Evaluation of the treatment of clubfeet with the Diméglio score.

Between January 1994 and November 1997, 17 children with 25 clubfeet were treated and evaluated. This group was divided into a group of only conservatively treated feet (group A, n=13) and a group of feet which had conservative treatment and complementary operative treatment (group B, n=12). Both groups were evaluated according to the Diméglio classification method in which the objective clinical evaluation is scored only. This was performed for the starting-point (at presentation until 2 weeks after birth), with the necessary information received from the patient's files where all the passive limitations were recorded in a standardized way and also for the end-point (at the time of the follow-up). After comparing these results to each other, all 25 feet had improved after treatment and the operative group had improved more than the conservative group, however the end result was equal, because the operated feet were more severely deformed before the treatment. After treatment, the results were considered acceptable in 92% of the feet, comparable to 93%, 75-85%, 88%, 77%, and 96% in other studies. Moreover, the forefoot adduction was the most common residual sign in the treated feet, confirmed by results in other studies. We conclude that the Diméglio method is an appropriate tool for the follow-up of clubfeet from birth to the end of treatment.

Osteogenic activity of OP-1 bone morphogenetic protein (BMP-7) in a human fibular defect.

We performed a prospective, randomised double-blind study in 24 patients undergoing high tibial osteotomy to evaluate the effectiveness of human recombinant osteogenic protein (OP-1) on a collagen type-I carrier in a critically-sized fibular defect. The study had two phases, each evaluated by clinical, radiological and DEXA methods during the first postoperative year. The first concerned the validation of the model of the fibular defect, using positive (demineralised bone) and negative (untreated) controls. The second phase concerned the osteogenic potential of OP-1 on collagen type-I v collagen type-I alone. The results of the first phase established the critically-sized nature of the defect. In the untreated group no bony changes were observed while, in the demineralised bone group, formation of new bone was visible from six weeks onwards. The results of the second phase showed no significant formation of new bone in the presence of collagen alone, while in the OP-1 group, all patients except one showed formation of new bone from six weeks onwards. This proved the osteogenic activity of OP-1 in a validated critically-sized human defect.

Six-year results of hydroxyapatite-coated total hip replacement.

We present the 5.6- to 7.6-year results of our first 118 hydroxyapatite (HA)-coated total hip replacements in patients under 66 years of age. The titanium femoral component has proximal HA coating and was usually articulated with an HA-coated threaded cup. The HA coating of 50 microns thickness has a porosity of below 3%, 97% HA purity and 65% crystallinity. The survival rate at a mean of six years was 100% for the HA-coated stems and 99% for the HA-threaded cups. The average Harris hip score at one year was 96, and at three years and thereafter 98. There was a very low incidence of early pain after surgery. Serial radiographs showed rapid bony integration of implants with evidence of bone apposition on the coating within six months. By Engh's criteria, all the femoral components had confirmed bone ongrowth after three years. We found no deterioration of results with time, and consider that our clinical and radiological results show that HA coatings can provide early pain relief and durable implant fixation.