Purpose: The purpose of this study was to compare postoperative quality of life in patients with dysplasia who underwent Bernese periacetabular osteotomy to those who had total hip arthroplasty.

Methods: Patients were included who had a diagnosis of dysplasia and were greater than 40 years old. Cases were patients who had a periacetabular osteotomy. Controls were patients who had undergone total hip arthroplasty. Patients were matched for gender, age, and comorbidity. There were 26 cases and 33 controls. Outcome tools were the Western Ontario McMaster Universities (WOMAC) osteoarthritis index, the SF-12, and the Arthroplasty Satisfaction Scale. T-tests were used to compare means between the groups. The chi-squared test was used to compare the percentage of patients who had very good, good, or poor outcomes between the groups. WOMAC scores were normalized on a 0–100 scale with 0 being worst and 100 being best. A WOMAC score > 75 was considered very good, 65–75 good, and below 65 poor.

Results: The mean follow-up was just over 4 years in both groups. There was a clinically and statistically significant difference in WOMAC pain and function scores favouring the total hip patients. Mean WOMAC pain scores were 89 vs 71 (p< 0.0050). Mean WOMAC function scores were 91 vs74 (p< 0.005). Ninety-seven percent of total hip patients had a good or very good result vesus 73% of the osteotomy patients (p< 0.05).

Conclusions: Total hip arthroplasty gives a more consistent and better return of quality of life in patients over 40 when measured at a mean of 4 years after operation. Future research should be directed toward preoperative and intraoperative factors that could improve the outcome of patients having an osteotomy in this age group.

Testing of cadaver ankle specimens was conducted to investigate the changes in kinematics with lateral ligament reconstructions. Testing included an intact condition, after injury at the ATFL and CFL sites, and separately a Brostrom repair and an anatomical gracil-lis graft reconstruction. Calcaneal range of motion was determined about the axis of applied moment in plantarflexion-dorsiflexion and in inversion-eversion directions. The injury and reconstructions were most sensitive during IE applied moment. Both reconstructions appeared to behave similar to intact motion. Failure of some Brostrom repairs however, suggest that the gracillis-graft reconstruction is initially a stronger repair.

Limited research has biomechanically investigated lateral ankle ligament reconstruction procedures. The objective of this study was to determine the changes in ankle kinematics with a dual ligament Brostrom repair and an anatomical gracillis graft reconstruction.

Seven cadaveric ankle specimens were tested independently in an intact condition, after an ATFL/CFL injury model, and two reconstructions. The anatomical graft reconstruction wove a gracillis tendon through the calcaneus and fibula to dually reconstruct the ATFL and CFL, and anchored to the talus. Moments were applied to the calcaneus for three cycles in plantarflexion-dorsiflexion (PD) and inversion-eversion (IE) while allowing unconstrained motion. Three dimensional motions of the calcaneus and tibia were optoelectronically tracked. Range of motion (ROM) was calculated about the axis of applied moment for the calcaneus with respect to the tibia.

The ROM increase from the intact condition with the injury model was only significant for IE (p=0.001). No significant differences were found between intact and any treatments in the PD configuration. In IE, both the graft reconstruction and the Brostrom repair were significantly different from the injury model (p=0.002 and p=0.015 respectively), where the gracillis reconstruction appears more similar to the intact condition. For two specimens the Brostrom repaired ATFL failed during applied inversion moment.

The injury and reconstructions were most sensitive during IE applied moment. Both reconstructions appeared to behave similar to the intact condition. Failure of some Brostrom repairs however, suggest that the gracillis-graft reconstruction is initially a stronger repair.

Funding: Workers Compensation Board of British Columbia

The cost effective management of diabetic foot infections is a challenge to the Canadian health system. The objective of this study was to predict preoperatively diabetic foot patients who will fail a transmetatarsal amputation (TMA) and end in a costly and disabling below knee amputation (BKA) and hence perform a primary BKA in select patients.

Twenty-one patients failing TMA and revised to BKA within the first year were compared with a matched cohort of twenty-one successful TMA’s. The factors that were selected for comparison were: age at amputation, sex, smoking, type of DM, use of osetoset, presence of charcot fractures, previous contralateral surgery, previous debridement before TMA, debridement after TMA, dialysis, duration of ulcer prior to TMA, hemoglobin level at time of TMA, HbA1C, presence of heel ulcer, prior ipsilateral toe amputation, pulse status prior to TMA, vascular reconstruction and presence of unre-constructable vascular problem. Chi-square was done for group data, and ANOVA for numeric data.

Long-term control of blood glucose level (HbA1C) was found to be significant in predicting the success of TMA. Need of debridement after TMA was found to be a significant predictor of failure of TMA. There was a trend towards duration of ulcer prior to TMA and smoking being significant. All other variables, including vascular status or renal failure were not significantly different between the two groups.

As we have previously achieved a 75% success rate with TMAs in diabetics, we recommend a TMA as the first procedure in all diabetics with major forefoot infection or ulceration instead of a BKA. Obtaining good diabetic control in patients at risk for or requiring amputation for foot infection may prevent the TMA from failing and the subsequent need for BKA.