Leg-length inequality is not uncommon following primary total hip arthroplasty and can be distressing to the patient. An excellent clinical result with respect to pain relief, function, component fixation, range of motion and radiographic appearance can be transformed into a surgical failure because of patient dissatisfaction due to leg-length inequality. Postoperative leg-length discrepancy was determined radiographically for 200 patients who had had a primary custom total hip arthroplasty. In all cases the opposite hip was considered to have a normal joint center. The femoral component was designed and manufactured individually for each patient using screened marker x-rays. A graduated calliper was used at the time of surgery to control depth of femoral component insertion. The transverse acetabular ligament was used to control placement of the acetabular component and therefore restore acetabular joint center. Using this method 94% of subjects had a postoperative leg-length discrepancy that was 6mm or less when compared to the normal side (average, +0.38mm). The maximum value measured for leg-length discrepancy was +/−8mm. We describe a simple technique for controlling leg length during primary total hip arthroplasty and propose an alternative radiographic method for measuring leg-length discrepancy.
The aim of this study was to define objectively gait function in children with treated congenital talipes equinovarus (CTEV) and a good clinical result. The study also attempted an analysis of movement within the foot during gait. We compared 20 children with treated CTEV with 15 control subjects. Clinical assessment demonstrated good results from treatment. Three-dimensional gait analysis provided kinematic and kinetic data describing movement and moments at the joints of the lower limb during gait. A new method was used to study movement within the foot during gait. The data on gait showed significantly increased internal rotation of the foot during walking which was partially compensated for by external rotation at the hip. A mild foot drop and reduced plantar flexor power were also observed. Dorsiflexion at the midfoot was significantly increased, which probably compensated for reduced mobility at the hindfoot. Patients treated for CTEV with a good clinical result should be expected to have nearly normal gait and dynamic foot movement, but there may be residual intoeing, mild foot drop, loss of plantar flexor power with compensatory increased midfoot dorsiflexion and external hip rotation.
Introduction: Traditionally, the degree of correction for derotational femoral osteotomies in cerebral palsy has been based on clinical or radiographic measures. Recently, three dimensional gait analysis has been used to plan and evaluate orthopaedic surgery. Our aim was to assess the outcome of derotation osteotomies, where the degree of rotation at surgery was guided by transverse plane kinematics (aiming at reducing peak hip rotations to normal limits). Method: Pre and post-operative gait analyses were reviewed in a group of these patients (16 legs) and compared with a similar group of 8 patients (16 legs) who had soft tissue procedures only. Results: Improvement following derotation osteotomy occurred in all but one case; 11/16 osteotomies resulted in peak internal rotation within one standard deviation (SD) of peak normal internal rotation (normal range −6° to +11°), the other 4 were within 1.4 SDs. Discussion: Objective improvement in hip rotation during gait was measured in 15/16 subjects undergoing dero-tation osteotomy based on gait analysis. There was no rotational change overall in patients who had soft tissue procedures only. Average dynamic correction of internal rotation during gait was slightly less than intra-operative correction, possibly due to tensioning of spastic muscles.
Thirty-one patients (33 knees) with symptomatic patello-femoral osteoarthritis and minimal tibiofemoral changes underwent LCS total knee replacement without patellar resurfacing. Average age was 73 years (range, 58–89 years) with a female to male ratio of 5:1. Average follow-up was 20 months (range, 12–40 months). All except four patients had grade 3 or 4 patello-femoral osteoarthritis. Preoperatively all patients had significant knee pain. Sleep disturbance was reported in 21 patients. All but 10 patients required walking aids. Average range of motion was 1080 (80–125). At latest review, 21 knees are pain-free, the remaining 12 knees describing only occasional knee pain. Two patients continue to have night pain. Average range of motion was 1040 (70–1350). Lateral patellar tilt improved in all but five knees by an average of 70 (1–260). Patellar congruency improved in all but three knees by an average of 18% (3–63%). None of the patients to date have required revision surgery. We suggest that knee arthroplasty without patellar resurfacing is an effective option in older patients with isolated patello-femoral osteoarthritis.
In terms of function, range of movement is an important measure of outcome. The purpose of this study was to determine whether or not stripping the capsule of the distal femur at the time of primary total knee arthroplasty had a significant effect on the range of knee movement achieved at the end of the operation. An improvement of 5 degrees or more was considered significant. One hundred and twenty-five patients (47 males; 78 females) presenting for primary total knee arthroplasty were recruited. All operations were performed by the senior author using the LCS rotating platform system without patellar resurfacing. Preoperatively, the tip of the greater trochanter, the lateral femoral epicondyle and the anterior border of the lateral malleolus were marked. Using a digital camera, images of the limb proposed for surgery were taken with the knee in extension, forced extension, flexion and forced flexion. Camera set up was standardised for all photographs. Using a random numbers program, patients were randomised either to have release of the posterior knee joint capsule or not. The surgeon was informed at the time of the operation. At the end of the procedure the digital images were repeated. Total arc of knee movement preoperatively ranged from 41° to 161° (average, 115°). Postoperatively, this varied from 95° to 157° (average, 124°). Average arc of knee movement was 125° for the no release group and 123° for the released group. Of the 78 patients where the increase in total arc of knee motion was significant, 41 had been released and 37 had not. No statistically significant difference was noted. In conclusion, we report that releasing the posterior capsule of the knee joint routinely during primary total knee arthroplasty conveys no significant advantage in terms of the range of knee motion achieved immediately following surgery. Consequently, it is unlikely to increase the long-term range of movement.
A single pre-bent 1.6 millimetre Kirschner wire was inserted into the medullary canal through a drill hole in the metacarpal base and passed across the reduced fracture into the metacarpal head. The proximal end of the wire remained protruding percutaneously. Following stabilisation of the fracture, early mobilisation was commenced.
