Andrew A. McBeath

Plantar fascia release for chronic plantar fasciitis in runners

Plantar fascia release has been suggested to be of benefit for patients with symptoms of chronic unre sponsive plantar fasciitis. However, results of this pro cedure have not been published. We performed 11 releases in 9 long-distance runners whose symptoms had been present for an average of 20 months and had not responded to nonsurgical treatment. The results of these operations were excellent in 10 feet and good in 1 foot at an average follow-up time of 25 months. Eight out of nine patients returned to desired full training at an average time of 4.5 months. Histologic examination of surgical biopsy specimens from these patients showed collagen necrosis, angiofibroblastic hyperpla sia, chondroid metaplasia, and matrix calcification. Plantar fascia release was an effective procedure for these patients.

Hip arthrodesis in young patients. A long-term follow-up study.

We evaluated the results in fifty-three patients who had had a successful hip arthrodesis at least twenty years (average, thirty-eight years) prior to the study and who had been less than thirty-five years old at the time of operation. We determined the functional history of each patient and the current status of the opposite hip, the knees, and the back. Radiographs were made and each joint was rated according to standard clinical scales. Seventy-eight per cent of the patients were satisfied with the arthrodesis, and all were able to work. Fifty-seven per cent had some low-back pain and 45 per cent, some knee discomfort. Only seven patients (13 per cent) had had a total hip arthroplasty on the arthrodesed hip.

Metastatic breast cancer in the femur. A search for the lesion at risk of fracture.

Clinical records and radiographs of 203 female patients with 516 metastatic breast lesions located in the proximal femur were examined retrospectively to determine: the dimensions of those lesions that were at risk of fracture; and the relationship of other variables (bone pain, body habitus, age, and radiation treatment) with the occurrence of a pathologic fracture. Twenty-three patients sustained 26 pathologic fractures. Their average age, height, and weight were not significantly different from the 180 patients without fractures. Similarly, moderate to severe bone pain was experienced by a great majority of the total patient population, yet only 11% sustained fractures. Fifty-six patients received radiation treatment of a femoral metastasis. Ten of these patients subsequently sustained fractures. Radiation treatment relieved bone pain but did not have any consistent curative effect on the lesion itself. Finally, the authors were unable to identify either a specific percent involvement of the bone or a critical diameter for metastases that fractured because: 296 (57%) of the 516 metastases were permeative lesions and unmeasurable; 14 (54%) of the 26 pathologic fractures observed occurred through unmeasurable lesions; and the 12 measurable lesions that fractured had the same range of percent involvement as the 208 measurable lesions that did not fracture. Breast metastases at risk of fracture cannot be identified by measurements obtained from standard radiographs alone.

Femoral Component Loosening After Total Hip Arthroplasty

To determine the long-term durability of total hip arthroplasty and to identify factors responsible for femoral component loosening, 106 total hip arthroplasties were reviewed in patients with a minimum postoperative period of 3 years. Seventy-four had Charnley-Müller prostheses and 32 had Charnley prostheses. Femoral component loosening occurred in 16 of 106 hips. Not all loose components were symptomatic. The femoral component at risk was the femoral Charnley-Müller type that had been inserted in varus position in a functioning active heavy patient who previously had had a femoral head prosthesis.

Canine intersegmental hip joint forces and moments before and after cemented total hip replacement

Intersegmental forces and moments (i.e. resultant free body forces and moments computed at the joint centers) were studied in canine hindlimbs before and after cemented total hip replacement (THR). Five large, adult, mixed-breed dogs were selected. Their gait was recorded (while leash-walked) before surgery using high-speed cinematography and a force plate. Cemented total hip replacement was unilaterally performed on each dog. Gait was again recorded at one and four months after surgery. Segmental properties (mass, center of mass, and mass moment of inertia) of the hindlimbs were experimentally determined, and an inverse dynamics approach was used to compute intersegmental forces and moments in the sagittal plane. Significant reductions in intersegmental joint forces and moments were observed in the operated hindlimb one month after surgery, although kinematic gait parameters were unaltered. Decreases of 77.0% for vertical forces, 61.9% for craniocaudal forces, and 66.2% for extension moments were determined. Four months after surgery, the joint forces and moments had returned to their preoperative values. This experiment demonstrates that the dynamics of normal walking can be restored in a canine model by four months after THR. It also shows that kinetic (rather than kinematic) parameters are more descriptive of antalgic gait in the canine.

Efficiency of Assisted Ambulation Determined by Oxygen Consumption Measurement

The energy used for walking with crutches and canes was determined by measuring oxygen consumption in ten normal subjects who used Lofstrand and axillary crutches with four different gaits. For all assisted gaits the self-selected velocity was less than that for normal walking and the energy used was greater than for normal walking. Use of each crutch type required the same amount of energy. Use of a cane or crutches with twqoint alternating and three-point partial-weight-bearing gaits required about 33 per cent more energy than normal walking. The swing-through and the three-point non-weight-bearing gaits required about 78 per cent more energy than normal walking. It is suggested that these energy requirements be considered when prescribing an assistive device.

A complication of Silastic hemiarthroplasty in bunion surgery.

Seven cases of painful reactive synovitis following great toe Silastic hemiarthroplasty have been observed. All cases were treated successfully with synovectomy and removal of the implant. Microscopic examination of the synovium uniformly demonstrated a chronic foreign-body giant-cell reaction with intracellular and extracellular silicone elastomer particles. Gross examination of the implants showed varying degrees of erosion of the articulating surface. Abrasion of a Silastic implant creates tree-floating silicone elastomer particles that can precipitate a reactive synovitis. The authors believe an irregular, degenerated first metatarsal head is a contraindication to an interpositional Silastic hemiarthroplasty.

Walking efficiency before and after total hip replacement as determined by oxygen consumption.

Seventy-seven patients receiving either unilateral or bilateral total hip replacement were studied before and for as long as four years after operation. Their walking velocity and efficiency (the latter determined by measuring oxygen consumption) improved after operation. Total hip replacement allowed relatively equal postoperative efficiency and velocity for patients with unilateral and bilateral disease. While no consistent relationships were found between the components of the Iowa hip-rating scale, significant correlations were found between the composite Iowa hip-rating score and oxygen consumption. Data indicate that measurement of self-selected velocity in patients with hip disease is a satisfactory indicator of walking efficiency.

Long-term follow-up of Perthes disease treated with spica casts.

Forty adults with a history of Legg-Calve-Perthes disease treated with spica casts were clinically and radiographically evaluated an average of 30 years post-treatment (range 14 to 40 years). Clinical results were 85% good, 5% fair, and 10% poor. Five percent showed significant degenerative joint disease on follow-up radiographs and 7% had undergone prosthetic replacement. Fifteen percent of the patients had a positive family history of Perthes disease. Factors associated with a better result included: diagnosis before age 9, shorter length of follow-up, minimal femoral head and neck involvement, and a congruous joint.

BICYCLE ACCIDENTS AND INJURIES. A RANDOM SURVEY OF A COLLEGE POPULATION

To determine the incidence of bicycle-related accidents and injuries in a given population 1,200 questionnaires were sent to a random sample of college students. Seventy-one percent of the students responded. Of the responders, 62% were bicyclists and 13% of these had been involved in an accident in the previous 1-year period. Sixty-two percent of those involved in an accident sustained an injury and 32% were significant enough to require medical attention. Only 8% of accidents were police-reported. If these trends hold true for other populations, studies based on hospital or police records fail to give a true picture of bicycle-related accidents and injuries.