Leg length inequality in total hip replacement.

Clinical and radiographic leg length inequality and pelvic tilt were measured in the erect posture in 36 patients before and after total hip replacement. Good correlation was observed between clinical and radiographic evaluations of pelvic tilt, assessed as height difference between iliac crests. Intraoperative alteration of leg length correlated well with changes in pelvic tilt but not with changes in true radiographic leg length inequality. It is suggested that adjustment of leg length during total hip arthroplasty should aim at correction of preoperative pelvic tilt observed during clinical and radiographic examination. True leg length, assessed as the height of the vertex of the femoral or prosthetic head is misleading. It does not reveal functional leg length, which is determined not only by the true leg length but also by the position of the hip joint on the pelvic wall.

Results and complications after arthroplasty with a totally constrained total knee prosthesis (GUEPAR).

A series of 51 patients (55 knees) with implanted GUEPAR totally constrained endoprosthesis was followed up clinically and radiologically for a mean of 5.0 years (range 1.5-11.8 years). Good relief of pain, increased range of knee movement and of walking capability were observed. There was, however, an unacceptable amount of severe complications. Three endoprostheses had to be removed and arthrodesis performed. Revision arthroplasty was carried out in 8 cases due to aseptic loosening of the prosthesis. In 25 cases lateral displacement or total dislocation of the patella was confirmed with tangential patellar X-ray projections. We suggest that the GUEPAR totally constrained total knee endoprosthesis and similar constructions should be chosen in only special cases, when aged patients have extremely damaged and unstable knee joints and non-constrained prostheses are not considered suitable.

Alcohol-associated femoral head necrosis.

Fifty-seven patients with femoral head necrosis (FHN), treated since 1976 at the Orthopaedic Hospital of the Invalid Foundation, Helsinki, were studied. The incidence of alcohol-associated FHN was 29% (N = 15, 13 male) and of idiopathic FHN 11.5% (N = 10, 6 male). Nine patients with alcohol-associated FHN were heavy drinkers, four were alcoholics and two were moderate drinkers at the time of the onset of the symptoms. At follow-up 80% of the alcohol-associated cases showed increased gamma-glutamyltransferase (GGT) activity in the serum. Our findings among alcohol-associated cases support previous reports according to which disturbed liver function is an important factor in the aetiology of FHN. Because of GGT's rather high sensitivity in the detection of heavy drinking in FHN, it is recommended to be used as a diagnostic aid in suspected FHN.

Comparison of iohexol and meglumine iothalamate in single contrast knee arthrography. A double-blind investigation.

A prospective double-blind study was performed to assess the side effects and visualization quality of 2 contrast media, iohexol and meglumine iothalamate in single contrast arthrography. There were very few adverse reactions during the examination. During the 2 days after arthrography pain occurred in about 29% of each group. Iohexol caused somewhat less delayed pain on movement and fewer sensations of swelling than iothalamate. The quality of the arthrograms was significantly better with iohexol both in films taken immediately after injection as well as after 20 minutes.

Leg length inequality after total hip arthroplasty.

Leg length inequality (LLI) in 55 patients with cemented total hip arthroplasty (THA) was measured from weight-bearing anteroposterior (AP) hip radiographs. The mean radiologic LLI was 8.7 mm in unilateral and 11.6 mm in bilateral THA, differing significantly from the clinically measured values (2.8 mm and 4.2 mm, respectively). LLI as a cause of aseptic loosening and unexplained pain warrants investigation in THA patients.

Development of heterotopic ossification around the hip. A long-term follow-up of patients who underwent surgery with two different types of endoprostheses.

Heterotopic ossification has been reported in many pathological situations, most important clinically as a sequel to hip arthroplasty and spinal trauma. The etiology of heterotopic ossification is yet not clear, but the disease is supposed to be connected with trauma. Heterotopic bone was found in 53% (1.2% with the severe form) of 623 patients operated on at the Orthopaedic Hospital of the Invalid Foundation, Helsinki, Finland; the operations included 849 arthroplasties. The rate of heterotopic ossification was higher after revision arthroplasty, following operation of the contralateral side, in men, and in primary coxarthrosis, and the incidence was higher with the Brunswik (metal-on-plastic) endoprosthesis than in the McKee-Farrar type (metal-on-metal). Heterotopic bone formation generally seemed to increase and to be more manifest during long-term observation.

Iohexol and meglumine iothalamate in shoulder arthrography. A double-blind investigation.

The first clinical experience with the new contrast medium, iohexol, in shoulder arthrography is reported. A double-blind comparison of iohexol and meglumine iothalamate, a conventional medium in standard use for arthrography, was carried out in a consecutive series of 60 adult patients forming two groups of 30 subjects each. No difference in the radiographic quality was seen immediately after contrast injection but in exposures at 20 min iohexol gave a significantly better arthrographic quality. Practically no adverse effects occurred during the examinations. Although minor side effects were numerous in both groups during the two days following arthrography, they were somewhat more frequent in patients given iothalamate.

Medial and lateral gonarthrosis treated with high tibial osteotomy. A prospective study.

A prospective series comprising 52 knees in 48 patients suffering from medial or lateral unicompartmental gonarthrosis and treated by means of high tibial osteotomy shows, by comparing mechanical axis (MA) 0 degrees corrected knees, how important is the overcorrection of the MA into valgus in medial osteoarthritis. The clinical results were significantly correlated to overcorrection, the results 2 years postoperatively being better than those obtained at a follow-up 1 year after the operation. Of the results, 82% were good within a limit of +/- 3 degrees after 2 years, while only 77% were correspondingly good 1 year postoperatively. In lateral gonarthrosis overcorrection was not as good, but there was a mean overcorrection of +2 degrees, and with respect to this overcorrection, the results were quite acceptable. The results were directly correlated to the opening up of the joint space affected (80%) and diminution or disappearance of subluxation, 1/3 being 0 degrees preoperatively, 1/2 postoperatively in medial gonarthrosis. In lateral gonarthrosis, subluxation was increased, with 2/3 being 0 degrees preoperatively, 1/3 being 0 degrees postoperatively. The extension deficit in varus knees significantly diminished after valgus osteotomy; the change in valgus knees was also evident but not significant. The mean value of extension deficit was below 5 degrees in all cases at the 2 years' follow-up examination. However, 95% of all patients showed good or fair results after a follow-up period of 2 years.

Spontaneous correction of severe tibiofemoral deformity in growing children.

The progress of pronounced varus and valgus deformities of the knees in 20 children were followed. The most pronounced varus deformity as 33 degrees and the most pronounced valgus deformity was 20 degrees. The tibiofemoral angle in growing children was measured on roentgenograms by drawing a longitudinal axis between the femoral and tibial diaphyseal cortices. Spontaneous correction was seen in all cases during the growth period.

Osteochondritis dissecans of elbow, ankle and hip: a comparison survey.

In 36 patients treated for osteochondritis dissecans (OCD) of the elbow, ankle and hip during a period of 20 years in the same hospital, trauma seems to have been the main etiologic factor in about half of the patients. The first symptoms of the lesions occurred when the patients were between 15 and 20 years of age. Osteochondritis dissecans of the elbow was seen in 19 men. Osteochondritis dissecans in the ankle occurred in 6 men and 5 women. Osteochondritis dissecans in the hip appeared in 5 men and one woman. The first symptoms were pain and restriction of joint movement. Conservative treatment was satisfactory for about one-half of the patients. When operative treatment was indicated, extirpation of loose bodies or loosening fragments was the treatment of choice in OCD of the elbow and ankle. Fixation of the fragment gave satistfactory results in some cases of OCD of the hip. Late results were excellent in only about one-half of the patients. Osteoarthritic changes appeared in the hip, elbow, ankle, in order of decreasing frequency.

Arthrography of the hip in the diagnosis of postoperative painful conditions after total hip replacement.

Arthrography of the artificial hip joint was performed postoperatively in 29 patients with pain after total hip replacement. In 23 cases the arthrographic findings were checked by operation and corresponded in 91%. In two arthrographies which did not give reliable results sinuses outside the thigh or a large pseudocapsule prevented a satisfactory performance of the arthrography. The unoperated patients had only mild discomfort or were considered a high risk for reoperation; they were treated with physiotherapy and medication. As a result of this investigation arthrography can be regarded as a highly reliable method of diagnosing the various causes of pains in the hip after total hip replacement.