Aseptic loosening of BonelocR cemented hip prostheses.

We present a systematic clinical and radiographic study of 147 patients who had total hip replacements from February 1992 to May 1993. BonelocR cement was used in 108, and PalacosR cement with gentamicin in 39 patients who had an increased risk of infection. At follow-up after 24 to 39 months, 26 cases with BonelocR cement had failed; there were no clinical failures in the PalacosR group.

Hip replacement for congenital dislocation and dysplasia.

Seventeen patients with arthrosis secondary to congenital dislocation or dysplasia of the hip were treated by total hip replacement. Nine hips were completely dislocated, while 12 were dysplastic and subluxated. The operation was performed as a modification of Charnley's standard technique, the acetabular prosthesis was always placed in the neoacetabulum, and no particular attempt was made to correct the shortening of the leg. In eight patients bone grafting to the upper lateral acetabular edge was done. Only a few complications occurred and no postoperative dislocations. On average 4 years after the operation, the clinical and radiographic results were satisfactory. The operation used here is less difficult than placing the cup in the original acetabulum.

Lateral ligament reconstruction of the ankle with a modified Watson-Jones operation.

A modified Watson-Jones technique, using only half of the peroneus brevis tendon, was applied as an operative procedure for lateral ankle instability. Twenty-nine patients with 30 operated ankles were examined with an average follow-up period of 7 years and 6 months. Functional stability was achieved in all but one of the operated ankles. In 15 cases there were periodic pains and swelling on activity, while the remaining 14 ankles were without symptoms. Supination of the foot was slightly decreased in 4 cases.

Primary osteoarthritis of the hip. Interrelationship between intraosseous pressure, X-ray changes, clinical severity and bone density.

The intraosseous pressure of the femoral head and greater trochanter was measured during 146 Charnley hip replacement operations. In 108 hips with primary osteoarthritis the pressure in the femoral head averaged 49.6 and in the greater trochanter 31.6 mmHg. The pressures in the greater trochanter were significantly lower than those in the femoral head. There was no sex difference, and the pressures were independent of age. The intraosseous pressure in the femoral head varied appreciably with a dispersion which did not significantly differ from the normal distribution. There was a faintly positive correlation between the mean blood pressure and the intraosseous pressure. No relationship was found between the pressure in the femoral head and the radiological severity of the osteoarthritis or between the intraosseous pressure and the duration of symptoms, severity of rest pain, walking ability, range of motion or degree of bone density at the site of measurement. The haemodynamic conditions in bone depend upon blood flow and resistance. Variations in these two factors determine the actual intraosseous pressure. As a consequence intraosseous pressure measurement as the only evaluation of the haemodynamic conditions is of limited value. The vascular factor in osteoarthritis needs further clarification.

Clinical and social status following injury to the lateral ligaments of the ankle. Follow-up of 144 patients treated conservatively.

Out of 174 patients treated conservatively for injuries to the lateral ligaments of the ankle 144 were seen at follow-up after 3.1--6.1 years (mean 4.2 years), and clinical as well as social sequelae were recorded. The diagnostic criterion was a difference in talar tilt of 6 or more degrees between the injured and uninjured foot on inversion stress radiographs. Occupational and athletic injuries, almost equally represented, made up a total of 64 per cent. Residual symptoms were present in 21 per cent, mainly in the form of functional instability, but only four patients (3 per cent) reported daily complaints. One patient had developed reflex dystrophy, and this was the only patient who had been referred for further orthopaedic treatment. There was a close correlation between pain on movement in the ankle joint and residual symptoms which were, incidentally, unrelated to the degree of primary talar tilt. All the patients seen at follow-up had normal range of movement in the talocrural and subtalar joints. Two patients with residual symptoms had stopped working, while in the others the working ability was unaffected. The period off work had been twice as long for patients having heavy and fairly heavy work as for those doing light work. All football players with residual symptoms had had to give up playing, but only a few had daily complaints. This indicates that some symptom-free patients have in fact latent symptoms, elicited only by fairly severe strain.

Radiological and muscular status following injury to the lateral ligaments of the ankle. Follow-up of 144 patients treated conservatively.

An average of 4.2 years after conservative treatment of injury to the lateral ligaments of the ankle 144 patients attended a follow-up examination which included radiography and measurement of the strength of plantar flexion. Prior to treatment all of the patients had a difference in talar tilt of 6 or more degrees between the injured and uninjured side. At follow-up there was instability in 28 patients, or 19.4 per cent, but no correlation between instability and residual symptoms. Nine patients had an anterior "drawer sign" exceeding 2 mm, but this was also without relation to residual symptoms. Radiological evidence of osteoarthrosis was found in five patients, but four of them had a stable ankle joint and only one had residual symptoms. The mean age of the patients with osteoarthrosis was twice that for the entire material. Two patients had osteochondritis of the talus. The strength of plantar flexion was measured in 124 patients. There was significantly less strength in the injured than in the uninjured leg, but there was no statistically significant correlation between residual symptoms and reduced strength or between radiological instability and reduced strength. According to the results of the present study and a previous one (Hansen et al. 1979) and to the results reported in the literature, we find no reason to alter our present principles regarding the diagnosis and conservative treatment of injury to the lateral ligaments of the ankle.

Asymmetry of plantar flexion strength in the foot.

A study of plantar flexion strength and calf circumference in 30 conscripts is submitted. It showed an asymmetry of strength amounting to 6--11 per cent (95 per cent confidence limits). The right leg was significantly stronger than the left, but there was no difference in strength between the dominant and non-dominant leg. There was little correlation between circumference and strength.

Below-knee amputation for ischaemic gangrene. Prospective, randomized comparison of a transverse and a sagittal operative technique.

In a prospective, randomized study a comparison was made of the results of primary below-knee amputation for ischaemic gangrene carried out by two methods: In 47 cases by the transverse technique with a long posterior musculo-cutaneous flap and in 41 cases by the sagittal technique using equally large medial and lateral musculo-cutaneous flaps--in both instances followed by 2 weeks in a half-open plaster cast with extended knee. The sex ratio and age distribution were the same in both groups. Minor differences in the vascular condition between the groups, assessed by the duration of rest pain, pulsation findings, extent of gangrene, and frequency of diabetes, wholly or partially equalized each other. The course of healing was the same in both groups, primary healing being attained in 38 per cent and 41 per cent, respectively (0.70 less than P less than 0.80). There was also no difference between the results as regards limb fitting, ambulation, occupational, or social status. It is concluded that the choice between the two methods can be based merely upon surgical skill and the ischaemic changes in the lower leg.

Intraosseous pressure in the femoral head and greater trochanter before and 1-3 years after osteotomy for osteoarthritis of the hip joint.

To elucidate the long-term effect of osteotomy upon the intraosseous pressure in osteoarthritis of the hip, pressure measurements in the femoral head and greater trochanter were performed in 22 patients before intertrochanteric osteotomy and 11.5-33.5 months later, on the occasion of removing the osteosynthesis material after the osteotomy had healed. Preoperatively the mean pressure in the femoral head was higher (35.0 mmHg) than in the greater trochanter (23.4 mmHg). At follow-up the mean pressure in the femoral head had fallen, but not significantly (0.10 less than P less than 0.20). A significant reduction in pressure (0.001 less than P less than 0.005) was found in 10 patients in whom the primary pressure was high (exceeding 35 mmHg) and in 16 patients seen at follow-up less than two years after the osteotomy (0.01 less than P less than 0.02), whereas with a longer observation period there was a tendency towards an increasing pressure. The trochanteric pressures accompanied the pressures in the femoral head, but without significant changes. No close correlation was found between intraosseous pressure and pain at rest. The operation had a good clinical effect, especially upon the pain at rest. A reduction in intraosseous hypertension may be a contributory cause, but the tendency to another increase in pressure after a long observation period indicates the possibility of a subsequent recurrence.