Aims

To compare long-term survival of all-cemented and hybrid total hip arthroplasty (THA) using the Exeter Universal stem.

Hip disease occurs in between 8% and 28% of patients with Down’s syndrome, many of whom develop disabling pain. We have carried out total hip replacement in six adult patients (9 hips) with severe arthritis of the hip. The mean follow-up was 7.75 years (2 to 14). At the latest review, all had relief of pain and full hip function. Increasing longevity and a high incidence of hip disease in these patients suggest a greater role for total hip arthroplasty in the future

1. A method of treatment of posterior malleolar fracture is described which restores the proximal surface of the ankle joint to its normal position. 2. Reduction is achieved with a special clamp and the position held with a strong plate. Early ankle movements may therefore be encouraged without fear of redisplacing the fracture. 3. Perfect reduction is necessary to avoid the later onset of arthritis, and this was achieved in five of six patients reported

Eleven patients with tears of the acetabular labrum are discussed and the syndrome of the torn labrum is defined. In all cases the lesion was associated with acetabular dysplasia, and a constant early radiological sign was a cyst in the lateral aspect of the acetabulum. The diagnosis was confirmed by arthrography. It is suggested that these tears are degenerative, occurring as a consequence of abnormal stresses imposed by the uncovered lateral portion of the femoral head. Once a tear is present a localised stress point occurs on the femoral head, leading rapidly to degenerative arthritis

Two patients are described, each with a fracture-dislocation of the hip combined with a fracture of the neck of the same femur. Open reduction combined with internal fixation was performed in both cases. Eight years later one patient had developed avascular necrosis of the femoral head; no signs of avascular necrosis or associated arthritis have appeared in the other patient after four years. A plea is made for considering this more conservative type of operation for these serious injuries before resorting to total hip replacement

1. Seventy-seven operations on the patella have been reviewed. 2. There is no evidence that arthritic changes in the femoral condyles are an inevitable sequel of complete excision of the patella. 3. There is a direct relationship between the severity of symptoms after complete excision of the patella and the extent of ossification in the quadriceps tendon. 4. Patello-femoral arthritis after partial excision of the patella may be due to faulty realignment of the patellar ligament and consequent tilting of the patellar remnant towards the femoral condyles

Aims

The diversity of femoral morphology renders femoral component sizing in total hip arthroplasty (THA) challenging. We aimed to determine whether femoral morphology and femoral component filling influence early clinical and radiological outcomes following THA using fully hydroxyapatite (HA)-coated femoral components.

In fifty-two knees with spontaneous osteonecrosis the diagnosis was based on a subchondral transradiancy in the weight-bearing surface of the medial femoral condyle. Strontium-85 scintimetry showed a unique pattern, indicating a lively repair reaction by localised high values. Thirteen of fifteen knees followed between two and twenty-three years developed osteoarthritis. The prognosis was based on the size of the transradiancy and the focality of the lesion as determined by scintimetry. It is suggested that scintimetry permits differentiation between primary osteoarthritis and arthritis secondary to osteonecrosis

1. The late results in nineteen cases of total excision of the carpal scaphoid bone for ununited fracture have been reviewed. 2. The results are least satisfactory when there is clinical evidence of arthritis on the dorsal aspect of the wrist, or subluxation of the os magnum and semilunar. In other cases good results usually can be expected. 3. The operation must be done carefully without injury to the neighbouring bones and ligaments. Total excision is preferable to excision of the proximal pole alone

The rotator cuff is often severely damaged in arthritis of the shoulder and there is no satisfactory technique for its repair. patients with a ruptured cuff and an eroded glenohumeral joint may have intractable pain, and standard methods of joint replacement are then inappropriate. A ball and socket prosthesis has been designed to replace the function of both the rotator cuff and the glenohumeral joint. Mechanical testing has shown that the scapular cup can be securely fixed. The outcome in 71 shoulders operated upon since 1973 is reported

We report a new technique of talectomy for patients with Hawkins group III fracture-dislocation of the talus. Talectomy is performed through a medial incision, the foot is displaced anteriorly, and the fractured or osteotomised medial malleolus is moved laterally and fixed to the tibia with a malleolar screw. Full weight-bearing is allowed after six weeks. In four patients at 36 to 57 months after operation the results were excellent in three and good in one, with no pain or early evidence of degenerative arthritis in the remaining joints of the foot

We have sought to clarify whether the traditional Arabic lifestyle prevents restriction of movement in patients with degenerative arthritis of the knee. The range of movement of 68 osteoarthritic knees of Arabic patients was compared with that of 51 healthy knees of Muslim patients and 83 osteoarthritic knees in non-Arabic patients. The range of flexion of the osteoarthritic knees in the Arabic patients matched that of the healthy control knees, but was significantly better than that of the osteoarthritic knees in the non-Arabic patients. There was also a statistically significant difference between the mean extension deficit of the two groups with osteoarthritis. Exercises may help to prevent restriction of movement in osteoarthritis of the knee

This paper describes the development, operative technique and results of an unconstrained total elbow arthroplasty. Forty-seven elbow replacements were carried out in 44 patients between 1974 and 1982. There was a high rate of loosening in the early condylar replacements. The results in patients with post-traumatic arthritis were poor. The later design employs an ulnar stem, with a humeral stem if the distal humeral bone stock is poor. When used in carefully selected patients with rheumatoid arthritis, pain is reduced significantly, stability and movement are preserved and function is improved

Aims

The aim of this study was to compare the clinical effectiveness of Kirschner wire (K-wire) fixation with locking-plate fixation for patients with a dorsally displaced fracture of the distal radius in the five years after injury.

The causes of persistent symptoms after meniscectomy have been assessed clinically, radiologically and arthroscopically in 174 knees. The commonest finding was early degenerative arthritis (chondromalacia) of the femoral condyle (40 per cent). Retained fragments of meniscus were less common than expected (13 per cent), and lesions of the other meniscus were rare (5 per cent). The clinical diagnosis was altered in 42 per cent by arthroscopic examination. Arthroscopy was found to be a valuable technique in this group of patients with problems of diagnosis

1. The results of ischio-femoral arthrodesis for tuberculous arthritis of the hip in thirty-five adults and in twenty-nine children are reported. The "blind" technique of Brittain was used in thirteen patients and the open technique in fifty-one. 2. Bony fusion was obtained by the first operation in thirty-three out of the thirty-five adults and in twenty-three out of twenty-nine children. In children strikingly better results were gained from the posterior open technique than from the original "blind"technique of Brittain. 3. There was no evidence that ischio-femoral arthrodesis in children interfered with the growth of the limb

Infantile idiopathic scoliosis is a structural scoliosis seen in infants, usually boys, with the major curve to the left in almost all cases, and almost invariably in the mid-or lower thoracic region. It occasionally disappears, but in general the curve tends to increase. In the absence of any discoverable etiology it is termed "idiopathic" and it is believed not to differ in essentials from the more common adolescent scoliosis. Lumbar idiopathic scoliosis has a good prognosis as to deformity, but leads more often than any other curvature to degenerative arthritis and pain in later life

We examined 16 feet, 33 to 133 months (mean 83) after simultaneous calcaneocuboid and talonavicular fusions performed for a variety of painful disorders of the hindfoot. Objectively, four feet were rated excellent, eight good, four fair and none poor. There was one asymptomatic nonunion of the talonavicular joint. Progressive degenerative arthritis of the ankle was seen in six patients and of the naviculocuneiform joint in seven. Biomechanically, simultaneous calcaneocuboid and talonavicular arthrodesis is better than an isolated talonavicular fusion and is a simple and effective alternative to triple arthrodesis

We have carried out a retrospective review of 11 Souter-Strathclyde primary total elbow arthroplasties in ten patients with osteoarthritis, over a period of nine years. The diagnosis was primary osteoarthritis in nine elbows and post-traumatic arthritis in two. The mean follow-up was 68 months (15 to 117). Although no patient was symptomatic, radiological review revealed evidence of loosening affecting three humeral and two ulnar components, one of which subsequently failed and was revised at 97 months. There were no dislocations, deep infections or mechanical failures. Complications included two superficial wound infections and two neurapraxias of the ulnar nerve which resolved. This study shows that the unlinked Souter-Strathclyde total elbow arthroplasty can be considered for patients with osteoarthritis and gives good symptomatic relief and improvement in function

A study of excision arthroplasty (Girdlestone's pseudarthrosis) for infected total hip replacements is presented. Twenty-two patients were reviewed with a minimum follow-up of one year. Reduction in pain was significant but the functional results were poor. Factors contributing to poor function were old age, poor medical condition and arthritis of the contralateral hip; these were in addition to the gross instability resulting from the pseudarthrosis. The patients were easily fatigued and dependent on external supports; calipers were found to be unacceptable. The symptoms after excision arthroplasty are compared with those before the original hip replacement