To review local experience using the Avon patellofemoral arthroplasty All patients were retrospectively reviewed with respect to function, radiology and satisfaction Fourteen patients were followed up. There were no revisions and very good functional outcome. Patient satisfaction was high. The Avon patellofemoral arthroplasty is an effective implant in selected patients.
Since 1989 the Ganz periacetabular osteotomy has been performed in Christchurch for pain arising from hip dysplasia in selected patients. This review was performed to assess symptoms, function and radiographic appearances at a medium term follow up. The results of 14 peri-acetabular osteotomies performed in 13 patients was evaluated. The mean age of the patients at the time of surgery was 23 years (range 17–44). The mean duration of follow up was 5 years (3 months to 13 years). The follow up examination included clinical evaluation, chart review and radiographic analysis. Of the 13 patients evaluated, improvement in pain was achieved in 12. One required a hip replacement and intermittent discomfort was noted in 3 resulting in restriction in activites. Complications included sciatic nerve palsy (1), leg length discrepancy (2), superficial wound infection (1), scar tenderness (2), numbness in lateral femoral cutaneous nerve distribution (5) and pain from prominent metalware (1). Improvement in femoral head coverage was seen in all patients on follow up x-ray with minimal progression of arthritic changes. Improvement in symptoms ranging from complete relief of pain and participation in high intensity sporting events to intermittent discomfort was achieved. One failure occurred requiring arthroplasty. Significant complications occurred but have largely resolved. The osteotomy was successful in obtaining good relief of symptoms and has prevented the requirement for total hip replacement in this young active group.
Surgical dislocation of the hip joint using the technique developed by Rheinhold Ganz, is a relatively new method for surgical exposure of the hip. A review of 8 cases that underwent surgical dislocation of the hip joint was undertaken, to assess the short term outcome, complications associated with the procedure and to identify some of the indications for this technique. This is a retrospective analysis of surgical dislocation in two centers undertaken by the same surgeon with a maximum follow up period of one year. Surgical dislocation of the hip allows access to the hip joint with some associated morbidity due to the surgical exposure but there were no cases of avascular necrosis in the short term follow up. We were able to define specific pathological conditions affecting the hip where there is significant improvement following treatment using this method of exposure of the hip joint. Good exposure of the hip joint is obtained via surgical dislocation so allowing good access for surgical intervention. There is an associated morbidity with the technique but this method of hip exposure allows an alternative to hip arthroscopy and allows easier access to the joint for the treatment of intra articular pathology.
We compared function in two groups of high demand patients who had undergone total knee arthroplasty (TKA), one group using a posterior cruciate sacrificing (PCS) prosthesis and the other a posterior cruciate retaining (PCR) prosthesis of similar design. Patients were eligible for the study if surgery had been performed more than two years ago and they were under 65 years of age and had no coexisting morbidity that markedly decreased their physical activities. One surgeon operated on 28 patients in group A (20 TKAs), routinely retaining the posterior cruciate ligament (PCL). A second surgery operated on 19 patients in group B (25 TKAs) and routinely sacrificed the PCL. A mobile bearing prosthesis of similar design was used in each group. Patients were independently selected and assessed using a questionnaire specifically developed to assess higher levels of activity not usually assessed by other knee scores. Patients in the two groups were matched in terms of age, range of motion and follow-up The gross activity score was 3.36 in group A and 3.12 in group B. The combined walking, running and stair-climbing score was in group A (7.68) than in group B (6.64). Patients in group B had decreased anterior knee pain and perceived their TKA closer to a normal knee (2.00 compared to 2.32). We conclude that retaining the PCL in TKA results in better patient function without obvious complications.
