Medium- and long-term results of high tibial osteotomy for varus gonarthrosis in an agricultural population.

High tibial valgus osteotomy for varus gonarthrosis was performed in 63 consecutive patients in a homogenous agricultural population using two different surgical techniques. Patients were divided into two groups. A two-level Mittelmeier osteotomy was performed in group A patients, and a lateral closed wedge high tibial osteotomy using the AO/ASIF L-plate was performed in group B patients. Operations were performed by two different groups of surgeons. Patients were evaluated postoperatively for correction of knee axis, functional result, subjective impression, and complications. In group A patients, 80% of the operated knees were corrected to the mechanical axis and in group B patients, 82% of the knees were corrected to 6 degrees-10 degrees valgus of the anatomical axis. Ninety percent, 70%, and 54% of group A and 91%, 73%, and 57% of group B patients were rated as satisfactory results at 5, 9, and 12 years postoperatively, respectively; these differences were not statistically significant. One year postoperatively, 91% of group A and 96% of group B patients reported their symptoms had improved. However, patient satisfaction decreased at 5, 7, and 12 years postoperatively, with 91%, 89%, and 66% of group A and 96%, 93%, and 68%, respectively, of group B patients reporting their symptoms had improved; these differences were not statistically significant. Postoperatively, most patients returned to full agricultural activity. Total knee arthroplasty, which was later required in 12% of the knees, was not significantly jeopardized by the previous osteotomy.

Acetabular roof reinforcement rings.

A series of 30 total hip arthroplasties was performed in 29 patients with the use of the Mueller roof reinforcement ring (RRR). The mean follow-up observation time was 30 months (standard deviation [SD] = 7.6). The clinical and radiologic results were evaluated according to the Mayo Clinic scoring system. The overall preoperative clinical score of 21.963 (SD = 18.776) points improved to a follow-up examination score of 69.533 (SD = 11.599), a correction of 68.41%. The authors' goal in this series was to implant the ring together with the polyethylene socket as close to the anatomic position of the acetabulum as possible. There was no loosening of the RRR or the polyethylene sockets, nor was there material failure in the last evaluation of the hips. No statistically significant difference was found when the differences between the follow-up scores of the primary versus the revisionary procedures were compared. The roof replacement ring has been helpful for primary and revision arthroplasties of acetabular deficiencies occurring within five years after operation.