Between 1971 and 1976 eight patients underwent excision of the carpal lunate for pain from Kienbock's disease. The bone was replaced by a silicone rubber implant. An average of 84 months had elapsed when they were reviewed in December 1980. All eight were very satisfied with their operations. Objectively, the
Our study describes the mid-term
We describe the mid-term
We present the outcome of 47 Souter-Strathclyde replacements of the elbow with a mean follow-up of 82 months (12 to 129). The
The
Simple decompression of the extensor tendons at the wrist was carried out on fifty-four wrists in a total of forty-one patients with rheumatoid disease. This procedure was combined with excision of the ulnar head in forty-five wrists. Complete resolution of the synovitis occurred in 81.5 per cent of the wrists. In two patients the tendons ruptured soon after operation and in both cases this was due to prolapse of the ulnar stump after an associated Darrach procedure. The
Laboratory experiments and clinical investigations have confirmed the various claims made originally by Buchholz and Engelbrecht (1970) that antibiotic-loaded acrylic cement releases the antibiotic into the surroundings in useful concentrations. Palacos R cement released higher concentrations than CMW, Simplex and Sulfix brands of cement and over longer periods. Concentrations of gentamycin and fucidin were sufficient to penetrate dead cortical bone. These conclusions need to be assessed with animal studies, mechanical testing and
The results of Charnley stabilisation of the hip in forty-three patients observed for one to four and a half years are reported. The operation readily produced a bony fusion in young patients and also in some of the older ones. Fibrous ankylosis, with or without some movement in the joint, gave an excellent result. Even when a pseudarthrosis or a stress fracture occurred, the
The optimal method of tibial component fixation remains uncertain
in total knee arthroplasty (TKA). Hydroxyapatite coatings have been
applied to improve bone ingrowth in uncemented designs, but may
only coat the directly accessible surface. As peri-apatite (PA)
is solution deposited, this may increase the coverage of the implant
surface and thereby fixation. We assessed the tibial component fixation
of uncemented PA-coated TKAs Patients were randomised to PA-coated or cemented TKAs. In 60
patients (30 in each group), radiostereometric analysis of tibial
component migration was evaluated as the primary outcome at baseline,
three months post-operatively and at one, two and five years. A
linear mixed-effects model was used to analyse the repeated measurements.Aims
Patients and Methods
We describe 88 knees (79 patients) with lateral unicompartmental osteoarthritis which had been treated by the St Georg Sled prosthesis. At a mean follow-up of nine years (2 to 21) 15 knees had revision surgery, nine for progression of arthritis, six for loosening, four for breakage of a component and four for more than one reason. Six patients complained of moderate or severe pain at the final follow-up. Only five knees were lost to follow-up in the 21-year period. We performed survivorship analysis on the group using revision for any cause as the endpoint. At ten years the cumulative survival rate was 83%, and at 15 years, when ten knees were still at risk, it was 74%. Based on our
An abnormal lateral position of the tibial tuberosity causes distal malalignment of the extensor mechanism of the knee and can lead to lateral tracking of the patella causing anterior knee pain or objective patellar instability, characterised by recurrent dislocation. Computer tomography is used for a precise pre-operative assessment of the tibial tubercle-trochlear groove distance. A distance of more than 15 mm is considered to be pathological and an indication for surgery in symptomatic patients. In a prospective study we performed a subtle transfer of the tibial tuberosity according to the information gained from the pre-operative CT scan. This method was applied to two groups of patients, those with painful lateral tracking of the patella, and those with objective patellar instability. We evaluated the
Of 92 children reviewed three to five years after treatment for fractured neck of femur (Lam 1976), we have been able to reassess 41, both clinically and radiographically, at 13 to 23 years after injury. The earlier
We performed eight osteochondral autologous transplantations from the knee joint to the shoulder. All patients (six men, two women; mean age 43.1 years) were documented prospectively. In each patient the stage of the osteochondral lesion was Outerbridge grade IV with a mean size of the affected area of 150 mm. 2. All patients were assessed by using the Constant score for the shoulder and the Lysholm score for the knee. Standard radiographs, magnetic resonance imaging and second-look arthroscopy were used to assess the presence of glenohumeral osteoarthritis and the integrity of the grafts. After a mean of 32.6 months (8 to 47), the mean Constant score increased significantly. Magnetic resonance imaging revealed good osseointegration of the osteochondral plugs and congruent articular cartilage at the transplantation site in all but one patient. Second-look arthroscopy performed in two cases revealed a macroscopically good integration of the autograft with an intact articular surface. Osteochondral autologous transplantation in the shoulder appears to offer good
We studied the natural history of Perthes’ disease in 62 children in whom the onset of symptoms was in adolescence. Three patterns of disease were noted, namely, late-onset pattern, segmental collapse, or destructive with failure of revascularisation. In the late-onset pattern, the disease followed the sequence of healing seen in younger children, but adequate epiphyseal remodelling did not occur. Consequently, the femoral head was never spherical after revascularisation. With segmental collapse, early and irreversible collapse of part of the epiphysis occurred with gross deformation of the femoral head. The destructive pattern was characterised by a failure of revascularisation and repair of the avascular epiphysis. The radiological outcome was poor in all three patterns. The poorest
Thirty-seven patients have been reviewed after arthrodesis of the ankle in order to determine the reduction of dorsiflexion and plantarflexion of the foot, the incidence of tarsal hypermobility and its relevance to the
We have reviewed 20 patients stage-IIIB and stage-IV Kienböck’s disease in order to examine the efficacy of two forms of radial osteotomy, namely radial wedge osteotomy and radial shortening. Lateral closing wedge osteotomies and radial shortenings were carried out on 11 and nine patients, respectively. There were no preoperative differences with respect to age, gender, and radiological stage. After a mean follow-up of 29 months, all patients, in both groups, had either a good or an excellent outcome. After the lateral closing wedge osteotomy, the radioscaphoid angle significantly increased and the St̊hl index significantly decreased. Progression of the degenerative changes at the radioscaphoid joint was found in two patients in this group. By contrast, there were no significant changes in any radiological parameters after radial shortening. Both procedures gave acceptable
1. Fifty-two patients with Perthes' disease (affecting both hips in six instances) have been reviewed ten or more years after the beginning of treatment. 2. Judged radiographically, approximately one-third developed good, one-third fair and one-third poor femoral heads. 3. The
Fourteen cases of hemiarthroplasty for four-part fractures of the proximal humerus were reviewed. Pain relief was satisfactory, but function was limited, mainly due to loss of glenohumeral abduction despite electromyographic proof of actively contracting abductors in all cases. Analysis of special radiographs of nine cases showed a direct relationship between the
Shelf operations performed on 24 patients (27 hips) for late presentation of congenital hip dysplasia were evaluated. The mean age at operation was 14 years 9 months and the mean follow-up 16 years 8 months. Two-thirds of the hips had good
Six highly unstable elbows with severe bone loss due to rheumatoid arthritis were replaced by a non-constrained, unlinked prosthesis. Bone defects were filled with autogenous bone grafts. The mean follow-up was 4.5 years (2 to 8). The