The total condylar knee prosthesis in osteoarthritis. A 5- to 10-year follow-up.

In 124 patients with osteoarthritis 152 knee arthroplasties were evaluated with a mean follow-up of 7 years (range 5.2-9.1 years). Forty-six patients (53 knees) were either dead or otherwise lost to follow-up. Thus, 99 knee arthroplasties were evaluated. Three arthroplasties had been revised. Of the remaining 96 knee arthroplasties, 95% had achieved a satisfactory result. Five arthroplasties were unacceptable. One had a poor result and four a fair result. The reason for the poor/fair results was in one case a loose patellar component and in one case malposition of the components and ligament insufficiency. In 54.2% of the arthroplasties, there were radiolucent lines beneath the tibial component. There was one fatal pulmonary embolism, and four knees with superficial wound infection. One of these probably went on to late loosening. There was one case of peroneal nerve palsy. Three cases of deep vein thrombosis were diagnosed.

Operative versus nonoperative treatment of Achilles tendon rupture. A prospective randomized study and review of the literature.

One hundred eleven patients with acute rupture of the Achilles tendon were included in a prospective trial and randomly assigned to groups for operative (56 patients) or nonoperative (55 patients) treatment. All of the patients were followed with clinic evaluations at 4 months and 1 year after the rupture. The major complications in the operative treatment group were three reruptures and two deep infections as compared with seven reruptures, one second rerupture, and one extreme residual lengthening of the tendon in the nonoperative group. There were fewer minor complications in the nonoperative group than in the operative group. The operatively treated patients had a significantly higher rate of resuming sports activities at the same level, a lesser degree of calf atrophy, better ankle movement, and fewer complaints 1 year after the accident. The conclusion we reached through this randomized prospective study is that operative treatment of ruptured Achilles tendons is preferable, but nonoperative treatment is an acceptable alternative.

Revision of the uncemented hip prosthesis.

In a series of 213 consecutive total hip replacements a.m. Lubinus, the clinical course after 72 revisions and 141 primary procedures was compared after 5 years. The revised THRs were uncemented Ring prostheses. Dislocation and peroperative fracture were more common in the revision group. Two failures because of aseptic loosening occurred in the revision group and 3 in the control group. No excisional arthroplasty was required, and no infections occurred. Radiographic evaluation of prosthetic positioning, component loosening, calcar resorption, and paraarticular ossification disclosed only slightly inferior results in the revision group. Clinically, the revised cases were not inferior to the primary ones. Revision of the uncemented hip seems less difficult than of the cemented hip.

Revision of failed total hip arthroplasty.

Ninety-seven revisions of total hip replacements are reviewed with a median time of observation of 47 months. Satisfactory pain relief was obtained in 86%. There were six complete failures which were reduced to three by further surgery. One hip became infected and was excised. In 12 cases the revisions were complicated by peroperative fractures and in five by dislocations. Radiographic analysis disclosed a high percentage of periarticular ossification and 25 cases of radiographic loosening of the femoral implant.

St Georg modular knee prosthesis. A two-and-a-half to six-year follow-up.

The St Georg modular knee replacement has been studied in 59 cases with an observation period ranging from 28 to 73 months. In 47% of the knees both compartments were replaced; five of the six poor results were in this group. These were revised to a hinge arthroplasty or, in one case, to an arthrodesis. Other complications were few and insignificant. There were no infections. We concluded that unicompartmental knee arthroplasty can be recommended when joint involvement is localised to one compartment only. With more generalised joint disease we prefer a semiconstrained total condylar prosthesis.

The Catterall classification of Perthes' disease: an assessment of reliability.

The reliability of the Catterall grouping of Perthes' disease was examined by determining the agreement between pairs of observers using weighted kappa statistics. Anteroposterior and lateral radiographs of 100 hip joints were grouped independently by four experienced observers. There was a low, and in our opinion, unacceptable degree of inter-observer agreement even when Groups 2 and 3 were combined.

Habitual dislocation of the elbow.

Two cases of habitual dislocation of the elbow are presented, both of them in mentally deficient patients. Aetiology and operation methods are discussed and relevant literature reviewed.

St. Georg hinged-knee prosthesis. A 2.5- to 8-year follow-up.

Thirty-eight St. Georgs hinged-knee arthroplasties were studied with a follow-up of 2.5-8 years; 86.8% of the patients obtained an excellent or a good result, and 7.9% of the arthroplasties were failures. There was an infection rate of 3.8% and 3.8% loose prostheses. Among the failures there were two infected arthroplasties. One was arthrodesed, resulting in a pseudoarthrosis and one was successfully revised. One traumatic loosening lead to arthrodesis. It is concluded that hinged-knee arthroplasty under special circumstances may be a useful procedure.