A patient in his thirties developed synovitis with grade 4 chondrolysis and a stiff knee with a fixed flexion deformity between three and six years following PLC and PCL reconstruction using LARS (Ligament Augmentation and Reconstruction System, Corin). There was histologic evidence of foreign body reaction, the knee was painful, swollen and stiff.

We did not use any further LARS ligaments for soft tissue reconstructions of the kneein our practice. We commenced a recall programme for all 83 patients patients who underwent a soft tissue knee reconstruction using LARS. Of those contacted, 41 replied (49%) and 16 patients had symptoms (19%) and were investigated further with XRay, MRI and arthroscopy as indicated.

We discovered a total of five patients had histologically proven synovitis with foreign body reactions (6%), three of whom had life-changing symptomatic pain, swelling and stiffness with degenerate changes (3.6%). These patients had undergone various reconstructions, including a) PLC only, b) ACL and PCL, c) PCL and PLC and d) ACL, PCL and PLC. A further single case of massive bone cyst formation was noted, following PCL reconstruction using LARS (1.2%).

The design of every post-surgical knee arthroplasty study begins with the question “How soon after surgery should we assess the patients?”. The consensus, based primarily upon clinical rating systems, is that patients' scores reach a plateau roughly one year after surgery, and that observations performed at that time should be indicative of the long-term behavior of the joint. This is satisfactory for long-term studies of clinical performance. However, when new devices are introduced there is a need to determine as quickly as possible if the device performs as designed. Waiting a year or more after surgery to characterize a device's performance may place additional patients at risk of receiving an inferior design, or may delay widespread availability of a superior design. The goal of this study was to assess knee arthroplasty patients at 6–12 weeks, 6 months and 1 year after surgery to determine if their tibiofemoral kinematics changed during functional activities.

A total of 13 patients (7 female) were recruited from an ongoing clinical study to participate in this IRB-approved sub-study. All subjects received fixed-bearing, cemented, posterior-cruciate-retaining total knee arthroplasty of the same design from a single surgeon. Subjects averaged 69 years, 169cm tall, and 28 BMI. Subjects were studied at 6–12 weeks, at 6 months and at 12 months post-surgery, when they showed an average clinical flexion of 106°, 113° and 115°, respectively. Subjects' knees were observed using pulsed-flat-panel-fluoroscopy during three activities: lunging to maximum flexion with their foot placed on a 20cm step, kneeling to maximum flexion on a padded bench, and step-up/down on a 20cm step without progression of the contralateral limb. Model-image registration was used to register 3D geometric models of the implants with their radiographic projections based upon measured projection parameters. 3D knee kinematics were derived from the registered models, including joint angles and the antero-posterior translation of the medial and lateral condyles relative to the tibial baseplate.

There were no statistically significant changes in knee kinematics between the 6–12 week and 6 month, and 6-month and 12-month visits during the kneel and lunge activities (Table 1). Similarly, there were no pair-wise differences in tibial rotation or condylar translation during the dynamic step activity at any flexion angle (Figure 1).

Traditional thinking suggests studies of knee mechanics should be performed at least one year after surgery to make observations that are predictive of long-term joint function. In three different functional activities, we could not demonstrate significant changes in knee kinematics between 6–12 weeks and 6 months, nor between 6 months and 12 months. If these results can be confirmed in a larger subject cohort, and for a range of TKA designs, then functional follow-up studies of novel knee arthroplasty designs might be justified as early as 6–12 weeks after surgery, making it possible to accelerate confirmation devices are performing in patients as designed.

For any figures or tables, please contact the authors directly.

Surgery for DDH is one of the common paediatric orthopaedics procedures in a tertiary care paediatrics hospital.

There are no uniformly agreed guidelines about the pre-operative work up related to blood transfusion in DDH surgery. This leads to lack of uniformity in practice, sometimes causes cancellations of operations on the day of surgery (due to no cross matched blood available) and on other occasions wastage of the cross matched blood.

The aims of our study were to know the incidence of perioperative blood transfusion in a series of DDH operations and to determine what types of operations/kids have more chances of needing a blood transfusion peri-operatively.

We included all children who had surgery for DDH between April 2009 and October 2012 in our institution. We found out which of these children had blood transfusion peri-operatively and reviewed their notes to determine any trends in transfusion requirements

165 children had operations for DDH during the study period. This included operations ranging from hip open reduction to Ganz osteotomy.

6 out of 165 (4%) were transfused blood. Children needing blood transfusion tended to be older and had multiple hip operations previously. Only 3 (2 during Ganz and 1 during bilateral hip reconstruction) of these 6 children needed intra-operative blood transfusion. None of the under 4 years old children needed intra-operative blood transfusion.

We conclude that children for unilateral primary hip operations for DDH do not need pre operative blood cross match. A group and save is enough in these cases.

Symptomatic tarsal coalitions failing conservative treatment are traditionally managed by open resection. Arthroscopic excision of calcaneonavicular bars have previously been described as has a technique for excising talocalcaneal bars using an arthroscope to guide an open resection. We describe an entirely arthroscopic technique for excising talocalcaneal coalitions and present a retrospective two-surgeon case series of the first eight patients (nine feet).

Outcome measures include restoration of subtalar movements, return to work and sports, visual analogue pain scales and Sports Athlete Foot and Ankle Scores (SAFAS). Follow-up ranges from 1 year to 5.5 years.

Subtalar movements were improved in all feet. Deformity was not always fully corrected but pain and SAFAS scores improved in all patients bar one. They all had a rapid return to good function apart from this same patient who required subsequent fusions. The posterior tibial nerve was damaged in one patient.

Minimal destruction of bone and soft tissues allows early mobilization and minimizes pain. We acknowledge the risk of neurological damage from any operative technique. Patient selection and preoperative planning are crucial. This series from two independent surgeons supports the feasibility and effectiveness of this technique.

Introduction

Through the paediatric LCP Hip plating system, the highly successful technique of the locking compression plate used in adult surgery, has been incorporated in a system dedicated to paediatrics. The purpose of this study was to review the outcome of the paediatric LCP Hip plate use in children, both with and without neuromuscular disease, for fixation of proximal femoral osteotomy for a variety of indications.

Through the paediatric LCP Hip plating system (Synthes GmBH Eimattstrasse 3 CH- 4436 Oberdorff), the highly successful technique of the locking compression plate used in adult surgery, has been incorporated in a system dedicated to pediatrics. We are presenting the outcome of the paediatric LCP hip plating system used for a variety of indications in our institution.

We retrospectively reviewed the notes and radiographs of all those children who have had Paediatric LCP Plate for the fixation of proximal femoral osteotomy and proximal femur fractures in our institution, between October 2007 and July 2010, for their clinical progress, mobilization status, radiological healing and any complications.

Forty-three Paediatric LCP hip plates were used in forty patients (24 males and 13 females) for the fixation of proximal femoral osteotomies (n=40) and proximal femur fractures (n=3). The osteotomies were performed for a variety of indications including Perthes disease, developmental dysplasia of hip, Cerebral Palsy, Down's syndrome, coxa vara, Leg length discrepancy and previous failed treatment of Slipped Upper Femoral Epiphysis.

Twenty-five children were allowed touch to full weight bearing post operatively. Two were kept non-weight bearing for 6 weeks. The remaining 13 children were treated in hip spica due to simultaneous pelvic osteotomy or multilevel surgery for cerebral palsy.

All osteotomies and fractures radiologically healed within 6 months (majority [n=40] within 3 months). There was no statistically significant difference (p= 0.45) in the neck shaft angle between the immediately postoperative and final x-rays after completion of bone healing.

Among the children treated without hip spica, 1 child suffered a periprosthetic fracture. Of the children treated in hip spica, 2 had pressure sores, 3 had osteoporotic distal femur fractures and 2 had posterior subluxations requiring further intervention.

There were no implant related complications.

The Paediatric LCP Hip Plate provides a stable and reliable fixation of the proximal femoral osteotomy performed for a variety of paediatric orthopaedic conditions.

Introduction

PIPJ replacement has become increasingly popular however, there is very little clinical data available apart from small studies and those from the originators of the prostheses. We present a review of our initial experience with the Acension^(c) Pyro-carbon PIP joint.

All surgical operations have the potential for contamination, and the equipment used can harbour bacteria. We collected samples from 100 elective primary hip and knee arthroplasties. These showed rates of contamination of 11.4% for the sucker tips, 14.5% for light handles, 9.4% for skin blades and 3.2% for the inside blades used during surgery; 28.7% of gloves used for preparation were also contaminated. Of the samples taken from the collection bags used during hip arthroplasty, 20% grew bacteria, which represents a significant microbial reservoir. Also, 17% of theatre gowns were contaminated at the end of the operation. Contamination was found in 10% of the needles used during closure of the fascia. Overall, 76% of the organisms grown were coagulase-negative staphylococcus. A total of 63% of operations showed contamination in the field of operation. Some changes in practice are suggested. Follow-up for a minimum of two years revealed one deep infection but the organism was not identified as a contaminant. These data provide a baseline for studying the bacteriology of the surgery of revision arthroplasty.