The results of using the Ring uncemented polyethylene-to-metal (UPM) prosthesis in patients with protrusio acetabuli or
1 . Six patients have been presented in whom an established diagnosis of non-osteogenic fibroma of bone was made. Metaplastic bone was identified within the tumour tissues. 2. Three other patients are reported in whom the diagnosis appeared to be, on radiological and histological grounds, either fibrous
The aim of this study was to report the long-term results of rotational acetabular osteotomy (RAO) for symptomatic hip dysplasia in patients aged younger than 21 years at the time of surgery. We evaluated 31 patients (37 hips) aged younger than 21 years at the time of surgery retrospectively. There were 29 female and two male patients. Their mean age at the time of surgery was 17.4 years (12 to 21). The mean follow-up was 17.9 years (7 to 30). The RAO was combined with a varus or valgus femoral osteotomy or a greater trochanteric displacement in eight hips, as instability or congruence of the hip could not be corrected adequately using RAO alone.Aims
Patients and Methods
We studied the pathogenesis, incidence and consequences of avascular necrosis in 184 children treated for congenital dislocation of the hip. Of 210 hips, 99 (47%) had some evidence of avascular necrosis (total 81, partial 18). The incidence was not influenced by the age at reduction, the duration of traction or the use of adductor tenotomy. Patients treated by closed reduction without preliminary traction did not have a higher incidence of avascular necrosis. At long-term clinical and radiological review of 81 hips, early avascular necrosis significantly increased the chance of a poor outcome but did not predispose to acetabular
Residual muscle weakness in obstetric brachial plexus palsy results in soft-tissue contractures which limit the functional range of movement and lead to progressive glenoid
Hyperphosphatasia, or hereditary bone
From 1956 to 1965, congenital dislocation of the hip was treated in a standard manner in 191 cases. Reduction and plaster immobilisation was followed by a period in a Batchelor type plaster in full medial rotation. Femoral neck anteversion was then corrected by derotation osteotomy. In 95 children 117 hips were treated in this way and have been reviewed annually for 18 to 27 years. In 1983 they were assessed; there were 101 hips with good clinical results; radiologically, on a modified Severin scale, 62 were good, 39 were fair and 16 were poor. Derotation osteotomy proved to be the stimulus for growth of the acetabular roof in most cases; its safety, ease of performance and predictability suggest that it is superior to other methods of correcting the
Debate continues about whether it is better to use a cemented or uncemented hemiarthroplasty to treat a displaced intracapsular fracture of the hip. The aim of this study was to attempt to resolve this issue for contemporary prostheses. A total of 400 patients with a displaced intracapsular fracture of the hip were randomized to receive either a cemented polished tapered stem hemiarthroplasty or an uncemented Furlong hydroxyapatite-coated hemiarthroplasty. Follow-up was conducted by a nurse blinded to the implant at set intervals for up to one year from surgery.Aims
Methods
To determine the natural history of dislocation of the hip in cerebral palsy, and to evolve methods to predict dislocation, the notes and radiographs of 462 patients with cerebral palsy were reviewed. Dislocation occurred in 10% of patients by progressive migration and subluxation of the proximal femur in the presence of acetabular
We implanted 300 uncoated cementless PM prostheses into 271 patients and followed 251 (92.6%) of them for four to seven years. By then 37 had already been revised for aseptic and three for septic loosening. The survival rate with implant failure as the endpoint was 88.8% for the cup and 85.3% for the stem after six years. There was a higher risk of implant loosening in congenital
The lumbar spines of 485 skeletons of adult South African "Whites" and "Blacks" of both sexes were examined to determine the incidence and morphology of defects in the pars interarticularis. The overall incidence was 3.5%, without significant variation between races and sexes. The incidence of lumbar spina bifida in the whole sample was 1.9%, but was 11.8% in those skeletons with spondylolysis. Some instances of unilateral spondylolysis demonstrated obvious callus formation, suggesting a capability for normal repair. It is possible that the defects in bilateral cases represent established non-union of fractures of the pars interarticularis resulting from excessive mobility, and are not due to
We treated 31 hips in 30 patients with advanced osteoarthritis of the hip secondary to acetabular
We evaluated scapular
We reviewed lesions of the femoral condyles seen in 5,000 knee arthroscopies, recording the findings and the age and sex of the patients. We were able to distinguish the characteristics of developing and late osteochondritis dissecans, acute and old osteochondral fractures, chondral separations, chondral flaps and idiopathic osteonecrosis, and suggest that these are separate distinct conditions. Haemarthrosis was associated only with acute osteochondral fractures. The characteristic feature of osteochondritis dissecans was an expanding concentric lesion at the 'classical' site on the medial femoral condyle which appeared during the second decade of life and progressed to a concave steep-sided defect in the mature skeleton. Caffey's (1958) classification of epiphyseal
In 1957 Somerville and Scott described their "direct approach" to the management of established congenital dislocation of the hip; arthrography after a period of traction served to distinguish the dislocated from the subluxated hip. We review the long-term outcome of hips which, using their criteria, were subluxated; 72 hips have been reviewed at periods ranging from 15 to 37 years after treatment by traction, closed reduction and femoral osteotomy. The results have been classified clinically and radiologically according to Severin's criteria. There was progressive deterioration with age in both clinical function and radiographic appearance: 48.5% of hips showed evidence of
Sixty-nine patients with congenital abnormality of the femur were reviewed. Their manifestation of femoral
1. Neurofibromatosis is a disease involving both neuro-ectodermal tissues and mesodermal elements. In the past it has usually been assumed that the mesodermal abnormalities were secondary to the neuro-ectodermal ones. For example, skeletal deformities were considered to be caused by local neurofibromata. 2. It is becoming increasingly recognised that in neurofibromatosis there may be abnormal development of bone without any local abnormality of neuro-ectodermal origin. Study of our patients confirms this view. Considerable deformity of vertebral bodies was demonstrated at sites where there was no evidence of any neurofibroma or other soft-tissue change. At other sites apparent erosion of bone was associated with the formation of a local meningocele. 3. The findings in this small series of patients with neurofibromatosis suggest that the scalloping of the vertebral bodies, deformity of pedicles and widening of the intervertebral foramina are usually caused by
The purpose of this study was to report the long-term results of extendable endoprostheses of the humerus in children after the resection of a bone sarcoma. A total of 35 consecutive patients treated with extendable endoprosthetic replacement of the humerus in children were included. There were 17 boys and 18 girls in the series with a median age at the time of initial surgery of nine years (interquartile range (IQR) 7 to 11).Aims
Methods
We have determined the natural history of hip development in 42 patients with multiple epiphyseal dysplasia (MED). Premature osteoarthritis was a frequent outcome and was almost inevitable before the age of 30 years in those with incongruent hips. There were two types of immature hips: type I, the more severe form, had a fragmented and flattened ossific nucleus and acetabular