Prevalence of degenerative joint complaints of the lower extremity: a representative study.

As part of the international campaign of the bone and joint decade, we aimed to present epidemiological data on the prevalence of major joint complaints in a Central European region. Ten thousand subjects aged between 14 and 65, selected randomly by the Hungarian central office of statistics from three counties in southern Hungary, were surveyed using our own questionnaire based on widely accepted scoring systems in the literature, focusing on major degenerative joint complaints, and using the short form 36 (SF-36) questionnaire. We found that the prevalence of hip pain in the observed group was 22.2%, the prevalence of knee pain 30.3%, and frequent ankle pain occurred in 9.7%. The results of the SF-36 questionnaire showed that with the exception of social function, neither of the values of the examined health dimensions reached levels of other international surveys. Details of the survey and the possible causes of the higher prevalence are discussed, along with the results of the SF-36 questionnaire.

Surgical correction of Scheuermann's kyphosis.

This is a retrospective study of eight consecutive patients of mean age 19 (13-27) years with severe Scheuermann's kyphosis who underwent anterior and/or posterior fusion using the Cotrel-Dubousset (CD) instrumentation. In two an anterior release and fusion with rib grafts had been previously performed. The mean follow-up was 5 years. The preoperative hyperkyphosis averaged 86 degrees (71 degrees - 99 degrees), which was postoperatively 44 degrees (32 degrees - 58 degrees). The average loss of correction was 4.6 degrees (1 degrees - 12 degrees). The lumbar hyperlordosis spontaneously improved from -67 degrees to -48 degrees. Two patients, who had chronic back pain refractory to conservative treatment, improved considerably after surgery.

Characteristics of degeneration in an unstable knee with a coronal surface step-off.

To investigate the effect of instability on the remodelling of a minor articular surface offset, we created a 0.5 mm coronal step-off of the medial femoral condyle in 12 New Zealand white rabbits and transected the anterior cruciate ligament (ACL). A control group of 12 rabbits had only ACL resection and the opposite knee was used as the non-operated control. The osteoarthritic changes at 6, 12 and 24 weeks after surgery were evaluated histologically. In addition, changes in the immunological detection of 3-B-3(-) and 7-D-4 chondroitin-6-sulphate epitopes were determined because of the previous association of such changes with repair of cartilage and early osteoarthritis. In the instability/step-off group there was rapidly progressing focal degeneration of cartilage on the high side of the defect, not seen in previous step-off studies in stable knees. The rest of the femoral condyles and the tibial plateaux of the instability/step-off group had moderate osteoarthritis similar to that of the instability group. 3-B-3(-) was detectable in the early and the intermediate stages of osteoarthritis but no staining was seen in the severely damaged cartilage zones. Immunoreactivity with 7-D-4 increased as degeneration progressed.

The surgical treatment of spinal deformities in the Department of Orthopaedic Surgery, University Medical School of Pécs, Hungary: history and development.

Since its foundation in 1966, a great deal of attention has been paid to the treatment of spinal deformities, especially idiopathic scoliosis, in the Department of Orthopaedic Surgery, Medical School of University, Pécs. The authors compared the results of three different surgical methods (modified Hibbs, Harrington, Cotrel-Dubousset) on 171 patients between 1966 and 1992. The average follow-up period was between 2 and 13.2 years. In cases in which the modified Hibbs procedure was used we achieved a 26% correction, in the Harrington cases we achieved a 43.9% correction, and the loss of correction was 100% after the Hibbs operation and 18% after the Harrington operation in the follow-up period. In cases of Cotrel-Dubousset Instrumentation we achieved about 70% correction, but the follow-up period was too short (2 years) to evaluate the loss of correction in these cases.

[Early synovectomy in the treatment of juvenile rheumatoid arthritis]. / Korai térdízületi synovectomia a juvenilis rheumatoid arthritis kezelésében.

Authors report on the results of 15 synovectomies of the knee for iligoarticular juvenile rheumatoid arthritis. The operation was performed in every case in the early stage before the development of the radiological destruction. Excellent and good results were obtained in 11 cases; in 4 cases the operation was unsuccessful. It is stated that there is good chance to prevent destruction of the knee with juvenile rheumatic arthritis with an early synocvectomy. The operation is suggested after 6 years of age. The key of the good result is the early intensive mobilization of the joint.

[Overhead extension in delayed diagnosis of congenital hip dislocations in children, following failure of treatment with the Pavlik harness]. / Pavlik hámra nem gyógyuló és késön felismert csípöficam overhead extenziós kezelése.

Authors report, based on a retrospective examination of 103 dislocated hips of 85 children, on experiences with the overhead treatment of congenital hip dislocations, resistant to Pavlik harness or lately recognized. The results are compared with those of 23 hips of 20 children treated with Pavlik harness and plaster casts. Follow-up time was 3-15, in average 7 years. It is stated that the overhead extension treatment not followed by stiff fixation resulted in 92 per cent reduction in resistant and lately recognized hip dislocations. This procedure has caused in only 4 per cent severe necrosis of the femoral head with lasting consequences. Their experience with Pavlik harness combined with plaster cast are unfavourable as in 4 of 23 hips treated subtotal, in another 7 partial femoral head necrosis has developed.

[Management of metatarsalgia using Helal's method for metatarsal osteotomy]. / Metatarsalgia kezelése Helal szerinti metatarsus osteotomiával.

Authors report on the result of Helal's metatarsal osteotomies performed on 62 feet of 48 patients for metatarsalgia. In 85 per cent the result proved to be excellent, in 15 per cent there was no improvement. Analysing the causes of the postoperative complaints they call attention to the overload of the marginal arches and to the metatarsalgia developing on the non osteotomized neighbouring arch. These complaints appeared in 1/3 of their material and could be generally well influenced with conservative treatment.

[Complete surgical correction of congenital hip dislocation (one-stage surgery)]. / A veleszületett csípöficam komplett mütéti megoldása (one-stage operáció).

A 3-10 years follow-up and the evaluation of the 55 cases operated 1980 through 1988 on the Orthopaedic University Hospital in Pécs is presented. The age of the patients at operation was 4.5-10 years, in average 4 years. The operation consisted of four components: operative reduction, varus derotation femoral osteotomy, acetabular plasty and transposition of the iliopsoas muscle. In 53 cases excellent or good Roentgen anatomical and functional results were found. In one case after the operation complete femoral head necrosis has developed, in two cases a transient ischaemic state was observed that healed however without functional deficiency.

[Vertical talus]. / Talus verticalis.

Authors differentiate four etiological groups of vertical talus. In their material the congenital and symptomatic rocker bottom foot was rarer than the paralytic one. Good result can be expected mainly from the operative treatment. From 69 cases good clinical and radiological result was reached in 58, whereas in 6 cases the treatment had no result. It was their experience that a reduction of the talus and of the navicular bone can be reached by tenotomies and capsulotomies and by these a normal form of the foot can be secured. In the conservation of the operative results the significance of the organized care is stressed.

[First cases of using Cotrel-Dubousset instrumentation in Hungary]. / A Cotrel-Dubousset instrumentáció elsö hazai esetei.

In the treatment of scolioses of different origin the spondylodeses performed from a dorsal exposure have an outstanding role. For the fixation of the spine several instruments were constructed; one of them is the Cotrel-Dubousset Instrumentation used since 1983 by which it became possible, beside the spinal correction and fixation in three dimensions, the omission of the external fixation devices. Authors report on the first experiences in Hungary with the CDI system on five patients and state that from the numerous advantages of the CDI the expansion of correction possibilities, the development the physiological spinal curvatures, the correction in three dimensions and the omission of the external fixation are outstanding.

Weight bearing in Perthes' disease.

Results of two different types of treatment for 82 varus-derotation femur osteotomies to cure Perthes' disease are presented. Patients were treated between 1974 and 1984. Postoperatively, in 30 cases weight bearing was allowed, while in 52 cases, non-weight bearing braces were applied. Comparing the results of the two groups and considering the risk factors, the authors found that non-weight bearing does not influence end results after proximal femur osteotomy.

[Chiari's pelvic osteotomy in the management of Perthes disease]. / Chiari-féle medenceosteotomia a Perthes-betegség kezelésében.

Authors deal, on the basis of an analysis of 3 own cases and of the literary data, with the indication of Chiari's osteotomy in Perthes' disease. It is stated that the operation is to be performed over the age of 8-9 years, in severe lesion of the femoral head, and if the femoral head is so much flattened, widened and extruded from acetabulum that it can not be centralized with varisation. The operation promotes the rebuilding of the femoral head epiphysis, the biomechanical relations are improved and the early arthrosis can be prevented.

[Perthes disease and relief of weight bearing]. / Perthes-betegség és tehermentesítés.

Authors compare in two different groups of treatment the results of varus derotation osteotomies in Perthes' patients treated on the Department of Orthopaedics of the Pécs University of Medicine in 1974-1984. In 30 cases running was allowed after the osteotomy whereas in 52 cases an apparatus to relieve of weight bearing was used. It is stated after the comparison of results, considering also the role of the "risk" factors, influencing the results that the relieve of weight bearing does not influence the end result.

Acetabular development in Legg-Calvé-Perthes disease.

The normal development of the proximal femur epiphysis and the acetabulum of 50 children with unilateral Perthes disease were analyzed on the unaffected side with serial x-rays using the epiphysis and the acetabular index. The same factors were studied on the affected side. A pathological process has been established in the affected hip. However, while these pathological processes run parallel up to 9 to 10 years of age on the femur epiphysis and in the acetabulum, the elastic ability of the acetabulum ceases over 9 years of age. This smaller plastic ability is the probable cause of unfavorable results in older children.