Joint preservation surgery for correction of flexible pes cavovarus in adults.

BACKGROUND: Cavovarus foot deformity often results from muscular imbalance. If deformities are still flexible, surgical correction can be aimed primarily at improving muscular balance. MATERIALS AND METHODS: We retrospectively assessed the outcome of 19 procedures (in 15 patients) to evaluate patient satisfaction. All patients had a flexible deformity. The surgical procedures that were used included soft-tissue releases, tendon transfers and lengthenings, and osteotomies of either the first metatarsal or the calcaneus. The surgical results in terms of pain, function and alignment of the foot were evaluated by means of standardized questionnaire (AOFAS foot score and the Dutch version of the Foot Function Index), patient interview, physical examination and X-ray. The changes in calcaneal pitch and talus-metatarsal I angle were calculated. RESULTS: Overall patient satisfaction was good. The results were very satisfactory in five procedures, satisfactory in ten, moderately satisfactory in two, unsatisfactory in one, and very unsatisfactory in one procedure. The AOFAS hindfoot score was on average 82.5 +/- 16. The talus-metatarsal I angle significantly decreased from 22.5 to 17 degrees (p = 0.002). The anatomical corrections of the foot did not show association with the patients' clinical characteristics. CONCLUSION: Our results show that in joint preserving flexible pes cavovarus correction patient satisfaction is generally good. Radiographic alignment of the foot was not significantly associated with patient-based outcome in this small series of patients.

Performance of 3 gelatine-based resorbable cement plugs: a study on 15 synthetic femurs and a prospective randomized study on 103 patients.

BACKGROUND: Intramedullary plugs are key factors in improving cement fixation of the femoral component. We investigated the performance of 3 commercially available resorbable cement restrictors in vitro and in vivo. METHODS: We measured the migration of the SEM II, the C-plug, and the REX plug in 15 Sawbones synthetic femurs and in 103 patients during total hip surgery. Cement pressures were also measured distally and proximally in vitro. RESULTS AND INTERPRETATION: Our in vitro results showed poor performance of the C-plug compared with the REX and SEM II plugs. In vivo, the mean migration was least for the SEM plug and most for the C-plug. The smaller sizes performed significantly better than the larger ones for all 3 plug types. The overall in vivo performance of all 3 plug types was unsatisfactory. Differences between the SEM II and REX plugs were small and therefore not significant. The SEM II performed better than the REX, the former being much cheaper and easier to insert. The Rex plug looks promising; however, the insertion device must be improved for better results. The C-plug proved to be unstable.