With the increasing life expectancy, a greater number of elderly patients are being referred to an orthopaedic department to have elective total knee arthroplasty (TKA). Total knee arthroplasty should be considered in the very elderly only after carefully balancing the benefits of surgery against the risks of surgery. The aim of this study was to analyse the mortality, morbidity and cost benefits of elective TKA in a cohort group of the nonagenarian population. Between 1990 and 2006, 42 patients ≥90 years of age had TKA surgery. Patient's notes were retrospectively analysed. A cost-benefit analysis was carried out by comparing the surgical costs against nursing home placement. The mean age at surgery was 90.4 years (range: 90-90.6). There was one major and 11 minor postoperative complications with no immediate or late postoperative deaths. The Knee Society Scores improved from 25 points (range: 8-44) to 81 points (range: 60-95), and the WOMAC Scores improved from 62 points (range: 54-73) to 41 points (range: 34-46) (p < 0.002). The calculated cost-benefit savings for 42 patients at 5 years after TKA was estimated to be £2,746,839. Total knee arthroplasty in the nonagenarian population is safe, beneficial and cost-effective.Résumé L'augmentation de la durée de vie fait qu'une population de plus en plus âgée présente les conditions pour bénéficier d'une prothèse totale du genou. La prothèse totale du genou doit être considérée dans cette population en comparant les bénéfices de la chirurgie et les risques de celle-ci. Le but de cette étude est d'analyser la mortalité, la morbidité, le rapport coût/bénéfice après prothèse totale du genou dans une cohorte de patients nonagénaires. Le rapport coût/bénéfice de ces 42 patients à 5 ans de l'utilisation de la prothèse a été estimé à 2.746.839£. La prothèse totale du genou dans une population de nonagénaire est une intervention sûre et qui permet un rapport coût/ bénéfice positif pour la société.

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A 50-year-old male underwent surgery for infective aortic valve endocarditis, which had been refractory to medical treatment. The valve was bicuspid, and involvement of the annular and subannular structures was recognized. A large suppurative discharge was obtained on incising this portion. Although there was no interventricular shunt, the abscess cavity was revealed to extend through the epicardial surface of the right atrioventricular groove. Following extensive debridement and irrigation, the defect was closed by an autologous pericardial patch. A 23 mm mechanical valve was implanted placing some of the stitches deep into the muscular interventricular septum. Infection was controlled by six-week administration of cefazolin sodium and gentamicin sulfate, and the patient survived.

A 70-year-old woman presented with right knee pain and a 'grinding' sensation 6 months after a total knee replacement for osteoarthritis. Clinical examination revealed a valgus deformity, patellofemoral crepitus and a reduced knee flexion. Radiographs revealed distinctive findings including the 'bubble sign', 'cloud sign' and the 'metal line sign', which are diagnostic of metallosis. Metallosis is an uncommon complication of total joint replacements, where bone and periprosthetic soft tissues are infiltrated by metallic debris from wearing of the prostheses. This usually occurs in high-wear joints such as hips and knees. Treatment for patients diagnosed with metallosis is synovectomy and a revision surgery. Our patient underwent revision surgery 5 years after her initial surgery.