We report five patients with tibia vara due to focal fibrocartilaginous dysplasia of the medial aspect of the proximal tibia. In three patients spontaneous correction occurred, while in one of the remaining two treated by operation, a valgus deformity and neurological complications resulted. Conservative management is therefore recommended

We report the results of supramalleolar varus osteotomy on seven ankles (in six patients) for haemophilic arthropathy and secondary valgus deformity. The operation reduced pain and the frequency of intra-articular bleeding while preserving joint function for a mean of nine years. The procedure is an attractive alternative to the more commonly used surgical option of arthrodesis

The results of fifty-one Manchester knee arthroplasties in forty-one patients are reviewed and discussed. Excellent and good results were obtained in 85.4 per cent of arthroplasties. Varus and valgus deformity can be corrected and stability preserved or restored. Complications occurred in only twelve patients but resolved in all except one

A new technique is described for extra-articular subtalar arthrodesis; it combines the main elements of the Batchelor and the Grice procedures. Results were reviewed after a minimum of three years. Of the 25 feet treated 24 had solid fusion and had maintained the operative correction of the valgus deformity; the one non-union was due to deep infection

Varus osteotomy of the distal femur is recommended for osteoarthritis of the knee with significant valgus deformity, but the operation is difficult to plan and perform. A simple technique involving a jig referenced to the line of the tibia is described. This allows accurate overcorrection by a few degrees, with impaction and secure fixation at the osteotomy. It has been successful, with no complications, in 12 consecutive knees

Aims

Patellofemoral problems are a common complication of total knee arthroplasty. A high compressive force across the patellofemoral joint may affect patient-reported outcome. However, the relationship between patient-reported outcome and the intraoperative patellofemoral contact force has not been investigated. The purpose of this study was to determine whether or not a high intraoperative patellofemoral compressive force affects patient-reported outcome.

1. Thirty-four cases of calcaneal osteotomy for mobile flat foot in nineteen patients are reviewed. 2. The function was markedly improved in seventeen of the nineteen patients. 3. The operation was successful in correcting the valgus deformity of the heel in thirty of the thirty-four feet. it was less successful in improving the longitudinal arch, especially when the flat foot deformity was severe

We reviewed 21 patients with Mason type-III fractures of the radial head treated by resection, evaluating the results at 16 to 30 years by a standard questionnaire and clinical and radiological examination of the elbow and wrist. Seventeen patients had an excellent result, three were good and one fair. Resection of the radial head is a satisfactory method of treatment of such fractures. Prosthetic replacement seems to be indicated only when there is valgus instability of the elbow

We describe three patients who developed gross calcaneus deformity following surgery for talipes equinovarus. One also had an associated valgus deformity and another had supination of the forefoot; all had intractable problems with footwear. Operation for transfer of the tibialis anterior to the heel, with correction of the associated deformities, was successful and improved both their gait and the shoe problems

1. The results are presented of upper tibial osteotomy carried out in ten patients for osteoarthritis of the knee associated with lateral deformity. 2. The operation is indicated when there is severe pain, valgus or varus deformity, and a range of flexion of at least 90 degrees. 3. In every case pain has been relieved, and recovery of movement after operation has been easy

We treated 13 patients who had a fixed valgus deformity of the knee with a semiconstrained total knee arthroplasty combined with advancement of the lateral collateral ligament by means of a lateral femoral condylar sliding osteotomy. At follow-up of between one and 6.5 years all patients were assessed using the Knee Society score. The mean knee score improved from 32 to 88 and the functional score from 45 to 73. The mean tibiofemoral angle was corrected from 191° to 180°. There was no postoperative tibiofemoral or patellar instability and, in most knees, distal transposition of the lateral femoral condyle achieved satisfactory stable alignment

Standardised radiographs of the weight-bearing foot were analysed in fifty young patients undergoing osteotomy of the first metatarsal for hallux valgus. True metatarsus primus varus was not found more frequently than in a control series. The intermetatarsal angle was significantly greater in affected feet compared with controls. The structural abnormality in hallux valgus in the young is therefore due to a valgus disposition of the second and subsequent metatarsals, rather than varus inclination of the first metatarsal

A method of repair for anteromedial rotatory instability of the knee is described and the results of operations on 36 knees reviewed. Complete static correction occurred in 30 of these patients (84 per cent), three patients showed improvement (8 per cent) and three showed no improvement (8 per cent). Although the operation was not reliable as a correction for valgus instability, it did not increase this instability. This operation may be combined with other procedures to correct all instabilities or problems of the knee

We studied, clinically and radiologically, the growth and remodelling of 21 hips after valgus femoral osteotomy with both rotational and sagittal correction for hinge abduction in 21 patients (mean age, 9.7 years) with Perthes’ disease. The exact type of osteotomy performed was based on the pre-operative clinical and radiological assessment and the results of intra-operative dynamic arthrography. The mean IOWA hip score was 66 (34 to 76) before surgery and 92 (80 to 100) at a mean follow-up of 7.1 years (3.0 to 15.0). Radiological measurements revealed favourable remodelling of the femoral head and improved hip joint mechanics. Valgus osteotomy, with both rotational and sagittal correction, can improve symptoms, function and remodelling of the hip in patients with Perthes’ disease

Twenty patients with an average age of eighteen and a half years sustained osteochondral fractures of the lateral femoral condyle as the result of a sudden twist and valgus strain to the straight or almost straight knee. All the patients felt sudden pain at the moment of injury, all had a haemarthrosis, and yet the fracture escaped early diagnosis in one-third of the cases. Internal fixation of the fragment with early mobilisation is recommended if the diagnosis is made within two weeks of injury, and excision of the fragment if it is only later identified

In two years we treated four women with ununited stress fractures of their proximal tibial diaphyses. They all had arthritis and valgus deformity. The stress fractures had been treated elsewhere by non-operative means in three patients and by open reduction and internal fixation in one, but had failed to unite. After treatment with a modular total knee prosthesis with a long tibial stem extension, all the fractures united. A modular total knee prosthesis is suitable for the rare and difficult problem of ununited tibial stress fractures in patients with deformed arthritic knees since it corrects the deformity and the adverse biomechanics at the fracture site, stabilises the fracture and treats the arthritis

Aims

The aim of this study was to establish the results of isolated exchange of the tibial polyethylene insert in revision total knee arthroplasty (RTKA) in patients with well-fixed femoral or tibial components. We report on a series of RTKAs where only the polyethylene was replaced, and the patients were followed for a mean of 13.2 years (10.0 to 19.1).

We describe a congenital deformity of the foot which is characterised by calcaneus at the ankle and valgus at the subtalar joint; spontaneous improvement does not occur and serial casting results in incomplete or impermanent correction of the deformities. Experience with five feet in four children indicates that release of the ligaments and tendons anterior and lateral to the ankle and lateral to the subtalar joint is the minimum surgery necessary; subtalar arthrodesis may be required in addition. The foot deformity described may occur as an isolated condition or in association with multiple congenital anomalies. The possibility of a neurological deficit should always be excluded

A retrospective survey of 135 posterior dislocations and fracture-dislocations of the hip was carried out in order to define the pattern of associated knee injuries. Thirty-five patients had sustained a significant injury to the knee, of which twenty-five were clearly attributable to a direct blow on the front of the knee (fractured patella, traumatic chondromalacia, fractures of femoral and tibial condyles) and ten were compatible with valgus, yams or rotational forces (medial, lateral and cruciate ligament tears). The second type of injury has not been widely recognised but it is important that it should not be overlooked