The use of a quadrupled hamstring graft in ACL reconstruction is well established. There are many described techniques in securing graft fixation, the optimal method is not yet established. The aim of this study was to review the results of a single surgeon series using the above implants looking at functional outcome for the patient and implant survivorship.

Patients were recruited for the study who had completed 8 months of post-op rehabilitation following primary ACL reconstruction and that had received the same surgical technique using the same implants from one surgical team. Patients undergoing a revision procedure were excluded. All patients received the same post-operative rehabilitation. Those who met the inclusion criteria were contacted via a postal survey using the Lysholm and Tegner questionnaires.

In total 77 patients were eligible for inclusion, consisting of 10 females and 67 males with a mean age of 31 (range 16-56). A 77% survey return rate was achieved with average follow up of 25 months (range 9-44). The mean Lysholm score was 82.1, with 59% ranking their knee as good or excellent. On average patients dropped 1.8 levels on the Tegner activity rating from a pre-injury average of 7.5 to post rehabilitation average of 5.7. There was a 100% survivorship of implants with no revisions undertaken due to implant failure.

The study has shown that this cohort of patients has produced self reported outcomes analogous to findings in the current literature. No obvious problem with implants was observed. It has highlighted the multiple factors associated with the outcome of ACL reconstruction and demonstrates that the quadrupled HT graft using Bio-Intrafix and Rigidfix implants produces short to mid-term functional and activity levels in keeping with the literature standard.

AIMS

To review the results of a single surgeon series using the above implants looking at functional outcome and implant survivorship.

The study aimed to determine how well recorded pain levels and range of motion relate to patients' reported levels of functional ability/disability pre- and post- total hip arthroplasty.

Range of motion (ROM), Oxford Hip Score (OHS) and Self-Report Harris Hip Score (HHS) were recorded pre-operatively and 3 months post-total hip arthroplasty. Pearson's correlation coefficients were calculated to determine the strength of the relationships both pre- and post-operatively between ROM (calculated using the HHS scoring system) and scores on OHS and HHS and response relating to pain from the questionnaires (question 1 HHS and questions 1, 6, 8, 10, 11 and 12 of OHS) and overall scores.

Only weak relationships were found between ROM and HHS pre- (r = 0.061, n = 99, p = 0.548) and post-operatively (r = 0.373, n = 66, p = 0.002). Similar results were found for OHS, and when ROM was substituted for flexion range. In contrast, strong correlations were found between OHS pain component and HHS pre- (r = -0.753, n = 107, p<0.001) and post-operatively (r = -0.836, n = 87, p<0.001). Strong correlations were also found between the OHS pain component correlated with the HHS functional component only (HHS with score for questions relating to pain deducted) pre- (r = -0.665, n = 107, p<0.001) and post-operatively (r = -0.688, n = 87, p<0.001). Similar results were found when the HHS pain component was correlated with OHS.

In orthopaedic clinical practice ROM is routinely used to assess the success or failure of arthroplasty surgery. These results suggest that this should not be done. Instead, asking the patient the level of pain that they are experiencing may be a good determinant of level of function. The results of this study may aid the development of arthroplasty scoring systems which better assess patients' functional ability.

To assess whether prosthetic femoral stem centralisers have a detrimental effect on the macroporosity of the cement mantle, and if so, whether this is independent of their design and the rate of implantation, 30 identically cast moulded prosthetic femora were divided into 3 groups. Group 1: no centraliser (control), Group 2: centraliser A and Group 3: centraliser B. Using third generation cementation techniques and pressure monitoring, Charnley C-stems +/− the appropriate centraliser were implanted to a constant depth. Half in each group were implanted as rapidly as possible and the other half over 90 seconds. The stems were removed and the cement mantle then underwent a preliminary arthroscopic examination prior to being sectioned transversely at 3 constant levels. Each level was then photographed and digitally enlarged to a known scale to allow examination and determination of any cement voids (macropores) surface area.

There were no significant pressure fluctuations between the groups. Preliminary arthroscopic examination revealed that cement voids appeared more common when a centraliser was used. This difference was confirmed (p=0.002) following sectioning of the specimens, with cement voids found in 85% of femora when a centraliser was used and only 20% in the control group. Centraliser B performed worst with cement voids of a larger volume and more frequent occurrence (p=0.002). The macroporosity of the cement mantle was independent of the rate of implantation (p=0.39).

The use of femoral stem centralisers is helpful in preventing malposition of the implant but results in increased macroporosity of the cement mantle. This may have implications regarding the longevity of an implant in terms of early loosening and therefore their design and use must always be carefully considered.