Thirty-three children with traumatic dislocation of the hip who had been treated at the Hospital for Sick Children between 1960 and 1977 were reviewed. The amount of trauma causing dislocation of the hip in younger children was less than that for older children. The most frequent complication was soft-tissue interposition which usually required a posterior arthrotomy to clear the interposed tissue. Less frequent complications included avascular necrosis, redislocation of the hip and an irreducible hip. Nineteen children were reviewed with an average follow-up time of
The results of 276 cemented revision total hip arthroplasties performed for aseptic failure between 1977 and 1986 have been reviewed. The mean time between revision and review was 75 months (range 30 to 144). Of 220 cases available for review, 159 were assessed clinically and radiographically, and 32 by postal questionnaire. Eighteen hips required further revision, 12 for loosening, two for sepsis, two for persistent pain, and one each for fracture and recurrent dislocation. A further six hips were radiologically and symptomatically loose. Pain was mild or absent in 83%. Over half were able to walk a mile or more; 70% flexed more than 70 degrees; 15% had a flexion deformity, but in only 7% was this more than 10 degrees. The mean Harris hip score was 74. Survival at five years was 95% and at
Forty patients with tuberculosis of the lower cervical spine (second to seventh cervical vertebrae) have been reviewed. Pain and stiffness were important and dominant symptoms. Two types of disease were recognised. In children under
We investigated the spines of 15 patients who had significant leg-length inequality as a result of femoral shaft fractures sustained after skeletal maturity but below the age of 21 years. The patients were examined at least
Thirty-four patients wtih fibrodysplasia (syn., myositis) ossificans progressiva are described. Marked delay in diagnosis was usual, but all had characteristic skeletal malformations and ectopic ossification. The clinical features included: four types of malformation of the big toe, reduction defects of all digits, deafness, baldness of the scalp, and mental retardation. Progression of disability was erratic in all, but severe restriction of movement of the shoulder and spine was usual by the age of
Exchange operation is recommended as the treatment of choice for most deep infections involving a total hip replacement. This revision arthroplasty comprises, in one stage, excision of soft tissue, removal of implant and cement, replacement with an appropriate implant using Palacos R acrylic cement loaded with an appropriate antibiotic and, more recently, systemic antibiotics. During our first
Total hip replacement using an alumina head and socket and a titanium alloy stem is evaluated in a series of patients under 50 years of age. Between April 1977 and December 1986, 86 such replacements were performed in 75 patients, but mainly because patients had difficulty travelling from Africa, only 71 hips were followed up adequately; of these, 56 were primary procedures and 15 revisions. Survivorship analysis showed that 98% of the prostheses were retained for
We have reviewed a series of 94 Chiari pelvic osteotomies carried out from 1966 to 1982. In 83 hips the indication for surgery had been pain, and of these patients 73 (88%) had appreciable relief within one year of operation. The other 11 hips were all in children and were painless; in them the osteotomy had successfully stabilised progressive subluxation of the hip. At review after a mean follow-up of
Of 47 patients with spina bifida who had had transplantation of the iliopsoas more than
A method of analysing the results of knee replacement operations, which makes it possible to estimate the annual failure rate and the proportion of implants which will survive successfully for
From 1970 to 1980 cemented metal-on-plastic total hip replacement was performed on 799 hips with primary osteoarthritis using one surgical technique. At the 10- to 20-year follow-up there had been 97 revisions for mechanical loosening. Univariate survivorship analysis showed that an increased risk of revision was associated with male gender, young age at primary THR, the Brunswik and Lubinus snap-fit prostheses with large femoral heads (as compared with the Charnley prosthesis), and varying experience of the surgeon. Multivariate statistical analysis showed a three-fold increased risk of revision for men (p <
0.0001), an increase in relative risk of 1.8 per
We treated 37 infants with 53 idiopathic club feet by posterolateral release alone at a mean age of 2.4 months. They were reviewed after a mean follow-up of
We have evaluated two methods of surgical treatment of adolescent idiopathic double major scoliosis in 59 patients. In group 1, 31 patients were treated by fusion of the upper curve only. In group 2, 28 patients had lumbar fusions also including most of the lower curve. The magnitude of the lower curve and the correction obtained in traction were good indicators of the correction achieved postoperatively. Forty-four patients were reviewed at a minimum of
We reviewed the results of 545 consecutive total hip replacements using a cementless non-coated high-density polyethylene acetabular component combined with a cemented Muller stem at five to
The results of treating 148 hips in 135 children (aged 7 to 16 at the onset of management) for Perthes' disease are analysed. Cases are classified according to the amount of epiphysial containment and the results assessed according to the degree of preserved sphericity. It is concluded that to obtain satisfactory results in this age group treatment should be prolonged until the restitution of the epiphysis so as to maintain the initially achieved containment throughout the reparative process. Containment should be secured initially as follows: by non-operative treatment, in children aged seven to nine years with contained and also with slightly subluxated epiphyses; by femoral osteotomy, in children aged seven to nine years with severely subluxated epiphyses and also in children aged 10 and more with slightly subluxated epiphyses; by Salter's osteotomy, in children aged
Forty-eight patients with achondroplasia and 24 with hypochondroplasia have been reviewed in order to clarify the differences between the two disorders and establish the height, body proportions and other clinical and radiological variations within each group. Some of the "classical" findings in achondroplasia are not always present, and hypochondroplasia at its most severe is indistinguishable from achondroplasia at its least severe. The frequency of spinal stenosis and neurological complications was established in an unselected group of 27 achondroplastic and 12 hypochondroplastic patients aged
The incidence of clinically significant avascular
necrosis (AVN) following medial open reduction of the dislocated
hip in children with developmental dysplasia of the hip (DDH) remains
unknown. We performed a systematic review of the literature to identify
all clinical studies reporting the results of medial open reduction
surgery. A total of 14 papers reporting 734 hips met the inclusion
criteria. The mean follow-up was
The primary aim of this study was to compare the knee-specific functional outcome of patellofemoral arthroplasty with total knee arthroplasty (TKA) in the management of patients with patellofemoral osteoarthritis. A total of 54 consecutive Avon patellofemoral arthroplasties were identified and propensity-score-matched to a group of 54 patients undergoing a TKA with patellar resurfacing for patellofemoral osteoarthritis. The Oxford Knee Score (OKS), the 12-Item Short-Form Health Survey (SF-12), and patient satisfaction were collected at a mean follow up of 9.2 years (8 to 15). Survival was defined by revision or intention to revise.Aims
Patients and Methods
From 1975 to 1990 we performed subtalar or triple arthrodesis on 54 patients; 48 of them were reviewed after a mean follow-up of
We present the electromyographic (EMG) results
ten years after open decompression of the median nerve at the wrist
and compare them with the clinical and functional outcomes as judged
by Levine’s Questionnaire. This retrospective study evaluated 115
patients who had undergone carpal tunnel decompression at a mean
of