We reported on the outcome of 84 Charnley low friction arthroplasties performed by one of us (GH), the period 1973 to 1984, in 69 patients, less than fifty-five years old, with osteoarthritis mainly due to congenital hip disease. The patients were followed prospectively; clinically using the Merle D’Aubigné and Postel scoring system, as modified by Charnley and also radiographically. At the time of the latest follow-up, thirty-seven hips had failed (44%). In thirty-two hips, twenty-eight acetabular and thirty femoral components were revised because of aseptic loosening (six of the femoral components were broken). Three hips were infected and converted to resection arthroplasty. In two more hips a periprosthetic femur fracture occurred three and ten years postoperatively and were treated with internal fixation. After a minimum of twenty-two years from the index operation, 37 original acetabular components and 36 original femoral components were in place for an average of 29 years. The probability of survival for both components with failure for any reason as the end point was 0.51 (95% confidence interval, 0.39 to 0.62) at twenty-five years when 35 hips were at risk. These long term results can be used as a benchmark of endurance of current total hip arthroplasties performed in young patients, with OA mainly due to congenital hip disease.
The purpose of this study was to evaluate the results of the surgical treatment of the thoracic outlet syndrome. Between 1990–2002, 46 patients, 15 male and 31 female aged ranging from 23 to 49 years old (mean age 34 years) underwent decompressive surgery of the thoracic outlet syndrome. Some 9 patients required bilateral operations. Symptoms due to compression of neural elements were present in 23 patients, of vascular elements in 12 patients and of both elements in 11 patients. The duration of symptoms was less than 2 years in 25 patients and 2 to 6 years in 21 patients. Operations consisted of scalenectomy in 47 cases with brachial plexus neurolysis for neurogenic indication, release of the pectoralis minor muscle insertion in 5 cases and cervical rib resection in 3 cases. The follow up period ranged from 1 to 12 years (mean 5 years). The results were classified as excellent with symptoms elimination in 27 cases, good with symptoms significant improvement in 19 cases and poor with symptoms persistent or aggravation in 9 cases. First rib resection in 4 patients with poor results and release of the pectoralis minor muscle insertion in 1 patient leaded to significant improvement of their symptoms. Some 90% of patient with symptoms less than 2 years had a successful result compared with only 76% in those with symptoms longer than 2 years. Complications included pneumothorax in one case and temporary phrenic nerve palsy in another case. A selective surgical decompression of the thoracic outlet syndrome yields satisfactory results in appropriately selected patients.
