We describe 83 knees (69 patients) which had had patellectomy for anterior knee pain (52), patellofemoral osteoarthritis (25) or comminuted fractures (6) between 1942 and 1978. The patients were questioned about their symptoms and the function of the operated knee 14 to 50 years after operation. In the group with anterior knee pain, 76% achieved good results and were satisfied with the operation. Only 54% of the osteoarthritis group had satisfactory relief of pain and most had progressive deterioration of function. Sixteen patients who had had unilateral patellectomy were assessed by dynamometry, ultrasound and
In order to study the effect of pure torsional forces upon the rotational development of the growing tibia, 35 immature rabbits underwent torsional loading of one tibia in vivo with a spring-loaded cylinder while the other tibia was a control. The
Forty-three patients with unilateral congenital short tibia with partial or complete absence of the fibula are reviewed. The factors influencing the degree of leg shortening at maturity are considered. Serial
This paper reports a detailed examination of three lesions of aseptic necrosis of bone occurring in a man who had worked in compressed air eleven years previously. Although two of the lesions were juxta-articular, in neither had the bone collapsed. Histology of only one similar lesion is reported in the literature (McCallum et al. 1966). Necropsy material is considered, together with radiographs and bone scans of the same lesions taken four years earlier. Similar changes have been shown to occur in commercial divers. On the evidence of this case it becomes clear that
1. Based on studies in seventy-five patients, a technique is described for body surface activity measurements over localised skeletal lesions up to one month after injection of the λ-emitting isotopes Ca. 47. and Sr. 85. . 2. The activity was high over skeletal lesions like fracture, metastatic cancer, eosinophilic granuloma, chondroma, osteomyelitis and Paget's disease. 3. The high isotope uptake is interpreted as evidence of an increased rate of bone tissue turnover. 4. These findings suggest that external counting of Ca. 47. and Sr. 85. may be used for quantitation of the rate of formation of normal and pathological bone tissue. A special application would be localisation and delineation of metastatic cancer in cases where
We reviewed at a minimum elapsed time of five years a consecutive series of 143 primary Exeter hip replacements in which matt-surfaced femoral stems had been used. Twenty-five patients had died and six stems and two sockets had been revised before follow-up. The remaining 110 hips were all examined clinically and radiographically. In 15 hips there were
We have reviewed the results of 19 ankle arthrodeses in 18 patients by a new technique of posterior internal compression. Sixteen of the ankles fused at a mean time of 14 weeks and the other three after reoperation. Complications included one case each of infection, Sudeck's atrophy and non-fatal pulmonary embolism. Clinical assessment using Mazur's ankle score showed excellent or good results in nine ankles and three painfree ankles in patients who were wheelchair-bound for other reasons. The mean position of fusion was in 1.7 degrees equinus and 0.8 degrees varus, and the mean range of midtarsal movements was 15.8 degrees. Twelve patients showed
Medial tibial plateaux excised during 46 unicompartmental arthroplasties for osteoarthritis were collected and photographed. The anterior cruciate ligament was intact in all joints. In every case the cartilage and bone erosion was centred anteriorly on the plateau and the posterior cartilage was intact. The site of the lesion and the intact state of the cruciate ligaments taken together explain why varus deformity was observed only in the extended knee, and why the deformity was correctable and had not become fixed. Failure of the anterior cruciate ligament may allow the erosion to extend posteriorly, producing fixed varus deformity and leading to degeneration of the lateral compartment. Anteromedial osteoarthritis is a distinct clinicopathological entity; its
We reviewed the results of 277 intertrochanteric valgus-extension osteotomies performed between 1973 and 1975 for primary or secondary osteoarthritis. The average age of the patients was 51 years and follow-up varied from 11 to 15 years. At the latest evaluation 67% of the hips were good or excellent on the Merle D'Aubigne scale. Better results were obtained in patients under 40 years of age with unilateral involvement and a mechanical (secondary) aetiology. An elliptical femoral head, minimal subluxation and an adequate pre-operative range of motion were also favourable. There was
Computed tomography was performed on 40 patients with recent hip trauma.
We report 60 benign bone tumours treated by resection and curettage followed by the implantation of calcium hydroxyapatite ceramic (CHA). After follow-up of six to 60 months (average 36), no patient had local recurrence of the tumour or any adverse effects from the implants. In almost all cases
We used ultrasound to investigate the anatomy and stability of the hip during the phase of joint stabilisation after closed reduction of unilateral late CDH in 15 infants aged from two to 15 months. Conservative treatment by splintage in abduction led to complete stability in all hips in from three to 13 weeks. Immediately after reduction, interposed soft tissue caused lateralisation of the femoral head, but this progressively disappeared, and the initially smaller femoral head on the dislocated side regained normal size. Ultrasonic evaluation of the hip in late CDH is a valuable and safe tool; it reduces the need for
It has been suggested that matrix metalloproteinase-3 (MMP-3, stromelysin-1) has an important role in the degeneration of intervertebral discs (IVDs). A human MMP-3 promoter 5A/6A polymorphism was reported to be involved in the regulation of MMP-3 gene expression. We suggest that IVD degeneration is associated with 5A/6A polymorphism. We studied 54 young and 49 elderly Japanese subjects. Degeneration of the lumbar discs was graded using MRI in the younger group and by
Some arthritic knees with varus deformity show excessive valgus angulation of the femoral joint surface with proximal tibia vara. This causes a downward and medial inclination of the articular surfaces in the coronal plane. The patients we studied had a medial shift of the standing load-bearing axis, and arthritic changes mainly in the medial compartment. Some also had lateral tibial subluxation with twisting of the distal femur and proximal tibia in opposite directions. We assessed the articular geometry by precise
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 dysplasia. Statistical analysis identified the
We report four patients with a mean age of 17 years (14 to 22) with external rotation injuries of the knee in slight flexion.
Thirty-four patients with adolescent idiopathic scoliosis were assessed by
In the search for a simple method of assessing the therapeutic efficacy of sodium fluoride, a prospective study of vertebral
The cavities left after resection of bone bridges for partial closure of growth plates in children have commonly been filled with free fat grafts. Such cavities have been seen to elongate and thus enlarge during growth after the operation, but the fate of the grafts has been unknown. Similar cavities, made in the tibiae of growing pigs were filled with autogenous fat and studied by
Cemented Ti-6Al-4V components were used to resurface ten femoral heads in nine young adult patients with osteonecrosis of the femoral head (average age 32 years; range 20 to 51). There were eight hips at Ficat stage III and two at stage IV. Five hips have maintained satisfactory function for an average period of 11.2 years (10 to 12.2) with no