Fresh osteochondral allografts were used to repair post-traumatic osteoarticular defects in 92 knees. At the time of grafting, varus or valgus deformities were corrected by upper tibial or supracondylar femoral osteotomies. A survivorship analysis was performed in which failure was defined as the need for a revision operation or the persistence of the pre-operative symptoms. There was a 75% success rate at five years, 64% at ten years and 63% at 14 years. The
We have reviewed 32 patients with rheumatoid disease of the cervical spine who underwent a total of 40 operations aimed at correcting instability and improving any associated neurovascular deficit. Apart from four patients with intractable pain, the main indication for surgery was progressive neurological impairment. Of the 32 primary operations, 19 (60%) were successful; the remainder failed to achieve their objective and there were two deaths in the immediate postoperative period. Of eight secondary operations performed for recurrence of symptoms or failure to relieve cervical myelopathy, only four were successful. Of nine operations for bony decompression to relieve cord compression from irreducible subluxation, only four were successful. The overall results show a success rate of 57% and a
We have undertaken a randomized clinical trial comparing two methods of reconstruction of the anterior cruciate ligament in patients with chronic instability. We used an ipsilateral bone-patellar-tendon-bone autograft in 27 patients and the Ligament Advancement Reinforcement System (LARS) artificial ligament in 26. Assessment before and at two, six, 12 and 24 months after surgery, included the history, physical examination, a modified International Knee Documentation Committee (IKDC) score, the Tegner score, the Knee Injury and Osteoarthritis Outcome Score (KOOS) and instrumented laxity testing. There were no cases of reactive synovitis or of infection of the knee, and there was no difference regarding the
We examine the hypothesis that a knee replacement is most likely to survive successfully if it is stable with a coronal tibiofemoral angle close to 7 degrees of valgus, the accepted normal. The records of 428 knee replacements followed up for one to nine years were analysed. The highest success rate was indeed found in those so aligned at operation and such knees were most likely to remain stable. Nevertheless, half of the failures occurred in knees correctly aligned at operation and two-fifths in knees which had remained stable in this alignment; many failures must have been caused by factors other than malalignment. Some knees, well aligned at operation, deteriorated into severely varus or valgus positions; their
We present the short- and medium-term clinical results of thermal shrinkage in selected groups of patients with multidirectional or capsular stretch-type instability. We treated 56 patients (61 shoulders) by laser-assisted capsular shrinkage (LACS) and 34 patients (38 shoulders) by radiofrequency (RF) capsular shrinkage. The two groups were followed for mean periods of 40 months and 23 months, respectively. In the LACS group the mean Walch-Duplay score improved to 90 points 18 months after the operation, but then declined to a plateau of about 80 points; 59% of patients considered their shoulders to be ‘much better’ or ‘better’ but there was a
We reviewed the records of the long-term outcome of 208 Charnley and 982 Stanmore total hip replacements (THR) performed by or under the supervision of one surgeon from 1973 to 1987. The Stanmore implant had a better survival rate before revision at 14 years (86% to 79%, p = 0.004), but the difference only became apparent at ten years. The later Stanmore implants did better than the early ones (97% to 92% at ten years, p = 0.005), the improvement coinciding with the introduction of a new cementing technique using a gun. Most of the Charnley implants were done before most of the Stanmore implants so that the difference between the results may in part be explained by improved methods, but this is not the complete explanation since a difference persisted for implants carried out during the same period of time. We conclude that improved techniques have reduced
Arthroplasty for end-stage hallux rigidus (HR) is controversial. Arthrodesis remains the gold standard for surgical treatment, although is not without its complications, with rates of up to 10% for nonunion, 14% for reoperation and 10% for metatarsalgia. The aim of this study was to analyze the outcome of a double-stemmed silastic implant (Wright-Medical, Memphis, Tennessee, USA) for patients with end-stage HR. We conducted a retrospective review of 108 consecutive implants in 76 patients, between January 2005 and December 2016, with a minimum follow-up of two years. The mean age of the patients at the time of surgery was 61.6 years (42 to 84). There were 104 females and four males. Clinical, radiological, patient reported outcome measures (PROMS) data, a visual analogue score (VAS) for pain, and satisfaction scores were collected.Aims
Methods
When the present study was initiated, we changed the treatment for late-detected developmental dislocation of the hip (DDH) from several weeks of skin traction to markedly shorter traction time. The aim of this prospective study was to evaluate this change, with special emphasis on the rate of stable closed reduction according to patient age, the development of the acetabulum, and the outcome at skeletal maturity. From 1996 to 2005, 49 children (52 hips) were treated for late-detected DDH. Their mean age was 13.3 months (3 to 33) at reduction. Prereduction skin traction was used for a mean of 11 days (0 to 27). Gentle closed reduction under general anaesthesia was attempted in all the hips. Concurrent pelvic osteotomy was not performed. The hips were evaluated at one, three and five years after reduction, at age eight to ten years, and at skeletal maturity. Mean age at the last follow-up was 15.7 years (13 to 21).Aims
Methods
We examined radiographic polyethylene wear in 233 cemented total hip arthroplasties (201 patients) with either a metal-backed or a non-metal-backed acetabular cup. All patients had identical cemented one-piece titanium femoral stems with a femoral head diameter of 28 mm. The mean linear wear rate was 0.11 mm/yr in metal-backed sockets and 0.08 mm/yr in non-metal-backed sockets (p = 0.0002). The mean volumetric wear rate was 66.2 mm3/yr in the metal-backed sockets and 48.2 mm3/yr in the polyethylene sockets (p = 0.0002). The addition of metal backing to a cemented acetabular cup therefore resulted in a 37% increase in mean polyethylene wear rates which may partially explain the higher
We evaluated 38 hip reconstructions in 36 patients at a mean follow-up of 5.9 years (range 4 to 9.1) after femoral head allografts had been used to augment severely deficient acetabular bone stock. The patients were all relatively young and had many previous operations. Their pre-operative Harris hip rating averaged 46 points (range 18 to 73). All the allografts united and there were no infections. However, 12 acetabular components (32%) became loose; six of these had needed revision using the healed allograft, and two hips had required resection arthroplasty. The 30 surviving hips had a mean Harris hip score of 82 points. Some radiographic evidence of graft resorption was seen in 23 hips, though this was mild in 17. The extent of cover provided by the allograft and the severity of graft resorption both correlated with acetabular loosening. Although structural allografts had allowed successful hip reconstructions in many of these patients with major bone loss, the
Reports of differing
We have reviewed 65 bipolar arthroplasties of the hip in 55 patients with osteoarthritis secondary to dysplasia. The mean age at operation was 56 years (42 to 79) and the mean period of follow-up was 7.2 years (5.0 to 13.0). The average Merle d’Aubigné and Postel score before operation was 10.3 and at final follow-up 15.0. There were excellent or good results in 42 hips (65%). Migration of the outer head was observed in 50 hips (77%), most often in the group with a centre-edge angle of less than 0°, an acetabular head index of less than 60%, coverage of the outer head by the original acetabulum of less than +10° and after bone grafting of the acetabulum. This migration was progressive in 31 (62%) of the 50 hips, with massive osteolysis of the acetabulum in eight. The extent and progression of migration were closely associated with this osteolysis. Four hips required revision for extensive migration of the outer head with destruction of the acetabulum or severe acetabular osteolysis, and nine hips are awaiting revision for failure of the bipolar prosthetic head. The overall
A lack of supporting clinical studies have been published to determine the ideal length of intramedullary nail in fixation of trochanteric fractures of the hip. Nevertheless, there has been a trend to use shorter intramedullary nails for the internal fixation of trochanteric hip fractures. Our aim was to determine if the length of nail affected the outcome. We randomized 229 patients with a trochanteric hip fracture between two implants: a ‘standard’ nail of 220 mm and a shorter nail of 175 mm, which had decreased proximal angulation (4° vs 7°) and a reduced diameter at the level of the lesser trochanter. Patients were followed up for one year by a nurse blinded to the type of implant used to determine if there were differences in mobility and pain with two nail designs. Pain was assessed on a scale of 1 (none) to 8 (severe and constant) and mobility on a scale of 1 (full mobility) to 9 (immobile).Aims
Methods
The treatment algorithms for displaced fractures of the femoral neck need to be improved if we are to reduce the need for secondary surgery. We have studied 102 patients of mean age 80 years, with an acute displaced fracture of the femoral neck. They were randomly placed into two groups, treated either by internal fixation (IF) with two cannulated screws or total hip replacement (THR). None showed severe cognitive dysfunction, all were able to walk independently, and all lived in their own home. They were reviewed at four, 12 and 24 months after surgery. Outcome measurements included hip complications, revision surgery, hip function according to Charnley and the health-related quality of life (HRQoL) according to EuroQol (EQ-5D). The
1. Experimental evidence suggests that the autogenous graft exhibits some advantage over refrigerated homogenous grafts in that healing takes place more rapidly but that in the end the results are the same. 2. Histological study of fragments of healing grafts, both autogenous and refrigerated, that have been removed from human hosts shows no significant difference in the rate or method of repair. 3. Study of the clinical results of the use of homogenous transplants in 307 operations shows the bone to be well tolerated. The rate of infection in clean cases was 2·6 per cent; loss of bone occurred in only two cases. 4. Follow-up studies of 248 cases showed successful results obtained in 210, or 85 per cent. These are comparable with the results obtained with autogenous grafts. The healing of cancellous transplants takes place more rapidly than with cortical grafts. Transplants that have been preserved for more than one year do not heal as well as those that have been preserved for a shorter period and the
We reviewed 32 children after the treatment of simple bone cysts by intralesional injections of methyl-prednisolone acetate. The age of the child and the activity and size of the cyst did not significantly affect the radiological outcome. The earliest time at which the radiological response could be reliably determined was three months. After a median period of review of five years, four (13%) cysts had healed, 20 (62%) cysts were partially visible but sclerotic, four (12.5%) were still visible but opaque and four (12.5%) were clearly visible. The healed and partially visible but sclerotic cysts were classified as having satisfactory radiological healing. This was observed in 13 of 32 cysts (41%) after the first injection, in eight of 21 (38%) after the second injection, but in relatively few of the remaining cysts after subsequent injections. A satisfactory symptomatic outcome was achieved in all of the 18 children with humeral cysts and in the one child with a fibular cyst irrespective of the radiological outcome, but only in nine (67%) of the 13 children with femoral or tibial lesions, in whom the cysts were healed or sclerotic. The remaining four children had exertional bone pain and repeated fractures of their femoral or tibial cysts which were incompletely healed with sclerosis in one and opacities in three. We conclude that the healing response to intralesional corticosteroids is unpredictable and usually incomplete even after multiple injections. The
