A review of 100 consecutive Richard's total knee replacements.

One hundred consecutive Richard's Maximum Contact (RMC) knee replacements were performed in Belfast between 1978 and 1982. Most of the 100 knees (86 patients) involved had been in severe pain, had marked stiffness or gross knee deformity, or were chairbound because of the knee. They were reviewed between five and eight and a half years (mean five years and eleven months) after operation. Thirteen patients (13 knees) died before review leaving eighty seven knees in 73 patients available for study. Using a modification of the British Orthopaedic Association knee function assessment chart, 26 knees (30%) were graded as excellent, 22 (25%) as good, 19 (22%) as fair and nine (10%) as poor. There were five implant failures, four the result of deep infection, one due to loosening. Six patients were chairbound at review and were also graded as failures. These results support the view that total knee replacement approaches the predictability and success of arthroplasty of the hip.

High tibial osteotomy in degenerate diseases of the knee.

Between 1970 and 1981, 64 patients underwent 77 tibial osteotomies for degenerate diseases of the knee at the Withers Orthopaedic Centre in Belfast. Records on 11 patients (12 knees) were either missing or inadequate, leaving 53 patients who underwent 65 tibial osteotomies for study. There were 23 males and 30 females, ranging in age from 23 to 75 years (mean 59.8 years). The predominant diagnosis was osteoarthrosis and the indication for operation in all cases was pain. With a follow-up of from two to ten years (mean 4.8 years), 39 knees were assessed as good, 15 as fair (improved, but still symptomatic), and 11 as failures. Patients with valgus deformity did worse than those with varus deformity. The importance of adequate pre-operative assessment is stressed, the operation itself is outlined, and the end result is seen to correlate closely with the degree of correction obtained.

[Vibration arthrography in the diagnosis of knee joint diseases]. / Vibrationsarthrographie in der Diagnostik von Kniegelenkskrankheiten.

In this paper, the principles of vibration arthrography are briefly described and the analysis of the resulting signals is explained. Using such a system, localisation of signals from within the joint is possible. Finally, the development of a vibration-based arthrographic system is proposed as a safe, relatively inexpensive, and totally non-invasive aid to the diagnosis of internal disease of the knee.

[Current trends in phonoarthrography]. / Moderne Tendenzen in der Phonoarthrographie.

The detection of sounds from the human body for diagnostic purposes has a long history. In the respiratory and circulatory systems such auscultation is a precise science yielding much useful information. The detection and interpretation of joint sounds, however, has been much less successful in its development. In this paper we outline the history of joint auscultation, of phonoarthrography, and of their modern equivalent: vibration arthrography. The relative merits of acoustic and vibration based systems are discussed and these are illustrated with data from simultaneous recordings of several joint phenomena. Finally, we concluded that the future of phonoarthrography as a clinical test is based on its further development using accelerometers rather than microphones as detectors.

Failure of the femoral component in the Howse total hip arthroplasty.

Fatigue failure of the femoral stem is reported in ten cases of the Howse modification of the Charnley total hip arthroplasty. The overall incidence is comparable to the Charnley original design. Torsional forces are important in the mechanism of failure. Medical cracking (not previously described) was discovered leading to stepped fracture surfaces. Multiple medial cracking has long-term implications for the Howse design. Torsional forces result in oblique fracture lines that are not always visible before surgery. Weight-bearing roentgenograms are advised prior to revision surgery.

Instrumentation for the revision of total hip arthroplasty.

Revisions of total hip arthroplasties are destined to overload operating schedules in the next decade. An analysis of present trends and highlights of some unresolved problems reveal the urgent need to develop specific jigs and instrumentation to make revision surgery easier on both patient and surgeon.

Brain abscesses in Northern Ireland: a 30 year community review.

One hundred and seventy-two cases of intracranial abscesses, obtained from Neurosurgical and Centralised Autopsy Records for Northern Ireland for the 30 years, 1947--1976, have been reviewed. The incidence of the disease has fallen from five to three per million of population per year over the past three decades. Intracranial abscesses were three times as common in males as in females. Twenty-nine per cent of the abscesses were in the temporal lobe, 25% frontal, 10% parietal, 6% cerebellar, 3% occipital, and 7% were either subdural or in deep sites such as the thalamus; the remainder (20%) were multiple. Multiple and occipital abscesses were all fatal, temporal and parietal abscesses were associated with a 65% mortality, and 45% of patients with frontal abscesses died. Chronic suppurative otitis media was the single largest cause, and it was the only aetiological factor to have shown a progressive decline over 30 years. For those seen and treated in the neurosurgical unit the mortality was 53%, but if those obtained from the necropsy records were included the overall mortality was 70%.