High failure rate of soft-interface stem coating for fixation of femoral endoprostheses.

Twenty-five total hip arthroplasties were performed in 25 patients using a femoral stem with a soft-interface coating of Proplast (Vitek, Houston, TX). Follow-up periods for 24 of the hips ranged from 82 to 104 months (median, 96 months). Fourteen (58%) of the hips were judged to be failures, and nine of the failures were revised. The prostheses were thought to have failed because the coating was not strong enough to withstand normal weight-bearing loads. This inner-substance failure of the coating was seen in all revision operations. During these revisions, parts of the coating remained in the shaft as well as on the prosthesis stem. The combination of clinically manifest midthigh pain and radiologic scalloping and/or the pedestal sign seem to justify a strong suspicion of looseness of this type of cementless femoral endoprosthesis.

[Good results but many complications in unilateral leg lengthening techniques]. / Goede resultaten, maar veel complicaties bij unilaterale beenverlengingstechnieken.

OBJECTIVE: Assessment of the results and complications of limb lengthenings according to Wagner and De Bastiani. DESIGN: Retrospective. SETTING: University Hospital Groningen, the Netherlands. METHODS: Between 1978 and 1993, 10 Wagner and 23 De Bastiani limb lengthenings were performed on 16 patients with leg length discrepancy and 3 patients with short stature. The lengthening procedures were assessed for mean lengthening, healing index (treatment days per centimeter of lengthening) and complications. The residual length discrepancy was measured indirectly. Total gain in body height was measured in the short stature patients. RESULTS: For the Wagner upper leg procedures the mean lengthening was 40 mm and the healing index 81 days/cm. For the lower leg these were 37 mm and 81 days/cm respectively, for the Bastiani lengthenings because of length discrepancy the figures were 70 mm and 46 days/cm (upper leg) and 53 mm and 52 days/cm (lower leg), and for short stature 74 mm and 46 days/cm (upper leg) and 57 mm and 55 days/cm (lower leg). There were 37 complications. Lengthening in 6 Wagner and 3 De Bastiani procedures was interrupted because of several of these complications. In 9 patients with length discrepancy the final result was satisfactory, 3 patients were not yet fully grown. Four patients had a residual length discrepancy of 2.5 to 3.5 cm. The short stature patients gained an average of 13.1 cm in height. CONCLUSION: Limb lengthenings are accompanied by many complications and patients should be monitored intensively, but the results are usually good.

Congenital knee dislocation in a 49,XXXXY boy.

We report on a 12 year old mentally retarded boy who presented at birth with bilateral knee dislocations, dislocation of the right hip, and general joint laxity. Cytogenetic studies showed a 49,XXXXY karyotype. Hyperlaxity of joints is known to occur in 49,XXXXY patients, but congenital knee dislocation has not been reported. Rarely in 49,XXXXY and 49,XXXXX syndromes Larsen-like features may be seen. Patients with congenital joint dislocation or laxity, combined with other malformations, especially if psychomotor development is delayed, should be karyotyped to exclude chromosomal abnormalities.

Uniform System for the Evaluation of Substances. IV. Distribution and intake.

This is the fourth article in the series on USES, the Uniform System for the Evaluation of Substances. This article describes the modelling approach used to predict concentrations in the environmental media (air, surface water, agricultural soil and groundwater) and the intake media for humans (fish, drinking water, root crops, leaf crops, meat and milk) and for predatory birds and mammals (fish and earthworms). Distribution and intake are estimated on two spatial scales: locally near a point source, and regionally over a larger area. This article focuses on the local distribution and the general intake models. Local distribution is modelled in a hypothetical standard environment, using typical environmental characteristics. Humans and predators are assumed to be exposed to food products from the contaminated system. The choice of models in a system like USES, is limited by the small data sets legally required for risk assessment purposes. Therefore, USES focuses on relatively simple models, and is able to work with the limited input data.

[The treatment of leg length discrepancy using Phemister's method of epiphysiodesis]. / Behandeling van beenlengteverschillen met behulp van de epifysiodes volgens Phemister.

A retrospective study is reported of the results of epiphysiodesis in 67 children. In 47 patients (70%) the final inequality was less than or equal to 1.0 cm. In 9 patients the final inequality was greater than or equal to 1.6 cm. The average leg length inequality could be reduced from 3.2 cm preoperatively to 1.2 cm at maturity. Technical errors were minimal. Failures (9 patients) resulted mainly from problems in timing epiphysiodesis.

Operative treatment for acetabular fractures.

We report a retrospective study of 54 acetabular fractures treated by open reduction and internal fixation, with an average follow-up of 9.6 years (3 to 17). Reduction leaving displacement of less than or equal to 2 mm was achieved in 36 hips (67%); good or excellent functional results were obtained in 33 patients (61%). Early complications requiring re-operation included postoperative loss of reduction in one case and an intra-articular screw in another. Arthrodesis or total hip arthroplasty had been performed in 10 patients (19%) who had late symptomatic degenerative changes. Failure to obtain accurate reduction was the most important factor leading to a poor result, but heterotopic calcification caused poor results in seven patients, five of whom had had an anatomical reduction.

[Osteoid osteoma and osteoblastoma]. / Het osteoïde osteoom en het osteoblastoom.

A follow-up study, based on clinical, radiological and pathological information was performed of 20 patients who had suffered from an osteoid osteoma and of three patients who had been treated for an osteoblastoma in the period 1978-1988. 50% of the patients mentioned both pain at night and a good reaction to salicylates. In 87% of the cases a correct diagnosis was made with the aid of conventional radiography, tomography and bone scanning. Primary treatment consisted of intracapsular (mostly piecemeal) excision in all cases. A local recurrence was observed in one patient with osteoid osteoma and in two with osteoblastoma. At the time of this follow-up study none of the 23 patients had complaints. Histopathological examination did not reveal any difference between the two types of bone tumour.

[Extra-articular subtalar arthrodesis in children]. / De extra-articulaire subtalaire artrodese bij kinderen.

A retrospective study is reported of the results of 28 subtalar arthrodeses by Grice's technique, performed in 18 children because of a neurological condition causing a progressive valgus deformity of the posterior and an eversion deformity of the anterior part of the foot. The results were indifferent. Indications and complications are discussed.

Acetabular fractures in children and adolescents.

A retrospective study of 23 acetabular fractures in patients up to 17 years of age is presented, with an average follow-up of eight years. Good or excellent functional results were achieved in 21 patients; radiographic results were good or excellent in 16. Conservative treatment gave consistently good results in fractures with minimal initial displacement, stable posterior fracture-dislocations and Salter-Harris type 1 and 2 triradiate cartilage fractures. Less favourable results were seen in type 5 triradiate cartilage fractures and in comminuted fractures, but operation was no better. Unstable posterior fracture-dislocations and irreducible central fracture-dislocations need operative treatment but the results may still be unsatisfactory.

Bilateral total hip and knee replacement in rheumatoid arthritis patients.

Between 1978 and 1983, 14 patients suffering from rheumatoid arthritis were treated by bilateral total hip and knee replacement. At the time of this follow-up study (32-92 months postoperatively) one patient had died of concomitant disease and was excluded. The postoperative results regarding pain relief, improvement in performing daily activities, and function were studied in the remaining 13 patients. A 200-point rating scale was used, which compared the pre- and postoperative findings at follow-up. All patients showed marked relief from pain, good function and a good functional score. Although walking ability did not always improve, all patients were enthusiastic.

Percutaneous transhepatic balloon dilatation of strictured hepaticojejunostomies.

Strictured hepaticojejunal anastomoses can be surgically repaired with excellent results. However, remedial surgery may be difficult or hazardous in some patients and percutaneous transhepatic balloon dilatation (PTHBD) may be used as an alternative. Three patients with complicated strictured hepaticojejunostomies have been managed with PTHBD with good short-term results. The procedure was safe, technically easy and associated with low morbidity. Although long-term efficacy is not proven, this method can be used to prepare patients for elective surgery or as a definitive procedure in patients who are poor surgical risks.

Injuries of the acetabular triradiate cartilage and sacroiliac joint.

Four patients with injuries of the acetabular triradiate cartilage are presented. In three of them premature fusion of the cartilage occurred; two of these developed acetabular deformity and subluxation of the hip. In all patients the sacroiliac joint also was injured; in two, the joint was completely disrupted, leading to fusion and growth disturbance of the ilium. As injury of the triradiate cartilage is easily missed on the initial radiograph, it is advised that all patients with pelvic trauma should be followed clinically and radiographically for at least one year.

Dynamic splint for treatment of congenital dysplasia of the hip.

A prospective review of 108 cases of dysplasia of the hip treated with a new dynamic splint is presented. The success rate in restoring the acetabular angle was 100%, with no incidence of ischemic necrosis.