Lateral epicondylitis, or ’tennis elbow’, is a common condition that usually affects patients between 35 and 55 years of age. It is generally self-limiting, but in some patients it may continue to cause persistent symptoms, which can be refractory to treatment. This review discusses the mechanism of disease, symptoms and signs, investigations, current management protocols and potential new treatments.

Cite this article: Bone Joint J 2013;95-B:1158–64.

Introduction

Massive rotator cuff repairs have up to 60% failure rate and repair of a chronic repair can have up to 40% failure rate. With this in mind, new methodologies are being to being developed to overcome this problem. The use of tendon augmentation grafts is one of them. Prior attempts have shown equivocal or poorer outcomes to control repairs. Aims and objectives: The specific aim of these expereiments was to test how well ovine tendon cells would take to a specific biological augmentation graft (Ligamimetic), and wheter tissue engineering techniques would enhance this.

Introduction

Rotator cuff tears remain a problem, with massive tears having a failure rate of repair reported of up to 60%, despite advances in surgical techniques. Tissue engineering techniques offers the possibility of regenerating damaged tendon tissue to a pre-injury state. We explore these techniques by implanting two novel tendon augmentation grafts with use of platelet rich plasma (PRP) in sheep.

Purpose

To define the orthopaedic problems associated with pseudoachondroplasia (PSACH) and their functional impact.

Here we present the results of functional outcome of 531 patients (aged from 27.6 to 88.7, mean 62.6) who have had the Trilogy (Zimmer; Warsaw IN, USA) acetabular shell implanted for 5 years or longer. All patients operated at our unit between 20/1/1992 and 31/3/2004 were included, looking at both Primary (431) and Revision (100) hip arthroplasties. All surgery was performed by the senior surgeon using the Trilogy shell and liners. The Trilogy acetabular shell was used with either an ultra-high molecular weight polyethylene liner or ceramic liner, along with a wide variety of femoral stems, mainly: Harris Pre-coat stem (183 patients, Zimmer), Versys cemented stem (102 pts, Zimmer), CADCAM (140 pts, Stanmore), and HAC Furlong (96 pts, JRI). There were a variety of other stems, including Exeter and Pro-femur. 48 patients had revision of socket only.

Functional outcome was assessed by three questionnaires: the Oxford Hip Questionnaire (12 best function-60 worst), the Harris Hip Score (100 best to 0 worst), and the WOMAC Hip Score (0 best-96 worst).

Patients filled in these questionnaires at every postoperative follow-up clinic. These were compared with the pre-operative scores obtained from questionnaires which the patients completed retrospectively. Mean follow up questionnaire times were 76.5 months postoperatively for primary arthroplasties, and 70.6 months for the revision arthroplasties.

For primary arthroplasty mean scores improved from 40.8 pre-operatively to 16.4 post-operatively (Oxford), 43.9 to 92.9 (Harris), and 51.8 to 9.4 (WOMAC) (all p< 0.05). For revision arthroplasty mean scores improved from 39.1, 41.7, and 49.3 pre-operatively to 19.6, 88.0, and 12.5 (all p< 0.05).

No patients required re-operation for loosening, one patient dislocated at day 5.

We can conclude that the Trilogy acetabular component is a versatile acetabular implant which can be used with a wide range of femoral components, both in primary and revision Total Hip Arthroplasty, with successful functional outcome scores greater than 5 years after implantation.