Aim: Inability to lose weight is often attributed to restriction of mobility due to painful arthritic joints. We hypothesise that removing the pain by total hip replacement or knee replacement will improve patients exercise tolerance thereby helping them lose weight.

Method: A prospective study of obese patients (BMI > 30) undergoing consecutive primary total hip or knee replacement. BMI was measured pre operatively and 1 year post operatively. Patients with medical conditions or complications of surgery that would limit mobility were excluded. A questionnaire detailing pre and postoperative activity levels, walking distance/aids and diet was completed.

Results: 37 patients were included in the study. All patients had symptomatic osteoarthritis. There were 21 female and 16 male patients with an average age of 70 (range 51 – 85). 23 patients had total knee replacements and 14 had total hip replacement. The average follow up was 11.4 months (range 8 – 12 months).

The International classification of adult weight according to BMI was used to categorise patients. Obesity is defined as a BMI greater than 30 and is graded in severity. Class I is a BMI of 30.0 – 34.9, Class II is 35.0 – 39.9 and Class III is greater than 40.0

There were 14 patients in obese class I. 5 patients increased their BMI, 4 patients remained the same and 5 patients decreased their BMI. There was an average increase in BMI of 0.36. 13 patients had an improvement in walking distance and in 1 patient it remained unchanged.

There were 16 patients in obese class II. 6 patients increased their BMI, 5 patients remained the same and 5 patients decreased their BMI. There was an average increase in BMI of 0.62. 14 patients had an improvement in walking distance and in 2 patients it remained unchanged.

There were 7 patients in obese class III. 1 patient increased their BMI, 1 patient remained the same and 5 patients decreased their BMI. There was an average decrease in BMI of 1.3. 5 patients had an improvement in walking distance and in 2 patients it remained unchanged.

There was an average increase of BMI of 0.19 in all patients. All patients reported an improvement in activity levels and a reduction in the use of walking aids.

Conclusion: Overall there was an increase in the BMI of obese patients undergoing total knee or hip replacement. This study suggests that total knee or hip replacement in obese patients for osteoarthritis despite improved activity levels does not result in a reduction in BMI. This is either as the improvement in mobility is not sufficient to confer a significant loss of weight or that pre-operative obesity is unrelated to inactivity due to osteoarthritis. Interestingly, the weight loss in obese class III patients (BMI > 40) who undergo total hip or knee replacement suggests that they benefit more from surgery than other classes of obesity.

Assess the outcome of plating of lateral end clavicle fractures. Lateral end clavicle fractures can be treated both conservatively and surgically. Different surgical methods are available to stabilize lateral end clavicle fractures. We treated 15 lateral end clavicle fractures with plate fixations (4 AO ‘T’ plate and 11 ACUMED lateral clavicle plate) from September 2002 to December 2005. There were 12 males and 3 females and the mean age was 33.12 year (range 23–61). 3 were done for non-union and 13 for acute fractures. 2 non-unions were treated with AO ‘T’ plate and 1 with ACUMED lateral clavicle plate. 1 patient with non-union had bone grafting at the time of the procedure. Acute fractures were stabilized with in 3 weeks from the time of the injury. All fractures were Type 2 according to Neer classification of lateral end clavicle fractures. The cause of the injury was, simple fall (3), fall from pushbike (3), assault (3), sports/skate-board (3), and RTA (3). The senior author operated on all patients. The arm was immobilized in a sling for six weeks post operatively. The follow up ranged between 5 months to 36 months All but one fracture healed. 1 ‘T’ and 1 ACUMED plate was removed 7 months after the index procedure after fracture consolidation. There was no superficial or deep infection. Patients were assessed clinically with Constant and DASH scores; patient satisfaction with the procedure was also recorded and union assessed radiologically.. Lateral end clavicle fractures pose a challenge due to the small size of the distal fragment. In our experience plating of these fractures give satisfactory results. Oblique fracture patterns result in better fixation and union rates. The plate design and advantages of the ACUMED contoured distal clavicle plates are further discussed in the paper.

Between 1997 and 2005, 10 patients with chronic instability of the elbow underwent surgical stabilisation. There were 5 men and 6 women with a mean age of 41 years (16 to 58). All patients had initially dislocated the elbow at a mean of 5.6 years (6 months to 25 years) prior to surgical reconstruction. There were 8 chronic lateral and 2 medial reconstructions performed. The presenting symptoms, findings on clinical examination and methods of surgical reconstruction are defined. Two patients underwent reconstruction using an artificial ligament (Corin) as they had evidence of ligamentous laxity and at the time of assessment all the other patients had been treated using autografts. At a mean follow up of 3 years (1 to 6 years) all patients except one reported no symptoms of pain or instability and had been able to return to their normal work and social activity. The one patient with persisting elbow instability had Ehlers-Danlos syndrome and underwent a second revision procedure again using an artificial ligament (Corin). This review represents our surgical experience and functional outcomes with this rare form of ligamentous elbow injury.

Between 1993 and 1996, 35 Kudo unlinked total elbow replacements were performed in a consecutive series of 33 rheumatoid patients. All patients had radiological changes of Larsen grade IV or grade V and met the diagnostic criteria of the American Rheumatism Association. The indication for surgery was intractable pain leading to loss of function. There were 6 men and 27 women with a mean age of 60 years (37 to 79) at the time of surgery. A total of 23 patients were reviewed at a mean follow up of 12 years (10 to 13). Ten patients (11 replacements) had died from unrelated causes prior to the review period. Function was assessed with regards to activities of daily living with the Mayo Clinic Performance Index and DASH scoring. Seven patients had undergone revision surgery after the index procedure with conversion of the Kudo replacement to a Coonrad-Morrey prosthesis. The mean time to revision was 6 years (1 to 11). The indications for revision were periprosthetic fracture (n=1), infection (n=2) and aseptic loosening (n=5). This review represents the longest follow up of the Kudo implant outside of the design unit and includes a detailed assessment of the failed arthroplasties.

Introduction To evaluate the Fast-Fix meniscal repair system, which is a disposable, pre knotted ‘all-inside’ suture with similar pull out strength to vertical mattress suture.

Materials and Methods Between September 2001 and May 2002, we performed 39 meniscal repairs in 38 patients, 1 patient had bilateral injury. The average age was 24(16–37). The cause of the meniscal injury was sports related in 70%, unrelated to sports in 16% and with no history of trauma in 14%. The average time from injury to repair was 2–3 weeks. The majority had associated Anterior Cruciate Ligament Rupture 73% (28 patients). 23 patients had medial meniscal and 16 had lateral meniscal repair. All cases were done as a day case by the senior author. The meniscus was repaired, if the tear was vertically oriented and in the periphery. Two Fast-Fix sutures were used for each repair. Concomitant ACL injury was reconstructed 6 weeks post meniscal repair.

Meniscus was considered to have healed if a) confirmed at arthroscopy or b) No mechanical symptoms after repair. 31 patients had repeat arthroscopy, 28 for ACL reconstruction, 2 for persistent mechanical symptoms and 1 following re-injury.

Results The range of clinical follow up was between 3 to 20 months. In 26 patients healing of the meniscus was confirmed during arthroscopy. 7 patients had no mechanical symptoms following repair. The healing rate was 86% (33 patients). 5 repairs were considered as failures and were excised subsequently. The healing rate was higher in patients with associated ACL injury (92%) compared to isolated meniscal tear healing rate of 70%.

Discussion We feel early results show the Fast-Fix to be safe, simple to use all- inside meniscal repair technique and has the advantage of vertical mattress sutures and no separate incision. Healing rates with combined ACL injuries are better than isolated meniscal tears.