Lengthening scarf osteotomy for recurrent hallux valgus.

BACKGROUND: We describe using the scarf osteotomy to correct a recurrent hallux valgus deformity and lengthen the shortened first metatarsal in symptomatic iatrogenic first brachymetatarsia. METHODS: Thirty-six lengthening scarf osteotomies were undertaken in 31 patients. Clinical and radiographic measures were taken pre and postoperatively. RESULTS: Mean age at presentation was 53.4 years, and mean followup 3.9 years. The mean lengthening achieved was 4.9mm. All osteotomies united with no complications. The mean IMA reduction was 4.0° (p<0.001) and HVA 13.0° (p<0.001). The mean AOFAS score increase was 33.8 (p<0.001). There was a positive trend but no correlation (r=0.28) between amount of metatarsal lengthening and AOFAS score change. CONCLUSIONS: We describe the largest lengthening scarf osteotomy series for recurrent hallux valgus with iatrogenic first brachymetatarsia. The results suggest the procedure is successful, with a low complication rate. We anticipate that restoring first metatarsal length and alignment may reduce biomechanical transfer metatarsalgia over time.

Long term results of cementless total hip replacement for reversal of hip ankylosis.

Fifteen patients (16 hips) with an ankylosed hip joint for a mean of 36 years (3.5 to 65), had their hips converted to a cementless Total Hip Replacement (THR). They were followed-up for a median of 10.75 years (5.0 to 19) with none lost to follow-up. All patients showed improved mobility and function post-operatively. The Harris Hip Score improved from 70 (SEM 3.4) to 83 post-operatively (SEM 4.4), which was statistically significant (p < 0.05). There was one acetabular cup revision at 5 years post implantation for aseptic loosening. All other femoral and acetabular components remained clinically and radiographically well fixed. We conclude that a previously ankylosed hip can be effectively converted to a cementless total hip replacement with good long term results.