip, while effective for treatment of femoroacetabular impingement, carries a high re-operation rate at 7 years follow up. Finally, as the prevalence of hip arthroscopic procedures continues to rise, it is important to recognise that failure to address the underlying structural pathologies can lead to failure and rapid joint destruction. In summary, several treatment modalities are available for the management of hip pain and dysfunction in patients with a preserved joint space. While joint preservation procedures can help improve pain and function, they rarely alter the natural history of hip disease. The status of the articular cartilage at the time of surgery is the most important predictor of treatment success or failure

Introduction. Humeral head subluxation in patients with cuff tear arthropathy (CTA) and in patients with primary arthrosis has been classified by Hamada and by Walch (type B). These classifications are based on 2D evaluation techniques (AP X-ray view, axial CT images). To our knowledge no 3D evaluation of the direction of humeral head subluxation has been described. Aim. To describe a reproducible 3D measuring technique to evaluate the direction of the humeral head subluxation in shoulder arthropathy. Methods. 72 shoulders with arthrosis type B, 51 nonoperated CTA patients and 151 normal shoulders were 3D reconstructed using Mimics®. The center of rotation on the glenoid was determined using 3-matic® 6.1 with a published technique. Next best fitting sphere of the humeral head and its center was determined. Finally the direction of migration was quantified. The reproducibility of this technique was evaluated using inter- and intra-observer reliability. Results. This technique showed a good inter and intra-observer reliability (p = 0.9). In patients with CTA the humeral head is subluxed in the superoposterior direction (p=0.006) (94°:X-axis; 94° Y-axis versus 92°:X-axis; 92° Y-axis) regardless the type of rotator cuff tear (anterosuperior or superoposterior). In patients with arthrosis type B, the humeral head is subluxed posteriorly (p=0.005) (112°: X-axis; 92° Y-axis versus 92°: X-axis; 92° Y-axis) regardless the type (B1 or B2). Conclusion. With the use of this new developed reproducible measuring technique, the direction of humeral head migration can be evaluated in 3D. In CTA the direction of the migration is superoposterior and in arthrosis type B posteriorly regardless sub-classifications

Introduction and Objective. Joint malleolar fractures have been estimated around 9% of all fractures. They are characterized by different both early and late complications. Among the latter, arthrofibrosis and early secondary arthrosis represent the two most common ones. Moreover, these two complications could be considered related to each other. Their real cause is still under investigation, even if residual post-operative hematoma and acute post-traumatic synovitis appear to be the most accredited. Supporting this hypothesis, joint debridement and the evacuation of the post-operative hematoma could represent a possible solution. The aim of this prospective study is to evaluate the role of arthroscopic lavage and debridement during internal fixation in order to prevent late joint complications. Materials and Methods. Sixty consecutive patients who reported dislocated articular ankle fractures with surgical indication of open reduction and internal fixation (ORIF) have been included in this study. 27 patients underwent ORIF surgery associated with arthroscopic washout and debridement, while 33 patients, representing the control group, underwent just internal reduction and osteosynthesis. Patients with pure dislocations, non-articular fractures, polytrauma, previous local trauma, metabolic and connective pathologies were excluded. Follow-up was performed at 40 days (T1), 3 (T2) and 6 months (T3) after trauma for all patients. If necessary, some have been re-evaluated 12 months after the trauma. Efficacy of the treatment was evaluated through the VAS scale, Maryland scale, search for local complications such as dehiscence or infections, and finally radiographic evaluation. T-Student was estimated in order to individuate statistical significance. Results. VAS scale showed higher values for the case group than the control group with mean values of 2.7 and 4.2 at T1 and 2.1 and 3.8 at T2, respectively. At 6 months follow-up, the VAS values resulted similar with 2.6 for the case group and 2.8 for the control group. The same projections were found for the Maryland scale, with values of 61.5 and 40.7 at T1, 80.8 and 68.0 at T2 and 87.8 and 85.0 with no significant differences at T3 respectively. No significant differences were detected for complications or radiographic evaluation. Conclusions. Our study has shown significance differences in terms of pain and time for recovery only in the very short term follow up. Although our study, due to the specific limits, cannot be considered diriment, on the basis of the data, we could hypothesize that the aforementioned hypothesis may remain valid for the non-acute hematoma or that the cause of the arthrofibrosis should be sought somewhere else. However, evidence is low, and further research is needed

Patients presenting with arthrosis following high tibial osteotomy (HTO) pose a technical challenge to the surgeon. Slight overcorrection during osteotomy sometimes results in persisting medial unicompartmental arthrosis, but with a valgus knee. A medial UKA is desirable, but will result in further valgus deformity, while a TKA in someone with deformity but intact cruciates may be a disappointment as it is technically challenging. The problem is similar to that of patients with a femoral malunion and arthrosis. The surgeon has to choose where to make the correction. An ‘all inside’ approach is perhaps the simplest. However, this often means extensive release of ligaments to enable ‘balancing’ of the joint, with significant compromise of the soft tissues and reduced range of motion as a consequence. As patients having HTO in the first place are relatively high demand, we have explored a more conservative option, based upon our experience with patient matched guides. We have been performing combined deformity correction and conservative arthroplasty for 5 years, using PSI developed in the MSk Lab. We have now adapted this approach to the failed HTO. By reversing the osteotomy, closing the opening wedge, or opening the closing wedge, we can restore the obliquity of the joint, and preserve the cruciate ligaments. Technique: CT based plans are used, combined with static imaging and on occasion gait data. Planning software is then used to undertake the arthroplasty, and corrective osteotomy. In the planning software, both tibial and femoral sides of the UKA are performed with minimal bone resection. The tibial osteotomy is then reversed to restore joint line obliquity. The placing of osteotomy, and the angling and positioning in relation to the tibial component are crucial. This is more important in the opening of a closing wedge, where the bone but is close to the keel cut. The tibial component is then readjusted to the final ‘Cartier’ angle. Patient guides are then made. These include a tibial cutting guide which locates both the osteotomy and the arthroplasty. At operation, the bone cuts for the arthroplasty are made first, so that these cuts are not performed on stressed bone. The cuts are not in the classical alignment as they are based upon deformed bone so the use of patient specific guides is a real help. The corrective osteotomy is then performed. If a closing wedge is being opened, then a further fibular osteotomy is needed, while the closing of an opening wedge is an easier undertaking. Six cases of corrective osteotomy and partial knee replacement are presented. In all cases, the cruciates have been preserved, together with normal patello-femoral joints. Patient satisfaction is high, because the deformity has been addressed, restoring body image. Gait characteristics are those of UKA, as the ACL has been preserved and joint line obliquity restored

Purpose. The patella provides a mechanical advantage to the knee extensor mechanism. Patellectomy, performed for trauma or patellofemoral arthrosis, does not preclude the development of tibiofemoral arthrosis. Total knee arthroplasty is the mainstay of treatment for tibiofemoral arthrosis. The purpose of this study was to evaluate the outcomes of total knee arthoplasty in patients who previously underwent patellectomy. Method. A retrospective analysis was completed on a prospectively collected database to identify all patients who underwent total knee arthroplasty following a previous patellectomy. Sixty-one total knee arthroplasties in 57 patients were identified. Patient demographics as well as functional outcome scores, including WOMAC and Knee Society Scores, were evaluated. Results. Thirty-six females (63.2%) and 21 males (36.8%) underwent a Total knee arthroplasty between July 1984 and April 2010. Mean follow up was 6.0 years (3 months–20 years). Mean Age and BMI was 59.8 8.6 and 30.5 5.8 respectively. Patellectomy was performed for trauma (56) and patellofemoral arthosis (five). All polyethylene inserts were cruciate substituting. There were five deaths and 10 knees (16.4%) required revision surgery. Causes for failure included aseptic loosening (2), polyethylene wear (3), component fracture (2), infection (2) and stiffness (1). WOMAC scores improved from 38.0 14.1 pre-operatively to 58.5 22.1 at latest review. Knee Society scores improved from 81.5 31.2 to 136.0 41.0. Range of motion and extensor lag changed preoperatively from 105.7 15.9 and 4.3 15.5 degrees to 110.7 12.1 and 6.3 7.1 degrees postoperatively. Conclusion. Despite the mechanical disadvantage to the knee extensor mechanism rendered by patellectomy, total knee arthroplasty is an effective treatment option for tibiofemoral arthrosis in these patients

Introduction and Objectives: Treatment of arthrosis secondary to massive rupture of the rotator cuff using anatomical prostheses has offered limited results. The growing use of inverted prostheses, with biomechanics completely different from anatomical prostheses, have given promising results and offer an alternative treatment for this problem as well as other functionally-similar pathologies. Materials and Methods: This multicentre study included 25 patients with Delta III inverted prostheses (IP) from Puy®, with a minimum follow-up period ranging from 3 to 22 months. There were 23 females and 2 males in the study. Average age was 71.04 years. Pre-operative diagnoses included arthrosis secondary to massive rupture of the rotator cuff (15), prosthesis revision (4), fracture sequelae (3) and acute fracture (3). Average preoperative Constant score with secondary arthrosis was 21. Results: Evaluation using the Constant scoring system yielded the following mean results: secondary arthrosis of less than 6 months progression: 55.75; greater than 6 months progression: 58.14; prosthetic replacement at less than 6 months of progression: 32; and fracture sequelae of more than 6 months progression: 47.66. There was one postoperative dislocation, which required corrective surgery, and one infection that required surgical cleaning. Discussion and Conclusions: 1). Good results were achieved using inverted prostheses in the treatment of arthrosis secondary to massive rupture of the rotator cuff (average 37 point improvement in Constant score.) 2). Limited results were attained for other conditions. The most significant result was reduction in pain

Arthroscopic intervention for early symptoms of arthrosis of the knee was a well-established procedure until Moseley cited his study showing no difference in outcomes when compared to “sham” surgery. Now there is no opportunity for reimbursement with arthroscopic debridement unless mechanical internal derangement can be documented. There are, however, several specific lesions of arthrosis which respond well to arthroscopic intervention and are reimbursed by third party payers. Arthroscopic three compartment microfracture with non-weight bearing and passive motion for eight weeks post- op has significantly relieved symptoms. Second look biopsies have confirmed type II hyaline cartilage and increased joint interval. Proper patient selection is paramount and guidelines will be discussed. Isolated severe patellofemoral arthrosis with patella subluxation responds to arthroscopic patella lateral facetectomy. Jones has reported significant pain relief up to two years with this excellent option for a difficult patient problem. The technique and results will be presented in detail. Loss of terminal extension in the arthritic knee can accelerate deterioration and force earlier decision for TKA. Parson's third tubercle is an osteophyte that forms just anterior to the ACL insertion on the tibia and is the frequent cause of extension loss. Arthroscopic resection of the tubercle results in increased extension and diminishes the stress concentration assuring better longevity for the native knee. The diagnostic characteristics, resection techniques and results of the Dallas series will be presented

Introduction. Resurfacing of the glenohumeral joint has gained popularity since its first introduction in 1958. Advantages of resurfacing over conventional shoulder arthroplasty include preservation of humeral bone stock, closer replication of individual anatomy, reduction of periprosthetic fracture risk, non-violation of medullary canal, and ease of revision to a stemmed component if needed. Materials and Methods. We reviewed a group of patients with arthrosis of the glenohumeral joint who underwent humeral resurfacing, and who were at a minimum of two years post surgery. From January 2000 to March 2011, 51 humeral resurfacing procedures were performed in 49 patients. Patients were contacted for review, and assessed using patient reported outcome measures. An Oxford Shoulder score as well as a subjective satisfaction and outcome questionnaire was completed, as well as details regarding further surgery or revision. 2 patients had died, 11 patients were not contactable, and in 4 the medical files had been lost. In the remaining 32 shoulders, the average follow-up was 5.9 years. The mean age at time of surgery was 62.3 years (range 36 to 84). Results. Complications included 7 revisions (average 2.4 years post surgery), a further 2 patients await revision. There were 2 subscapularis tendon ruptures managed operatively. A further 2 patients required surgery – one for impingement and acromioclavicular joint arthrosis, and the other for instability. The mean Oxford Shoulder score in the unrevised shoulders was 35.4 (range 10 to 47). Conclusion. We have encountered a high rate of revision in patients undergoing humeral resurfacing for glenohumeral arthrosis. In those who have not been revised, there is a wide spread of patient satisfaction as evidenced by the subjective outcome scores. NO DISCLOSURES