ABSTRACT
Girdlestones procedure has become a salvage operation reserved for patients with significant co-morbidities. Recent literature addresses this infrequently used intervention inadequately. This observational study aims to update current literature and review the modern role of this intervention in orthopaedic practice. Twenty-four records were obtained from which patient demographics, indications and co-morbidities were investigated. Seventeen patients completed an abridged Harris Hip Scoring questionnaire and commented on satisfaction. The average age was 78 years and patients had multiple co-morbidities. Dementia was the most frequent condition but several patients suffered from cardiovascular and respiratory disease. The most common operative indication was persistent prosthetic infection with Staphylococcus aureus, the most common pathogen. Overall mortality was 41% but all surviving patients had complete resolution of infection and 65% had adequate pain control. No patients mobilised without aids although 29% of patients were able to manage stairs and 29% were able to mobilise outdoors. Only 29% were unsatisfied with the outcome. This study demonstrates that Girdlestones candidates are an ageing high-risk group and shows that the Girdlestones procedure can, in select cases, provide good functional outcomes. However such intervention comes at the expense of high mortality and should therefore only be used as a last resort.
Subject(s)
Arthroplasty, Replacement, Hip/statistics & numerical data , Hip Prosthesis , Prosthesis-Related Infections/surgery , Adult , Aged , Aged, 80 and over , Arthroplasty, Replacement, Hip/methods , Female , Follow-Up Studies , Humans , Male , Middle Aged , Patient Satisfaction , Prosthesis Failure , Reoperation/methods , Reoperation/statistics & numerical data , Retrospective Studies , Surveys and Questionnaires , Treatment OutcomeABSTRACT
The authors report seven cases of unconstrained knee arthroplasty with excision of both cruciate ligaments, after previous patellectomy. Six of these seven cases were completely painfree and function was satisfactory in all cases. The reasons for previously reported pain and instability after total unconstrained knee arthroplasty with excision of the cruciate ligaments and a previous patellectomy are discussed.
Subject(s)
Knee Joint/surgery , Knee Prosthesis , Patella/surgery , Aged , Female , Humans , Knee Joint/physiopathology , Male , Methods , Middle Aged , Postoperative Complications , Range of Motion, Articular , WalkingABSTRACT
Thirty-seven patients with extensive acetabular defects due to loose implants had revisions with uncemented components, the acetabulum being augmented with homograft bone. In six of these, a histological study of graft incorporation was made. At a mean follow-up of 1.5 years 34 patients were free of pain and 35 could walk for 30 minutes or longer. No graft had obviously sequestrated. Two components had radiological evidence of migration but remain asymptomatic. We conclude that cementless revision surgery with homograft supplementation of the acetabulum is clinically successful in the short-term. The long-term outcome is unknown.
Subject(s)
Acetabulum/surgery , Bone Transplantation , Hip Prosthesis , Adult , Aged , Bone and Bones/pathology , Female , Graft Survival , Hip Joint/diagnostic imaging , Hip Joint/surgery , Humans , Male , Methods , Middle Aged , Prosthesis Failure , Radiography , Reoperation , Transplantation, HomologousABSTRACT
Conventional systems of assessing the hip before and after surgery use the range of movement as an indicator of functional results. We found that the range of movement, defined as the flexion arc or the total range, is a poor indicator of function as measured by ability to reach the feet. A different and more direct basis for assessing function is proposed.
Subject(s)
Hip Prosthesis , Hip/physiology , Adult , Aged , Aged, 80 and over , Female , Follow-Up Studies , Hip/surgery , Humans , Male , Middle Aged , MovementABSTRACT
A new prosthesis for the metcarpo-phalangeal joint is presented. Its advantageous design features and the early results following its use suggest that it is of value in treating the painful, stiff and ulnar deviated metacarpo-phalangeal joint in the rheumatoid hand.
Subject(s)
Finger Joint/surgery , Joint Prosthesis , Metacarpophalangeal Joint/surgery , Surgical Flaps , Aged , Arthritis, Rheumatoid/surgery , Female , Humans , Male , Methods , Middle Aged , Postoperative Complications , Prosthesis DesignABSTRACT
The bone cement interface of four clinically stable hip-joint prosthetic components was examined histologically for the presence of macrophages using routine staining and a histochemical technique for acid phosphatase. Macrophages were found in the absence of wear debris in all four cases. Because these cells are capable of bone resorption, their presence at a well-fixed interface must give cause for concern.
Subject(s)
Bone Cements , Bone and Bones/cytology , Hip Prosthesis , Macrophages/cytology , Acid Phosphatase/analysis , Aged , Bone and Bones/enzymology , Female , Humans , Immunohistochemistry , Male , Middle Aged , Prosthesis FailureABSTRACT
Forty-nine patients older than 35 years of age (mean, 45 years) undergoing arthrotomy for clinically diagnosed meniscal tears had preoperative double-contrast arthrograms. Fifty of 53 meniscii were visualized as torn and treated by surgical excision. At the time of operation the incidence of transverse tears was high (34%). In only 72% of cases was there complete correlation between the preoperative arthrographic diagnosis and the definitive surgical diagnosis. This diagnostic disparity was most marked on the lateral side (53% correlation) and unrelated to the high incidence of transverse tears (66% correlation). In this age group, arthrography is not a reliable indicator to the diagnosis of torn meniscii.
Subject(s)
Tibial Meniscus Injuries , Adult , Age Factors , Aged , False Negative Reactions , Female , Humans , Male , Menisci, Tibial/diagnostic imaging , Menisci, Tibial/pathology , Middle Aged , RadiographyABSTRACT
British surgeons and engineers contributed various types of knee prostheses, including hinged, unconstrained, and semiconstrained prostheses, in the development of total knee arthroplasty. Methods of implant fixation, the place of stems, pegs, the use of special instrumentation, and alignment procedures ensure both intrinsic and extrinsic prosthetic stability.
Subject(s)
Knee Prosthesis/history , History, 20th Century , Humans , Prosthesis Design/history , United KingdomABSTRACT
Five cases of hydatid disease affecting the vertebrae are described. Clinical features, radiologic appearance, and poor prognosis are emphasized. Four patients had some degree of neurologic deficit at the time of presentation and in three cases there was an increasing kyphosis. In two patients, spinal instrumentation with Harrington apparatus supplemented removal of hydatid material, and its use improved the previous neurologic deficit with stabilization of kyphosis. The antihelmintic drug mebendazole was used in two cases.
Subject(s)
Echinococcosis/surgery , Spinal Diseases/surgery , Adult , Cervical Vertebrae/diagnostic imaging , Cervical Vertebrae/surgery , Combined Modality Therapy , Echinococcosis/complications , Echinococcosis/drug therapy , Female , Humans , Male , Mebendazole/therapeutic use , Middle Aged , Radiography , Spinal Diseases/diagnostic imaging , Spinal Diseases/drug therapy , Spinal Diseases/etiology , Thoracic Vertebrae/diagnostic imaging , Thoracic Vertebrae/surgeryABSTRACT
Observations were made on the growth rate of proximal and distal tibial epiphyseal growth plates in three children treated by free vascularized fibular grafts for congenital pseudarthrosis of the tibia. Postoperative measurements show that the distal tibial epiphysis can grow faster than the proximal epiphysis; the successful transfer of vascularized fibula may increase blood supply to the distal tibial epiphyseal plate, thus stimulating its growth.
Subject(s)
Fibula/transplantation , Growth Plate/growth & development , Pseudarthrosis/congenital , Tibia/growth & development , Child, Preschool , Humans , Infant , Pseudarthrosis/physiopathology , Pseudarthrosis/surgery , Tibia/surgeryABSTRACT
In the past ten years, three related prostheses (Freeman-Swanson, ICLH, Freeman-Samuelson) have been used at the London Hospital. The new findings reported in this article are the result of cementless fixation of the ICLH prosthesis has not deteriorated with time; the patellofemoral complications and postoperative limitation of movement seen with the ICLH prosthesis has been resolved by the Freeman-Samuelson design; and cementless press-fit fixation of all three components of the Freeman-Samuelson design resulted in a 1.6% (tibial) revision rate in the first four years.
Subject(s)
Knee Prosthesis , Adult , Aged , Evaluation Studies as Topic , Female , Follow-Up Studies , Humans , Knee Joint/physiology , Male , Middle Aged , Movement , Prosthesis DesignABSTRACT
The concentration of the platelet specific protein B-thromboglobulin, (BTG) was measured in salivary samples obtained pre and postoperatively from 30 patients without evidence of renal disease and having total hip replacement arthroplasty. When postoperative deep-vein thrombosis (DVT) was detected using percutaneous ascending phlebography there was total correlation with elevated salivary BTG levels taking 0.33 micrograms/1 or greater on 2 consecutive occasions or more as indicating a deep venous thrombus. Eight of nine patients with a positive diagnosis of DVT on urokinase scanning would have been diagnosed using the same criterion. However BTG was elevated in a further 5 patients in whom labelled urokinase failed to demonstrate a DVT. These may have been localised in the calf and thus missed by, or lysed prior to, the scanning technique.
Subject(s)
Beta-Globulins/metabolism , Hip Prosthesis/adverse effects , Postoperative Complications/diagnosis , Saliva/metabolism , Thrombophlebitis/diagnosis , beta-Thromboglobulin/metabolism , Aged , Diagnostic Errors , Female , Humans , Male , Phlebography , Postoperative Complications/etiology , Postoperative Complications/metabolism , Thrombophlebitis/etiology , Thrombophlebitis/metabolism , Urokinase-Type Plasminogen ActivatorABSTRACT
Three cases of adamantinoma of the tibia, seen in one hospital over a period of 7 years, are described. They illustrate the difficulty in differentiating this lesion from fibrous dysplasia on radiographic and histological grounds. Thermography may help in the differential diagnosis.
Subject(s)
Bone Neoplasms/diagnosis , Fibrous Dysplasia of Bone/diagnosis , Tibia , Adult , Bone Neoplasms/pathology , Diagnosis, Differential , Female , Fibrous Dysplasia of Bone/pathology , Humans , Male , Thermography , Tibia/pathologySubject(s)
Knee Prosthesis , Adult , Aged , Female , Follow-Up Studies , Humans , Male , Middle Aged , Orthopedic Equipment , Postoperative Complications/etiology , Prospective Studies , Prosthesis Design , Prosthesis FailureABSTRACT
Sixty-four patellar fractures treated either by internal fixation or by patellectomy were reviewed retrospectively from 3.5 to 10.1 years (average 6.2 years) after operation. Results were assessed subjectively and objectively. Of the 64 patients, 45% had a good result, 27% fair and 28% poor. On the whole, patellectomy produced better results (60% good, 20% fair, 20% poor), than internal fixation (31% good, 33% fair, 36% poor). Nevertheless, the best results of all were achieved by precise anatomical reduction of the patellar fracture and fixation with K-wires and a tension band. Where this could not be achieved, however, patellectomy gave the best results.
Subject(s)
Fractures, Bone/surgery , Patella/injuries , Adult , Aged , Female , Fracture Fixation, Internal , Humans , Male , Middle Aged , Patella/surgery , Retrospective StudiesABSTRACT
Entrapment of the superficial peroneal nerve is an unusual cause of pain in the ankle and foot. In such cases decompression of the nerve at the point of exit from the deep fascia will produce a good result. Three cases are described.
Subject(s)
Nerve Compression Syndromes/surgery , Peroneal Nerve , Adult , Female , Humans , Male , Nerve Compression Syndromes/diagnosis , Peroneal Nerve/surgeryABSTRACT
Five cases of congenital pseudarthrosis of the tibia successfully treated by a free vascularised fibular graft are described. Follow-up ranged from 5 to 34 months with a mean of 17.5 months. The technique, which includes radical excision of abnormal bone and soft tissue around the pseudarthrosis, also permits primary bone lengthening, and correction of deformity. The early results indicate that satisfactory bony union is achieved in a relatively short period of time.
Subject(s)
Fibula/transplantation , Pseudarthrosis/surgery , Tibia/surgery , Child , Child, Preschool , Female , Fibula/blood supply , Follow-Up Studies , Humans , Infant , Male , Methods , Pseudarthrosis/congenital , Pseudarthrosis/diagnostic imaging , RadiographyABSTRACT
A metastasis in a terminal phalanx which presented with the clinical features of a pulp space infection is described. The primary was a carcinoma of the esophagus.