It remains a matter of debate whether displaced fractures of the neck of the femur should be treated by internal fixation or arthroplasty. We have compared the two methods with regard to complications, mortality and functional outcome. We studied 409 patients, aged 70 years and over, with subcapital fractures graded as Garden 3 or 4, in a two-year prospective multicentre study from 12 Swedish hospitals. They were randomised to internal fixation or arthroplasty. Patients who were mentally confused, bedridden or in a nursing-home were excluded from the survey. After two years the rate of failure was 43% in the internal fixation (IF) and 6% in the arthroplasty group (p < 0.001). In the IF group 36% had impaired walking and 6% had severe pain compared with 25% and 1.5%, respectively, in the arthroplasty group (both p < 0.05). There was no difference in mortality. With a high rate of failure and poor functional outcome after IF, we recommend primary arthroplasty for displaced fractures of the neck of the femur in patients over 70 years of age.

Background Whether or not ankles can be replaced with reasonable safety has been the subject of debate. We present the results of a nationwide series of total ankle arthroplasties.Patients and methods All Swedish hospitals that implant or have implanted modern three-component ankle prostheses reported demographic data and date of index and revision surgery to a central register. After the data had been introduced into a database, prosthetic survival rates with exchange or permanent extraction of components as endpoint were calculated.Results Of the 531 prostheses implanted, 101 had been revised by June 15, 2006. The overall survival rate at 5 years was 0.78 (95%CI: 0.74-0.82). For the three surgeons who had inserted the majority of the STAR ankles, the survival rates became significantly higher after the first 30 cases had been performed and was estimated to be 0.86 (0.80-0.93) at 5 years. Lower age at index surgery implied increased risk of revision whereas diagnosis or gender did not.Interpretation Ankle replacement is a valuable alternative to arthrodesis. However, replacing an ankle is a demanding procedure and the survival is not comparable to that after hip or knee replacement. It is obvious that with increasing experience, the results-including prosthetic survival-will improve.

Background and purpose A questionnaire was introduced by the New Zealand Arthroplasty Registry for use when evaluating the outcome of total ankle replacement surgery. We evaluated the reliability, validity, and responsiveness of the modified Swedish version of the questionnaire (SEFAS) in patients with osteoarthritis or inflammatory arthritis before and/or after their ankle was replaced or fused.Patients and methods The questionnaire was translated into Swedish and cross-culturally adapted according to a standardized procedure. It was sent to 135 patients with ankle arthritis who were scheduled for or had undergone surgery, together with the foot and ankle outcome score (FAOS), the short form 36 (SF-36) score, and the EuroQol (EQ-5D) score. Construct validity was evaluated with Spearman’s correlation coefficient when comparing SEFAS with FAOS, SF-36, and EQ-5D, content validity by calculating floor and ceiling effects, test-retest reliability with intraclass correlation coefficient (ICC), internal consistency with Cronbach’s alpha (n = 62), agreement by Bland-Altman plot, and responsiveness by effect size and standardized response mean (n = 37).Results For construct validity, we correlated SEFAS with the other scores and 70% or more of our predefined hypotheses concerning correlations could be confirmed. There were no floor or ceiling effects. ICC was 0.92 (CI 95%: 0.88–0.95), Cronbach’s alpha 0.96, effect size was 1.44, and the standardized response mean was 1.00.Interpretation SEFAS is a self-reported foot and ankle score with good validity, reliability and responsiveness, indicating that the score can be used to evaluate patients with osteoarthritis or inflammatory arthritis of the ankle and outcome of surgery.

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