Acetabular labral tears and associated intra-articular
pathology of the hip have been recognised as a source of symptoms.
However, it is now appreciated that there is a relatively high prevalence
of asymptomatic labral tears. In this study, 70 young asymptomatic
adult volunteers with a mean age of 26 years (19 to 41) were recruited
and underwent three tesla non-arthrographic MR scans. There were
47 women (67.1%) and 23 men (32.9%). Labral tears were found in 27 volunteers (38.6%); these were
an isolated finding in 16 (22.9%) and were associated with other
intra-articular pathology in the remaining 11 (15.7%) volunteers.
Furthermore, five (7.1%) had intra-articular pathology without an
associated labral tear. Given the high prevalence of labral pathology in the asymptomatic
population, it is important to confirm that a patient's symptoms
are due to the demonstrated abnormalities when considering surgery. Cite this article:
To review local experience using the Avon patellofemoral arthroplasty All patients were retrospectively reviewed with respect to function, radiology and satisfaction Fourteen patients were followed up. There were no revisions and very good functional outcome. Patient satisfaction was high. The Avon patellofemoral arthroplasty is an effective implant in selected patients.
Since 1989 the Ganz periacetabular osteotomy has been performed in Christchurch for pain arising from hip dysplasia in selected patients. This review was performed to assess symptoms, function and radiographic appearances at a medium term follow up. The results of 14 peri-acetabular osteotomies performed in 13 patients was evaluated. The mean age of the patients at the time of surgery was 23 years (range 17–44). The mean duration of follow up was 5 years (3 months to 13 years). The follow up examination included clinical evaluation, chart review and radiographic analysis. Of the 13 patients evaluated, improvement in pain was achieved in 12. One required a hip replacement and intermittent discomfort was noted in 3 resulting in restriction in activites. Complications included sciatic nerve palsy (1), leg length discrepancy (2), superficial wound infection (1), scar tenderness (2), numbness in lateral femoral cutaneous nerve distribution (5) and pain from prominent metalware (1). Improvement in femoral head coverage was seen in all patients on follow up x-ray with minimal progression of arthritic changes. Improvement in symptoms ranging from complete relief of pain and participation in high intensity sporting events to intermittent discomfort was achieved. One failure occurred requiring arthroplasty. Significant complications occurred but have largely resolved. The osteotomy was successful in obtaining good relief of symptoms and has prevented the requirement for total hip replacement in this young active group.
Surgical dislocation of the hip joint using the technique developed by Rheinhold Ganz, is a relatively new method for surgical exposure of the hip. A review of 8 cases that underwent surgical dislocation of the hip joint was undertaken, to assess the short term outcome, complications associated with the procedure and to identify some of the indications for this technique. This is a retrospective analysis of surgical dislocation in two centers undertaken by the same surgeon with a maximum follow up period of one year. Surgical dislocation of the hip allows access to the hip joint with some associated morbidity due to the surgical exposure but there were no cases of avascular necrosis in the short term follow up. We were able to define specific pathological conditions affecting the hip where there is significant improvement following treatment using this method of exposure of the hip joint. Good exposure of the hip joint is obtained via surgical dislocation so allowing good access for surgical intervention. There is an associated morbidity with the technique but this method of hip exposure allows an alternative to hip arthroscopy and allows easier access to the joint for the treatment of intra articular pathology.
We compared function in two groups of high demand patients who had undergone total knee arthroplasty (TKA), one group using a posterior cruciate sacrificing (PCS) prosthesis and the other a posterior cruciate retaining (PCR) prosthesis of similar design. Patients were eligible for the study if surgery had been performed more than two years ago and they were under 65 years of age and had no coexisting morbidity that markedly decreased their physical activities. One surgeon operated on 28 patients in group A (20 TKAs), routinely retaining the posterior cruciate ligament (PCL). A second surgery operated on 19 patients in group B (25 TKAs) and routinely sacrificed the PCL. A mobile bearing prosthesis of similar design was used in each group. Patients were independently selected and assessed using a questionnaire specifically developed to assess higher levels of activity not usually assessed by other knee scores. Patients in the two groups were matched in terms of age, range of motion and follow-up The gross activity score was 3.36 in group A and 3.12 in group B. The combined walking, running and stair-climbing score was in group A (7.68) than in group B (6.64). Patients in group B had decreased anterior knee pain and perceived their TKA closer to a normal knee (2.00 compared to 2.32). We conclude that retaining the PCL in TKA results in better patient function without obvious complications.
One hundred and twenty-seven consecutive patients with displaced subcapital fractures of the femoral neck (Garden Grade III or IV) all under 80 years of age and independently mobile, were randomly allocated to fixation with either double divergent pins or a single sliding screw-plate device. The incidence of non-union and infection in the sliding screw-plate group was significantly higher, and we believe that when internal fixation is considered appropriate multiple pinning should be used. Mobility after treatment was disappointing in about half of the patients, and we feel that internal fixation can only be justified in patients who are physiologically well preserved and who maintain a high level of activity.
The management of displaced subcapital fracture of the hip is still controversial because of the high incidence of complications after internal fixation or hemiarthroplasty. To avoid some of these complications we have used primary total hip replacement for independently mobile patients over 65 years of age. A total of 163 cases, operated on over four years, have been reviewed. There were relatively more dislocations after operation for fracture than after total replacement for arthritis, and these were associated with a posterior approach to the hip. Only seven revision operations have been required. Of 57 patients who were interviewed an average of 42 months after replacement, 62% had excellent or good results as assessed by the Harris hip score. All the others had major systemic disease which affected their assessment. This inadequacy of current systems of hip assessment is discussed. It is concluded that total hip replacement is the best management for a selected group of patients with this injury, and that further prospective studies are indicated.
