Summary Statement

The Dkk3-derived cells represent a branch of the periosteal mesenchymal lineage that produces fibrocartilage as well as regenerating the periosteal structures.

We prospectively reviewed 2440 Cemented Anantomical (side specific) AGC total knee replacements performed on 2074 patients between 2002 and 2008 in our unit. The surgery was performed by a number of surgeons, both Consultant and Trainee grades. 1357 underwent PCL sacrificing surgery with implantation of Posterior Stabilised Femoral Implant (Cam and Grove) and 1083 underwent PCL retaining surgery with implantation of a Non-Stabilised Femoral Implant. The mean age at date of surgery for Posterior Stabilised prosthesis was 69 years (range 23-94) and Non-Posterior Stabilised prosthesis was 70 (range 33-97) with no significant difference p< 0.05 (C.I 95%). Follow up at present mean 4 years (range 1-6 years).

11 patients underwent secondary patella resurfaced for anterior knee pain at a mean of 1.5 years following the index procedure (range 0.5-4.1 years) with 6 patients reporting a marked improvement in anterior knee pain post operatively. 3 patients underwent removal of patella buttons for symptomatic loosening at a mean of 2.7 years follow index procedure.

A total of 17 patients underwent a revision of either tibial or femoral components (0.7%). Indications for revision were infection in 11 patients, gross instability in 1 patient, periprosthetic fracture in 1 patient, persistent stiffness in 1 patient. 3 patients underwent revision for symptomatic loosening of the tibial component at a mean of 2.9 years (range 1.1-4.0).

These short to medium term results for the Anatomic AGC total knee replacement agree with published results from other centres.

Statement : A prospective review of the clinical outcome following reconstruction of isolated posterolateral corner (PLC) injuries to the knee.

Method : 10 patients underwent an isolated PLC reconstruction for symptomatic instability. All patients had preoperative and post operative clinical examination, and functional knee scores.

Results : There were 9 males and 1 female, mean age of 35, with 100% follow up. Median length of follow up was 46 months (range 2 – 69). At the latest follow up, the mean Lysholm scores were 89.9, with an average increase in Tegner scores of 3.3 (range 2–10). IKDC scores showed a median of 93 (66 – 100). All patients had < 3 mm mean side to side difference using the KT1000 arthrometer, and no increase in PLRI. There were no complications and no clinical failures requiring further surgery. All the patients said they would undergo the surgery again.

Conclusion : In this series of patients with symptomatic PLC injury, hamstring graft reconstruction has restored knee stability with good functional outcomes.

We report 40 cases in one family of an autosomal dominant bone dysplasia, which, though similar in some aspects to Paget's disease, seems unique in some features and in its natural history. The disease shows both general and focal skeletal changes, the latter being mainly in the limbs with an onset from the second decade. Progressive osteoclastic resorption is accompanied by medullary expansion which leads to pain, severe deformity and a tendency to pathological fracture. The serum alkaline phosphatase and urinary hydroxyproline are variably elevated, while other biochemical indices are normal. Most patients had an associated deafness of early onset and loss of dentition. No previous description of this disease has been found in the literature.