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View my account settings1. Experimental evidence is advanced to suggest that the effect of the McMurray displacement osteotomy in osteoarthritis of the hip is to diminish the load carried by the head of the femur, firstly by correction of deformity, and secondly by a "pelvic support" action.
2. A review of seventy-five cases has revealed certain important details in selection and operative management. The end-results indicate that the operation, when correctly performed, is successful in relieving pain and diminishing disability.
1. The operation of pseudarthrosis of the hip joint is described and the results are assessed in ninety-three patients.
2. The result was good in eighty-three cases and poor in seven cases. Three patients died as a result of the operation.
3. Pseudarthrosis is the most satisfactory and the most reliable operation: 1) in ankvlosing spondylitis, and 2) in patients over sixty years of age with disabling osteoarthritis.
4. The more formidable operation of cup arthoplasty may prove to be superior in younger patients with osteoarthritis.
We have endeavoured to make known the results of a simple type of arthroplasty of the hip which is well tolerated even by elderly patients. It has not been the purpose of this article to compare former operations with our own, a newcomer in the field of surgery of the hip. In particular we do not wish to compare our comparatively recent results with Smith-Petersen's well-established method of cup arthroplasty—a magnificent contribution to the surgery of the region. The results we have already obtained, however, appear sufficiently favourable to merit further study and development of the method. If the future confirms the value of our early results, we shall perhaps be able to suggest operation to patients who suffer more from loss of function than from pain.
1. The operation of "dynamic" osteotomy is designed to secure a stable and freely mobile pseudarthrosis in cases of quiescent tuberculosis of the hip joint.
2. The principles and technique of the operation are described and illustrated.
3. The results of 224 operations are presented.
1. The anatomical and physiological principles underlying the operation of ischio-femoral arthrodesis by an anterior approach are discussed.
2. The technique of the operation is described.
1. The indications for open reduction in congenital dislocation of the hip are discussed.
2. The technique of the operation and the post-operative treatment are briefly described.
3. The results of the operation in fifty hips are presented.
4. The function and the radiographic appearances of the hip were usually good in the early years after open reduction, but there was a marked tendency to deterioration ten to thirteen years afterwards.
5. The indications for the shelf operation and for rotation osteotomy after open reduction are discussed.
1. Clinically, hallux rigidus is a painful condition of the joints of the great toe associated with loss of dorsiflexion of the first phalanx.
2. Pathologically, the morbid changes are those of a traumatic synovitis followed by an early development of osteoarthritis, the initial lesions of which are erosions of the cartilage at the centre and near the dorsal margin of the base of the proximal phalanx. There is no fundamental pathological difference between the adult and adolescent varieties of hallux ngidus. Both represent stages in the developmental cycle of osteoarthritis in the proximal joint of the great toe.
3. The radiographic density and apparent fragmentation of the phalangeal epiphysis do not represent an abnormality of the bone and have no significance in the etiology of hallux rigidus.
4. The cause of hallux rigidus is an abnormal gait developed either to protect an injured or inflamed metatarso-phalangeal joint from the pressure of weight-bearing, or to stabilise a hypermobile first metatarsal. The effects of this gait are to transfer most of the pressure from the flexor brevis tendon and the two sesamoids to the base of the first phalanx. Excessive pressure on this joint predisposes to osteoarthritis.
5. Evidence of this abnormal gait is found in the peculiarities of wear seen in old shoes.
6. There is a high correlation between unilateral hallux rigidus and the patient's footedness.
1. A case of osteochondritis of the cuboid, with co-existing tuberculosis of the third cuneiform bone, is reported.
2. The possible relationship between osteochondritis and tuberculosis is discussed.
1. Small indian ink marks were made at intervals along the length of tendons in the limbs of young rabbits, and the distance between the marks was measured during the operation. The rabbits were killed two to three months later, and the amount of longitudinal growth that had occurred was determined by re-measuring the distance between the marks.
2. The experiments showed that the whole of the tendon grows interstitially in length, but that maximal growth occurs near the muscle-tendon junction.
3. Histological examination of the tendons and control experiments involving adult tendons indicated that growth was not significantly interfered with by marking the tendons.
1. Synovial fluid acts mechanically by forming a convergent lubricant film between the fixed and the moving joint surfaces. This term and the underlying theory are explained.
2. The fatty pads assist lubrication by reducing the "mechanical curvature" in joints with more highly curved surfaces.
3. The intra-articular discs and menisci increase the "mechanical curvature" in joints with surfaces of small curvature.
4. Sesamoid bones exert a "bow-string pressure" upon the bones with which they articulate. This is a corollary from the theory of lubrication.