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The Journal of Bone & Joint Surgery British Volume
Vol. 85-B, Issue 7 | Pages 1088 - 1088
1 Sep 2003
WAINWRIGHT AM AULD T BENSON MK THEOLOGIS TN


The Journal of Bone & Joint Surgery British Volume
Vol. 84-B, Issue 7 | Pages 1020 - 1024
1 Sep 2002
Wainwright AM Auld T Benson MK Theologis TN

We have assessed the reliability of four classification systems for club foot. Four observers evaluated nine children (18 feet) at different stages in the first six months of life, a total of 180 examinations. Each observer independently assessed all feet according to the classification systems described by Catterall, Diméglio et al, Harrold and Walker, and Ponseti and Smoley.

The variation between observers was assessed using the kappa test which for no more agreement than chance has a value of 0, and for complete agreement between observers a value of 1. The kappa values varied between 0.14 and 0.77 depending on which classification system was used. The system of Diméglio et al was found to have the greatest reliability.

Our findings suggest that current classification systems for the analysis of congenital talipes equinovarus are not entirely satisfactory.


The Journal of Bone & Joint Surgery British Volume
Vol. 83-B, Issue 7 | Pages 988 - 995
1 Sep 2001
Porter DE Benson MK Hosney GA

We defined the characteristics of dysplasia and coxa valga in hereditary multiple exostoses (HME) by radiological analysis of 24 hips in 12 patients. The degree and effect of the ‘osteochondroma load’ around the hip were quantified.

We investigated the pathology of the labrum and the incidence of osteoarthritis and of malignant change in these patients. Coxa valga and dysplasia were common with a median neck-shaft angle of 156°, a median centre-edge angle of 23° and Sharp’s acetabular angle of 44°. There was overgrowth of the femoral neck with a significantly greater ratio of the neck/shaft diameter in HME than in the control hips (p < 0.05), as well as correlations between the proximal femoral and pelvic osteochondroma load (p < 0.05) and between the proximal femoral osteochondroma load and coxa valga (p < 0.01). Periacetabular osteochondromas are related to Sharp’s angle as an index of dysplasia (p < 0.05), but not coxa valga. No correlation was found between dysplasia and coxa valga.

These data suggest that HME may cause anomalies of the hip as a reflection of a generalised inherited defect, but also support the theory that osteochondromas may themselves precipitate some of the characteristic features of HME around the hip.


The Journal of Bone & Joint Surgery British Volume
Vol. 80-B, Issue 3 | Pages 556 - 556
1 May 1998
MCNALLY EG FRCR BENSON MK


The Journal of Bone & Joint Surgery British Volume
Vol. 79-B, Issue 5 | Pages 724 - 726
1 Sep 1997
McNally EG Tasker A Benson MK

We performed MRI on 13 infants after operative reduction for developmental dysplasia of the hip (DDH). Using an axial gradient-echo sequence, MRI accurately depicted the acetabular anatomy and confirmed adequate reduction in 12 patients. The one patient with redislocation after surgery was correctly identified. MRI can be carried out quickly, inexpensively and without risk of radiation and is the investigation of choice to confirm adequate reduction in DDH.


The Journal of Bone & Joint Surgery British Volume
Vol. 79-B, Issue 4 | Pages 621 - 623
1 Jul 1997
Ballaro A Gibbons CLM Murray DM Kettlewell MGW Benson MK

Acute colonic pseudo-obstruction is a poorly recognised and potentially fatal complication of hip surgery.

Between 1991 and 1994 six patients were observed who required laparotomy after failure of medical management. In three the indication was signs of peritonism, while in the other three exploration was required to exclude segmental ischaemia and to decompress the bowel. In all, there was no evidence of mechanical obstruction.

Patients having total hip replacement are at risk of developing pseudo-obstruction due to their age, comorbidity, high doses of analgesics and the nature of the operation. If postoperative ileus persists for more than 48 hours acute colonic pseudo-obstruction should be suspected and confirmed by plain radiography. Prompt recognition and treatment with early referral to a colorectal unit are indicated. Laparotomy appears to carry less risk than that for patients with idiopathic pseudo-obstruction, but should be performed only if colonic ischaemia is suspected.