Femoral head autografting with total hip arthroplasty for lateral acetabular dysplasia. A 12-year experience.

The use of a lateral femoral head autograft with total hip arthroplasty is an effective method to treat moderate to severe acetabular dysplasia with an excellent chance of satisfactory results. The operation was performed on 42 hips in 37 patients over a 12-year period. The average follow-up period was 5.7 years, with none shorter than two years. A posterior approach was used with no trochanteric osteotomy in 38 hips. Average operative time was 133 minutes and average blood replacement was 435 ml. All grafts united. Average Harris hip ratings increased from a preoperative 39.1 points to a postoperative 89.8 points. Complications included three loose femoral components (one definite, one probable, and one possible), two loose acetabular components (one definite and one possible), one Class IV heterotopic ossification, and two cases of thrombophlebitis. Two patients required revision surgery for loosening. To date, there are no infections, dislocations, pulmonary emboli, nerve palsies, or deaths.

Works in progress #5. Total knee arthroplasty using a long-stem tibia component A novel approach to traumatic arthritis accompanying nonunion and multiple stress risers of the tibia.

Constrained total knee arthroplasty (TKA) using a long-stem modular tibia component has been successful in three cases that presented an unusual combination of technical problems. The constrained TKA described allows successful salvage in patients with traumatic arthritis, extreme ligamentous damage, and either nonunion or the presence of multiple screw holes of the proximal tibia. The average follow-up period for these three cases has been only 18 months, but the results so far are very promising.

Tuberculosis joint infection following total knee arthroplasty.

Delayed onset tuberculosis infection appeared in a total knee implant in a 61-year-old former coal miner. After a five-day interval the knee was salvaged by removal, aggressive debridement, suction-irrigation, and reinsertion. Antituberculosis drugs were administered immediately following surgery on the basis of the characteristic exudate and stat histologic sections showing granulomata formation. At one year follow-up examination the result was excellent. Retention of the total knee implant is a viable alternative to arthrodesis or fibrous ankylosis of the knee in such a case. Tuberculosis should be included in the differential diagnosis in patients with knee joint degenerative disease.

Treatment of intertrochanteric fracture of the femur using sliding screw plate fixation.

Sliding screw plate fixation of intertrochanteric fractures of the femur is not always a simple operation with universally excellent results. There is a need to recognize potential pitfalls of this technique by careful analysis of a large number of cases. A retrospective study of 295 intertrochanteric fractures of the femur over a nine-year period was conducted. All fractures were fixed with a sliding screw sideplate device. Mechanical fracture complications occurred in 9% of 142 stable fractures and 19% of 37 unstable fractures. Medial displacement fixation reduction lowered the complication rate of unstable fractures to 10% of 19 cases. A roentgenographic study of 179 hips identified a technical error rate of 22.9% using described criteria. Including 39 deaths, 30 fracture complications, and 45 general complications, the serious complication rate was 38.6%. The sliding screw sideplate device can provide satisfactory fixation, but success is dependent on many other factors, including reduction, operative technique and postoperative care.

Unicompartmental modular total knee arthroplasty.

Currently there is a difference of opinion regarding the advisability of unicompartmental total knee replacement. This report describes eight cases from a series of 100 consecutive total knee arthroplasties; results averaged 85.5 by the Cleveland Clinic knee evaluation forms. The followup period averages 37.4 months, with a range of 21 to 60 months. Indications for this procedure, provided disease is limited to a single compartment, include osteonecrosis, failed hemiarthroplasty, and traumatic arthritis. Postoperative pain, settling of tibial components, and rapid deterioration of the opposite compartment have not occurred.

Tuberculosis joint infection.

A retrospective study of tuberculosis infection of joints over a 10 year period has identified 21 documented cases. The patients were, for the most part, of rural, middle-class background and usually in the fifth to seventh decade. Diagnosis was commonly missed with the exception of spinal lesions. Presentation was usually monoarticular with roentgenograms showing progressive joint destruction. Sedimentation rate elevation and positive skin testing were helpful, but the diagnosis depended on culture and histologic examination of tissue. Chemotherapy was very effective and urgent surgery was performed on spinal lesions for neurologic deficit.

Rupture of the musculotendinous cuff of the shoulder.

Codman established the diagnostic criteria and treatment for musculotendinous cuff rupture over 40 years ago. Chronic shoulder pain after a history of trauma which is unresponsive to usual conservative treatment may indicate rotator cuff tear. Point tenderness, weakness of abduction and external rotation, atrophy, and palpable crepitus or a gap are confirming signs. X-rays may be negative in the acute injury but show definite changes with chronicity. An arthrogram confirms the presence of a tear. An electromyograph should be performed to rule out suprascapular nerve lesions. Surgical repair will result in good or excellent results in at least two-thirds of cases properly selected. Complications which can adversely influence the results include deltoid avulsion, residual impingement and ectopic bone formation. A successful repair is generally permanent.

Combined trochanteric and ipsilateral shaft fractures of the femur treated with the Zickel device: a case report.

An unusual double fracture of the femur in the trochanteric and shaft areas of a 39-year-old clerical worker has been successfully treated by open reduction and internal fixation with the Zickel device. Only one other instance of the application of this method to a double fracture seems to have been reported previously. Recovery was uneventful, prompt, and the patient showed good evidence of healing at the 10-month followup examination. The described case represents the seventh report of this unusual lesion in the literature.

Dysplasia epiphysealis hemimelica. A case report.

Experience with a 9-year-old girl with Dysplasia Epiphysealis Hemimelica in the right lower extremity demonstrates that avoidance of confusion leading to medical--legal problems and promotion of effective management would have been possible by early recognition of the condition.