We investigated the early results of modular porous metal components used in 23 acetabular reconstructions associated with major bone loss. The series included seven men and 15 women with a mean age of 67 years (38 to 81), who had undergone a mean of two previous revisions (1 to 7). Based on Paprosky’s classification, there were 17 type 3A and six type 3B defects. Pelvic discontinuity was noted in one case. Augments were used in 21 hips to support the shell and an acetabular component-cage construct was implanted in one case. At a mean follow-up of 41 months (24 to 62), 22 components remained well fixed. Two patients required rerevision of the liners for prosthetic joint instability. Clinically, the mean Harris Hip Score improved from 43.0 pre-operatively (14 to 86) to 75.7 post-operatively (53 to 100). The mean pre-operative Merle d’Aubigné score was 8.2 (3 to 15) and improved to a mean of 13.7 (11 to 18) post-operatively. These short-term results suggest that modular porous metal components are a viable option in the reconstruction of Paprosky type 3 acetabular defects. More data are needed to determine whether the system yields greater long-term success than more traditional methods, such as reconstruction cages and structural allografts

The National Institute for Clinical Excellence (NICE) produces recommendations on appropriate treatment within the National Health Service (NHS) in England and Wales. The NICE guidelines on prophylaxis for venous thromboembolism in orthopaedic surgery recommend that all patients be offered a low molecular weight heparin (LMWH). The linked hospital episode statistics of 219 602 patients were examined to determine the rates of complications following lower limb arthroplasty for the 12-month periods prior to and following the publication of these guidelines. These were compared with data from the National Joint Registry (England and Wales) regarding the use of LMWH during the same periods. There was a significant increase in the reported use of LMWH (59.5% to 67.6%, p < 0.001) following the publication of the guidelines. However, the 90-day venous thromboembolism events actually increased slightly following total hip replacement (THR, 1.69% to 1.84%, p = 0.06) and remained unchanged following total knee replacement (TKR, 1.99% to 2.04%). Return to theatre in the first 30 days for infection did not show significant changes. There was an increase in the number of patients diagnosed with thrombocytopenia, which was significant following THR (0.11% to 0.16%, p = 0.04). The recommendations from NICE are based on predicted reductions in venous thromboembolism events, reducing morbidity, mortality and costs to the NHS. The early results in orthopaedic patients do not support these predictions, but do show an increase in complications

Aims

The aim of this study was to evaluate the prosthesis characteristics and associated conditions that may modify the survival of total femoral endoprosthetic replacements (TFEPR).

We report the technique and early results of the Dwyer-Hartshill method for segmental fixation of the spine. This uses pedicular screws wired to a rectangular frame and is indicated after laminectomy

This was a randomised controlled trial studying the safety of a new short metaphyseal fixation (SMF) stem. We hypothesised that it would have similar early clinical results and micromovement to those of a standard-length tapered Synergy metaphyseal fixation stem. Using radiostereometric analysis (RSA) we compared the two stems in 43 patients. A short metaphyseal fixation stem was used in 22 patients and a Synergy stem in 21 patients. No difference was found in the clinical outcomes pre- or post-operatively between groups. RSA showed no significant differences two years post-operatively in mean micromovement between the two stems (except for varus/valgus tilt at p = 0.05) (subsidence 0.94 mm (. sd.  1.71) vs 0.32 mm (. sd. 0.45), p = 0.66; rotation 0.96° (. sd. 1.49) vs 1.41° (. sd. 2.95), p = 0.88; and total migration 1.09 mm (. sd. 1.74) vs 0.73 mm (. sd. 0.72), p = 0.51). A few stems (four SMF and three Synergy) had initial migration > 1.0 mm but stabilised by three to six months, with the exception of one SMF stem which required revision three years post-operatively. For most stems, total micromovement was very low at two years (subsidence < 0.5 mm, rotation < 1.0°, total migration < 0.5 mm), which was consistent with osseous ingrowth. The small sample makes it difficult to confirm the universal applicability of or elucidate the potential contraindications to the use of this particular new design of stem. Cite this article: Bone Joint J 2015; 97-B:595–602

1. The technique and results of arthroplasty of the metatarso-phalangeal joints for the grossly deformed forefoot are described. 2. The early results are very encouraging. 3. Attention is drawn to some of the complicating problems in rheumatoid arthritis, particularly the hazard of arteritis

1. It is suggested that the obstruction causing delayed reduction of the congenitally dislocated hip is the infolded limbus. 2. An operation is described by which the infolding limbus may be easily and safely removed. 3. The early results of the operation are reported. 4. The evidence for the original assumption is discussed

Conclusions based on forty-six osteotomies show this to be a sound pain-relieving operation for osteoarthritis of the hip. The field of operation has been widened and some of the disadvantages have been avoided by nail and plate fixation. Early results from this method are similar to those from osteotomy and immobilisation in plaster, and it seems likely that the relief of pain will be just as enduring

Aims

The use of vitamin E-infused highly crosslinked polyethylene (HXLPE) in total knee prostheses is controversial. In this paper we have compared the clinical and radiological results between conventional polyethylene and vitamin E-infused HXLPE inserts in total knee arthroplasty (TKA).

We investigated 14 patients with pyogenic flexor tenosynovitis for increased tissue pressures in involved digits. All showed raised pressures, in eight to 30 mmHg or more. These levels are consistent with a compartment syndrome. We describe the results of a modified operative technique which includes irrigation of the sheath and the leaving open of a lateral incision. This also allows early active mobilisation of the finger and has given satisfactory early results

1. High tibial osteotomy-above the tibial tubercle-gives good results in elderly patients disabled by arthritis of the knee. 2. A technique of operation is described in which fixation is secured by four pins gripped in compression clamps. 3. No other fixation is needed, and knee movements and walking are encouraged within a few days of operation. 4. The early results warrant further trial of the method

1. The properties and behaviour of ethoxyline resins, which are already well known in industry, are discussed. 2. Experiments in the use of these compounds for the bonding of fractures of the long bones of sheep are described. 3. There has been no evidence of toxic reaction to the presence of the resin in the tissues. 4. Application of the method to fractures in man has been studied, and two such fractures have been bonded with promising early results

Five cases of congenital pseudarthrosis of the tibia successfully treated by a free vascularised fibular graft are described. Follow-up ranged from 5 to 34 months with a mean of 17.5 months. The technique, which includes radical excision of abnormal bone and soft tissue around the pseudarthrosis, also permits primary bone lengthening, and correction of deformity. The early results indicate that satisfactory bony union is achieved in a relatively short period of time

We reviewed 80 shoulders (77 patients) at a mean follow-up of 44 months after insertion of a Grammont inverted shoulder prosthesis. Three implants had failed and had been revised. The mean Constant score had increased from 22.6 points pre-operatively to 65.6 points at review. In 96% of these shoulders there was no or only minimal pain. The mean active forward elevation increased from 73° to 138°. The integrity of teres minor is essential for the recovery of external rotation and significantly influenced the Constant score. Five cases of aseptic loosening of the glenoid and seven of dissociation of the glenoid component were noted. This study confirms the promising early results obtained with the inverted prosthesis in the treatment of a cuff-tear arthropathy. It should be considered in the treatment of osteoarthritis with a massive tear of the cuff but should be reserved for elderly patients

The use of standing radiographs to determine correction angles for high tibial osteotomy is not appropriate because the relative angle of the articular surfaces (condylar-plateau angle) in the weight-bearing knee changes after the osteotomy. This may give unpredictable results postoperatively. We found that the condylar-plateau angle in postoperative standing films is very similar to that seen in non-weight-bearing supine views, and suggest that these latter radiographs be used for pre-operative planning. We describe our early results, using a special osteotomy jig, in 140 knees

The early results of revision osteoarticular allografts in weight-bearing joints are reported. Sixteen consecutive patients underwent surgery over a six-year period between 1982 and 1988. At the time of review eight patients (50%) had surviving second allografts with an average follow-up time of 48 months (range 12 to 87). Five patients were graded excellent according to the Mankin scale, one good and two fair. Eight patients (50%) required further surgery, but only two patients came to amputation

In a prospective study, we evaluated the clinical results of 23 patients with a cryopreserved non-tissue-antigen-matched meniscal transplant at a follow-up of from two to five years. These early results were satisfactory in 20 patients. Three transplantations failed and the allografts were removed after 12, 20 and 24 months. Post-transplantation arthroscopy showed that most meniscal transplants had healed to the knee capsule. Histological examination showed revascularisation of the transplant and evidence of viable meniscal chondrocytes. The failures were probably caused by malalignment, resulting in impaired revascularisation of the graft

A prospective single-cohort study was designed to include 20 patients with enchondromas but was stopped because of poor early results. Four patients with an enchondroma, three in the proximal humerus and one in the distal femur, were treated by curettage and filling of the defect with Norian SRS cement. Clinical and radiological follow-up including CT and MRI was carried out for 18 months. All three patients with lesions in the proximal humerus had severe pain and limited movement of the shoulder. The radiological and CT appearances of the cement were unchanged at follow-up. There were characteristic appearances of synovitis and periosteitis on MRI in two patients. Since the cement induces a soft-tissue reaction the bony cavity should be sealed with the curetted and burred bone after curettage and introduction of Norian cement, especially in sites where a tourniquet cannot be applied

1. Further consideration has been given to the lateral rotation which occurs at the ankle joint in uncorrected club feet. 2. Medial rotation osteotomy of the tibia may be used to restore more normal alignment to the hind foot at the expense of an increase in varus of the forefoot, which must be corrected at a second operation. 3. The early results in seven feet treated in this manner are reported. 4. We hope that this paper will be regarded more as a contribution to the understanding of the anatomy of uncorrected club foot than as advocacy of a new method of surgical treatment

1. A new operation of body-to-body intervertebral fusion by grafts introduced through a posterior approach is described. This is a preliminary report of early results, with follow-up to two years, which seems to be encouraging. 2. In spondylolisthesis, abnormal mobility of the loose posterior neural arch is believed in itself to cause nerve root pressure, and excision of the arch is an important part of the operation. 3. In the few cases where spinal fusion is needed after removal of a prolapsed intervertebral disc—and the proportion is now very low—posterior intervertebral fusion has proved very satisfactory