Abstract

Aims

To assess if older symptomatic children with club foot deformity differ in perceived disability and foot function during gait, depending on initial treatment with Ponseti or surgery, compared to a control group. Second aim was to investigate correlations between foot function during gait and perceived disability in this population.

Aim of Prospective Study To assess the long-term survival of Souter-Strathclyde replacements and determine the causes of failure.

Materials and Methods: Between 1977–97, 445 Souter-Strathclyde replacements were undertaken by the presenting author in 321 patients, ranging in age from 25–81 years (mean 59). The Larsen X-ray grading at the time of surgery was Gd III-2%, Gd IV-43%, Gd V-55%. The standard humeral component was used in 76% and the long-stemmed model in 24% of cases, the standard ulna in 91%, and the long-stemmed in 9%.

Clinical and radiological assessments were carried out before surgery and at 6 months and one year after surgery and annually thereafter until the death of the patient or the revision of one or both components, the mean follow-up being 8.9 years (S.D. 5.6).

The survival statistics are based on Kaplan-Meier survival curves and Cox regression analysis applied to 3 Groups with differing end-points: 1) Revision of one or both components of the prosthesis 2) Ditto or the development of a complication, seriously threatening the survival of the arthroplasty and 3) As in (2) or definite evidence of progressive radiological loosening.

Results Very satisfactory pain relief was achieved in 90% of cases. Mean flexion improved from 129° to 144°, pronation from 42° to 59°, and supination from 43° to 62°. Once achieved, these results were well maintained. Mean extension was slightly reduced after surgery (47° to 52°)

For Group 1: the survivorship at 5, 10, 15 & 20 years was 95, 89, 82, & 81% respectively; for Group 2: 93, 87, 76 & 69%; and for Group 3: 91, 84, 72, & 68%. In Group 1, indications for revision or removal of one or both components were persistent dislocation (5), fracture (5), aseptic loosening complicated in some cases by fracture (20) and infection (14). In Group 2 the threatening complications included instability (2), un-united fracture of the ulna (4), infection (7), and clinical loosening (2)

Conclusions This method of elbow replacement offers very successful and durable pain relief and restoration of function in the adult rheumatoid patient. Survivorship in the first decade after surgery is very acceptable. Later, due to increasing disability and reliance on crutches, resulting from multi-joint involvement, more problems are likely to arise from aseptic loosening, fracture and infection.