Introduction: Plantar fasciitis is a common syndrome characterized by pain at the origin of the plantar fascia, most often on rising after a period of inactivity. It is usually self limited. Treatment includes: NSAIDs, physical therapy, orthotics, steroid injections, and lately shock wave therapy. Patients who fail to respond to non-operative treatment are often referred to one of a variety of surgical procedures.

We report our experience with one such procedure, percutaneous release via a medial approach.

Methods: At our institution, patients with plantar fasciitis who fail to improve despite first (NSAID, PT) and second (injection, orthotics) line therapy, are referred for percutaneuos plantar fasciotomy. We retrospectively reviewed 34 patients who underwent 38 procedures between 1999–2006. Mean patient age at surgery was 50 (30–65). 24 were evaluated by an uninvolved orthopedic surgeon at an outpatient clinic, and 10 responded to a mail or telephone questionnaire. Assessment included pain relief, functional improvement, complications, and willingness to re-undergo, or recommend the surgery.

Results: Average VAS score dropped from 8.9 to 2.1. Function improved in 93%. The surgery met or exceeded expectations in 76%, and 82% would have re-undergone or recommended the procedure. Injury to the lateral plantar nerve was encountered in 3 patients.

Conclusion: Percutaneous plantar release is an effective treatment for resistant plantar fasciitis. Care should be taken to prevent nerve injury by accurate technique.

Introduction Musculoskeletal injuries, especially fractures, cause reduced limb mobilization. The diminished limb activity promotes muscular atrophy, leading to a slower return to function. Attempts to prevent this atrophy using electrical stimulation have been described after knee reconstruction.

The Myospare percutaneous electrical stimulator has been developed to prevent immobilization related atrophy. We undertook this pilot study to assess feasibility, safety, and efficacy of applying electrical stimulation under a cast after ankle fractures.

Patients and Methods Between May and December 2004, patients who sustained closed ankle fractures requiring surgery, were recruited to participate in this study. 24 patients took part in the study, sixteen male and eight female. Age range was 18 to 62 years (average 40). All patients underwent open reduction and internal fixation using standard AO technique. A short walking cast was applied after surgery. Patients were randomized into a treatment and a control group. The experimental device was applied in the treatment group for 6 weeks. Patients were examined at 2, 6 and 12 weeks.

Evaluation included measurement of calf and ankle circumference, dorsiflexion and plantiflexion, and calculation of the ratio between the injured and uninjured side. At each visit pain intensity was assessed using a visual analog score, and patients filled out a function assessment questionnaire. Analysis was performed using chi square, t-test and repeated measures analysis.

Results All patients tolerated the stimulator well. No adverse effects were encountered. There is a trend toward improvement in calf diameter, dorsiflexion and plantarflexion. However, with the small number of patients in this study, no significant difference was apparent. Functional recovery and VAS scores were borderline higher in the treatment group at 12 weeks (p=0.043 and p=.049) when compared to baseline.

Discussion The use of the Myospare device under a cast in patients after surgical fixation of ankle fractures has been demonstrated as feasible and safe. In this pilot study a trend toward enhanced recovery was apparent in the treatment group.

We describe two patients in whom poor healing after chemical ablation for ingrown toenails unmasked significant vascular disease of the lower extremities. We have found no similar reports in the English language literature.

Introduction: Cementless hydroxyapatite coated prosthesis are mainly selected for a relatively young and active patient population. Most clinical studies demonstrate excellent osseous integration of the HA coating and good outcome. The clinical follow-up reports of the ABG group suggest excellent results, however we observed an alarming rate of acetabular osteolysis and polyethylene wear which required revision surgery. Thus a comprehensive retrospective evaluation of all operated patients had been conducted.

Patients and Methods: 162 ABG hips were replaced in 148 patients, of them 75 patients were studied and followed-up. Mean age was 56 (range 33–71). 48 patients were women and 27 were men. 8 patients had bilateral hip replacement. Etiology of hip disease varied and included primary osteoarthritis (27 patients – 36%), congenital hip dysplasia (24 patients – 32%), osteonecrosis (12 patients – 16%), ankylosing spondylitis (5 patients – 6.6%), post traumatic arthritis (5 patients – 6.6%) and post-infectious arthrosis (2 patients – 2.6%). Postoperative follow-up period averaged 4 years (range 15–80 months).

Results: The mean postoperative Harris hip score was 89 (range 52–100). 23 patients (30%) reported of modified life activity after surgery, and the majority had resumed their previous occupations.

Complications included 3 early and one late dislocations – one patient required an early cup revision, one patient suffered a fracture of the femur during stem insertion, and 3 patients (4%) had deep vein thrombosis. There was one case of a femoral vein injury and one resolving superficial infection. No deep infections were noted.

13 patients had undergone cup revision due to severe polyethylene wear and periacetabular osteolysis. Of them 5 were diagnosed during this retrospective study and 8 were referred for revision due to clinical symptoms. Thus the revision rate of the entire operated population is 13/162 = 8.0% and 13/75 = 17.3% of the studied patients. The true loosening rate should be between these 2 figures.

In 2 patients the entire cups were removed and revised due to loosening. In 11 patients following the removal of the polyethylene inserts the metal back proved to be stable. In these cases the bone defects were filled-up with bone graft substitute, and a highly cross-linked polyethylene (22 mm head) were cemented into the metal shell. No stems needed revision.

Conclusion: In spite of a relatively high Harris Hip Score and generally good long-term follow-up a high rate of acetbular lysis and polyethylene wear were observed. This observation warrants avoiding the use of the ABG cups until further investigation is performed. A continued clinical and radiographic analysis is required for the entire operated patients. In all cases of polyethylene wear or significant osteolysis revision is indicated.