Charnley total hip prostheses: clinical and radiographic results after 10 to 18 years.

The work reviews 76 Charnley cemented total hip prostheses applied between 1970 and 1977 using a traditional cementation technique. Long-term results after an average of 12 years (minimum 10 and maximum 18) were excellent or good in 79% of the cases, fair in 2.6% and poor in 7.9%. The revision rate was 10.5% Cases characterized by radiographic signs of loosening were studied in detail, and correlations with clinical and radiographic data searched for.

Diagnosis, surgical indications and treatment of lumbar stenosis.

A diagnosis of vertebral lumbar stenosis is based on clinical and instrumental data derived from radiographic studies, CT scan, magnetic resonance, and myelography. Indications are based on an overall evaluation of clinical and instrumental data, in the search for a precise correlation between neurological symptoms and images. Conservative treatment includes medical and physical therapy, and use of a brace. Problems related to surgical treatment substantially consist in how many levels to open and how far to laterally release the nervous structures.

Comparative multicenter trial of teicoplanin versus cefazolin for antimicrobial prophylaxis in prosthetic joint implant surgery. Italian Study Group for Antimicrobial Prophylaxis in Orthopedic Surgery.

A randomized multicenter study was carried out in 12 centers in Italy to compare administration of a single dose of teicoplanin (400 mg i.v. bolus at time of anesthesia) versus that of five doses of cefazolin over a 24-h period (2 g at induction of anesthesia and 1 g every 6 h postoperatively, i.v. bolus) as antimicrobial prophylaxis in patients undergoing hip or knee arthroplasty. Of 860 patients enrolled, 427 received teicoplanin and 433 cefazolin. A total of 846 patients (422 teicoplanin and 424 cefazolin) were evaluable for safety and 826 patients for efficacy. Six patients (1.5%) in the teicoplanin group and seven patients (1.7%) in the cefazolin group developed a surgical wound infection during their postoperative hospital stay: this difference was not significant. Proven or suspected infections involving other body systems occurred in 114 patients (57 in each group). Seven hundred ninety-two patients completed a 3-month evaluation and 738 patients a 12-month evaluation: the success rates in evaluable patients at these observation times were 99.2% and 99.7% for teicoplanin and 99.2% and 99.7% for cefazolin, respectively. Adverse events occurred in three (0.7%) teicoplanin patients and nine (2.1%) cefazolin patients (P = 0.083). A single preoperative dose of teicoplanin ensures adequate surgical antisepsis, with results comparable to a standard multiple-dose regimen of cefazolin.

Tibial osteotomy for the varus osteoarthritic knee.

High tibial osteotomy is a reliable method for relieving pain in the varus osteoarthritic knee. In a review of 139 osteotomies, excellent and good results were noted in 64% of the knees after a follow-up period of at least ten years. The ideal candidate for this operation has Grade I or II osteoarthritis; less than 10 degrees of varus deformity, as measured by a single leg standing roentgenogram; no lateral subluxation; and no instability. The lateral closed wedge osteotomy without internal fixation is the preferred technique, and correction beyond the normal anatomic position, to 5 degrees of valgus, is advised. Protected weight-bearing after the second postoperative day is allowed. Complications have been infrequent and minor. Forty-seven knees were managed in this manner, and 88% had an excellent or good result at a four-year follow-up evaluation. In the majority of the well corrected knees, the alignment did not change with time, and the osteoarthritis did not progress. No failures in this series were attributable to the associated patellofemoral osteoarthritis; the reaction of the patellofemoral joint to osteotomy is obscure.

Correction of valgus knee deformity with a supracondylar V osteotomy.

Valgus deformities at the knee can be successfully corrected with V-shaped supracondylar osteotomy. The advantages of this relatively simple technique are low morbidity, good stability with early weight-bearing, no need for internal fixation, and ability to adjust alignment with postoperative cast. Healing is relatively rapid (two months), and the range of motion returns (two months after cast removal) to preoperative values. This technique proved useful for deformities in both young and old patients with osteoarthritis. This is a preliminary report of the surgical technique, postoperative management, and short-term results of a prospectively evaluated series of 14 consecutive cases.

[Aseptic loosening of the Charnley prosthesis]. / Allentamento asettico nella protesi di Charnley.

Out of 100 Charnley prostheses implanted for idiopathic arthrosis and followed up a minimum of 5 years after surgery, 59 were fixed, 24 were characterised by probable radiologic loosening of the femoral component, 13 by probable loosening, and 4 by possible radiologic loosening of the acetabular component. None of the patients was submitted to further surgery. Some of the features of the patients were found to be associated with a higher incidence of femoral loosening. In most of the cases loosening was minimal, only radiologic, and not clinically apparent, and numerous technical improvements in the use of cement and in the design of the prosthesis were introduced subsequent to the period when these patients were operated on.

[Total hip prosthesis according to Charnley. Review of our cases]. / La protesi totale d'anca secondo Charnley. Revisione della nostra casistica.

This is a follow-up study of 363 Charnley hip replacements out of 548 implanted from 1970 to June 1984. Clinical results, with a 2-year minimum follow-up (average 5 years, maximum 15 years) are excellent or good in 89.5% of the cases. In the group with minimum 5-year follow-up (average 7, maximum 15 years) the clinical results remain good to excellent in 89.2% of the cases. Radiographic results have been studied in the group with minimum 5-year follow-up. Component stability or radiographic loosening have been studied, taking into account the presence of radiolucent lines between bone and cement, between metal and cement, or based on component migration or positional shift. We have detected radiographic loosening in 11.5% of the acetabular and 13.5% of the femoral components. A correlation was sought between radiographic loosening and some clinical (diagnosis, weight, follow-up period) and radiographic (postoperative component position, polyethylene wear, cement technique, periosteal reaction, myositis ossificans) parameters. There is no strong relationship between radiographic loosening and clinical results, as 28 of 35 radiographically loose prostheses maintained excellent or good results. Finally, the results of a selected group of 29 hips, with a minimum follow-up of 10 years, is reported.

Teicoplanin--its role as systemic therapy of burn infections and as prophylaxis for orthopaedic surgery. Italian Study Groups for Antimicrobial Prophylaxis in Orthopaedic Surgery and Burns.

Two randomized studies have been initiated to establish the role of teicoplanin as systemic therapy for infections in burns patients and as short-term prophylaxis for orthopaedic implant surgery. Opportunistic micro-organisms causing infections in burn patients are often acquired in hospital. These infections commonly involve Gram-positive organisms which may be resistant to several antibiotics. Teicoplanin, alone and in combination with additional antibacterial drugs, is effective in the treatment of Gram-positive infections of various types. In addition, teicoplanin has proved useful as prophylaxis against infection in orthopaedic surgery. Deep prosthetic infections are very difficult to cure without removing the infected device; the outcome can be devastating, such as total loss of joint function, amputation, and, occasionally, death. Preliminary results from the two studies are encouraging and show that teicoplanin has a role to play both in treatment of infection and as prophylaxis against hospital-acquired infection.

Total hip replacement with bone grafting using the removed femoral head in severe acetabular dysplasia.

We carried out total hip replacement and femoral head bone-grafting in 21 hips with congenital dysplasia or dislocation, obtaining as much support of the cup by the host bone as was possible. A Charnley small or extra small cup was implanted in 20 cases and a miniature femoral component in 15. The results of 20 hips were reviewed prospectively at an average of 10 years. Nineteen patients had no pain. Three cups showed radiological signs of loosening, one was causing other symptoms. All the stems, except one, were radiologically stable and were symptomless. The graft had fused without resorption in 18 cases. Two grafts showed severe resorption with loosening of the cup. Satisfactory long term results of total hip replacement and femoral head bone-grafting can be achieved using special surgical techniques and the appropriate components. Medialisation of the hip and the use of small cups are important in allowing sufficient support of the prosthesis by bone so that the distribution of load on the graft is minimised. The grafted femoral head provides suitable bone stock for reconstruction of the acetabulum.

Pigmented villonodular synovitis of the hip joint (review of the literature and report of personal case material).

The authors illustrate the diagnostic and therapeutic problems posed by pigmented villonodular synovitis of the hip by reviewing the literature and reporting on six original cases. Four of these cases were treated by synovectomy and two by prostheses. The best results were obtained with the total prostheses, but this must be considered in the light of the fact that most of the patients were young.