Resurfacing of the patella in young patients.

The results of prosthetic resurfacing of the patella in 15 knees of 14 patients who ranged in age from 18 to 38 years at the time of surgery have been presented. The results were excellent in two knees, good in one knee, fair in eight knees, and poor in four knees. No mechanical failures occurred. The follow-up period ranged from 6 weeks to 8 years. I believe that the use of prosthetic resurfacing of the patella should be limited to patients, regardless of age, who have grade 3 or 4 chondromalacia of the patella and extremely poor quadriceps function. These are patients who have remained grossly symptomatic in spite of continuous conservative and/or surgical treatment for a period of at least 2 years.

Cystic degeneration and calcification of muscle: late sequelae of compartment syndrome.

Cystic degeneration and calcification of the leg are uncommon late sequelae of compartment syndrome. Previously reported cases have all involved the anterior compartment of the leg. We present a 68-year-old man with a mass in the superficial posterior compartment of the leg who presented 37 years after the initial trauma and ischemic myonecrosis. MRI was useful in establishing the diagnosis and early surgical intervention. The mass was excised and closed primarily over a drain. Patient was followed up for 29 months, and there were no secondary infections, chronic sinus formation, or recurrences. Based on our experience and the available literature review, we recommend considering either excision and primary closure, or repeated needle aspiration of the mass. Packing the wound and delayed closure may lead to secondary infection, chronic sinus formation, and lower limb amputation as potential complications.

Prosthetic resurfacing of the patella.

Accumulated data from many sources seem to indicate that prosthetic resurfacing of the patella may be an acceptable alternative to patellectomy in the treatment of chondromalacia patellae or patellofemoral arthrosis. A patellar prosthesis which is made of cobalt-chromium alloy is attached to a remnant of the original patella by means of the acrylic cement, polymethyl methacrylate. An analysis fo the results of the use of this prosthesis in 14 knees of 13 patients reveals excellent or good results in 13 cases and one poor result. The longest follow-up period was 2 years and 9 months and the shortest was 6 weeks. Based on current experience and the experience of others, prosthetic resurfacing of the patella may give the patient some years of pain-free patellofemoral function. This is especially true in patients with poor quadriceps reserve in whom the lever-arm distance of the extensor torque should be maiwtained. Until the ideal resurfacing material is developed, the use of presently available patellar prostheses with or without femoral prosthetic components, is recommended for further investigation.

A comparison of patellectomy with prosthetic replacement of the patella.

Eight adult mongrel dogs were used to compare patellectomy with prosthetic replacement of the patella. All of the dogs who underwent patellectomies displayed functional disturbances when examined four weeks postoperatively. None of the dogs with patellar prostheses displayed discernible functional disturbances. All but one of the dogs with patellectomies developed pathological alterations in the patellar bed of the femur. None of the dogs with patellar prostheses had pathological alterations in the patellar bed of the femur.

Cystic degeneration and calcification following ischemic paralysis of the leg.

Increased pressure within a closed space which leads to a compromise of the circulation and function of tissues is referred to as a compartmental syndrome. The resulting changes range from the mild reversible ones to extensive necrosis and fibrosis. Rarely, a cystic calcified mass may develop in the affected area years after the onset of ischemia. Two such cases which involve the lower limb have been reported by Gallie. The authors report one new case of late cystic degeneration and calcification following ischemic paralysis of the leg.

Fracture of a metal-backed acetabular cup. A case report.

In this case of fracture of a metal-backed polyethylene acetabular component after a total hip arthroplasty, there was no history of difficulties prior to the component fracture and no history of trauma.

Aggressive angiomyxoma of the female pelvis and perineum: review of the literature.

Aggressive angiomyxoma is an uncommon neoplasm which predominantly involves the pelvis and perineum of young White females. Misdiagnosis is common. Treatment typically involves surgery, and in spite of apparently complete resection, recurrences are common. Local spread into the adjacent fascia and musculature is frequently reported, and rarely, extension into intestine and bladder. The first reported case of pubic bone involvement, including its histology, radiologic features, and operative management, is discussed. Including this patient, 26 women with this tumor have been reported in the literature and are reviewed, along with 2 previously reported cases from the University of New Mexico Tumor Registry.

Femoral neck fractures in patients receiving long-term dialysis.

The morbidity and mortality of 11 femoral neck fractures were analyzed to compare operative and conservative management of femoral neck fractures in dialysis patients. All fractures occurred in older men with severe cardiac, pulmonary, gastro-intestinal, and neurologic conditions and with advanced renal osteodystrophy. Six of the seven operated patients survived the surgery and achieved varying degrees of ambulation. Stability of the operated hip was excellent in each case. Post-operative complications included transient confusional state related to narcotics, pneumonia, decubitus ulcers, and severe hypoalbuminemia. All four patients who were managed conservatively died from complications of the fracture. Progressive deterioration was noted in each nonoperated patient, with confusion caused by narcotics and analgesics, pneumonia, hepatic coma, decubitus ulcers, severe depression, and severe hypoalbuminemia. Therefore, operative management was superior to conservative management for femoral neck fractures of patients receiving chronic dialysis with multiple medical problems and advanced renal osteodystrophy. Narcotics must be used with great caution, and efforts should be directed toward prevention of malnutrition and decubitus ulcers.