Avascular necrosis (AVN) of the immature femoral head is the final common pathway of the Legg-Calve-Perthes (LCP) disease. Since cigarette smoking has been linked to the development of vascular disease, a study was performed to see if there was any association between parental smoking and LCP disease.

The biological parents of 97 children with LCP disease were questioned on their smoking habits, which were compared to a control group of parents with unaffected children. Further comparison was made with respondents from the Perthes’ Association website who completed an on-line questionnaire.

Parents were classified as being smokers or non-smokers on the basis of their smoking habit pre-pregnancy, during pregnancy and at the time of diagnosis of LCP being made. There was a higher proportion of children in the LCP group who had parents who smoke (N=67/97, 69%) compared to the control group (N=14/87, 16%). Further analysis showed that the highest rate occurred when both parents smoke before pregnancy (N=37/97, 38%) followed by when only the father smoked (N=23/97, 24 %). Maternal smoking alone appeared to have the least association (N=7/97, 7 %).

In the control group the non-smoking rate was 58/87 [67%]. The changes in smoking patterns with respect to the pregnancy concerned were also noted.

Fisher’s Exact test was used to determine any difference between the study group and the control group. There was a significant difference between the Perthes’ SE group concerned to the controls in all respects except maternal smoking.

Comparison made with data obtained from the Perthes’ association website showed no difference between the two Perthes’ groups.

Conclusion: These results support an association between parental smoking and the development of disease LCP disease.

There has been a longstanding need for a structural biomaterial that can serve as a bone graft substitute or implant construct and is effective for fixation by bone ingrowth. A porous tantalum material was developed to address these issues. The purpose of this paper and presnetation is to describe the properties and 2 to 5 year clinical results of porous tantalum in various reconstructive orthopaedic procedures.

Porous tantalum has been used to manufacture primary and revision acetabular cups, acetabular augments, tibial and patella implants, patellar augments, structural devices for the treatment of osteonecrosis, and spinal fusion implants. Clinical follow-up includes: 2–5 year clinical and radiographic evaluation of: 414 monoblock cups in primary THA, 36 monoblock cups and 587 revision hemispheres used in revision THR, 16 hips revised with acetabular augments and revision hemispheres; 2 to 4 years for 101 tibial implants used in primary TKR and 69 patellas used in cementless TKR; 2–4 years for 11 patellar augments in salvage TKR, 1–5 years for 53 revision TKRs using knee spacers; 1–4 years for 91 osteone-crosis hip implants; and for 15 cervical fusion cases.

This innovative tantalum implant material with trabecular architecture possesses advantages in stiffness, friction coefficient, porosity, rate and extent of tissue ingrowth, and versatility in manufacturing of structural devices. It has been clinically validated in numerous and diverse reconstructive procedures.

This paper reports the prospective 2 to 4 year clinical results of a porous tantalum monoblock tibia used in primary TKR, with comparison to a cemented modular tibial implant of the same articulating design.

The subject tibial implant is relatively flexible design comprised of a porous tantalum base plate and direct compression molded polyethylene, with initial fixation achieved by press-fitting two porous tantalum posts. The porous tantalum implant was used without bone cement in 72 knees and with cement in 29 cases. The comparative tibial component was a cemented modular design with the same articulating surface. Clinical and radiographic data were collected prospectively, and consecutively, for 165 primary TKR cases implanted from 2000 – 2003

James Wood, Maurice Cates, Audley Mackel, Randall Morgan, Robert Poggie

The early clinical and radiographic results for the porous tantalum monoblock tibia (cemented and cementless) and the modular cemented implant were statistically the same. The preliminary evidence suggests that cementless application of this design is an attractive alternative for younger, more active patients.

This study is designed to assess and evaluate the results of arthroscopic acromioclavicular joint (ACJ) minimal excision arthroplasty.

Twenty-two patients with ACJ arthropathy underwent an arthroscopic limited excision of the ACJ preserving the superior ligamentous complex. The patients were assessed pre and post operatively using the Constant score. The average time from surgery to review was five months (three to nineteen months). A self assessment questionnaire was also used, evaluating outcome measures such as activities of daily living, shoulder function and patients satisfaction.

The mean preoperative Constant score was 28 and postoperative score was 71 with an improvement in pain from 15% to 80%, the subjective score from 22% to 45%, and the range of motion from 37% to 84%. The preoperative self assessment score was 25.9 and postoperative score was 83 with an improvement in activities of daily living from 28% to 78%, and shoulder function from 34% to 87%. Twenty patients were very satisfied, one was moderately satisfied and one patient was dissatisfied although his shoulder function increased from 20 to 60%.

This study suggests that this technique is well accepted by the patients and results in a good improvement in shoulder function. The results are comparable with those reported in the literature concerning the standard ACJ arthroplasty. We therefore believe that a limited excision of the ACJ is adequate and a reliable alternative to conventional techniques.