A significant number of hallux valgus is associated with valgus deviation of 2nd, 3rd and 4th toes. We recommend correction of the valgus deformity of all four rays simultaneously., because recurrence of the hallux valgus is very frequent if only the first ray is realigned. From 1978 to 1990 a series of 236 feet were operated upon for hallux valgus deformity using a distal osteotomy of the first rnetatarsal. These cases were followed up for a mean of 6, 1 years and showed that the recurrence rate was as high as 28%. Our observation was that, in the majority’ of cases, recurrence of the deformity occurred in those feet in which hallux valgus was combined with valgus deformity of the lesser toes due to varus deviation of the corresponded metatarsals. From 1990 to 1998, another series of 386 feet were operated for hallux valgus. In more than one third of them (142 feet in 96 patients) hallux valgus was associated by valgus deformity of the 2nd, 3rd, and 4th toes. These cases were operated using a distal osteotomy of the first rnetatarsal combined with osteotomies of lesser metatarsals aiming not only to face metatarsalgia, but to correct valgus deformity of the lesser toes simultaneously. These patients were followed up for a mean of 4.8 years. The results were excellent in 73 feet, good in 47, fair in 17 and poor in 5. The recurrence rate dropped to 7%. If hallux valgus is combined with valgus deformity of the lesser toes, correction of only the first ray creates a gap between first and second toe. Consequently there is no blocking effect toward valgus deviation of the great toe due to the gap remaining between the first and second toe. The above combined procedure seems to give better results with low recurrence rate in comparison with the results of single correction of the first ray.
The aim of this study was to evaluate and compare the results of acromioplasty in two groups of patients operated upon for impingement syndrome using two different techniques, In one group the insertion of the devoid was partially divided (deltoid off strategy) while in the other the insertion of the deltoid was preserved (deltoid on strategy). Twenty-one patients, suffering from impingement syndrome of the shoulder, were operated during the period 1996–2001. Preoperatively all patients presented with positive impingement test and they were complaining of night pain as well as pain during activity. Two different techniques were used. In 2 group of 10 patients. the “deltoid off’”strategy was applied and the acromioplasty was performed with the use of an osteotome. In a second group of 11 patients the “deltoid on” strategy was applied and the acrormioplasty was performed by using a high speed burr. Eight out of 10 patients of the first group were satisfied with the results of the operation, whereas all the 11 patients of the second group were satisfied. The return to full activity in patients with the “deltoid off” strategy was 10 weeks in average, while in the “deltoid on” group it was 8 weeks. Night pain subsided in ail patients in both groups. Two patients of the first group complained of mild pain with daily living activities, while 10 out of the 11 patients of the second group had no pain at all. Finally 2 patients of the first group and none of the second group presented residual painful arc. We conclude that the “deltoid on” technique for treatment of the impingement syndrome of the shoulder appears more simple and reliable, has less morbidity and gives better clinical results, compared to the “deltoid off” technique.
This study evaluates the results of our technique of proximal tibial osteotomy for treatment of osteoarthritis of the medial compartment of the knee. One hundred and thirty eight knees were operated upon from 1981 to 1990. The degree of appropriate correction was measured in standing radiographs of the whole limb. Our technique consists of the creation of an osteotomy running obliquely just above the tibial tuberosity to the posterior tibial surface. No wedge is removed. Realignment is obtained by sliding the two osteotomy surfaces until the desirable correction is obtained. The osteotomy is fixed by a 90° blade-plate. By this technique precise correction can be achieved. One hundred and seventeen knees were evaluated after a mean FU of 5, 5 years with 91% excellent or good result. In a second evaluation of 93 knees in a mean FU of 7.8 years, the good results dropped to 72%. In a third evaluation of 81 knees, after a mean FU of 11.8 years (range 9 to 16), only 54% of the knees maintained acceptable results. The best results in the last evaluation were seen in 43 knees in which the postoperative alignment of femorotibial angle was 178° to 182°. Undercorrected or excessively overcorrected knees showed deterioration of the results in 4 to 9 years depending on the degree of mal-correction. The results deteriorate with passage of time especially if precise correction is not achieved. Accurate preoperative radiographic measurements and precise operative technique is required to obtain exact correction of the axis in order to maintain the good results for a long period of time.
The aim of this study was to evaluate the results of total hip arthropiasty in osteoarthritis secondary to congenital hip disease. During the period 1986 to 1999, we performed 48 hip replacements with congenital hip disease. According to classification of Chanophylakidis there were 18 dysplastic hips without dislocation, 17 hips with low dislocation and 12 hips with high dislocation The mean age of the patients was 49 years (range from 31 to 64) Depended on the pathology of each case, different types of prostheses or combinations of them were used. The acetabular cup was placed in the anatomic position and in the majority of cases a component of 22 aim was used. In 28 cases the bottom of the acetabulum was fractured and protruded in order to fit the cup (acetabuloplasty). In these cases copious amounts of auto- and aiiografts were used and the cup was fixed with PMMA, Special femoral stems for CDH were used and in the majority of cases they were fixed with PMMA. In 17 cases with good acetabular bone stock and good femoral canal a standard prosthesis was used without PMMA. In 31 cases the hip was approached after osteotomy of the grater trochader and in 17 cases an anterolateral approach was used. Intra-operatively there were many problems and difficulties but we had no true complications. Early postoperative complications presented in eight patients and had to do with 2 haematomas, 3 DVT, 1 mild PE and 2 superficial infections. There was no case of deep infection, neurovascular damage, dislocation or fracture. The late results after a mean of 6, £ years were very satisfaaory. There was improvement of the HIP SCORE from 38 to 83 and subjective satisfaction of nearly all the patients. The late complications were limited and they concerned three migrations of the acetabular cup, one aseptic loosening of the femora) stem and one extensive osteoiysis the proximal femur. All the above cases were revised successfully.
