Aims

To assess the long-term effect of distal trochanteric transfer (DTT) on the clinical and radiographic outcomes of patients with Legg-Calvé-Perthes’ disease (LCPD) following a varus derotational osteotomy (VDRO).

Background: During the past decades many treatments and devices were developed in attempt to unload the diseased articular surface in knee Osteoarthritis (OA). A novel biomechanical device and treatment methodology (The APOS System) was introduced in order to unload the diseased articular surface during activity (dynamic wedging), strengthen dynamic stabilizers and train neuromuscular control by means of controlled biomechanical perturbations. The purpose of this study is to examine the effectiveness of APOS System in reducing pain and improving function in knee OA patients.

Method: A double blind, randomized, prospective study was performed with 61 knee OA patients, aged 49–83 (66 ±8.1) years and graded 1–4 (3 ±1) according to Kellgren & Lawrence. Patients were randomized into research (active) and control (placebo) groups. All patients under-went 8 weeks of treatment. Patients were examined at baseline and supervised 4 times during the study. Patients in the research group used the biomechanical device that consists of 2 biomechanical elements located under the strategic weight bearing spots of each of the patient’s feet and a mounting and positioning mechanism embedded in designated shoes. The treatment methodology that was applied to the research group included dynamic wedging of the diseased articular surface. Patients in the control group used a placebo device without the biomechanical elements. Patients were assessed at baseline, after 4 weeks and after 8 weeks at the end of the study using Knee Society Score, WOMAC, SF-36, ALF and VAS. The assessment was performed without the examiner knowing the group affiliation of the patient.

Results: The two groups were statistically similar (p> 0.05) at baseline with respect to age, Kellgren& Lawrence classification and all assessed parameters including subscales. Significant difference between groups over time was observed for Knee Score (p< 0.001), Knee Society Function Score (p< 0.001), WOMAC (p< 0.001), SF-36 (p< 0.001), ALF (p< 0.001) and VAS (p< 0.001). Significant improvement was observed in the research group throughout all assessed parameters (measured improvement for Knee Score, Knee Society Function Score, WOMAC, SF-36, ALF and VAS were a multiplication of 1.8, 1.4, 3, 1.4, 1.35 and 2 in the applicable scale respectively). A slight deterioration was observed in the control group throughout all assessed parameters at final assessment.

Conclusion: The findings demonstrate that APOS System is effective and significantly improves function and reduces pain among knee OA patients.

Aim: To evaluate the long term effect of Distal transfer of the greater trochanter in Perthes’ disease.

Patients and methods: Twelve patients (thirteen hip joints, 10 males and 2 females) who suffered from Perthes’ Disease were treated by distal transfer of the greater trochanter (DTT). The operation was performed because of progressive shortening of the articulo-trochanteric distance accompanied by signs of insufficiency of the hip abductors. Total or near total femoral head involvement was found in all the patients except for one of them. Follow up period was 28 years (21–35). Mean age at diagnosis of Perthes’ was 7 years (4–11). Patient were studied in 1992 and reviewed again 13 years later, using the Harris hip score, short form 36 (SF36), physical examination and A-P X-rays.

Results: Not one of the patients underwent a total hip arthroplasty. Mean Harris hip score is 80 (range 54–100, 4 patients under 70 score). Mean SF36 score was 71 (range 30–94) and was correlated to the Harris score. Three of the patients were working in a physically demanding profession. The rest were office workers. Two of them chose non strenuous type of work due to the hip condition. Limb length discrepancy was 1.7 cm short on the operated side (range 0–3) and correlated with Trendelenburg sign (4 patients with positive sign). Femoral head sphericity according to Stulberg classification was good in 5 patients (grades 1–2), fair in 3 patients (grade 3) and poor in 4 patients (grade 4–5). Head sphericity was not correlated to age at diagnosis, Harris score, SF36 score or level of hip pain.

Conclusions: Long term outcome are surprisingly good in those patients, considering the degree of head involvement, advanced age at diagnosis and severity of disease which necessitated high degree of varus osteotomy and hence trochanter transfer.