Bulletin of the Hospital for Joint Diseases Orthopaedic Institute最新文献

Fifty-five medial osteoarthritic knees in 50 patients who had undergone high tibial osteotomies (HTO) were followed up twice: once, six years after surgery, and again, 10-15 years postoperatively. The results were satisfactory in 85% of the knees at the six-year follow-up and in 62% of the knees at the 10-year follow-up. The results post 10 or more years had deteriorated significantly compared to those seen six years postoperatively. In patients maintaining excellent improvement of knee function post 10 or more years, the mean femorotibial angle (FTA) one year after surgery had been 165 degrees; this value remained constant for 10 years postoperatively. The authors believe that an FTA of 164 degrees - 168 degrees should be set as a goal when performing a high tibial osteotomy to ensure favorable long-term results in HTO.

Adolescent patellofemoral disorders which are associated with recognizable change in the articular cartilage of the patella are called chondromalacia patellae. This is a clinical syndrome characterized by persistent retropatellar pain, but not always associated with histopathological changes of the articular cartilage. When lateral retinacular release is performed in such patients, pain is frequently eased even though lateral release does not always cause an appreciable change in patellofemoral contact pressure. This suggests that pain, at times, may emanate from the peripatellar retinacular supports themselves. Thirty-five knees of 22 patients suffering from anterior knee pain (with or without an unstable patella) were investigated histologically. Pathological changes in nerves were graded on a 0 to 3 + scale of severity. There was severe degenerative neuropathy in nine knees, moderate change in nine, and slight change in 11; the remaining six knees were normal. Histological investigation of the resected lateral retinaculum suggested that pain originated in the lateral retinaculum in many patients, and that degenerative changes in the nerves of the lateral retinaculum may be an important cause of pain in patients with patellofemoral disorders.

Idiopathic clubfeet in children three years of age or older which have not been treated previously or which have recurred, can be treated successfully by using the Ilizarov technique. The authors report on four feet in three children which were treated by this method. Follow-up examinations at 11-24 months found all corrections successfully maintained.

Unicompartmental replacement with a Marmor knee prosthesis was performed in 53 patients with unicompartmental osteoarthritis (OA). A five year or longer follow-up study of 15 joints in 13 of these patients was possible, three of which are now more than 10 years post-operative. All 13 patients reported absence of pain on weight-bearing and were able to flex the replaced knee more than 105 degrees. However, the postoperative femorotibial angle (FTA) appeared to be worsening with time, especially in those cases with an immediate postoperative FTA of more than 180 degrees. Since the needed size of the Marmor prosthesis is no longer available, we began using a ceramic prosthesis recently which we are introducing in this article.

A case is presented of a 13-year-old girl with thoracic level myelomeningocele who developed an infected pseudarthrosis of the lumbar spine after an attempted kyphosectomy. The pseudarthrosis was successfully united through the use of special modifications of the Ilizarov apparatus. Rings and wires were applied to the iliac wings below and the thoracic laminae above the pseudarthrosis site. Preoperative planning was aided by a CT scan of the pelvis and spine. A cut-out foam mattress and a special wheelchair were used postoperatively to facilitate patient care.

Unicompartmental arthroplasty using the Marmor Modular knee was performed in 27 knees of 24 patients--three men and 21 women--aged 51-82 years (average age 68.9 years). The disease was osteoarthritis in 19 knees, steroid arthropathy in two knees, Charcot joint in three knees, and rheumatoid arthritis in three knees. Medial replacement was done in 24 knees and lateral replacement in three knees. Follow-up was from 2-7 years (average 4 years 9 months). Post-operatively, 14 knees were reported to be free of pain and 11 only occasionally mildly painful. Walking distance improved to more than 1 km in 17 patients. The knee score improved from 40.4 to 72.2 points (p less than 0.01). Complications included two knees with loosening due to postoperative limb malalignment; there were no instances of infection or fracture.

We have as yet no method of treating osteoporosis because we have no clue to its etiology. A study of the evolution of a hen's egg may help us gain insight into the relationship of estrogen to bone formation in mammals.

In children, 20-mm threaded sockets can be used to attach half pins to an Ilizarov frame. Applications to the humerus and femur are described.

The histories of 36 Charcot joints (including four fractures) in 22 patients were investigated and a new stage classification system (Stage I-III) was introduced. Scintiscanning showed the uptake magnitude of radioactive substance in the Charcot lesions ranged from 6-22 times that of normal areas.