Effectiveness of femoral varus osteotomy in patients with cerebral palsy.

This is a retrospective review of 144 hips in 99 patients treated with femoral varus osteotomy between 1975 and 1995. Average follow-up was 5 years (range, 2-15 years). The majority of patients (67%) were nonambulatory spastic quadriparetics. The average age at the time of surgery was 7.7 years (range, 3-15 years). Radiographic parameters analyzed were the neck-shaft and center-edge (CE) angles and Reimer's migration index (MI). Results were considered good if the CE angle was >20 degrees and the MI <30%, fair if the CE angle was 0 degrees - 20 degrees and the MI 30-50%, and poor if the patient had persistent pain, a CE angle of <0 degrees , or an MI >50%. Twelve hips (8%) remained painful at final follow-up, and 12 hips (8%) dislocated despite surgery. Previous surgery, unilateral surgery, performing a pelvic osteotomy, and age at the time of surgery had no statistical influence on outcome. Good results were obtained in 43.1%, fair in 41.5%, and poor in 15.4%. Only the quality of the reduction obtained at surgery, judged by the increase in CE angle and the reduction in MI, had a statistical influence on final result. Athetoid patients fared as well as those with spasticity. Femoral varus osteotomy was effective in providing a stable pain-free hip in 84% of patients.

Infection after rotator cuff repair.

Sixteen patients (15 men and 1 woman) were treated for infection complicating rotator cuff repair during the period 1975 through 1994. Eight of the 16 patients had their initial procedure performed elsewhere. The remaining 8 procedures were performed at our institution with the known incidence of this complication being 0.27%. In addition to intravenous antibiotic therapy, an average of 3.5 (range 2 to 8) operative procedures were required to eradicate the infections. Micro-organisms cultured were Propionibacter in 6, coagulase negative Staphylococcus in 4, Staphylococcus aureus in 4, Peptostreptococcus magnus in 1, and both Propionibacter and coagulase-negative Staphylococcus in 1. The deltoid was restored in all patients; the rotator cuff was reparable in 11. In the 12 shoulders with greater than 1 year of follow-up (average 51 months, range 14 to 165 months), active elevation averaged 110 degrees and external rotation 50 degrees. Four patients had no pain, 4 had minimal pain, and the remaining 4 had moderate pain. Satisfactory final results, which were determined by the patients' opinion or with the use of either the University of California, Los Angeles score or the modified Neer system, were obtained in 5 (42%) of the shoulders.

Long-term results of proximal femoral replacement for non-neoplastic disorders.

We reviewed retrospectively 50 consecutive total hip arthroplasties with proximal femoral replacement prostheses in 49 patients. All the patients had massive bone loss. There were 31 women and 18 men who had undergone a mean of 3.1 hip operations. At the last review, 15 patients had died and two had been lost to follow-up, so that 32 patients (33 hips) were available for assessment. The mean age of the patients at the time of the operation was 60.6 years. The mean length of clinical follow-up was 11.1 +/- 4 years, and mean radiographic follow-up was 7.6 +/- 3.2 years. The average preoperative Harris hip score was 46 +/- 13 points, which improved to 80 +/- 10 points after one year and to 76 +/- 16 points at the latest follow-up. The most frequent complication was dislocation, which occurred in 11 hips. Four femoral components and seven acetabular prostheses were revised because of aseptic loosening. With revision at the end point, survivorship after total hip arthroplasty with a proximal femoral replacement prosthesis was predicted to be 64% at 12 years. Although our preliminary results of hip salvage with a proximal femoral replacement prosthesis were encouraging, a longer follow-up has shown a higher rate of failure.