Long-term results of the Hohmann and Lapidus procedure for the correction of hallux valgus: a prospective, randomised trial with eight- to 11-year follow-up involving 101 feet.

As it remains unproven that hypermobility of the first tarsometatarsal joint (TMTJ-1) is a significant factor in hallux valgus deformity, the necessity for including arthrodesis of TMTJ-1 as part of a surgical correction of a hallux valgus is questionable. In order to evaluate the role of this arthrodesis on the long-term outcome of hallux valgus surgery, a prospective, blinded, randomised study with long-term follow-up was performed, comparing the Lapidus procedure (which includes such an arthrodesis) with a simple Hohmann distal closing wedge metatarsal osteotomy. The study cohort comprised 101 feet in 87 patients: 50 feet were treated with a Hohmann procedure and 51 with a Lapidus procedure. Hypermobility of TMTJ-1 was assessed pre-operatively by clinical examination. After a mean of 9.25 years (7.25 to 11.42), 91 feet in 77 patients were available for follow-up. There was no difference in clinical or radiological outcome between the two procedures. Also, there was no difference in outcome between the two procedures in the subgroup clinically assessed as hypermobile. This study does not support the theory that a hallux valgus deformity in a patient with a clinically assessed hypermobile TMTJ-1 joint requires fusion of the first tarso-metatarsal joint.

Total hip arthroplasty with Boneloc cement: Unsatisfactory results in 163 hips after 9 to 11 years.

Boneloc bone cement was introduced in the Netherlands in 1992. Inferior short-term results were reported which led to the withdrawal of Boneloc from clinical use in 1995. However, little is known about the long-term outcome of hip arthroplasties with Boneloc. Between April 1992 and August 1994, Boneloc was used in 163 Mallory-Head primary total hip arthroplasties in 163 patients. Follow-up analysis was performed in 2003. To date, 27 hips (17%) have been revised for aseptic loosening of the femoral component. Median time to revision was 5.5 years. Survival analysis based on revision for aseptic loosening showed 77% cumulative survival at 11 years. With revision for aseptic loosening and/or definite radiological loosening according to Harris as endpoint, cumulative survival was 59% at 11 years. In 27 of 43 patients with definite radiological loosening, a cement fracture was seen at a median of 2.9 years. These results show failure of Boneloc cemented total hip arthroplasties occurring even during the later follow-up. Continuing periodic clinical and radiological examination is recommended. (Hip International 2004; 14: 229-32).