After an allogenic bone-marrow transplant, a vascular necrosis of the femoral head may affect young adults, producing destructive lesions which require hip replacement. We have reviewed 27 consecutive such total hip arthroplasties (THA) at a minimal follow-up of two years. Of these, 20 were primary operations for Ficat (1985) stage-III and stage-IV lesions, and seven were revisions after the failure of previous surgery. The median age at operation was 30 years (17.5 to 44). The prostheses had a cemented, collared titanium-alloy stem, an alumina-alumina joint, and a press-fit socket. Seven had a titanium-alloy metal back and 20 had all-alumina cups of which six had to be cemented. At an average follow-up of five years, no patient had been lost to follow-up. One had died from septicaemia after two years and another with chronic graft-versus-host disease developed a deep infection 2.5 years postoperatively and had a successful revision. There were no revisions for aseptic loosening. The clinical results on the Merle d’Aubigné and Postel (1954) scale were very good or excellent in 23 hips (88%), good in one and fair in two. Ten hips showed incomplete acetabular radiolucencies less than 1 mm thick, but there were no radiolucent lines around the stems. We conclude that for these difficult patients THA with ceramic joints and careful technique provides the best short- and medium-term option after the failure of medical treatment.
We report 17 patients who had grafting of the common peroneal nerve after traction injuries. Sixteen were reviewed at a median follow-up of 36 months. The nerve gap ranged from 7 to 20 cm. A functionally satisfactory result was achieved in six patients (37.5%), a fair result in six and a poor result in four. Seven patients had, in addition, a posterior tibialis tendon transfer; this improved the result in five. Grafting produced some satisfactory results even when the nerve gap was as long as 20 cm.
Total hip replacement using an alumina head and socket and a titanium alloy stem is evaluated in a series of patients under 50 years of age. Between April 1977 and December 1986, 86 such replacements were performed in 75 patients, but mainly because patients had difficulty travelling from Africa, only 71 hips were followed up adequately; of these, 56 were primary procedures and 15 revisions. Survivorship analysis showed that 98% of the prostheses were retained for 10 years. On clinical and radiological examination 51 of the 71 hips were stable and acceptable, 15 had radiological changes on the acetabular side, and one on the femoral side; four other cases had clinical and radiological changes suggesting impending failure, possibly because fixation of the socket was inadequate. There were no differences between the results of the primary procedures and those of revisions. In these young patients, the results seem better with alumina-on-alumina hips than with other varieties, possibly because of their remarkably low wear.
Between October 1972 and December 1980, 139 post-traumatic brachial plexus palsies were operated upon by the same surgeon. The results of 63 are reported with a follow up of at least three years for the 32 complete palsies and two years for the 31 partial palsies. The protocol for examination and surgical repair is described. Major repairs were performed in 48, including suture, interfascicular grafting and nerve transfer. The remaining 15 had a neurolysis. The results are given for each type of lesion and for each kind of repair. Two series of complete palsies, one treated operatively, the other conservatively, are compared. It is concluded that surgical repair gives good results in partial palsies and in some complete palsies. Nerve transfer or graft gives some improvement but the usefulness of the limb remains disappointing.
