Subacromial decompression using modified acromioplasty

The aim of this work was to study the clinical results of subacromial decompression using modified acromioplasty in cases of shoulder impingement syndrome. Thirty two patients who had shoulder impingement syndrome were included in this study. Twenty patients were females and 12 were males. The average age at the time of operation was 43.2 years; 40.6 years for females and 47.6 for males. There were two indications for operation. One was the persistence of pain in the anterior aspect of the shoulder when the arm was elevated and the second was progression of symptoms despite the use of anti-inflammatory medications and rehabilitation program. All cases were managed operatively with a modified Neer acromioplasty. In the classic anterior acromioplasty as described by Neer emphasis was placed on resection of the inferior prominence of the acromion. Modified acromioplasty was done in two steps; the portion of the acromion that projects anteriorly beyond the anterior border of the clavicle was resected vertically and then an anteroinferior acromioplasty was performed. The follow up period ranged between 6-24 months, average 13 months. Nineteen patients had excellent result, 7 had good result and 6 had no improvement

use of bone graft in reconstruction of the acetabulum in primary hip replacement

Material: Between 1995 and 1998, 28 total hip replacements were performed. Autografting of the acetabulum was performed in all cases. Nineteen patients were females and 9 were males. The youngest patient was 38 years old and the oldest 83. Morselized bone graft was used in 15 hips [53.6%], bone graft and one plate in 8 hips [28.6%] and bone graft and titanium mesh in 5 hips [17.8%]. Acetabular defect was medical cavitary in 15 hips [53.6%], medial cavitary and medial segmental in 3 hips [10.7%], segmental superior in 6 hips [21.5%], segmental superior and anterior in 2 hips [7.1%], and segmental superior and posterior in 2 hips [7.1%]. Method: Posterior approach was used in all cases. Bone graft from the patient's own femoral head was cut into small pieces about 0.5 - 1.0cm manually using bone nibbler after removing the articular cartilage, or as a segment of cortico-cancellous graft. Follow-up period: The average follow up period was 3.9 years. The average modified Harris Hip score was 31.7 points and at the end of follow up 69.8. In 26 cases [92.86%] the graft appeared to be incorporated securely to the acetabulum as determined by radiographic examination. There were two failures [7.14%]. In one hip the cup was migrated 22 mm superiorly and the other cup showed upward migration of 8 mm. Femoral head autograft appears to provide a useful technique for the reconstruction of a severely deficient acetabulum during primary hip arthroplasty