Although previous studies have shown poor correlation between clinical symptoms due to lumbar stenois and radiologic stenosis, no study has corrected for congenital variation in vertebral body size among individuals. This purpose of this study is to determine the relationship between the degree of radiographic lumbar spinal stenosis, adjusted with an internal control for vertebral body size, and disability from lumbar stenosis. One hundred and twenty-three consecutive patients with clinical and radiologic confirmation of neural impingement secondary to lumbar stenosis were enrolled prospectively. Thecal sac AP diameter (TSD) and cross sectional area (CSA), and vertebral body AP dimension (VBD) were determined. These parameters were then correlated with patients’ symptoms using the modified Roland-Morris Questionnaire (RMQ) disability score. This study found no statistically significant inverse correlation between TSD and RMQ score (p=0.433) or CSA and RMQ Score (p=0.124). In addition, there was no significant inverse correlation between CSA/VBD ratio and RMQ score (p=0.036) or TSD/VBD ratio and RMQ score (p=0.109). There was a significant difference in mean RMQ scores when the patients were divided into those with CSA greater than or equal to 70 mm2 and those less than 70 mm2, with T=−2.104 and p=0.038. The degree of radiographic lumbar spinal stenosis, even with the use of an internal control of vertebral body size and standardized disability questionnaires, does not correlate with clinical symptoms. However, patients with more severe stenosis below a cross-sectional area critical threshold of 70mm2, have significantly greater functional disability.
Loosening was classified as possible if there was between 50 and 99 percent c-b radiolucency, probable when there was complete radiolucency, or definite when vertical subsidence was more than 5mm. The presence and type of radiological features analysed according to surgeon and whether a centraliser was utilised.
There is a lack of properly undertaken comparative studies of total hip replacement (THR). A randomised trial was established to examine the hypothesis that there are no important differences in clinical outcome at 2 years and at long-term follow-up between cemented and uncemented primary THR in middle aged patients.Eighty-three patients with 90 osteoarthritic hips were randomised to a cemented Exeter THR involving a matte or polished tapered stem (n=47, median age 68yrs) or an uncemented PCA proximally porous-coated cobalt-chrome stem and porous coated press fit cup (n=43, median age 66yrs). Patients underwent immediate full weight bearing post-operatively. The follow-up period is 8 to 16 years. The median Harris hip scores for the cemented and uncemented groups respectively were 92 and 95 at 2 years and 89 and 96 at long-term follow-up. Four cemented hips have been revised for aseptic loosening. There have been no failures of the polished stems. An analysis of a larger series of matt versus polished cemented stems also found that the results of the polished stems were superior. Four uncemented hips have been revised, two more recently for acetabular wear and osteolysis. There was a high rate of radiographic demarcation of the cemented cups. There were no important differences in the clinical scores between cemented and uncemented THR. Some matte surfaced femoral stems failed and this trend was confirmed by analysis of a larger series. Osteolysis around the uncemented acetabular components is a concern. Importantly immediate weight bearing was associated with good results of uncemented stems.
