For surgical treatment of hallux rigidus many different procedures have been described. Resection arthroplasty (‘Keller procedure’) is a surgical procedure mostly used for older patients suffering from severe osteoarthritis of the first metatarsophalangeal joint. As a modification of this procedure, resection arthroplasty is combined with cheilectomy and interposition of the dorsal capsule and extensor hallucis brevis tendon, which are then sutured to the flexor hallucis brevis tendon on the plantar side of the joint (capsular interposition arthroplasty, IA). Capsular interposition arthroplasty was performed on 22 feet of 14 patients (six male, eight female) suffering from osteoarthritis of the 1st MTP-joint were included in this study (group 1). These results were compared to the outcome of 30 feet of 22 patients (12 male, 10 female) treated with resection arthroplasty (group 2). The indication for resection arthroplasty were the same as for IA. The mean age was 55.3 years (37.6 to 71.2) in group 1 and 57.8 (43.5 to 75.6) in group 2. The age distribution of our patients at surgery did not differ significantly between both groups (p=0.633). The mean follow-up period was 15.1 month, range 6 to 27 months and did not differ between both groups (group 1: 16.5 month, group 2: 14.1 month; p=0.143). The mean follow-up period was 15 months. No statistically significant difference was found between both groups concerning patient’s satisfaction, clinical outcome and increase in range of motion of the first metatarsophalangeal joint. At follow-up, patients who had undergone interposition arthroplasty did not show statistically significant better AOFAS forefoot-scores compared to the Keller procedure group. A high rate of osteonecrosis of the first metatarsal head was found in both groups. These radiological findings did not correlate with the clinical outcome at follow-up. There is no benefit in clinical or radiological outcome for capsular interposition arthroplasty compared to the Keller procedure

Surgical results following proximal row carpectomy modified with proximal capitate resection and dorsal capsule interposition are presented. A consecutive cohort of thirteen patients was operated upon, and outcomes measured by radiograph, physical examination and DASH questionnaire. AROM values of 50° to 105° for the flexion/extension arc, restoration of grip strength to 72% of the contralateral extremity, and an improved functional outcome can be expected; and patients’ perceptions of functional outcome, as measured by the DASH, are significantly improved as early as six weeks. The results of PRC with interposition for stages II and III SLAC wrist were uniformly favorable. Eaton has described two modifications to the proximal row carpectomy (PRC) procedure: partial capitate resection and dorsal capsular interpositional arthroplasty. The objective is to enlarge the radiocarpal interface to form a broad mobile pseudoarthrosis that would disperse compressive forces across the wrist more effectively. We present the first consecutive cohort of patients (n=13) who have undergone this procedure,. We extend the indications for PRC in this series to include those wrists with stage III SLAC deformity; approximately 67% of wrists had capitolunate arthritis. AROM values of 50° to 105° for the flexion/extension arc, restoration of grip strength to 72% of the contralateral extremity, and an improved functional outcome can be expected from PRC with dorsal capsular interpositional arthroplasty. Patients’ perceptions of functional outcome, as measured by the DASH, are significantly improved as early as six weeks following the procedure. Mean flexion/extension arc achieved was 86° (range, 50° to 105°). Radial deviation averaged 13° (range, 10° to 20°), and ulnar deviation averaged 21° (range, 15° to 25°). Grip strength averaged 72% of the contralateral extremity. The mean decline in the revised carpal height ratio was 24%. The mean DASH score was 20.8 (range, 10 to 29). Visual analog pain improved from 9.25 to 2.67 on average, with one patient reporting no pain with heavy exertion. Patients were evaluated by active range of motion ; grip and pinch strength; radiographs; subjective analog pain; and DASH questionnaire

Introduction. Pathophysiology of glenohumeral arthritis differs depending upon type of arthritis. Osteoarthritis. Post-traumatic arthritis. Inflammatory arthritis (i.e. RA). Arthritis of instability. Crystalline arthritis (Milwaukee shoulder, cuff tear arthropathy). Avascular necrosis. Natural history as well as response to treatment are both pathology dependent. Soft-tissue involvement. Rotator cuff tear. Soft tissue contracture. Secondary osseous deformity. Regional osteopenia. Glenoid wear (concentric versus eccentric). Humeral collapse. Surgical options. Joint-sparing techniques. Arthroscopic capsular release/ joint debridement/synovectomy. Open debridement, subscapularis lengthening. Open capsular interposition. Osteotomy. Glenoid. Humeral. Cartilage transplantation. Arthrodesis. Resection arthroplasty. Joint replacement. Unconstrained. Hemiarthroplasty. Total shoulder replacement. Constrained. Joint-sparing Techniques. These techniques are only useful in patients with early changes or who are too young and active for joint replacement. Arthroscopic debridement or capsular release. Young patients. Normal joint alignment. Severe asymmetric capsular contracture (i.e. arthritis of instability). Open debridement. Large humeral osteophytes. Subscapularis lengthening. Open capsular interposition. Lateral edge of anterior capsule sutured to posterior labrum. Less severe degrees of contracture, subscapularis must be repaired anatomically. Osteotomy. Only useful in situations where there is abnormal humeral or glenoid alignment. Glenoid – posterior opening wedge for osteoarthritis in combination with posterior glenoid hypoplasia or increased retroversion. Humeral – most useful for post-fracture deformity (i.e. varus of the surgical neck). Cartilage Transplantation. Very early experience and really only attempted in any numbers in the knee. Chondrocyte transplantation very expensive and tedious. Currently, the most popular techniques involve transplanting plugs or cores of articular cartilage, subchondral bone, and cancellous bone. Autograft- harvest from non-weight-bearing or less weight-bearing area the same or different bone. Lateral femoral condyle. Posterolateral humeral head. Allograft. Early attempts limited by chondrocyte viability after harvest. Improved processing techniques have recently improved chondrocyte survival to 60–70%. Offers the desirable option of being able to preoperatively match radii of curvature of implant to donor site. Arthrodesis. Fortunately, rarely indicated. Patients miss the ability to rotate the humerus. Indications. Brachial plexus injury. Combined deltoid and rotator cuff deficiency. Young heavy labourer. Sepsis. Severe bone loss. Requires functional trapezius and serratus anterior. Resectional Arthroplasty (Jones Procedure). Even more rarely indicated than arthrodesis. Function is better if rotator cuff is attached to proximal humerus. Indications. Sepsis. Failed arthroplasty. Combined deltoid and rotator cuff deficiency. Conclusions. Hemiarthroplasty or total shoulder replacement with unconstrained implants is the surgical treatment of choice in the vast majority of patients with glenohumeral arthritis. Joint-sparing procedures are indicated in young patients with early, less extensive changes. Arthrodesis and resection arthroplasty are rarely indicated, except under unusual circumstances of soft-tissue deficiency, nerve injury, or sepsis. Cartilage transplantation shows promise in very select patients

Background: Intraarticular loose bodies following simple dislocations can lead to early degeneration. Non concentric reduction may indicate retained loose bodies and offer a method to identify patients requiring exploration to avoid this undesirable outcome. Methods: 117 consecutive simple dislocations of the hip presenting to the hospital from January 2000 to June 2006 were assessed for congruency after reduction by fluoroscopy and good quality radiographs. Patients with non concentric reduction underwent open exploration to identify the etiology and removal of loose bodies. The post operative results were analyzed using Thomson and Epstein clinical and radiological criteria. Results: 12 of the 117 (10%) dislocations had incongruent reduction which was identified by a break in Shenton’s line and an increase in medial joint space in seven patients, superior joint space in three patients or a concentric increase in two patients. CT scan performed identified the origin of the osteocartilagenous fragment to be from the acetabulum in six patients, femoral head in four, from both in one and one patient had inverted posterior labrum. In addition to this a patient had posterior capsular interposition. Following debridement, congruent reduction was achieved in all patients. At an average follow up of four years and nine months (4.9 years), the functional outcome evaluated by Thompson and Epstein criteria was excellent in 11 cases and good in one case. Conclusions: Intra articular loose bodies were identified by non-concentric reduction in 12 out of 117 patients with simple hip dislocation. Careful evaluation by immediate post reduction fluoroscopy and good quality radiographs are a must following reduction of hip dislocations

Purpose of the study: In the spastic quadriplegic non-ambulatory child, hip dislocation with severe adduction is a painful situation compromising perineal hygiene and local care as well as positioning in bed or wheel chair. We describe a method of treatment using Castle’s femoral resection-interposition arthroplasty and an external fixator to prevent proximal migration of the remnant femur. Description: Resection of the proximal femur with articulated distraction of the hip using an external fixator was performed in eight children (11 hips) with cerebral palsy. All patients (five boys, three girls, mean age 15 years) had painful neurological disorders with chronic hip dislocation incompatible with the sitting position and compromising perineal hygiene. The operation, described by Castle, consisted in subtrochanteric resection and suture of the quadriceps muscle around the femoral cut. The capsule detacted from the femur was closed around the acetabulum. The abductors were sutured between the shaft and the acetabulum in order to ensure interposition of enough soft tissue. An external fixator (Orthofix®) was installed for 90 days. This method has the advantage of producing the necessary distraction while allowing immediate mobility (hip extension flexion) and good balance in the sitting position as well as better perineal hygiene compared with the preoperative situation. At six months, there was a clear clinical improvement in terms of pain relief, tolerance to the sitting position, and perineal hygiene with a significant increase in joint motion (flexion, extension, abduction). Proximal migration of the femur was observed in one case after removing the external fixator. There were no cases of recurrent adduction deformity, stiffness or bone hypertrophy. Conclusion: Proximal resection of the femur with capsular interposition arthroplasty and articulated distraction with an external fixator decreases the pain of the dislocated spastic hip. This method is a reliable salvage alternative for painful hip dislocation in cerebral palsy children. Use of an articulated external fixator for the distraction enables immediate postoperative mobilization and the sitting position in a wheel chair, improving patient comfort compared with the classical Russell also described by Castle