Introduction: We present the long term results in 204 cases of Hallux Valgus deformity correction using a modified Mitchell’s osteotomy.

Methods: 168 patients (204 feet) that had Mitchell’s osteotomies between 1986 and 2001 were recalled for clinical and radiological evaluation. The patients had hallux valgus angles of up to 50o and intermetatarsal angles of up to 20o. They all had a modified procedure using two crossed Kirschner wires to fix the capital fragment into plantar displacement and angulation. Lateral soft tissue release was performed when deemed necessary during the procedure. Mild to moderate arthritis of the 1st metatarsophalangeal joint was not a contraindication. The AOFAS scores as well as any complications were recorded and the Xrays were used to measure hallux valgus and intermetatarsal angles. Mann-Whitney U test was used to analyze data.

Results: The mean follow up was 12.9 years. The mean AOFAS score improved from a preoperative of 49.6 to a postoperative of 87.9 points (p=0.004), due to improvement in the pain (14.2 Vs 37.6, p=0.001) and function (30.6 Vs 39.8, p=0.043) parameters. 57 cases (27.9%) had Hallux Valgus angles > 40o. Lateral soft tissue release was performed in only 16 of these cases with no significant difference in the postoperative Hallux Valgus angle compared to the ones not requiring soft tissue release (21.3o Vs 20.8o, p=0.08). There was a decrease in the pre-operative Vs post-operative incidence of lateral metatarsalgia and symptomatic callosities (18.33% Vs 11.8%, p=0.023). We had only one case of avascular necrosis.

Discussion/Conclusion: Mitchell’s osteotomy is a reliable technique with successful outcomes and minimal complications when performed with accurate surgical technique, stable fixation and lateral soft tissue release when appropriate. It may also be successfully performed for Hallux Valgus angles > 40o. We believe that it has still got a role in the treatment of Hallux Valgus.

100 randomized primary cementless THRs in 80 patients were reviewed retrospectively regarding the HA cover of the stem which was Waldemar Link’s, ribbed type, made of Titanium, with a collar and mostly applied without the trochanteric screw. The femoral neck was always retained high as possible. Full weight bearing on the operated leg started the 3rd postoperative day, while years earlier the 6th postoperative week. Two more or less, equal groups were formed: (A) without, (B) with HA covered stems and two subgroups: patients of 60 to70 years and 70 to 80 years. Gender was matched as possible and mean follow-up time was 8 years (range 7 to IO years). The Harris Hip Score was used for clinical evaluation and the method of “pencil and ruler” in plain X- Rays for radiographical one. Patients who died after the 8th postoperative year of evaluation were included.

Results

1, The postoperative hip score was at average for group (A) 92.1 points and for gr. (B) 92,4p.

2. In gr. (A) we found* at a rate 70% 2mm of symptom less, adaptive, slow early migration, while in gr. (B) this corresponded to 1 mm of same migration at a rate 60%. In both groups migration stopped by the second postoperative year.

3. “Alarming” stem migration was found in two cases: one in each group. The cause was that the stems applied, were undersized and the patients were women on menopausal osteoporosis. Both sterns were revised. Two more “alarming” stem migrations were found, one in each group, in patients suffering from collagenosis with the relevant bone quality. This migration was related to bone retreat primarily and irrelevant to stem’s loosening, gender or age of patients. Both stems have not been revised yet.

4. Similar and minimal-2% for gr. (A) vs 4% for gr. (B)- was the rate of symptomless, limited, non-sclerotic of less than 2mm wide demarcations gradually resolving, 5. Similar and minimal-2% for gr. (A) vs 5% for gr (B)- was the rate of stress shielding phenomenon resolving in 2 years time.

6. No further mechanical or biological loosening were noticed at mid-term results

7. Similar- 20% for gr (A) vs 15% for gr (B) was the rate of mild symptomless ectopic ossifications.

Conclusions: No significant differences were found at mid-term results between the two groups, the one without (A) and the other (B) with HA covered sterns. In case a stem happens to be undersized not securing primary fixation or in case the bone’s quality is not promising mechanical and biological fixation of the stem, then the presence of HA cover will not prevent the stem from “alarming” migration. Though we are still using successfully the cementless stem for patients over 70 years of age, when ever dealing with such quality of bone as with collagenosis then it would be wise to consider the use of the cement and even so reservations must exist.