Advertisement for orthosearch.org.uk
Results 61 - 80 of 200
Results per page:
The Journal of Bone & Joint Surgery British Volume
Vol. 38-B, Issue 1 | Pages 342 - 352
1 Feb 1956
Cholmeley JA

1. One hundred and forty-two cases of extra-articular arthrodesis of quiescent tuberculous hips with fibrous ankylosis have been reviewed.

2. The methods used were the ilio-femoral graft with and without osteotomy, and the ischio-femoral graft by the Brittain or Foley technique.

3. Success occurs more frequently when the grafting operation is combined with or followed by a femoral osteotomy.

4. It is suggested that this success is due largely to the increased immobilisation afforded by the osteotomy.

5. It appears that equally good results can be obtained with either an ilio-femoral or an ischio-femoral graft in these cases provided that an upper femoral osteotomy is also carried out, preferably at or soon after the grafting operation.

6. An upper femoral osteotomy will frequently convert an unsuccessful extra-articular hip graft into a successful one without further grafting.


The Journal of Bone & Joint Surgery British Volume
Vol. 30-B, Issue 3 | Pages 478 - 486
1 Aug 1948
Charnley JC

1. The technique of compression-arthrodesis of the knee joint is described.

2. Fifteen consecutive cases are reported in which clinical union was detected at the first inspection from twelve days to six weeks after operation. By this method the total period of disability is reduced to three months.

3. Three mechanical factors which might be responsible for this very early clinical union are examined: compression is believed to be the main factor, although fixation is also important.

4. A fallacy is exposed in the use of bone grafts for arthrodesis of the knee; the graft is less osteogenic than the substance of the bones which form the joint, and it provides inefficient internal fixation.

5. A theory is suggested that compression, even in the presence of slight movement, acts by producing a fixed "hinge" without shearing movement; at this point a bridgehead of flexible osteoid tissue is established in which ossification inevitably takes place despite slight bending movement.

6. A second theory is suggested that high compression forces stimulate early union by liberating bone salts at points of maximum pressure through the action of osteoclasts, and that the local excess of bone salts is redeposited under cellular activity within a range of a few millimetres where there is no pressure.


The Journal of Bone & Joint Surgery British Volume
Vol. 79-B, Issue 4 | Pages 644 - 647
1 Jul 1997
de Heus JAC Marti RK Besselaar PP Albers GHR

From 1975 to 1990 we performed subtalar or triple arthrodesis on 54 patients; 48 of them were reviewed after a mean follow-up of 10 years (6 to 15). There were 17 subtalar fusions in 14 patients and 37 triple arthrodeses in 28 patients. We assessed tibiotalar ankle function using the criteria of Mazur which gives a points score of a maximum of 100. Radiological evidence of degenerative change was graded on a scale of 0 to 4.

The mean Mazur score was 85 for the subtalar fusions and 78 for the triple arthrodeses. The radiological score showed no degenerative changes in 36 feet (24 triple and 12 subtalar arthrodeses) and an increase of one grade in 14 feet (10 triple and 4 subtalar), of two grades in three feet (all triple arthrodeses) and of three grades in one foot after a subtalar arthrodesis.

We found no statistically significant difference in the radiological score in unilateral fusions between feet with subtalar and triple arthrodeses and the contralateral foot. In all four feet which showed an increase in degenerative changes of two or more grades, there was an abnormality of the tibiotalar joint before the fusion operation. Of the 14 feet which showed an increase of one grade, there was a similar increase on the contralateral side in nine.

Our findings show that subtalar or triple arthrodesis has little adverse influence on the function of the tibiotalar joint, even after many years.


The Journal of Bone & Joint Surgery British Volume
Vol. 67-B, Issue 1 | Pages 47 - 52
1 Jan 1985
Knutson K Lindstrand A Lidgren L

Twenty consecutive patients treated by arthrodesis for failed knee arthroplasty are reviewed. Eight hinged, five stabilised and seven compartmental prostheses were removed, for infection (15 cases), loosening (4) and instability (1). One patient refused a second-stage operation but the remainder gained sound fusion. Infected knees had a two-stage procedure with temporary insertion of gentamicin-loaded beads after removal of the prosthesis; all infections healed. Six arthrodeses using a Hoffmann-Vidal external fixator resulted in two temporary failures. One Ace-Fischer external fixation was successful. Of 10 primary attempts at arthrodesis with an intramedullary Kuntscher nail, nine were successful; the tenth fused after two more attempts by the same method. The two failures of external fixation and two failures after Charnley single-frame compression done elsewhere were successfully fused with intramedullary nails. Delayed union in three cases fused after prolonged fixation and repeated bone grafts. The indications for and methods of arthrodesis after failed knee arthroplasty are discussed.


The Journal of Bone & Joint Surgery British Volume
Vol. 44-B, Issue 4 | Pages 800 - 805
1 Nov 1962
Gawne DW Fung GS

1. The results of treatment of twenty-five disintegrated tuberculous hips by excision, arthrodesis and anti-tuberculous drugs are reported.

2. The methods used are described.

3. Sound healing and bony fusion was obtained in all but three of the twenty-five hips treated.


The Journal of Bone & Joint Surgery British Volume
Vol. 41-B, Issue 2 | Pages 337 - 341
1 May 1959
Robins RHC

1. Sixty feet operated upon either by triple or pantalar tarsal fusion for instability after poliomyelitis were re-examined ten to twenty-four years later.

2. After triple fusion with preservation of the ankle joint there was a striking absence of late osteoarthritis of the ankle, and only a low incidence of troublesome lateral instability of the ankle. The results were generally good provided the patient had reasonable power of extension of the knee.

3. Triple arthrodesis for completely flail foot in patients without active muscle control of the knee was often disappointing, so far as the limb as a whole was concerned, because of a persistent flexion deformity of the knee which usually necessitated the wearing of an appliance.

4. The results of pantalar arthrodesis for the flail foot were satisfactory. When this operation was performed (with the foot in slight equinus) in patients who lacked active extension of the knee it helped to stabilise the knee in walking by encouraging hyperextension.


The Journal of Bone & Joint Surgery British Volume
Vol. 31-B, Issue 2 | Pages 222 - 226
1 May 1949
Foley WB

1. An operation is described for ischio-femoral extra-articular arthrodesis of the hip joint by posterior open approach, based on the techniques of Trumble and Brittain.

2. The operation has the advantages of affording adequate exposure of the sciatic nerve trunk and permitting visual control of the alignment and penetration of the chisel and graft.

3. The operation has been performed successfully without serious shock or subsequent complications in eighteen cases, mostly of tuberculosis of the hip.


The Journal of Bone & Joint Surgery British Volume
Vol. 85-B, Issue 1 | Pages 57 - 61
1 Jan 2003
White SP Porteous AJ Newman JH Mintowt-Czyz W Barr V

Nine patients underwent arthrodesis of the knee using a customised coupled nail (the Mayday arthrodesis nail), five after infected arthroplasty, one following failed arthrodesis, one for intractable anterior knee pain, one for Charcot instability and one after trauma. Comparison was made with 17 arthrodeses, eight undertaken using external fixation, four with dual compression plates, and five with long Küntscher nails. Union was achieved in all patients (100%) at a mean time of ten months using the customised implant. There were no complications despite early weight-bearing. No further procedures were required. This contrasted with a rate of union of 53% and a complication rate of 76% with alternative techniques. Of this second group, 76% required a further operative procedure.

We compared the Mayday arthrodesis nail with other techniques of arthrodesis of the knee. The differences in the need for further surgery and occurrence of complications were statistically significant (p < 0.001), and differences in the rate of nonunion and inpatient stay of less than three weeks were also significant (p < 0.05) using Fisher’s exact test.

We conclude that a customised coupled intramedullary nail can give excellent stability allowing early weight-bearing, and results in a high rate of union with minimal postoperative complications.


The Journal of Bone & Joint Surgery British Volume
Vol. 72-B, Issue 5 | Pages 839 - 842
1 Sep 1990
O'Doherty D Lowrie I Magnussen P Gregg P

We report a prospective randomised trial comparing Keller's arthroplasty and arthrodesis of the first metatarsophalangeal joint for the management of symptomatic hallux valgus and hallux rigidus in the older patient. In 81 patients (110 feet), with a minimum of two years follow-up, both procedures gave a similar degree of patient satisfaction and symptom relief. The incidence of metatarsalgia was also similar. As there were no obvious advantages to arthrodesis, and since six out of 50 arthrodesed toes required revision, we suggest that Keller's arthroplasty is the better operation in these patients.


The Journal of Bone & Joint Surgery British Volume
Vol. 51-B, Issue 3 | Pages 488 - 493
1 Aug 1969
Fitzgerald JAW

1. One hundred cases of arthrodesis of first metatarso-phalangeal joint have been reviewed after a post-operative interval of at least ten years.

2. Seventy-seven per cent of patients were completely satisfied with the late results ; only 9 per cent were dissatisfied.

3. The two major factors leading to poor results were found to be malposition of the arthrodesis, and interphalangeal osteoarthritis.

4. The ideal position for fusion is considered to be in at least 20 degrees of valgus, preferably between 20 and 30 degrees ; between 20 and 40 degrees of dorsiflexion ; and most importantly, neutral rotation.

5. The precise operative technique is not important provided it maintains the position obtained at operation until the arthrodesis is sound.


The Journal of Bone & Joint Surgery British Volume
Vol. 42-B, Issue 2 | Pages 336 - 343
1 May 1960
Hall MC Pennal GF

1. The history of open operations on fractures of the calcaneum is reviewed.

2. A report is given of the results of treatment of comminuted and depressed fractures of the calcaneum by primary arthrodesis by a modified Gallie procedure.

3. Of twenty-nine patients, twenty-seven returned to full employment within an average of 6·4 months. Twenty-five of these returned to their previous jobs.

4. Poor tendo calcaneus function and lateral sub-malleolar pain were found to be closely allied; both complaints were absent in the usually successful case and occurred only where there had been some complication.

5. It is contended that subtalar arthrodesis is a successful method of treatment for this fracture, but that the operation should be performed soon after the injury in order that the deformity may be corrected.


The Journal of Bone & Joint Surgery British Volume
Vol. 83-B, Issue 1 | Pages 50 - 54
1 Jan 2001
Oostenbroek HJ van Roermund PM

We treated 15 patients by arthrodesis of the knee after removal of an infected total knee arthroplasty, using an Ilizarov ring fixator. Eight had a failed arthrodesis by another technique. The mean age of the patients was 75 years, the mean duration of retention of the frame was 28 weeks, the mean treatment time 51 weeks, and the mean follow-up 52 months. All but one knee fused at the first attempt, a rate of union of 93%. The incidence of complications related to treatment was 80%. The length of treatment and rates of complication were attributed to advanced age and the adverse local clinical factors in these patients. The Ilizarov method is a promising technique for achieving arthrodesis under these circumstances.


The Journal of Bone & Joint Surgery British Volume
Vol. 46-B, Issue 4 | Pages 748 - 763
1 Nov 1964
Adams JC

1. The risk of injury to the sciatic nerve during closed ischio-femoral arthrodesis by nail and graft has been assessed on the basis of clinical evidence and of anatomical studies in the living and in cadavers.

2. The margin of safety for the nerve is nearly always small.

3. The risk of injury to the nerve is prohibitive when there is marked deformity or hypoplasia of the pelvis. The risk is also increased when the buttock is compressed against the table and, because of the technical difficulties that are entailed, when the hip is in marked flexion. The risk is probably greater in children than in adults.

4. In properly selected cases in which none of these adverse factors is present it is submitted that the risk of nerve injury can be eliminated by proper attention to surgical technique and by the observance of certain definite precautions.

5. When there is doubt in the surgeon's mind about his ability to complete the operation without injuring the nerve the closed technique should be abandoned in favour of the open posterior approach.


The Journal of Bone & Joint Surgery British Volume
Vol. 82-B, Issue 4 | Pages 566 - 570
1 May 2000
Anderson GA Thomas BP

Between June 1991 and May 1996 we carried out arthrodesis on 15 patients with flail or partially flail wrists using an AO/ASIF dynamic compression plate (DCP) without a bone graft. The wrist was approached through the second extensor compartment. The minimum follow-up was for 24 months with a mean of 34.2 months. All 15 wrists fused without major complications at a mean of 11.9 weeks. Stabilisation improved the function of the hand affected with paralysis and the appearance of the extensively paralysed upper limb with a flail hand. In the absence of bony abnormality fusion can be obtained with a DCP alone without the need for bone grafting.


The Journal of Bone & Joint Surgery British Volume
Vol. 33-B, Issue 4 | Pages 598 - 599
1 Nov 1951
Grewal KS Singh I


The Journal of Bone & Joint Surgery British Volume
Vol. 68-B, Issue 2 | Pages 208 - 212
1 Mar 1986
Macdonald W Thrum C Hamilton S

Techniques are described by which metal implants can be designed and produced to fit precisely a bony site at a subsequent operation. CT scans and solid modelling were used to produce an accurate three-dimensional representation of the surface of the bone. These techniques were applied to the production of an internal fixation device for shoulder arthrodesis after the resection of a neoplasm of the proximal humerus. The reconstruction utilised a free vascularised fibular graft between the scapula and the distal humeral remnant, fixation being secured with the custom-made implant.


The Bone & Joint Journal
Vol. 95-B, Issue 3 | Pages 371 - 377
1 Mar 2013
Kugan R Aslam N Bose D McNally MA

Achieving arthrodesis of the ankle can be difficult in the presence of infection, deformity, poor soft tissues and bone loss. We present a series of 48 patients with complex ankle pathology, treated with the Ilizarov technique. Infection was present in 30 patients and 30 had significant deformity before surgery. Outcome was assessed clinically and with patient-reported outcome measures (Modified American Orthopaedic Foot and Ankle Society (MAOFAS) scale and the Short-Form (SF-36)). Arthrodesis was achieved in 40 patients with the Ilizarov technique alone and in six further patients with additional surgery. Infection was eradicated in all patients at a mean follow-up of 46.6 months (13 to 162). Successful arthrodesis was less likely in those with comorbidities and in tibiocalcaneal fusion compared with tibiotalar fusion. These patients had poor general health scores compared with the normal population before surgery. The mean MAOFAS score improved significantly from 24.3 (0 to 90) pre-operatively to 56.2 (30 to 90) post-operatively, but there was only a modest improvement in general health; the mean SF-36 improved from 44.8 (19 to 66) to 50.1 (21 to 76). There was a major benefit in terms of pain relief. Arthrodesis using the Ilizarov technique is an effective treatment for complex ankle pathology, with good clinical outcomes and eradication of infection. However, even after successful arthrodesis general health scores remain limited. Cite this article: Bone Joint J 2013;95-B:371–7


The Bone & Joint Journal
Vol. 102-B, Issue 6 Supple A | Pages 170 - 175
1 Jun 2020
Chalmers BP Matrka AK Sems SA Abdel MP Sierra RJ Hanssen AD Pagnano MW Mabry TM Perry KI

Aims. Arthrodesis is rarely used as a salvage procedure for patients with a chronically infected total knee arthroplasty (TKA), and little information is available about the outcome. The aim of this study was to assess the reliability, durability, and safety of this procedure as the definitive treatment for complex, chronically infected TKA, in a current series of patients. Methods. We retrospectively identified 41 patients (41 TKAs) with a complex infected TKA, who were treated between 2002 and 2016 using a deliberate, two-stage knee arthrodesis. Their mean age was 64 years (34 to 88) and their mean body mass index (BMI) was 39 kg/m. 2. (25 to 79). The mean follow-up was four years (2 to 9). The extensor mechanism (EM) was deficient in 27 patients (66%) and flap cover was required in 14 (34%). Most patients were host grade B (56%) or C (29%), and limb grade 3 (71%), according to the classification of McPherson et al. A total of 12 patients (29%) had polymicrobial infections and 20 (49%) had multi-drug resistant organisms; fixation involved an intramedullary nail in 25 (61%), an external fixator in ten (24%), and dual plates in six (15%). Results. Survivorship free from amputation, persistent infection, and reoperation, other than removal of an external fixator, at five years was 95% (95% confidence interval (CI) 89% to 100%), 85% (95% CI 75% to 95%), and 64% (95% CI 46% to 82%), respectively. Reoperation, other than removal of an external fixator, occurred in 13 patients (32%). After the initial treatment, radiological nonunion developed in ten knees (24%). Nonunion was significantly correlated with persistent infection (p = 0.006) and external fixation (p = 0.005). Of those patients who achieved limb salvage, 34 (87%) remained mobile and 31 (79%) had ‘absent’ or ‘minimal’ pain ratings. Conclusion. Knee arthrodesis using a two-stage protocol achieved a survivorship free from amputation for persistent infection of 95% at five years with 87% of patients were mobile at final follow-up. However, early reoperation was common (32%). This is not surprising as this series included worst-case infected TKAs in which two-thirds of the patients had a disrupted EM, one-third required flap cover, and most had polymicrobial or multi-drug resistant organisms. Cite this article: Bone Joint J 2020;102-B(6 Supple A):170–175


The Bone & Joint Journal
Vol. 102-B, Issue 2 | Pages 220 - 226
1 Feb 2020
Clough TM Ring J

Aims. Arthroplasty for end-stage hallux rigidus (HR) is controversial. Arthrodesis remains the gold standard for surgical treatment, although is not without its complications, with rates of up to 10% for nonunion, 14% for reoperation and 10% for metatarsalgia. The aim of this study was to analyze the outcome of a double-stemmed silastic implant (Wright-Medical, Memphis, Tennessee, USA) for patients with end-stage HR. Methods. We conducted a retrospective review of 108 consecutive implants in 76 patients, between January 2005 and December 2016, with a minimum follow-up of two years. The mean age of the patients at the time of surgery was 61.6 years (42 to 84). There were 104 females and four males. Clinical, radiological, patient reported outcome measures (PROMS) data, a visual analogue score (VAS) for pain, and satisfaction scores were collected. Results. The survivorship at a mean follow-up of 5.3 years (2.1 to 14.1) was 97.2%. The mean Manchester Oxford Foot and Ankle Questionnaire (MOXFQ) scores improved from 78.1 to 11.0, and VAS scores for pain from 7/10 to 1.3/10. The rate of satisfaction was 90.6%. Three implants (2.8%) required revision; one for infection, one-month postoperatively, and two for stem breakage at 10.4 and 13.3 years postoperatively. There was a 1.9% reoperation rate other than revision, 23.1% of patients developed a minor complication, and 21.1% of patients had non-progressive and asymptomatic cysts on radiological review. Conclusion. We report a 97.2% survivorship at a mean follow-up of 5.3 years with this implant. We did not find progressive osteolysis, as has been previously reported. These results suggest that this double-stemmed silastic implant provides a predictable and reliable alternative with comparable outcomes to arthrodesis for the treatment of end-stage HR. Cite this article: Bone Joint J 2020;102-B(2):220–226