Cementless primary total hip prostheses with a third-generation alumina-on-alumina bearing showed very low wear and were associated with minimal osteolysis at the time of follow-up, at a minimum of five years.

We describe herein a modified technique for reconstruction of chronic rupture of the quadriceps tendon in a patient with bilateral total knee replacement and distal realignment of the patella. The surgery involved the application of a Dacron graft and the 'double eights' technique. The patient achieved satisfactory results after surgery and we believe that this technique of reconstruction offers advantages over other methods.

We report on the medium term outcome of five patients (ten hips) who underwent one stage bilateral total hip arthroplasty. Both Harris Hip Scores and Oxford Hip Scores improved postoperatively as did range of motion. There was no radiographic evidence of loosening in any hip arthroplasty involved in this study, however one revision surgery was needed due to periprosthetic fracture. There were no increased medical complications. Based on our limited experience, we believe that one stage bilateral total hip arthroplasty is safe in selected patients.

Polyethylene terephthalate (PET) artificial ligaments offer an unlimited source of ligaments without donor-site-related morbidity and with good mechanical properties for a rapid return to sporting activities. Developing PET artificial ligaments with excellent ligamentisation and ligament-bone healing is still a considerable challenge. This study aimed to investigate the effects of the profiled PET/collagen/calcium phosphate (PET/C/CaP) ligament upon cell growth, ligamentisation and ligament-bone healing in vitro and in vivo. Profiled PET/C/CaP filaments were made by melt-spinning process with 2 % CaP hybrid spinning and collagen coating. Rat mesenchymal stem cells (MSCs) were cultured on the profiled PET/C filaments for cytotoxicity, viability, scanning electron microscopy (SEM) and ligament-related gene expression analysis. MSCs’ osteogenic capacity on the profiled PET/CaP filaments was identified by detecting osteogenic gene expression and alizarin red S staining. For in vivo verification, an animal study was performed to evaluate the effect of the profiled PET/C/CaP ligament in a rabbit knee medial collateral ligament reinforcement reconstruction model. The graft ligamentisation and bone formation were investigated by SEM, histology, microcomputed tomography and mechanical tests. The profiled PET/C filaments enhanced MSC proliferation and ligament-related gene expression. Furthermore, they enhanced osteogenic gene expression, alkaline phosphatase activity and mineralisation of MSCs. The in vivo study indicated that the profiled PET/C/CaP ligament enhanced ligamentous matrix remodelling and bone formation. Therefore, their use is an effective strategy for promoting MSCs’ ligamentous and osteogenic potential in vitro and enhancing ligamentous matrix remodelling and bone formation in vivo.

The safety of simultaneous bilateral total knee arthroplasty (TKA) remains controversial. The objective of the current study was to investigate perioperative morbidity and mortality rates within 30 days of simultaneous bilateral TKA. A detailed analysis of medical, surgical and anaesthesia records of 183 consecutive patients who underwent total knee arthroplasty between 2002 and 2006 was performed. The mean age of the patients was 67.6 years old. More than 80% had one or more co-morbidities, but none of them had ASA score greater than class 2. The mean hospital stay was 10 days, and the mean surgical time 156 minutes. Less than half of the patients (42.6%) required blood transfusion. The rate of perimorbidity was 15.3 % and there was no mortality in this series. We believe that simultaneous bilateral total knee arthroplasty is a safe and cost effective option for our patients, provided that patients are selected and informed appropriately. Key Words:Bilateral total knee arthroplasty, Morbidity, Mortality INTRODUCTIONTotal knee arthroplasty (TKA) is a common orthopaedic procedure that is considered highly successful and safe, with very low rates of perioperative complications and death. However, there remains concern associated with simultaneous bilateral TKA. Several studies have reported increased risk of serious complications or even death when bilateral TKA are done simultaneously 1,2 , whereas other investigators have found that the rate of complications associated with simultaneous bilateral TKA is the same as or lower than that associated with unilateral TKA 3,4 .In Malaysia, due to the increased accessibility to affordable and success TKA, more and more patients are requesting this procedure. Many of these patients have bilateral knee arthritis requiring operative intervention on both knees. The surgeon and patient are then faced with the decision of whether to proceed with a staged bilateral TKA, performed as two unilateral TKA procedures on separate days, or a simultaneous bilateral TKA. It is therefore important to ascertain the risks and complications associated with simultaneous TKA in this country. In addition, the current published literature is based on the western population in well-established arthroplasty centres. At present, there is no published data on post-operative morbidity and mortality after simultaneous bilateral TKA in an Asian arthroplasty centre in general, and in Malaysia in particular.This study was therefore undertaken to assess the early complications and mortality occurring within 30 days of simultaneous bilateral TKA in our medical centre and to compare the outcome with that of other published reports, especially those from Western institutions. We also sought to identify any risk factors associated with increased morbidity and mortality of simultaneous bilateral TKA. MATERIALS AND METHODSThe operative database in University Malaya Medical Centre (UMMC) was searched to retrospectively identify all patients who had undergone simultaneous bilateral TKA between June 2002 ...