Relationship between femoral anteversion and osteoarthritis of the hip.

The purpose of this study was to establish a relationship between the magnitude of femoral anteversion and osteoarthritis of the hip. Sixteen osteoarthritic subjects were compared with 18 control subjects by an improved computed tomography (CT) scanning technique. Femoral anteversion was accurately determined with little radiation exposure. There was no significant difference in femoral anteversion between arthritic subjects and a "normal" control population. There was no significant difference in femoral anteversion between the involved and the uninvolved hips of these subjects with osteoarthritis. These results suggest that performing a derotational femoral osteotomy to prevent osteoarthritis is not indicated. The cause of primary osteoarthritis is multifactorial and does not depend solely on preexistence of higher femoral anteversion.

Comparison of functional outcome of total hip arthroplasties involving four surgical approaches.

One hundred thirty-seven total hip arthroplasty patients had a follow-up evaluation consisting of an orthopaedic physical evaluation, isokinetic strength testing, and collection of demographic and surgical information from medical records. The intraoperative variables of surgical time and blood loss and the functional outcome status of the subjects, as demonstrated by D'Aubigne--Postel ratings and isokinetic strength tests, were compared for various trochanteric management techniques: no osteotomy; complete Charnley-type osteotomy; sharp abductor release; and a wafer technique, in which a wafer of bone was osteotomized from the trochanter to release the abductors. A comparison of the mean values for the variables indicated that the wafer and sharp techniques were superior to the complete and no osteotomy techniques. The wafer technique resulted in statistically significant superior isokinetic strength measured in adduction, flexion, and extension. Surgical time was significantly greater in the complete osteotomy cases and blood loss was least in the wafer cases, although these differences were not significant.

A 30-year experience with bone graft epiphysiodesis in the treatment of slipped capital femoral epiphysis.

A retrospective review was carried out of all cases treated by bone graft epiphysiodesis for slipped capital femoral epiphysis at Children's Hospital Medical Center of Akron between the years 1950 and 1980. Only those cases followed for a minimum of 1 year following treatment were included in the review and evaluated as to their status of avascular necrosis, acute cartilage necrosis, or other complications attendant to the surgical approach. One hundred seventy-six patients representing 207 hips underwent bone graft epiphysiodesis over this 30-year period. One hundred fifty-nine patients representing 185 hips were followed a minimum of 1 year and were included in this study. There were 25 cases of acute slipping representing 26 hips and 134 patients representing 159 hips involved with the chronic slipping process. In the acute group of patients representing 26 hips, there were two cases of avascular necrosis and one case of acute cartilage necrosis. In the chronic group of 159 hips, there were four cases of reslipping, one due to graft resorption, one due to placement of the graft short the growth plate, and two that went on to acute slipping. All cases were salvaged with good results. There was one case of avascular necrosis in the chronic group; not a single case of acute cartilage necrosis was encountered. Owing to the rapid nature of growth plate closure following bone graft epiphysiodesis, the avoidance of hardware removal or pin penetration, and the extremely low incidence of overall complications, we suggest that bone graft epiphysiodesis is at least as good as multiple pin fixation in the treatment of slipped capital femoral epiphysis.

Patellectomy: a clinical study and biomechanical evaluation.

This study presents a long-term follow-up and evaluation of a single technique of patellectomy involving a cruciform repair of the extensor mechanism. The techniques of evaluation, namely: clinical observation, instant center analysis and an acoustical method of cartilage evaluation provide a more thorough and objective basis for clinical study than previously reported. Cruciform repair produced results comparable to conventional methods of surgical repairs. Patellectomized knees function well in people with patellofemoral disease but not in those with panarticular disease. Patellectomy substantially alters normal joint mechanics as evidenced by persistent changes in instant center analysis. Degenerative changes caused by the patellectomy are progressive. In view of newer concepts of the function of the patella in normal joint mechanics and improved designs of total knee arthroplasty, the indications for patellectomy are now more questionable than ever before in the history of orthopedics.

The development of the upper end of the femur in multiple hereditary exostosis.

A roentgenographic study of 50 hips suggests that an increased anteversion-valgus configuration of the upper end of the femur is an intrinsic component and common in multiple hereditary exostosis. In one 8-year-old girl, the increased anteversion-valgus may have accelerated dislocation of a septic arthritic hip.

Anterolateral rotary instability associated with chronic anterior cruciate insufficiency.

Patients with anterior cruciate tears identified by previous surgery were examined for anterolateral rotary instability of the knee. Twenty-four of 30 patients returning for examination had positive tests for anterolateral rotary instability using the techniques described by both Slocum and MacIntosh. The presence of anterolateral rotary instability was directly related to the attainment of full extension of the operative knee. Inherent ligamentous laxity and the degree of combined instabilities were thought to amplify the anterolateral rotary instability tests. Quadriceps rehabilitation, pes anserines transfers and semimembranosus transfers were thought not to influence anterolateral rotary instability.

Computed tomography in the measurement of femoral anteversion.

A new technique using computed tomography for measuring femoral anteversion is presented, with advantages over prior techniques. Computed tomography allows the visual portrayal of the cervical axis to be superimposed upon the diacondylar axis for direct goniometric measurement of the anteversion angle. Beyond its accuracy, the procedure requires no complicated positioning framework and can be done in a brief span of time.

Congenital dislocation of the hip. The relationship of premanipulation traction and age to avascular necrosis of the femoral head.

A retrospective study involving 276 patients with 319 congenitally dislocated hips was undertaken to assess whether premanipulation fraction prevents avascular necrosis. Roentgenographic criteria were utilized and only cases of frank dislocation unassociated with other disorders were included. It was found that in a child less than one year old, premanipulation traction of twenty-one days or more substantially reduces the incidence of avascular necrosis. For the child more than a year old, however, the prognosis is not as good, even if premanipulation traction is prescribed for twenty-one days or more. We found a 14 per cent incidence of avascular necrosis in children less than three months old and suggest that the cartilaginous femoral head prior to the appearance of the ossific nucleus is particularly vulnerable to vascular injury.