It is a well-known fact that total knee arthroplasty is a soft tissue operation. Soft tissue balancing is the key to success in total knee arthroplasty. It is paramount importance to preserve the maximal amount of bone on both the femur and tibial side. In Indian scenario, majority of the patients present relatively late with varus or valgus deformity. Adding to this problem is poor bone quality due to osteoporosis. Our technique of Posterior cruciate ligament (PCL) retaining TKA with tibial end plate resection facilitates soft tissue balancing, preserves PCL and maximizes bone preservation on both tibial and femoral side achieving good results in minimum seven year follow up.

We retrospectively analyzed seven year outcomes of 120 knees (110 patients), mean age was 65 years (range 55 to 75 years), who received contemporary cruciate-retaining prostheses with tibial end plate resection technique. The diagnosis was osteoarthritis in 96%, Rheumatoid arthritis in 2% and posttraumatic arthritis in 2% cases. There were more number of flexible varus knees as compared to flexible valgus knees. All the patients were followed up for minimum of 84 months with average follow up of 96 months. They were followed up at 3mths, 6mths, 1,3,5,7,9 and 10 years. The functional assessment was done using knee society knee and function scores. Radiographic analysis was done to rule out subsidence and aseptic loosening. The statistical significance was assessed using chi square test. Survival analysis was done using the Kaplan Meier analysis with revision taken as the endpoint. The average ROM was 100 degrees preoperatively and 120 degrees at last follow-up. The average knee society knee score improved from 45 points preoperatively to 90 points at last follow-up. The average knee society functional score improved from 48 points preoperatively to 84 points at last follow-up (p<0.05). Radiolucency was observed in 20 knees but all except four were non-progressive lesions smaller than 2 mm. None of the implants were revised for subsidence or aseptic loosening of tibial component.

The technique of PCL retaining total knee arthroplasty with tibial end plate resection in arthritic knees with flexible varus or valgus deformity yields good functional outcome in medium term follow up with relatively low incidence of subsidence of the tibial implant. This technique appears promising for total knee arthroplasty in osteoporotic bones where retaining the strong subchondral bone increases the longevity of the implant.

We stably transfected early passage chondrocytes with an anti-apoptotic Bcl-2 gene in vitro using a retrovirus vector. Samples of articular cartilage were obtained from 11 patients with a mean age of 69 years (61 to 75) who were undergoing total knee replacement for osteoarthritis. The Bcl-2-gene-transfected chondrocytes were compared with non-transfected and lac-Z-gene-transfected chondrocytes, both of which were used as controls. All three groups of cultured chondrocytes were incubated with nitric oxide (NO) for ten days. Using the Trypan Blue exclusion assay, an enzyme-linked immunosorbent assay and flow cytometric analysis, we found that the number of apoptotic chondrocytes was significantly higher in the non-transfected and lac-Z-transfected groups than in the Bcl-2-transfected group (p < 0.05). The Bcl-2-transfected chondrocytes were protected from NO-induced impairment of proteoglycan synthesis.

We conclude that NO-induced chondrocyte death involves a mechanism which appears to be subject to regulation by an anti-apoptotic Bcl-2 gene. Therefore, Bcl-2 gene therapy may prove to be of therapeutic value in protecting human articular chondrocytes.

The aim of this study was to assess patient-based outcome two years following non-operative management of displaced Colles fractures.

100 patients were evaluated at a minimum of two years after displaced Colles fracture. Fractures were reduced under regional anaesthesia and immobilised in a Colles-type cast for five weeks. The fractures were assessed radiographically by measurement of radial angle, dorsal tilt, radial shortening and carpal malalignment at the time of injury, post-manipulation, and after one and five weeks. The fractures were classified according to Frykman classification. A validated patient-based outcome questionnaire, using a visual analogue score, was used to assess outcome at the end of two years.

7 patients had died, 8 patients were unable to complete the questionnaire because of confusion and 5 were lost to follow-up. Complete outcome data were available on 80 patients.

The median age was 61 years. The median pain score was 5 (25%-2 and 75%-12, range 0–100). There was loss of reduction, with more than 5° dorsal angulation and/or 5mm radial shortening in 70% cases. We found that age had no effect on patient outcome except that patients over 50 years complained of more finger stiffness The Frykman classification was an important prognostic factor and a higher grade resulted in worse outcome in a number of areas. Dorsal angulation had no significant effect and carpal malalignment correlated with poor visual appearance. Radial angle and radial shortening were both associated with increased complaints of wrist pain and stiffness

This prospective patient based outcome study has demonstrated that patients make a good functional recovery following nonoperative management of Colles fracture. 70% of our patients had a poor radiological outcome but few reported problems with pain and function at 2 years. Extra-articular malunion due to radial angulation and shortening was common and correlated with wrist pain and stiffness at two years. Frykman classification correlated with pain and functional outcome.