Patella resurfacing during total knee arthroplasty: have we got the issue covered?

BACKGROUND: Management of the patella during total knee arthroplasty (TKA) is controversial. Multiple studies have examined mechanical and clinical results of TKA with native and resurfaced patellae with no clear consensus. METHODS: We surveyed a large cohort of consultant surgeons in a questionnaire based study in order to assess the indications for patella resurfacing and to correlate practice with degree of specialization, experience and volume of procedures performed. RESULTS: Six hundred and nineteen surgeons were included. The main indication for patella resurfacing was patellofemoral arthritis. The ratio of those who always:sometimes:never resurfaced was 1:2:1 irrespective of experience or volume performed. There was no difference between knee specialists and non-specialists (p = 0.977) or between high and lower volume surgeons (p = 0.826). Senior and high volume surgeons tended to always resurface. CONCLUSIONS: The majority of surgeons only sometimes resurfaced the patella. The number who always and never resurfaced were similar. There was a tendency for more experienced and high volume surgeons to always resurface.

The surgical anatomy of intra-abdominal prosthetic dislocation during hip arthroplasty.

Hip replacement surgery remains one of the most successful and common operations in modern orthopaedics. Many surgical approaches to the hip have been described. A potential anatomical weakness exists between the hip joint and the retroperitoneal space. We describe this potential space, which lies superficial to iliopsoas and its importance in hip replacement surgery. The clinical relevance of this space is illustrated by 2 cases of retro-peritoneal migration of prosthetic femoral heads and the consequences of these.

Transverse medial slide osteotomy for bunionette deformity: long-term results.

BACKGROUND: Bunionette deformity of the fifth metatarsal infrequently requires operative treatment. This study presents the long-term results of a simple operative technique. METHODS: Forty-four distal metatarsal medial slide osteotomies with pin fixation were performed for symptomatic bunionette deformity in 30 patients. After an average of 7 years and 8 months (range 69 to 110 months), 30 feet in 21 patients were available for clinical and radiographic evaluation. RESULTS: The patients' subjective assessment was excellent and good in 81% and fair and poor in 19% of feet. The mean pain score on a visual analogue scale was 1.8 (range 0 to 7) and the mean American Orthopaedic Foot and Ankle Society (AOFAS) score was 88.2 (range 47 to 100). Postoperative complications included pin track infection in three feet and delayed union in one. One patient developed transfer metatarsalgia and another patient had repeat surgery for recurrent symptoms on both feet after 5 years. CONCLUSIONS: This procedure combines technical simplicity with satisfactory and predictable long-term results in the operative treatment of bunionette deformity in the lateral forefoot.