The biomechanics of the hip joint provide an understanding of the development, evolution, and treatment of many disabling conditions of this joint. The available methods of biomechanical analysis include in vitro studies, in vivo studies, and theoretical mathematic analyses. The information obtained from these analyses have enabled the design of therapeutic programs to alleviate the symptoms of, and possibly delay the progression of, hip disease. The design of surgical procedures has been based on alterations of the biomechanics of the hip. These procedures have proven useful for treating pathologies such as osteoarthritis, hip dysplasia, and hip fractures. The study of biomechanics and biomaterials are integral to the current success of total hip arthroplasty in achieving pain relief and functional restoration. (+info)
Five-year assessment of controlled trials of short-course chemotherapy regimens of 6, 9 or 18 months' duration for spinal tuberculosis in patients ambulatory from the start or undergoing radical surgery. Fourteenth report of the Medical Research Council Working Party on Tuberculosis of the Spine.
(10/1315)
The five-year assessment of three randomised trials of short course (6, 9 or 18 months) chemotherapy for tuberculosis of the spine is reported. In Hong Kong patients were randomised to isoniazid plus rifampicin (HR) daily for 6 or 9 months, combined with radical surgical resection with bone grafting and streptomycin for 6 months for all patients. In Madras patients were randomised to chemotherapy with HR for 6 or 9 months, or 6 months HR chemotherapy combined with surgical resection. In Korea all patients were ambulatory and were randomised to different regimens of chemotherapy 6 or 9 months HR, or 9 or 18 months isoniazid plus ethambutol. (EH) or isoniazid plus PAS (PH). In all centres the results of the 6- and 9-month regimens of HR were excellent and similar to the 18-month EH and PH regimens. The 9-month EH/PH regimens were clearly inferior. In Hong Kong excellent results were achieved by the radical resection. The disease was however less extensive than in Madras, where the results after surgery were no better than with ambulatory chemotherapy. Chemotherapy is the critical factor in the management of tuberculosis of the spine. Efforts should be concentrated on ensuring that appropriate regimens are given under adequate supervision. (+info)
Effectiveness of glenoid osteotomy in atraumatic posterior instability of the shoulder associated with excessive retroversion and flatness of the glenoid.
(11/1315)
In this investigation, patients with atraumatic posterior instability of the shoulder were appraised in order to evaluate the effectiveness of glenoid osteotomy in the correction of excessive retroversion and flatness of the glenoid. In a series of 32 patients, 17 with posterior instability had no history of trauma. Posterior glenoid osteotomy was performed to correct excessive retroversion and to deepen the glenoid; 95% were re-examined after 5 years. In 81% the results were rated as good or excellent (Constant-Murley and Rowe scores), only 12.5% having had a recurrence. The glenoid could be deepened and on average the angle could be altered from -9.35 degrees to -4.62 degrees. In comparison, 50 volunteers had average angles of -4.4 degrees, thus differing significantly from the preoperative group. Twenty-five per cent of the patients showed postoperative degenerative changes in the glenohumeral joint. The study shows that excessive retroversion and flatness of the glenoid in persons with atraumatic posterior instability can be successfully treated by a posterior glenoid osteotomy. Nevertheless, the high rate of postoperative degenerative changes must be taken into account. (+info)
Screw versus suture fixation of Mitchell's osteotomy. A prospective, randomised study.
(12/1315)
We studied prospectively 30 patients who had a Mitchell's osteotomy secured by either a suture followed by immobilisation in a plaster boot for six weeks, or by a cortical screw with early mobilisation. The mean time for return to social activities after fixation by a screw was 2.9 weeks and to work 4.9 weeks, which was significantly earlier than those who had stabilisation by a suture (5.7 and 8.7 weeks, respectively; p < 0.001). Use of a screw also produced a higher degree of patient satisfaction at six weeks, and an earlier return to wearing normal footwear. The improvement in forefoot scores was significantly greater after fixation by a screw at six weeks (p = 0.036) and three months (p = 0.024). At one year, two screws had been removed because of pain at the site of the screw head. Internal fixation of Mitchell's osteotomy by a screw allows the safe early mobilisation of patients and reduces the time required for convalescence. (+info)
Halo femoral traction and sliding rods in the treatment of a neurologically compromised congenital scoliosis: technique.
(13/1315)
In severe congenital scoliosis, traction (whether with a halo or instrumental) is known to expose patients to neurologic complications. However, patients with restrictive lung disease may benefit from halo traction during the course of the surgical treatment. The goal of treatment of such deformities is, therefore, twofold: improvement of the respiratory function and avoidance of any neurologic complications. We report our technique to treat a 17-year-old girl with a multi-operated congenital scoliosis of 145 degrees and cor pulmonale. Pre-operative halo gravity traction improved her vital capacity from 560 c.c. to 700 c.c., but led to mild neurologic symptoms (clonus in the legs). To avoid further neurologic compromise, her first surgery consisted of posterior osteotomies and the implantation of two sliding rods connected to loose dominoes without any attempt at correction. Correction was then achieved over a 3-week period with a halofemoral traction. This allowed the two rods to slide while the neurologic status of the patient was monitored. Her definitive surgery consisted of locking the dominoes and the application of a contralateral rod. Satisfactory outcome was achieved for both correction of the deformity (without neurologic sequels) and improvement of her pulmonary function (1200 c.c. at 2 years). This technique using sliding rods in combination with halofemoral traction can be useful in high-risk, very severe congenital scoliosis. (+info)
Rotational acetabular osteotomy using biodegradable internal fixation.
(14/1315)
We used biodegradable poly-L-lactide screws in rotational acetabular osteotomy in 41 hips of 41 patients, and studied the complications after an average follow-up of 4.9 years (range 1.0-7.7 years). There were 39 females and 2 males, their average age at the time of the operation was 32 years (range 12-55 years). A small subcutaneous abscess appeared around the non-absorbable sutures in 2 patients after surgery. There was 1 case of thrombophlebitis and 1 of local dermatitis. The small subcutaneous abscess resolved after the removal of the suture material in the 2 cases, and the thrombophlebitis resolved with aspirin. The local dermatitis persisted but was cured by local steroid therapy over 5.8 years. The incidence of local dermatitis after the use of biodegradable implants should be further investigated. (+info)
External fixation in proximal tibial osteotomy: a comparison of three methods.
(15/1315)
During a period of 6 years (1990-1996), 154 patients with unilateral gonarthrosis underwent proximal tibial osteotomy using 3 different methods of external fixation: (1) closing wedge osteotomy and bilateral fixation; (2) closing wedge osteotomy with unilateral fixation, and (3) opening wedge osteotomy with unilateral fixation. The most common complications were pin-tract infection (25%), temporary nerve palsy (10%), and loss of alignment (17%). At least one complication developed in 33% of patients in this study, indicating that the use and technique of external fixation in proximal tibial osteotomy can be problematic. (+info)
Optimizing femorotibial alignment in high tibial osteotomy.
(16/1315)
OBJECTIVE: To study factors that affect femorotibial (F-T) alignment after valgus closing wedge tibial osteotomy. STUDY DESIGN: A review of standardized standing radiographs. Femorotibial alignment was measured 1 year postoperatively for over- and under-correction. Changes in F-T alignment and in tibial plateau angle were measured. SETTING: An urban hospital and orthopedic clinic. PATIENTS: Eighty-two patients with osteoarthritis and varus femorotibial alignment underwent valgus closing wedge tibial osteotomy. Patients having a diagnosis of inflammatory arthritis or a prior osteotomy about the knee were excluded. RESULTS: A 1 degree wedge removed from the tibia resulted in an average correction F-T alignment of 1.2 degrees. A knee that had increased valgus orientation of the distal femur had a greater degree of correction, averaging 1.46 degrees in F-T alignment per degree of tibial wedge. This resulted in excessive postoperative valgus alignment for some patients who had increased valgus tilt of the distal femur. Optimal F-T alignment of 6 degrees to 14 degrees valgus occurred when the postoperative tibial inclination was 4 degrees to 8 degrees of valgus. CONCLUSIONS: There was a trend for knees with increased valgus orientation of the distal femur to have greater correction in F-T alignment after tibial osteotomy, likely because of a greater opening up of the medial joint space during stance. Surgeons need to account for this in their preoperative planning. (+info)