Fibrous tether of the distal femur produced unilateral genu valgus with subsequent patellar dislocation: case report and review of the literature.

Fibrous tether at the distal femur is a rare condition that causes angular deformity of the lower extremity; only 18 cases have been reported previously. We report the case of a 2-year-old boy presenting with unilateral genu valgus. The patient had a subsequent lateral patellar dislocation, 1 year after surgical correction. A second surgery was performed to correct this patellar dislocation. Intraoperative finding indicated contracted lateral patellar retinaculum. To the best of our knowledge, this is the first report of such a finding. The natural history is still not understood. At the 6-month-follow-up visit, the patient still has good results without recurrent patellar dislocation or angular deformity. We also review the literature in terms of proper treatment and results of treatment.

Functional outcome and complications following reconstruction for Harrington class II and III periacetabular metastasis.

BACKGROUND: Metastatic bone disease involving the acetabulum is a debilitating condition causing significant pain and disability for patients. Many methods of reconstruction have been described for treating Harrington class II and III lesions with different results and complications. Our objectives were to report functional results, implant survival and complications following reconstruction for Harrington class II and III periacetabular metastases by using anti-protusio cages, screws and joint replacement. METHODS: We reviewed 22 patients undergoing acetabular reconstruction for metastatic disease. There were 5 Harrington class II and 17 class III lesions. Intralesional curettage, multiple screws and cemented total hip replacement were performed in all patients. Anti-protusio cages were used in 19 hips. No Steinmann pins were used. Sixteen patients died at a median survival time of 12 months (range, 4 to 28 months) after surgery. Six patients were alive at last follow-up at a median of 8 months (range, 3 to 15 months). RESULTS: Postoperatively, the average ECOG score was improved from 3.1 to 1.7 and Visual Analog Scale was improved from 8.4 to 2.2. One patient developed hip dislocation and one patient developed superficial infection. The mean Musculoskeletal Tumor Society (MSTS) functional score was 70 (range, 27 to 87). There was no prosthetic loosening or revision. Twenty patients were able to walk. Eight patients became community ambulators, twelve became household ambulators and two were bed-bound. CONCLUSIONS: Good functional outcome and better ambulation could be expected following class II and III periacetabular reconstruction using anti-protusio cages, screws and cemented hip replacement. Few complications were noted and manageable. Although most of these patients with metastatic disease had limited life expectancies, their quality of life would be improved with appropriate patient selection and surgical reconstruction.

Perception of leg length discrepancy after total hip replacement and its impact on quality of life.

OBJECTIVE: To assess the leg length discrepancy (LLD) in the patients who underwent primary total hip replacement both the actual inequality (anatomical LLD) and the perceived feeling of inequality (perceived LLD). Moreover the impact of the perceived LLD on quality of life was evaluated. MATERIAL AND METHOD: From January 2011-January 2012, 151 hips from 151 consecutive patients were studied about the post-operative LLD by measuring the post-operative radiographs at follow-up time. Questionnaires concerning the perception of LLD and the Harris hip score (HSS) were completed. Assessing the postoperative quality of life with the EQ-5D patient self-rating tool also was done. RESULTS: Seventy nine patients had anatomical LLD and 41 patients could perceive LLD. Age, gender, post-operative time at follow-up and the HSS were not significantly different between both perceived LLD and non-perceived LLD patients. After 12 months post-operatively all non-anatomical LLD patients perceived no LLD. Only the EQ-5D of non-perceived LLD group was significantly better. CONCLUSION: Perception of LLD after total hip replacement is a significant factor that influences the patients quality of life. However, this frustration could resolve or improve with time.

The remodeling of the neck-shaft angle after proximal femoral varus osteotomy for the treatment of Legg-Calve-Perthes syndrome.

OBJECTIVE: To study the corrections of the neck-shaft angle (NSA) and the related clinical symptoms after proximal femoral varus osteotomy (PFVO) for the treatment of Legg-Calve-Perthes syndrome (LCPS). MATERIAL AND METHOD: Retrospective cohort study. Consecutive cases of LCPS treated at Lerdsin General Hospital during 1999 to 2010 were reviewed. The patients were excluded if they had less than 3 years of follow-up, there was incomplete data, and bilateral involvement. Demographic data and clinical symptoms were collected. The NSA were measured before and after PFVO. RESULTS: Twenty-two patients were treated by PFVO. The mean pre-operative NSA was 140 degrees. The mean varus angle created by PFVO was 20 degrees. The mean post-operative NSA at 6 weeks, 6 months, 1 year, 2 years and 3 years were 119, 119, 118, 120 and 120 degrees respectively. No statistical difference between the mean NSA at 6 weeks and 3 years (p = 0.65). There were 9 patients whose NSA increased more than 5 degrees at 3 years after operation. This group of patients had a more varus angulation at the early post-operative period. No physeal arrest was detected in any cases at 3 years after PFVO. No correlation between the NSA and pain or limitation of the hip abduction were observed. There were 3 patients, who had NSA less than 110 degrees after PFVO, had limping gait. CONCLUSION: It is difficult to predict the degree of remodeling of an individual hip after proximal femoral varus osteotomy. Special attention should be paid to avoid excessive varus of the proximal femur less than 110 degrees whenever PFVO is performed.

Isolated PCl avulsion from the tibial attachment: residual laxity and function of the knee after screw fixation.

OBJECTIVE: To identify the posterior laxity of the knee after PCL fixation and to correlate the findings with the functional outcomes using the standard evaluation systems. MATERIAL AND METHOD: Ten isolated PCL avulsions from tibial attachment were enrolled. The operation was done within 16 days after injury. Anatomical reduction and internal fixation with a screw of the avulsion fragment was done under direct vision and was confirmed by radiographs. The follow up evaluation was done at an average of 40 months after the indexed surgery. RESULTS: Injured-normal side laxity difference at an average of 2.4 mm was observed. According to IKDC knee ligament standard evaluation, two knees were graded normal and eight knees were graded nearly normal. The average Lysholm score was 91. Two knees were graded as an excellent outcome and 8 knees were graded good outcome. CONCLUSION: Despite mild laxity in the injured knee, the functional outcomes after fixation of the PCL avulsion were good to excellent.