Lengthening scarf osteotomy for recurrent hallux valgus.

BACKGROUND: We describe using the scarf osteotomy to correct a recurrent hallux valgus deformity and lengthen the shortened first metatarsal in symptomatic iatrogenic first brachymetatarsia. METHODS: Thirty-six lengthening scarf osteotomies were undertaken in 31 patients. Clinical and radiographic measures were taken pre and postoperatively. RESULTS: Mean age at presentation was 53.4 years, and mean followup 3.9 years. The mean lengthening achieved was 4.9mm. All osteotomies united with no complications. The mean IMA reduction was 4.0° (p<0.001) and HVA 13.0° (p<0.001). The mean AOFAS score increase was 33.8 (p<0.001). There was a positive trend but no correlation (r=0.28) between amount of metatarsal lengthening and AOFAS score change. CONCLUSIONS: We describe the largest lengthening scarf osteotomy series for recurrent hallux valgus with iatrogenic first brachymetatarsia. The results suggest the procedure is successful, with a low complication rate. We anticipate that restoring first metatarsal length and alignment may reduce biomechanical transfer metatarsalgia over time.

The Biomet Bi-Metric total hip arthroplasty and universal acetabular cup: high polyethylene failure rate in the medium term.

We report on the medium-term results of the Bi-Metric (Biomet UK Ltd, Bridgend, UK) uncemented total hip arthroplasty system used with the Universal acetabular cup and polyethylene liner secured with the Ringloc (Biomet UK Ltd) mechanism. Fifty-eight total hip arthroplasties in 49 patients (mean age at implantation, 57.1 years) were identified, with 45 hips followed up at a mean of 7.6 years (range, 5-13 years). Of those hips not requiring revision, the mean Harris hip score was 89, 87% of the hips were judged to be very good or good according to d'Aubigne and Postel (J Bone and Joint Surgery 1954;36A:451), and the radiographic criteria by Engh et al (Clin Orthop Relat Res 1990;257:107) demonstrated the femoral components to be well fixed. Six patients required a revision procedure at a mean of 6.2 years postsurgery, with all failures attributed to marked wear of the polyethylene liner.

Iliopsoas tendonitis a complication after total hip arthroplasty.

The causes of pain after total hip arthroplasty are multiple. We present a series of 15 patients (16 cases) who presented with pain related to the iliopsoas tendon. All patients had previously undergone cementless hip arthroplasty and presented with similar symptoms and clinical signs. Surgery was carried out after failure of conservative measures. Release of the iliopsoas tendon from the lesser trochanter gave good symptomatic relief in all except one patient who required reposition of acetabular prosthesis, with the average Harris Hip Score improving from 58 (range, 44-70) to 91 (range, 78-95) postoperatively. This relatively uncommon condition should be considered in the differential diagnosis of all patients who present with groin pain after total hip arthroplasty. Surgical release of the iliopsoas tendon can give excellent results in these patients.