This is a prospective study evaluating the efficacy of four clinical signs believed to be useful in the diagnosis of scaphoid fracture. Two hundred and fifteen consecutive patients with suspected scaphoid fracture were examined on two separate occasions to evaluate tenderness in the anatomical snuff box (ASB), tenderness over the scaphoid tubercle (ST), pain on longitudinal compression of the thumb (LC) and the range of thumb movement (TM). At the initial examination ASB, ST and LC were all 100% sensitive for detecting scaphoid fracture with specificities of 9%, 30% and 48% respectively. These clinical signs used in combination, within the first 24 hours following injury, produced 100% sensitivity and an improvement in the specificity to 74%. TM had 69% sensitivity and 66% specificity. Our results suggest that these clinical signs are inadequate indicators of scaphoid fracture when used alone and should be combined to achieve a more accurate clinical diagnosis.

We reviewed a consecutive series of 241 uncemented, porous-coated anatomic (PCA) hip replacements at an average follow-up of five years (2 to 9). Of these, 32 had failed (13%), 26 at the acetabular component (11%) and six at the femoral component (2%). Acetabular failure was associated with local osteolysis and excessive polyethylene wear in 20 cases: in these histological examination showed giant macrophages incorporating numerous particles of high-density polyethylene. The femoral failures were related to a poor intramedullary fit with subsequent subsidence. Using the recommendation for revision as the end point, the cumulative survival rate for prostheses was 91% at six years (95% CI +/- 6%), 73% (+/- 11%) at seven years, and 57% (+/- 20%) at eight years. The result of uncemented PCA hip replacement is satisfactory up to six years, but then increasing failure of the acetabular component appears to be due to polyethylene wear, leading to osteolysis, loosening and component migration. At first, failure is often asymptomatic; routine follow-up of uncemented hip replacement is essential, especially after five years.

The Kinematic Stabilizer is a posterior-cruciatesubstituting design of total knee replacement. We have reviewed 109 primary total knee replacements in 95 patients at a mean follow-up time of 12.7 years (10 to 14). We used survival analysis with failure defined as revision of the implant. This gave a cumulative survival rate of 95% (95% CI± 5%) at ten years and 87% (± 10%) at 13 years.These results from an independent centre confirm the value of an established design of cemented total knee replacement and question the wisdom of the introduction of modifications and new designs without properly controlled trials. There are few reports from independent centres of total knee replacement with follow-up longer than ten years and we could find no long-term reports of knee replacement using the Kinematic Stabilizer design. We describe our 10-to 14-year results with this posterior stabilised total knee replacement. PATIENTS AND METHODSFrom 1980 to 1983 inclusive we performed 109 primary total knee replacements on 95 patients, most with rheumatoid arthritis, using the Kinematic Stabilizer prosthesis (Howmedica, Rutherford, New Jersey). In the first year, this implant was used for all knee replacements performed at this hospital. Subsequently, other types became available and the Kinematic Stabilizer was used only when the posterior cruciate ligament was absent or not functioning. All revisions were excluded from the series. All the operations were performed by the senior author (IMP) using the Universal-1 instrumentation and a standard operating technique. No patellae were resurfaced and all components were cemented.The Kinematic Stabilizer total knee replacement is a posterior-cruciate-substituting design (Walker 1980) in which a contoured central post on the tibial polyethylene tray engages a housing in the femoral component. The guiding surfaces provide anteroposterior stability from full extension to 30° of flexion. Posterior stability is maintained as flexion proceeds and the surfaces act to guide femoral rollback (Figs 1 and 2).Our series included 78 women and 17 men; their average age was 64 years (37 to 86) and 17 were under 55. The primary diagnosis was rheumatoid arthritis in 63, osteoarthritis in 29 and psoriatic arthritis in 3.All patients were reviewed annually. Those who did not attend at ten years were traced and contacted. Four patients (six knees) were unwilling to attend but provided information over the telephone. Patients were assessed according to the Knee Society clinical rating system , in which points are allocated for pain, range of motion and stability. Deductions are made for flexion contracture, extensor lag and poor coronal alignment. For the function score, points are gained for walking distance and stair-climbing, and deducted for the use of walking-aids. Each score is given out of a possible 100. Radiographs were obtained and assessed according to the Knee Society Radiological Evaluation Form (Ewald 1989).We performed survival analysis by constructing a life table (Armitage and Berry 1994) ...

PATIENTS AND METHODS A series of 96 patients underwent 108 primary total knee replacements using the uncemented PCA knee. We selected patients under 60 years of age and fit, active patients ofless than 70 for this type ofarthroplasty. Their ages ranged from 19 to 69 years (mean 51). The primary pathology was rheumatoid arthritis in 73 of the knees and osteoarthritis in 35. All the operations were per