Background: Total knee Replacement proved to be an effective surgery that leads to restoration of joint function, limb alignment, beside elimination of pain in patients with osteoarthritis. Aim of the work:To assess the results of treatment of osteoarthritis of the knee with severe malalignment by total knee arthroplasty.Patients and Methods: 30 patients [12 males & 18 females] aged from 48 -68 years who had advanced knee arthritis were operated by total knee replacement at Al-Azhar University Hospital [Damietta] and Damietta Specialized Hospital and followed up for average 12 months from December 2016 to March 2019. All patients were assessed by history taking, examination, radiological and laboratory investigations, and all were subjected to a three-phase postoperative rehabilitation protocol.Results: 19 patients [63.3 %] had excellent final result, 8 patients [26.7%] had good result, 2 patients [6.7 %] had fair result and one patient [3.3 %] had poor final result. In addition, there was significant improvement in pain relief and joint function. Conclusion:Total Knee Replacement in severe malalignment is a challenging surgery. However, it leads to significant changes in the quality of life in most patients; regarding pain relief, improvement in joint function and early return to daily activities.

Background: Acetabular fractures are a common clinical challenge. The posterior wall fractures represented 35% of all acetabular fractures and usually complexed. The curative treatment is surgical and depends on the fracture anatomy and surgeon preferences. Aim of the Work:The current study aimed to assess the short term results of posterior acetabular fractures management by open reduction and internal fixation.Patients and Methods: Thirty patients with displaced posterior wall acetabular fractures were included. They were treated by open reduction and internal fixation using neutralizing plates and screws. All patients were assessed by a preprepared trauma assessment sheet. Post-operative, active assisted and pain free passive range of motion exercises in all planes was advised. Functional outcome was evaluated using the Merle D'Aubinge and Postel score. Patients were followed up initially at 3 weeks intervals for first 2 months and thereafter at 6 weekly intervals for the next 6 months.Result: Patients were classified to two groups: Group [A] "70%" patients with isolated posterior wall fracture, and Group [B] "30%" of patients with posterior column plus posterior wall acetabular fracture. Both groups were comparable regarding age, gender, side and mode of trauma. The double plating fixation method was significantly increased in group B when compared to group A [77.8% vs. 0.0% respectively]. Group B was associated with significant increase of operative time than group A [164.44±13.33 vs. 128.57±27.80 minutes, respectively]. Blood loss significantly increased in group B than group A [1422.22±376.76 vs. 780.95±437.46 ml, respectively]. The excellent outcome was significantly associated with younger age, lower or absent complications, and anatomical [good quality] of direct postoperative radiological outcome. Conclusion:Most of our patients had an excellent and good outcome as a result to application of more strict selection criteria of patients and pattern.