Purpose of the study: Osteotomy of the first metatarsal has become the gold standard treatment for hallux valgus. We report a study on the changes in radiographic findings as a function of the degree of translation of the distal fragment of the metatarsal during scarf distal wedge osteotomy.

Material and methods: From the cohort of patients who underwent hallux valgus surgery in our unit, we collected 118 anteroposterior x-rays of the forefoot. Computer-assisted image processing established a trigonometric analysis of each forefoot before and after standardised virtual surgery. Variations in standard morphological measurements (phalangeal valgus: M1P1; metatarsal varus: M1M2; orientation of the joint surfaces of the first metatarsal: proximally (PMAA) and distally (DMAA).

Results: The successive translations significantly modified all of the morphological measurements. For M1M2, intermediary translation corrected the metatarsal varus (< 5) in 72% of the cases, maximal translation in 97%. For the M1P1 angle, intermediary translation only corrected the phalangeal valgus (< 8) in 44% of cases, maximal translation in 31%. For the DMAA angle, intermediary translation corrected the distal articular orientation (< 6) in 66%, maximal translation in 97%. Distal translation of the first metatarsal aggravated the obliquity of the proximal joint surface from a mean 1.57±4.5 to 7.7±4.7, with intermediary translation and to 13.92±4.9 with maximal translation.

Discussion: Considering the large number of techniques proposed, the choice of one osetotomy model is reductive, but it does demonstrate via a geometric application the limits of osteotomy translation of the first metatarsal for the correction of hallux valgus.

Purpose: The purpose of this study was to evaluate ten year outcome of the 28-mm head self-locking cemented Müller THA.

Material and methods: From May 1988 to May 1990, 187 second generation cemented prostheses were implanted via the transgluteal approach for osteoarthritis. The femoral implant was a straight Prostasul 10 implant with a 28-mm modular head and a gamma ray sterilised poly-ethylene cup. At ten years, for the 187 implants: 64 patients had died, 24 patients were contacted by telephone (all with implants in place) nine were lost to follow-up, and 90 implants in 82 patients were reviewed. The reviewed series included 42 women and 49 mean, mean age 65 years. Clinical outcome was noted with the Postel Merle d’Aubigné score (PMA). Radiographical assessment noted lucent lines, granulomas, migrations, wear, and ossification.

Results: Among the 187 implants, two patients required revision: one for infection and the other for posttraumatic dislocation. Among the 82 patients reviewed at ten years, the PMA score was 16.85 (92% good and very good results). Radiographically, the acetabulum showed nine lucent lines measuring greater than 1 mm and progressing between five and ten years, one migration, and two cases of migration as well as three cases of wear greater than 2 mm. Evaluation of the femur showed osteolysis in zone 3 and 4 in one hip and rarified bone in zone 7 in four. Linear penetration of the head in the cup was 0.08 mm/yr. Brooker stage 3 ossifications were found in 27% of the men and 14% of the women.

Discussion: The clinical results were comparable to other series of cemented prostheses. At ten years, potential loosenings were more frequent at the acetabular level with progressive lines always present at five years; and polyethylene wear that was not always associated with osteolysis or granuloma, while osteolysis and granulomas were always associated with wear greater than 2 mm. Furthermore, there was no anatomoclinical relationship and radiographic anomalies did not always have an effect on function. Prevention of ossifications appears to be important, particularly in men.

Purpose: Reports on the histological lesions observed in patients with degenerative disease of the shoulder have generally involved only a few cases. We conducted a prospective study in 662 shoulders operated on for impingement or rotator cuff tear.

Material: The cases analysed included 402 subacromial impingements and 260 rotator cuff tears.

Methods: Pathology specimens were obtained from the subacromiodeltoid bursa, the acromion, the acromio-coracoid ligament, the acromioclavicular joint, the borders of the rotator cuff tear, and the biceps tendon. There were 2573 pathology specimens.

Results: The pathology examination revealed degenerative lesions (fibrosis, oedema, calcifications, fissuration, atrophy, delamination, fatty infiltration, necrosis, chondroid metaplasia, fragmentation), or inflammation. The subacromiodeltoid bursa presented fibrosis lesions in 3 out of 4 cases (74%). Signs of inflammation were found in 21% of the cases, oedema in 9%, and no lesion in 15%. The acromiocoracoid ligament showed oedema in 35%, fissuration in 35%, delamination in 25%, fragmentation in 11%, atrophy in 8%, fatty infiltration in 6%, necrosis in 4%, hypervascularisation in 2%, chondroid metaplasia in 1%, and no lesion in 27%. For the acromion, degenerative lesions were present in 88%, impingement in 83%, cuff tears in 92%. Lesions of the cuff in patients with tears showed degeneration in 86% (fissuration 46%, necrosis 35%, fragmentation 30%, vascular penetration with chondroid metaplasia 17%, delamination 10%, haemorrhagic remodelling 4%, adipose degeneration 3%, atrophy 2%, oedema 42%, calcifications 30%, fibrosis 26%, inflammation 7%, and no lesion 1 case). The biceps tendon showed degenerative lesions (90%), inflammation 2 cases, no lesion 3 cases. The acromioclavian joint (67 cases) showed degenerative lesions in all cases. Rotator cuff tears showed inflammatory lesions 30%, and subacromial impingement 16%.

Discussion: The statistical analysis revealed a significant correlation between the presence of a normal subacromiodeltoid bursa and the type of pathology. There was a significant statistical relationship between the presence of inflammatory lesions and the type of pathology. There was no significant correlation with the pain score. There was a significant relationship between the presence of fibrosis of the acromiocoracoid ligament and the functional score at last follow-up. The presence of ligament fibrosis would be a sign of poor prognosis. This relationship was present irrespective of the pain, force and stability scores.

Conclusion: The acromiocoracoid ligament was not found to be particularly involved suggesting that the idea of impingement should be revisited. For cases with a tear, the presence of a acromiocoracoid ligament with no histological lesion confirms that tears are not always associated with an impingement. Among cuff tear or impingement cases, there was a number of acromions with no bone lesion. Inflammatory lesions were not frequent. Unravelling the pathology of the degenerative shoulder is a complex process making interpretation and correlation with clinical signs and proposed therapeutic protocols difficult.