Following successful adoption of the Ponseti method for clubfoot treatment, a team of physiotherapists and orthotists and one surgeon in Jalalabad, Afghanistan have begun to treat Congenital Vertical Talus (CVT) by the technique described by Dodds et al, adapted to locally available resources. We have reviewed the outcome. Since 2010, 38 feet in 31 patients have been treated. Diagnosis of CVT is confirmed with a stress radiograph. The underlying conditions are diverse. The technique involves serial passive stretches and plaster of Paris casts. Once the talo-navicular joint is judged to be reduced, the joint if fixed with a percutaneous pin under local anaesthetic and an Achilles tenotomy performed. Post-operative treatment is as per the Iowa technique with night-time bracing and an AFO for ambulant patients.Aim
Method
Negative remodelling of the femoral cortex in the form of calcar resorption due to stress shielding and cortical hypertrophy at the level of the tip of the implant, due to distal load transfer, is frequently noted following cemented total hip replacement, most commonly with composite beam implants, but also with polished double tapers. The C-stem polished femoral component was designed with a third taper running from lateral to medial across and along the entire length of the implant, with the aim of achieving more proximal and therefore more natural loading of the femur. The hoop stresses generated in the cement mantle are transferred to the proximal bone starting at the calcar, which should theoretically minimise stress-shielding and calcar resorption, as well as reducing distal load transfer, as signified by the development of distal femoral cortical hypertrophy. We present the results of a consecutive series of 500 total hip replacements performed between March 2000 and December 2005 at a single institution, using a standard surgical technique and third generation cementing with Palacos-R antibiotic loaded cement. Data was collected prospectively and the patients remain under annual follow-up. 500 arthroplasties were performed on 455 patients with an average age of 68.3 years (23–92). 77 patients have died (73 arthroplasties) and the average duration of follow-up for the entire series is 81 months (52–124).Introduction
Materials/Methods
Traditionally the use of small diameter femoral head (22mm) with the posterior approach has been perceived as an increased risk of dislocation. We present this prospective study of 400 consecutive total hip replacements performed using a 22mm femoral head and the posterior approach. Between March 2000 and November 2005 364 patients underwent 400 total hip replacements with a small diameter 22mm head under the care of four different consultants, using a standard posterior approach. All of the femoral implants were cemented using modular C-stems (Depuy Ltd.) and all of the acetabular components were cemented flanged monobloc all-polyethylene components with long posterior wall with a third generation cementing technique. A standard posterior approach was used in all cases, with direct repair of the capsule and short external rotators.Introduction
Materials/Methods
Success of TKR depends upon soft tissue balance and component alignment. The alteration of quadriceps mechanism while approaching knee for TKR can affect outcome of the surgery. To analyse the results of Trivector retaining arthrotomy for TKRIntroduction
Aim
Fixed Flexion deformity (FFD) is a common deformity amongst patients due to undergo TKR. For their correction surgical algorithm is documented. Resection of distal femur and clearing off posterior recess are two essential steps. In balancing these knees it is suggested to resect extra distal Femur to gain extension space. To demonstrate full FFD correction without resecting extra distal Femur.Introduction
Aim
The aim of the study was to whether the bone grafting techniques used affected the long term stability of the acetabular implant. 41 patients treated with a cemented total hip replacement with pre-operative protrusio or central acetabular defects at surgery were identified. The severity of initial protrusio was determined on plain AP pelvis radiographs by measuring the distance of the medial acetabular wall from the ilio-ischial line. The post-operative and last follow-up x-rays were reviewed, the thickness of the medial wall and the centre-edge angle of the cup was measured.Introduction
Methods
There is conflicting information regarding the recommendations of bracing, physical therapy and cessation of sports for young athletes with symptomatic spondylolysis. The purpose of this study was to identify factors affecting the prognosis and to find the optimal method of non-operative treatment. The patients in our study were athletes who visited our children's hospital for low back pain with lumbar spondylolysis and were treated non-operatively from 1990 to 2002. Clinical and radiological outcomes were reviewed retrospectively. The effects of bracing, physical therapy, cessation of sports, duration of symptoms before the first hospital visit, lateralisation of spondylolysis, age, gender, onset of low back pain after lumbar trauma during sports, bone scan uptake, vertebral level of the lesion, associated scoliosis or spina bifida and radiological bony healing were analysed using univariate and multivariate analysis with logistic regression. The mean age of patients was 13 years (range 7 to 18 years). The mean follow-up was 4.2 years (range 1.2 to 12 years). Of 132 patients, 48 patients had excellent results with no pain during sports, 76 good, 6 fair, and 4 poor. Cessation of sports, early non-operative intervention, and a unilateral spondylolysis appeared to be factors associated with excellent outcomes. However, bracing, physical therapy, age, gender, level of lesion, history of trauma, increased uptake on bone scan, or associated scoliosis or spina bifida were not factors. Bony healing was not related to the clinical outcome. The non-operative treatment of spondylolysis in children can yield excellent clinical outcomes, and the absence of bony healing has no influence on clinical outcome. Factors in this study found to correlate with an excellent outcome include unilateral spondylolysis, acute spondylolysis, and treatment with cessation of sports for 12 weeks.
The Clinical assessment was based on modified American Orthopaedic Foot and Ankle Society’s hallux-metatarsophalangeal scale. The subjective assessment was done by a questionnaire and radiological assessment was done by using digital radiographs.
Total Knee Replacement (TKR) is one of the commonest and successful orthopaedic operations performed in the UK with good long term results. The Natural knee (Sulzer – Centerpulse ) is one of the various types of prostheses available. This implant is unique because of the trochlear notch over the anterior surface of the femoral prosthesis that allows natural tracking of the patella and an asymmetric anatomical tibial component. To our knowledge there are no studies reviewing outcome of Natural Knee Replacement from the UK. We reviewed 177 consecutive TKRs in 147 patients including 30 bilateral simultaneous or staged procedures using Natural Total Knee prosthesis performed during 1994 to 1998, with a minimum of five years follow up. All these surgeries were performed at a single NHS District General Hospital by different grades of surgeons including consultants and trainees. 12 patients died and 10 were lost to follow up. 155 knees were available for final follow up and evaluation. We carried out an outcome related to patient satisfaction using Oxford Knee questionnaire system. We compared the preoperative and post operative scoring using the questionnaire and found an improvement of the score after the procedure. The average improvement in scores before and after surgery was 30 (20 pre op to 50 post op). Out of 155 knees evaluated, 143 knees (92%) were happy with the results while the rest did not have satisfaction with surgery. Complications included anterior knee pain in 12, DVT in 40 , non fatal pulmonary embolism in 2, wound infection in 3, stiffness in 8 of which 5 needed manipulation under anaesthesia, there were 2 revisions of which one knee was done for infection and one for a loose femoral component. Our results suggest that the five year follow-up results of this prosthesis are at par with other commonly used knee replacement prostheses in the UK.
We reviewed retrospectively 94 patients who had undergone soft-tissue release to correct flexion contracture of the knee to determine the incidence of postoperative hypertension. The cause of contracture in most patients was cerebral palsy (45) or old poliomyelitis (39). Twenty patients developed persistent hypertension. Two of them were symptomatic, one developing hypertensive encephalopathy. Patients who had had poliomyelitis were at a higher risk than those with cerebral palsy; the risk increased with bilateral procedures. The amount of correction achieved had no influence on the incidence of hypertension.