Greater trochanteric pain syndrome. A report of 15 cases.

Fifteen patients with identical symptoms of pain and tenderness at the tip of the greater trochanter are reviewed. Diagnosis by the referring doctor was usually osteoarthritis of the hip or sciatica, but localised tenderness and pain on resisted abduction were the only clinical signs. Radiographs were usually normal. Most cases were relieved by one or more local steroid injections. This disorder has much in common with tennis elbow, golfer's elbow, coccydynia and policeman's heel. We suggest that all these conditions may be traction syndromes.

The long-term results of Stanmore total knee replacements.

One hundred and three sequential Stanmore knee replacements were reviewed retrospectively on two occasions with a maximal follow-up period of nine years three months. This knee prosthesis, which is hinged, was successful in alleviating pain, stabilising an unstable knee and modestly increasing the arc of flexion. Walking capacity was increased and flexion contractures were reduced. There were seven cases of infection and four of fracture around the prosthesis. All these proved difficult to treat and two knees with both fracture and infection needed amputation. Eight knees were revised for aseptic loosening and a further 14 were found to have radiological signs of loosening. The results have been analysed by the methods advocated by Tew and Waugh and give a cumulative success rate of 80 per cent at seven years, provided success is judged solely by whether the prosthesis is still in situ. The role of the Stanmore knee as a primary arthroplasty is discussed.

The penetration of antibiotics into the normal intervertebral disc.

The role of antibiotics in the treatment of disc-space infection is controversial. This study assessed the tissue penetration of flucloxacillin and cephradine into the normal intervertebral disc after intravenous administration of a bolus dose of antibiotic. Twenty-five discs were removed from 12 adolescent patients having anterior spinal surgery to correct scoliosis; antibiotic had been administered between 30 minutes and four hours before operation. Despite high blood levels, no antibiotic could be detected by bioassay or by high-pressure liquid chromatography (h.p.l.c.) in any of the specimens from the nucleus pulposus or the annulus fibrosus.

A computer assisted orthopaedic surgical system for distal locking of intramedullary nails.

This paper presents a prototype system for computer assisted surgery, the purpose of which is to assist orthopaedic surgeons when performing distal locking of intramedullary nails. This system comprises three components, namely: an Intelligent Image Intensifier, a Trajectory Tactician and an Intelligent Trajectory Guide. The Intelligent Image Intensifier is an X-ray vision system that provides accurate X-ray images. Such images enable the Trajectory Tactician software to analyse the operation site and calculate the trajectory required for a screw to lock an intramedullary nail. This involves the capture of two X-ray images from which are extracted the projections of the nail's edge boundaries and its distal locking holes. Using an analytical mathematical model of the nail, the position and orientation of the nail is determined. The trajectory is then implemented by the surgeon using the Intelligent Trajectory Guide. Evaluation in the laboratory suggests that the system is capable of reliably inserting a locking screw into an intramedullary nail. The rapidity with which this computer assisted method achieves locking should benefit both patient and surgeon by reducing radiation dosage and the length of time required to lock a nail.

Hinged knee replacement in revision arthroplasty.

Fifty-two Stanmore hinged knee replacements were used as revision arthroplasties for failed arthroplasties. The patients were followed for a mean of 44.7 months. On clinical examination, 23% had good, 48% fair, and 29% poor results. Worst results were achieved when revising bulkier or more constrained primary knee joints. Two patients exhibited radiologic evidence of loosening, but at the latest follow-up examination no patients had clinical evidence of loosening. There was an infection rate of 4%. In view of the poor results and the advent of a new generation of knee arthroplasty devices, hinged knee implants may have only a limited place in revision arthroplasty.

Bilateral posterior dislocation of the shoulder.

The purpose of this article is to present two cases of bilateral posterior dislocation of the shoulder. A review of the previously reported cases reveals the rarity of this injury, its association with seizures and the frequency with which it is misdiagnosed.

Posterior lumbar interbody fusion and cages.

The author of the paper presents an overview of posterior lumbar interbody fusion (PLIF), including a historical note, a global surgical strategy as well as specific indications for this procedure (discogenic low back pain, spondylosis, spondylolisthesis, recurrent disc herniation, failed chemonucleolysis, spinal stenosis). A short description of surgical technique can also be found in the paper. The author also emphasises the possible complications linked with this procedure and the need for experienced surgeons in order to decrease the number of postoperative complications. Finally the paper contains a short description of the most commonly used implants during surgical corrections of lumbar biomechanics.

Patellar graft for late disability following tibial plateau fractures.

Patellar autografting as a primary procedure for depressed fractures of the lateral tibial plateau has been well discussed (Wilson and Jacobs, 1965). Three cases are documented in which this technique has been used as a salvage operation for late disability following severely comminuted fractures of one medial and two lateral tibial plateaux. All three patients had undergone previous attempts (one operative and two conservative) to reconstitute the depression in the proximal articular surface of the tibia.

The results and morbidity of varus osteotomy for Perthes' disease.

The results of varus proximal femoral osteotomy in 55 hips in 52 patients were analyzed by Harrison's radiologic autoassessment method. Excluding operations upon Catterall Grade 1 hips, 75.6% were either therapeutic successes or unchanged; 24.4% were therapeutic failures. These results are compared with and shown to be similar to those of patients treated conservatively by the Birmingham splint. In ten children with Catterall Grade 1 disease, seven were unchanged but three were therapeutic failures. Improved end results occurred in hips with greater surgical varus than those in which the end result worsened, but the statistical significance was questionable. The bone remodelling in response to surgical varus was unpredictable, but the greater the surgical varus the less the correction of the neck shaft angle at follow-up evaluation. Chronologic age cannot be used to predict such bone remodelling as may be impaired by the disease process. An analysis of the incidence and significance of leg shortening, limping, and abductor lurch is presented and some observations made on trochanteric overgrowth and the effect of surgery on the rate of femoral head reconstitution. New attempts to achieve containment of the hip by high-femoral osteotomy may determine the effects of a combination of varus and selective rotation osteotomy using ultrasound scans to measure femoral torsion before operation.

Penetration of amoxycillin and clavulanic acid into bone.

The levels of amoxycillin and clavulanic acid have been measured in bone, serum and synovial fluid following the administration of 1.2 g Augmentin prior to hip replacement. Both antibiotics readily enter synovial fluid in levels similar to that found in serum. The levels found in bone are a minimum of ten times lower than those found in serum. Sequential administration of Augmentin with a six-hourly dose schedule does not increase the levels found in any of the tissues studied.

Medullary femoral nailing of pathological fractures using the Derby nail--a preliminary report of 22 cases.

A new medullary femoral nail is reported. The device provides dynamic compression, producing rigid stabilization with resistance to rotational stresses. We present 22 cases of pathological fractures of the femur treated by the Derby nail. Rigid fixation was achieved with no sepsis, loosening or implant failure at the latest follow-up or death. The mean time spent in hospital was 20 days and patients took full weight, on average, by the 9th postoperative day.