We studied 37 patients with varus
We performed Kawamura's dome osteotomy of the pelvis, with simultaneous distal transfer of the greater trochanter on 101 hips in 91 patients with
Proximal tibial osteotomy is commonly performed for
The results of 757 intertorchanteric osteotomies for
We have followed up a series of total hip arthroplasties performed for secondary
Of 142 Chiari pelvic osteotomies for
A 10-year-old boy who sustained a fracture through a cyst in the ulna later developed a pseudarthrosis. During 13 years' follow-up the characteristic short bowed forearm developed but, instead of the more usual spontaneous dislocation of the head of the radius, the patient also developed the previously unreported complication of
1. Almost all patients with
1. Double osteotomy was performed on 1 50 knees between 1961 and 1969. The first fifty-seven cases were assessed independently. 2. The operation of osteotomy of the upper end of the tibia and the lower end of the femur is described. it is emphasised that the osteotomy sites are close to the bone ends and well within the cancellous expansion. 3. The indications for the operation are pain and loss of function in a mobile arthritic knee joint. 4. Flexion of the knee is important during the operation to allow the popliteal artery to be moved away from bone. Arteriograms at necropsy show the danger of damaging the popliteal artery when the knee is extended. 5. The operation appears to be equally effective in
1. Experimental evidence is advanced to suggest that the effect of the McMurray displacement osteotomy in
We studied 19 videotaped knee arthroscopies in 19 patients with mild to moderate
We studied the mechanical properties of cartilage from the apparently unaffected compartment of knees with unicompartmental
We report the long-term clinical and radiological outcomes of the Aequalis total shoulder replacement with a cemented all-polyethylene flat-back keeled glenoid component implanted for primary
Of 34 consecutive proximal tibial osteotomies for secondary degenerative arthritis in patients under 40 years of age, 33 were evaluated at least three years (mean 7.5 years) after operation. In all 73% were satisfactory, with four failures in 21 procedures in men and five failures in 12 procedures in women. The primary abnormalities were medial meniscectomy (11), medial and lateral meniscectomy (4), osteochondritis dissecans (3), osteochondritis dissecans with medial meniscectomy (4) and fracture (11). All four knees with both medial and lateral meniscectomy had unsatisfactory results despite obtaining anatomical alignment. Eight patients needed subsequent surgery; five of them had total knee replacement, four within four years of the osteotomy. Proximal tibial osteotomy in younger patients with secondary arthritis gives similar results to those for older patients with primary
Primary
Between 1995 and 1997 we undertook 40 bipolar hip arthroplasties in 35 patients with dysplastic
The relationship between heterotopic bone formation and the morphological type of
The Oxford Knee, a resurfacing prosthesis with a meniscal bearing, can be used for either bicompartmental or unicompartmental arthritis. The first 103 unicompartmental cases are presented at a mean time since operation of 36 months (range 21 to 56 months). In those cases with surviving arthroplasties, pain was relieved in 96%. The full range of pre-operative flexion was maintained and flexion deformity was improved from a mean of 6.7 to 5.4 degrees. Stability and alignment were restored to normal in nearly all the knees. Absence of the anterior cruciate ligament was associated with a significantly greater incidence of failure. Six failures occurred in 37 knees lacking a normal anterior cruciate ligament (16.2%); three occurred in 63 knees with a normal anterior cruciate ligament (4.8%) (p less than 0.02). Criteria for the future selection of patients have been deduced from our experience. The operation is recommended for knees with severe unicompartmental
1. The rate of non-union of 100 intertrochanteric osteotomies of the McMurray type, with internal fixation, is reported. One in five was not united one year after operation. The criteria of union are discussed. 2. The patient's disability in twelve ununited osteotomies has been assessed, and related to the mobility of the osteotomy. 3. The factors which prejudice union have been analysed. The principal cause of non-union appeared to be the varus angulation strain on a varus osteotomy displaced medially more than half the diameter of the bone. Obliquity inwards and upwards of the osteotomy was a contributory factor. The types of internal fixation used, the use of external splintage and the period of protected weight bearing with crutches did not appear to be related to the rate of union. 4. It is concluded that marked inward displacement of the osteotomy, combined with either obliquity of the osteotomy or a varus position, prejudices union; that the use of this technique is unfounded in principle and not supported empirically; and that displacement should be eschewed to avoid this complication of intertrochanteric osteotomy in the treatment of
The intra-osseous pressure, PO2, and PCO2 were measured in 32 hips (21 patients) which were painful but showed no severe degenerative changes. Pre-operative scintigraphy and radiography was performed in all patients. Thirteen hips showed early osteoarthritis, eight had early osteonecrosis, and 11 had no changes. Core biopsies were performed and the bone was examined histologically and graded for necrosis. Histologically, necrosis was present in 27 specimens. Scintigraphic findings did not correlate with the histological results but were more closely related to the radiographic findings. The intra-osseous pressure in hips with histological necrosis (mean 47 mmHg) was significantly higher than in hips without necrosis (mean 26 mmHg). The PO2 was lower in bone with histological necrosis (mean 44 mmHg) than in bone without (mean 71 mmHg). PO2 increased and intra-osseous pressure decreased after decompression. The results confirm that ischaemia plays a central role in the development of necrotic changes in bone. Histological necrosis was found in hips with radiographic signs of osteonecrosis and in those with