Introduction: The aim of this study was to report the clinical and radiographic results of a modified transtrochanteric rotational osteotomy (MTRO) for osteonecrosis of the femoral head.

Materials and Methods: A MTRO was performed in 43 hips with osteonecrosis. The mean age was 34 years (range, 20 to 51 years). According to the classification system of the Association Research Circulation Osseous, 17 hips were stage 2 and 26 stage 3. We performed simple MTRO in 15 cases, combination of MTRO and simple bone grafting in 3 cases, and a combination of MTRO and muscle pedicle bone grafting in 25 cases.

Results: At a mean 37 months after surgery, there was further collapse of the femoral head in 3 hips. All these lesions were in the lateral location, and 2 were large lesions. One of these 3 hips was converted to a total hip arthroplasty. The overall survival rate was 93 percent. Among the surviving 40 cases, excellent results were obtained in 26 hips, good results in 11, and fair results in 3 hips.

Conclusion: A MTRO is an effective method for delaying the progression of collapse in the treatment of osteonecrosis of the femoral head in selected cases.

Introduction: To compare the effect of complete and incomplete osteotomy of the medial cortex of proximal tibia in closing wedge high tibial osteotomy

Materials and methods: Total 153 cases of high tibial osteotomy (average age: 59.7 years) were divided into two groups: Group I; 57 cases of incomplete osteotomy of medial cortex and Group II; 96 cases of complete osteotomy. All osteotomies were fixed with 90¨¬angled blade plate. Two groups were evaluated to verify the difference of complete and incomplete osteotomies regarding the radiological changes of the mechanical axes.

Results: After average 3.5 years of follow-up (minimum 2.4 years), Group I showed recurrence of varus in 21 cases (36.8%) with average 10¨¬ correction loss, while Group II showed recurrence of varus in 11 cases (11.5%) with average 3¨¬ correction loss(P< 0.05). The blade plate fixation of high tibial osteotomy was not rigid enough to prevent loss of correction in case of osteoporosis of the proximal tibia as far as the medial cortex was left intact.

Conclusion: Authors recommend complete osteotomy of the medial cortex in closing wedge high tibial osteotomy in order to maintain the valgus correction by avoiding the spring effect of medial cortex. Blade plate fixation also provides more physiological tibiofemoral axis for future total knee surgery by lateral translation of the distal tibia after complete osteotomy of medial cortex.

Introduction: The purpose of this study was to evaluate the result of treatment of the infected total knee arthroplasty by two-stage revision using antibiotics-impregnated cement spacer and beads.

Materials and methods: Out of 56 total knee arthroplasty revisions, 26 revisions were performed for infected total knee arthroplasties between 1985 and 1996. Two cases of infected total knee arthroplasties were treated by immediate replacement and four cases by arthrodesis. Twenty infected total knee arthroplasties had been revised by two-stage revision and followed-up for 38.6 months in average (range, 18–105 months). They were nine male and eleven female patients of 61.6 years old in average. The primary cause of arthroplasty was osteoarthritis in all. Infection was diagnosed by physical finding, radiography, preoperative aspiration, culture of the pus from draining sinus and culture of surgical specimen. Twelve cases revealed positive growth of causative bacteria, while eight were not identified. The protocol for two-stage revision began with the removal of infected implants and cement. The surrounding bony and soft tissue were thoroughly debrided and cleaned. The dead space between femur and t

Results: Two-stage revision was successful in nineteen cases. One case revealed the recurrence of infection eleven months after reimplantation and underwent the repetition of the same two-stage procedure. At the final follow-up, the average Hospital for Special Surgery score was 81.1 points, the average Knee Society knee score was 78.6 points and the average function score was 76.7 points. Patients could regain average 105 degrees of knee flexion.

Conclusion: The result of two-stage revision for infected total knee arthroplasty is satisfactory, showing that this can be the method of choice for infection treatment and functional restoration. This procedure using antibiotics-impregnated cement spacer and beads can control infection and improve functional results.

The purpose of current study was to describe the results of complex acetabular fractures treated with open reduction using transtrochanteric approach and arthrotomy of the hip joint. Fourteen consecutive patients with both column fractures of the acetabulum were treated with open reduction and internal fixation. All patients had various associated injuries. Among them, one patient had pelvic abscess associated with traumatic bowel perforation. The acetabulum was approached with Y-shaped triradiate incision, osteotomy of the greater trochanter, and arthrotomy of the hip joint. During the operation, the osteochondral fragments were removed and torn labrum was resected. In 6 patients the fracture was fixed with reconstruction plates and in 8 patients the fracture was fixed with plates and wires. All the patients were followed for an average of 4.6 years(range, 2–8 years). The clinical evaluation was done by the method of Merle d’Aubigne. All the fractures and all osteotomies united at the latest follow up. One patient had delayed hematogenous infection at 5.5 years after the operation. Although myositis ossificans developed in 3 patients it was neither progressive after 1 year nor associated with significant limitation of hip motion. Four patients had narrowing of the hip joint space. Three of them had osteophyte formation around the femoral head. No femoral head necrosis was observed. Eleven patients had excellent or good outcomes in clinical score. No patient underwent total hip arthroplasty. This extensile approach allowed a good exposure of the fracture site, more accurate reduction, and easier fixation of fracture fragments. It also allowed the removal of osteochondral fragments and the resection of torn labrum. However, 3 patients showed osteophyte formation around the femoral head. We are concerned about the further progression of the osteophyte and its clinical implication.