The MOJE total joint arthroplasty for 1st metatarso-phalangeal osteoarthritis: a short-term retrospective outcome study.

BACKGROUND: Evidence regarding the efficacy of the MOJE ceramic press fit total joint replacement for the first metatarso-phalangeal joint (MTPJ) is lacking. OBJECTIVES: Our aim was to assess the clinical outcome for the MOJE arthroplasty in a single surgeon series using objective and subjective assessment tools. METHODS: A retrospective outcome study of 24 implants was performed in 22 patients undergoing first MTPJ replacement for osteoarthritis from 2004 to 2006. Each patient underwent clinical assessment using the American Orthopaedic Foot and Ankle Score (AOFAS) for the hallux and a patient outcome satisfaction questionnaire. All pre- and post-operative radiographs were reviewed. RESULTS: Average follow-up was 26 months with a median AOFAS score of 80 out of a maximum 100. The revision rate at 3 years was 12.5%. Only 63% of patients were 'very satisfied' with the overall outcome from the procedure. AOFAS for the hallux correlated strongly with patient satisfaction. Radiographical mal-alignment in four patients was significantly associated with lower AOFAS (p=0.01). CONCLUSIONS: This implant offers less reliable outcomes than the 'gold standard' arthrodesis and one would advise caution regarding its use for osteoarthritis of the first MTPJ.

Movement analysis of asymptomatic normal shoulders: a preliminary study.

The dynamic pattern of scapulothoracic rhythm during arm forward flexion in the scapular plane has been studied radiographically. The technique involves dynamic radiographic screening of shoulder movement in elevation. It has low levels of radiation compared with plane x-ray examination techniques of scapular movement analysis, and the results are comparable to those of previously published studies. We analyzed real-time video images of shoulder movement in 10 young male volunteers (group I; mean age, 35 years) and 9 older male volunteers (group II; mean age, 70 years) with the use of computer-aided software. Group I showed mean arm elevation of 154 degrees, glenohumeral movement of 107 degrees, and total scapular movement of 55 degrees. Group II showed mean arm elevation of 118 degrees, glenohumeral movement of 77 degrees, and total scapular movement of 40 degrees. No statistically significant difference was found in the glenohumeral-scapular or glenohumeral-arm movement ratios of these 2 groups. We conclude that although the total range of arm elevation reduces with increasing age, the glenohumeral-to-scapular movement ratio does not change. The technique of movement analysis described is dynamic, safe, and applicable to clinical studies of shoulder movement.

Neck-shaft angle remodelling after derotation varus osteotomy for severe Perthes disease.

Sixteen patients with a severe form of Perthes disease who underwent containment derotation varus osteotomy (DVO) of the proximal femur were studied retrospectively for the neck-shaft angle (NSA) remodelling. Analysis of results after a mean follow-up of 7 years (minimum of 5 years and maximum of 8.7 years) showed mean preoperative, immediate postoperative and the latest follow-up neck-shaft angles (NSA) as 135 degrees, 110 degrees (none had varus less than 90 degrees) and 125 degrees, respectively. A statistically significant relationship between NSA remodelling and the immediate post-op NSA (P = 0.0035) was established. Patients with smaller postoperative NSA showed better remodelling compared with those who had higher degrees of NSA immediately after the surgery. No significant relationship was found between the degree of NSA remodelling and the patient's age at diagnosis, age at surgery, severity of Perthes or the Stulberg grading at maturity. The authors conclude that up to 90 degrees or more varization after DVO for Perthes disease can remodel with time, and the remodelling process is independent of the patient's age at diagnosis, age at surgery, or severity of Perthes or Stulberg grading at maturity.

D-2-hydroxyglutaric aciduria in association with spondyloenchondromatosis.

D-2-hydroxyglutaric aciduria is a rare metabolic disorder, first reported in 1980, and does not yet have a clinically specific presentation pattern nor any specific treatment regime. We report a girl born with this uncommon metabolic disorder, who, at the age of 12 months, was also found to have a severe crippling form of skeletal dysplasia, spondyloenchondromatosis.

Severe osteopenia with recurrent fractures after bone marrow transplant for Wiskott-Aldrich syndrome: a case report.

Wiskott-Aldrich syndrome (WAS) is a rare inherited disorder characterised by thrombocytopenia, eczema, and immunodeficiency. Bone marrow transplantation (BMT) is a well-established modality of treatment now routinely used and often curative. We report the case of a boy who developed osteopenia and sustained multiple long-bone fractures over a 5-year period after bone marrow transplant for WAS. The femora and tibiae of both lower limbs were involved with a clinical presentation similar to osteogenesis imperfecta. After commencing calcitriol treatment at the age of 8 years, the patient has not sustained any further fractures. He is now 11 years old. Although short-term changes in bone metabolism after BMT have been documented, the occurrence of repeated fractures associated with osteopenia has not been previously reported.

Postoperative analgesia after arthroscopic knee surgery: a randomized, prospective, double-blind study of intravenous regional analgesia versus intra-articular analgesia.

SUMMARY: The aim of this study was to determine the quality of postoperative analgesia in patients undergoing arthroscopic knee surgery using preoperative intravenous regional analgesia. After initial consultation with a statistician, we allocated 36 patients randomly and double-blind to 1 of 3 groups. Group A received intravenous regional analgesia preoperatively, group B received standard postperative intra-articular analgesia, and group C received saline and acted as the placebo. Our results showed no statistically significant difference in pain levels between the groups. However, there was a significantly larger amount of morphine administered by patient-controlled pumps in the placebo group when compared with the 2 treatment groups. There was no such difference between the 2 treatment groups. We concluded that preoperative regional analgesia in this setting is as good as but no better than intra-articular analgesia and that neither technique has any advantages over diclofenac plus patient-controlled analgesia.

Scapulothoracic rhythm in normal male volunteers.

Dynamic pattern of Scapulothoracic rhythm during arm abduction in scapular plane is studied using computer-imaging technique. Aim of the study is to produce a reproducible and reliable way of calculating the scapular movement and glenohumeral movement using least possible roentgenographic exposure. Moving X-ray screening picture of the shoulder joint is analysed using video capture computer programme and the images at different degrees of abduction are then analysed for scapular movement using computer aided designer and drafting software. Results were comparable to the authoritative shoulder analysis carried out in the past, the difference of radiation exposure, approximately 10 times less.