Non-operative treatment methods of idiopathic clubfoot have become increasingly accepted worldwide as the initial standard of care. The Ponseti method has become particularly popular due to published short and long term success rates in North America. The purpose of the current study was to examine the early rate of relapse in a New Zealand population and analyze patient characteristics for factors predictive of relapse.

Fifty-one consecutive babies with seventy-eight club-feet treated by the Ponseti technique were followed prospectively for a minimum of two years from the start of treatment. Recurrence, defined as the need for any operative intervention, was analyzed with respect to severity at presentation, timing of presentation, the number of casts needed to obtain correction, family history of clubfoot, ethnicity, and compliance with abduction bracing. Recurrence was subdivided into minor recurrences, defined as a tendon transfer or Achilles lengthening, and major recurrences, defined as a full posterior or posteromedial release.

Twenty patients (39%) had a recurrence. Eleven patients (22%) had a major recurrence and nine patients (17%) had a minor recurrence. Only three of twenty-five patients (12%) who were compliant with bracing had a major recurrence. Twenty-five of fifty-one patients (49%) were compliant with bracing. The greatest risk factor for recurrence was non compliance with abduction bracing, with an odds ration of 5 (p = 0.009). Although not quite statistically significant (p = .07), ethnicity was also related to recurrence, with Polynesian patients being three times less likely than white Europeans to recur. No statistically significant relationships were found between recurrence and severity at presentation, timing of presentation, the number of casts needed to obtain correction, or family history of clubfoot.

Compliance with abduction bracing is crucial to avoiding recurrence of clubfoot. The Polynesian club-foot seems more amenable to Ponseti technique and less likely to recur than the white European clubfoot. In those patients who are compliant, the Ponseti method is very effective at maintaining a correction, with minimal need for major surgery. However, even among the compliant patients, minor recurrences are common, and among the noncompliant patients, many major and minor recurrences should be expected.

Controversy exists regarding the management of intra-articular fractures of the calcaneus. We present medium-term outcome data on 37 consecutive patients who underwent open reduction and internal fixation for comminuted intra-articular calcaneal fractures.

Operations were performed by one surgeon, CRW, following CT assessment of the fracture. All procedures were performed using an extensile lateral approach and early physiotherapy was standard. Case notes were reviewed retrospectively between three months and five years post-operatively. Patients were also invited to attend a follow-up clinic where outcomes were assessed using the American Orthopaedic Foot and Ankle Society Hind Foot Score and were questioned regarding on-going problems, change in shoe size and return to work.

Complete data is available for 16 patients, with additional information from other patients. Results show average AOFAS scores for type II fractures to be 59/100, type III to be 81/100 and 79/100 for type IV fractures. We have shown low rates of complications – one infection, three patients requiring a change in shoe size and an average return to work of seven months.

We have shown good medium-term outcome results for the operative management of displaced intra-articular fractures and to answer our question, we believe we should be operating on them.

We conducted a prospective, randomised and double blinded study to observe the recovery of knee function in 50 patients undergoing knee replacement with or without patella resurfacing.

Patients were assessed pre-operatively, at four months and a minimum 18 months after surgery using three scoring systems, the Knee Society Clinical Outcome Score, WOMAC and the SF-36 health questionnaire. In addition the active range of knee movement when weight bearing was measured using an electrogoniometer. Patients were asked to undertake 11 standardised activities including level walking, stair climbing and getting into and out of low chairs. Patients were randomised at the time of surgery into receiving a knee replacement with or without patella resurfacing.

Forty-two patients, (18 with patella resurfacing, 24 with no resurfacing) completed assessments at all time intervals. All patients in the study demonstrated an improvement in terms of pain relief and function by four months after knee replacement with a further but less significant improvement by 18 months. The active range of knee movement measured by electrogoniometry recovered to the pre-operative range for all activities but there was no increase in knee movement. Patients who had patella resurfacing had a significantly lower (p < 0.02) score on the Knee Society Clinical Outcome function score at 18 months compared to patients without patella resurfacing. There was no significant difference (p > 0.05) in the active range of knee movement with or without patella resurfacing, although patients with patella resurfacing in general had slightly poorer range of movement particularly for activities that required knee flexion beyond 70 degrees.

We concluded that in this study knee function was not improved by patella resurfacing when compared to a matched group of patients without resurfacing. As patients recovery stabilises by 18 months it appears that the final functional outcome following knee replacement is not enhanced by patella resurfacing.

One hundred and twenty-nine unselected club feet were classified at birth into three grades of severity; 123 were followed up. The results of primary treatment were analysed and it is shown that the bad feet did worst. Serial splinting in plasters achieved lasting correction in nine in ten mild club feet, in half of the moderately deformed, but in only one in ten of the severely affected. Surgical correction succeeded in two out of three of the resistant feet, but had to be repeated in the others.