Aims

Rotator cuff (RC) tears are common musculoskeletal injuries which often require surgical intervention. Noninvasive pulsed electromagnetic field (PEMF) devices have been approved for treatment of long-bone fracture nonunions and as an adjunct to lumbar and cervical spine fusion surgery. This study aimed to assess the effect of continuous PEMF on postoperative RC healing in a rat RC repair model.

Purpose: Patello-femoral arthritis presents a considerable challenge to the orthopaedic surgeon. Traditionally, surgical options have produced unsatifactory results. Arthroscopic debridement, patellectomy, isolated patellar resurfacing and grafting have a poor long term clinical outcome. Patello-femoral arthroplasty is an alternative to total knee arthroplasty and patellectomy for anterior compartment osteoarthritis. Patello-femoral arthroplasty provides a more conservative approach in younger and more active patients especially. Advances in component design and biomechanics have led to many new generation replacements. The aim of this study was to look at the long term functional outcome of patello-femoral arthroplasty.

Methods: From a prospective database 36 patients were identified having a patello-femoral arthroplasty between 1990 – 2000. Four patients were lost to followup. Eighteen patients (56%) underwent an additional procedure for patella re-alignment (patella tendon transfer or lateral release) at the time of the patello-femoral arthroplasty. Mean followup was 72 months (range 24 – 149 mo). Clinical data was collected from a personal questionnaire and physical examination. All data was processed and all patients were evaluated using the Hungerford-Kenna score and the modified Lysholm score. Radiographs were assessed pre-operatively and at the most recent follow up. Peri-operative documentation was evaluated for etiology, pre-operative functional and subjective impairment, intra-operative technical difficulties or complications, early and late post-operative complications and post-operative functional outcomes.

Results: At the time of the most recent follow up, 22 knees had good or excellent result, 4 had fair result and 4 had a poor result. The remaining 2 knees were revised to a total knee arthrplasty due to progression of osteoarthritis. No loosening of the components was observed. The mean Lysholm knee score improved from 35.4 (range 9–68) pre-operatively to 76.1(range 37–100) post-operatively and the mean Hungerford-Kenna knee score improved from 29.6(range 10–65) pre-operatively to 78.1(range 45–100) post-operatively.

Conclusion: With proper patient selection, patello-femoral arthroplasty is a reliable procedure for the treatment of the patello-femoral arthritis. This procedure delays the need for further surgical procedures such as total knee arthroplasty with good results.

We reviewed and discussed the results of one hundred and fifty-five proximal femoral allografts for revision total hip replacement at an average of eleven years (range , five to twenty years).We looked at graft survivorship, functional results, radiographic assessment and complications. We concluded that this is an excellent technique for restoration of bone stock in the multiplied revised hip.

To review the results of revision hip replacement with use of a proximal femoral allograft (PFA) to restore femoral bone stock.

Between 1983 and 1998 a PFA – prosthetic composite was used to revise two hundred and twenty-seven hips in two hundred and ten patients. Of these two hundred and ten revisions involved an allograft longer than 8 cm. The average age of the patients at the time of revision was sixty-six years. The average number of previous total hip replacements was 2.2. Each patient was assigned a SF-12 score and a Short WOMAC Score. Radiographic assessment for trochanteric union, allograft-host union, component stability, graft fracture and resorption was performed.

At an average of 11.2 years ( range, five to twenty years) after the revision, one hundred and eighty-five patients were alive, twenty-five patients had died and thirty were unavailable for follow-up. SF-12 and short WOMAC scores are still being calculated at the time of abstract submission. 4.4% of hips failed due to infection with 50% being successfully revised. Aseptic loosening of the construct occurred in 3.9% and 78% of these were revised at the time of follow-up. Nonunion of the allograft-host junction occurred in 4.8% and dislocation in 8.4%. Success was defined as a stable implant and no need for additional surgery at the time of follow-up. Success was noted in 84% of available cases.

At an average of eleven years revision hip arthroplasties with a PFA are performing very well. This technique remains an excellent alternative when confronted with femoral bone loss in the revision hip setting.

This is a retrospective study of fifty nine hips in fourty nine patients with a previous total hip replacement for developmental dysplasia of the hip who underwent a revision arthroplasty of the hip. Fifty three patients were available for follow up. Radiographs and charts were reviewed and functional outcome scores were obtained in order to determine if a correlation existed between cup position and functional outcome and survivorship. Cup height was found to be a statistically significant predictor for functional outcome and cup survivorship.

To determine if cup height, lateralization or angle are correlated with functional outcome or survivorship in revision total hip replacement (THR) in patients with a previous THR for developmental dysplasia of the hip (DDH).

There is a paucity of literature correlating functional outcome with cup position in revision THR.

Cup height was found to have a statistically significant (p< 0.05) correlation with Harris Hip, SF36, and WOMAC functional scores. High hip centers correlated with worse scores. In addition, patients with hip centers less than 3.5 cm above the radiographic tear drop had a statistically significant improvement in cup survivorship compared to those with higher hip centers.

A retrospective investigation of forty-nine sequential patients (fifty-nine hips) previously diagnosed with DDH who underwent revision THR at our center between 1984 and 2000 was performed. Forty-three patients (fifty-three hips) were available for survivorship analysis and thirty-five patients (forty-five hips) were available for functional analysis. The mean follow up was one hundred and eighteen months (range 36–230). Three independent variables identified apriori as possible correlates were cup height, lateralization and angle as measured on the AP radiographs. Functional outcome measurement consisted of the Harris Hip, SF36 and WOMAC questionnaires. Linear regression analysis and Kaplan-Meier curves were used to determine if any of the variables correlated with functional outcome or survivorship.

Restoration of hip center height to as close to the radiographic tear drop as possible improves functional outcome. Placement of the cup to within 3.5 cm of the tear drop improves cup survivorship.

Introduction: Distal femoral varus osteotomy (DFVO) has been advocated as the treatment of choice for lateral compartment osteoarthritis associated with a valgus knee in the young population in order to delay the need for total knee arthroplasty (TKA). The aim of this study was to evaluate the long-term results of DFVO for the valgus osteoarthritic knee.

Methods: A retrospective analysis was performed on 38consecutive patients (40 knees) who underwent a DFVO between 1984 and 2001. Two patients (2 knees) were lost to follow-up. Mean follow up was 123 months (range 39 to 245 months). Peri-operative documentation was evaluated for etiology, pre-operative functional and subjective impairment, intra-operative technical difficulties or complications, early and late post-operative complications and post-operative functional and subjective outcomes.

Results: At the time of the most recent follow-up, 24 knees had good or excellent result, 3 knees had a fair result and 3 had poor results. The remaining 8 knees were converted to a total knee arthroplasty. The mean Knee Society objective score improved from 18 (range, 0–74) to 87.2 (range, 50–100) and the mean Knee Society function score improved from 54 (range, 0–100) to 85.6 (range, 40–100). The ten-year survival rate of DFVO was 82% (95% confidence interval, 75%–89%) and the fifteen-year survival rate was 45% (95% confidence interval, 33%–57%).

Discussion: With proper patient selection, DFVO is a reliable procedure for the treatment of the valgus osteoarthritic knee. This procedure delays the need for further surgical procedures, such as TKA, with good results.

Background: Revision total hip replacement in patients with a previous diagnosis of developmental dysplasia of the hip (DDH) can be a challenging and technically demanding procedure. Two of the major concerns are deficient acetabular bone stock and the position of the acetabular implant, particularly if the hip centre was not restored during the primary procedure. The purpose of this study was to determine if cup height, lateralization or abduction angle are correlated with functional outcome or survivorship in revision total hip replacement (THR) in patients with a previous diagnosis of DDH.

Methods: A retrospective investigation of 51 sequential patients (63 hips) previously diagnosed with DDH who underwent revision THR at our center between 1984 and 2000 was performed. The mean duration of follow up was 119 months (range 36 to 238 months). Forty-one patients (52 hips) were available for functional outcome and survivorship analysis. The remaining ten patients (11 hips) were available only for survivorship analysis. Three independent variables identified apriori as possible correlates were cup height, lateralization and angle as measured on the AP radiographs. Functional outcome measurement consisted of the Harris Hip, SF36 and WOMAC questionnaires. Linear regression analysis and Kaplan-Meier curves were used to determine if any of the variables correlated with functional outcome or survivorship.

Results: Cup height was found to have a statistically significant (p< 0.05) correlation with Harris Hip, SF36, and WOMAC functional scores. High hip centers correlated with worse scores. In addition, patients with hip centers less than 3.5 cm above the radiographic tear drop had a statistically significant improvement in cup survivorship compared to those with higher hip centers.

Conclusion: Restoration of hip center height to as close to the radiographic teardrop as possible improves functional outcome and cup survivorship.

Introduction: Fractures of the proximal humerus account for 4–5% of all fractures. The number one cause of this type of fracture is age related osteoporosis associated with minimal trauma. Approximately 80% of these fractures are non or minimally-displaced, and can be treated conservatively with good results. However, treatment of displaced complex fractures is still controversial. The disadvantage of open procedures is the risk of damaging the blood supply to the humeral head, leading to a higher incidence of avascular necrosis.

Closed Reduction and Percutaneous Fixation (CRPF) is a minimal invasive procedure with a lower risk of damaging the blood supply. The main complication of this technique is loosening of the guide wires and displacement of the fragments requiring a second operation.

Purpose: The guide wire loosening leads us to improve the technique by adding an external fixator to stabilize the guide wires and secure fragment positioning. We report our experience of treating displaced fractures of the proximal humerus with Closed Reduction and External Fixation (CREF).

Materials and methods: Between the years 1996–2001 we operated on 37 patients for 38 complex fractures and fracture dislocations of the proximal humerus. We had 16 two part fractures, 13 three part fractures, 3 four part fractures, 5 two part fracture dislocation and 1 four part fracture dislocation according to the Neer’s classification.

The mean age was 60 years old ranging from 16–90 with a male to female ratio of 1:1. The patients were placed in a beach chair position using an image intensifier for AP and axillary views. Because the closed reduction was unsatisfactory, six patients underwent open reduction and external fixation. The remaining 32 shoulders underwent CREF.

Passive motion exercises were initiated on the first postoperative day. The external fixator was removed after four to six weeks (mean time for external fixator – 5.3 weeks). After removing the external fixator the patients began with active assisted mobilization of the shoulder and isometric strengthening exercises.

Results: The average follow up was 31.6 months (range 6–60 months). No loosening was observed upon removal of the external fixator, however the following complications were encountered: 5 patients had superficial pin tract infections, 1 patients developed an avascular necrosis of the humeral head, 1 patient had a non union of the fracture. Of the remaining patients, 13 patients had an excellent result, 15 patients had a good result and 5 patients had a fair result.

Conclusions: CREF is a minimal invasive technique for complex fractures of the proximal humerus, greatly reducing the damage to the blood supply when compared to open surgical procedures. It offers a better stabilization than CRPF, thus reducing the complication rate. The percutaneous technique causes less scaring and therefore a shorter rehabilitation program. Consequently, this procedure is recommended for complex fractures of the proximal humerus.