Charles Sorbie

A quantitative approach to radiography of the lower limb. Principles and applications

A method is described which provides standardised reproducible radiographic images of the lower limb. Anteroposterior and lateral radiographs are digitised and processed by computer to provide graphic/numeric displays of angles and linear measurements, relating the centre points of the hip, knee, and ankle. Two cases illustrate how surgical planning is facilitated when standardised data are available. These data confirm the close relationship between postoperative limb alignment and positioning of prosthetic elements.

Gait assessment in unicompartmental knee arthroplasty patients: Principal component modelling of gait waveforms and clinical status

The reduction and analysis of gait waveform data is a significant barrier to the clinical application of gait analysis. Principal component modelling of gait waveform data reduced the waveform data to measures of distance from normal and these distance measures were shown to be sensitive to changes in gait pattern associated with knee osteoarthritis and its treatment by unicompartmental arthroplasty. Principal component models were developed for eight knee kinematic and kinetic gait waveforms of a group of 30 normal elderly subjects. Each model consisted of a set of loading vectors, principal component scores and residuals. The loading vectors revealed the structure of the model and the scores and residuals were used as the distance measures about which confidence intervals were developed. Pre-operative and post-operative gait data from 13 unicompartmental arthroplasty (UCA) patients were used to demonstrate the application of the principal component models to pathological gait data. A gait score was developed to indicate the overall assessment of the kinematic and kinetic gait measures by the principal component models. This gait score was shown to agree with the clinical status as measured by the Knee Society Score (pre-op: rs=0.86; post-op: rs=0.73). Thus, the differences in gait pattern detected by the principal component models were clinical relevant.

Hemiarthroplasty in the Treatment of Hallux Rigidus

Background: Osteoarthritis of the first metatarsophalangeal (MTP) joint is a painful, disabling condition. It can interfere with the ability to run and even walk without pain. An implant of cobalt-chrome steel alloy to replace the base of the proximal phalanx is one solution. The purpose of this study is to review our results with one of these implants. Materials and Methods: A series of 23 cases of hemiarthroplasty for the treatment of hallux rigidus from June 2000 to October 2001 has been evaluated using the AOFAS rating system, and the results are presented. Results: The average preoperative AOFAS score was 57 (range, 39 to 80). The AOFAS score after hemiarthroplasty was 88 (range, 75 to 100) at last followup (34 to 72 months). There were no perioperative complications except for a small hematoma. Only one patient has required further surgery after 3 years for worsening of a preexisting tendency to hallux valgus. Conclusion: A hemiarthroplasty retained, in most cases, joint mobility, strength, and alignment while relieving pain. There was no evidence, at last followup, of component loosening or osteolysis.

The development of a surface arthroplasty for the elbow.

Complex kinematics, anatomical features, and load distribution have contributed to the poor function of constrained and semiconstrained cemented arthroplasties of the elbow. Resurfacing by porouscoated components has the potential, by reproduction of normal joint geometry and restoration of ligament balance, to recreate relatively normal kinematics and load-bearing and provide relief of pain. A method was developed to provide information on the geometry of the lower humeral joint surface and olecranon fossa. The information gained was used to design components to resurface the trochlea, capitellum, and olecranon fossa. A technique was also developed to remove a minimal amount of subchondral bone from the ulna and humerus in a precisely directed fashion for exact fit of the porouscoated components.

Arthroplasty in the treatment of subcapital hip fracture.

After reviewing recent literature on the treatment of displaced intracapsular fractures of the femoral neck (Garden types III and IV) and from personal experience, a number of conclusions can be made. Orthopedic surgeons and hospitals face the challenge of providing the treatment most beneficial to patients with intracapsular, subcapital hip fractures in the most cost-effective way. The numbers of patients will increase annually and exceed the 125,000 per year at present in the United States. Most authors agree that fractures with the least displacement and younger, more demanding patients will do well with a precise fracture reduction without delay and an accurately placed internal fixation system. However, an overall median risk for reoperation 2 years after internal fixation is 35%. A patient with a displaced intracapsular fracture will need to consider monopolar, bipolar, or THA as the treatment of choice. Monopolar and bipolar arthroplasty have a reduced survivorship compared to THA and are not as suitable for the younger, more active patient. A large femoral head implant leads to decreased motion from increased friction and an undersized head implant leads to reduced contact area with increased erosion and pain. Bipolar arthroplasties, while allowing early mobilization, may develop some of the characteristics of monopolar implants if motion is not mainly at the internal joint. The increased cost may not justify their use over monopolar arthroplasty. Should dislocation occur, monopolar implants are easier to reduce (closed) than bipolar. Ceramic heads on monopolar or bipolar arthroplasties offer reduced wear and less erosion of the acetabulum. Total hip arthroplasty provides early mobilization, long-term pain relief, and little additional morbidity at surgery. The increased rate of early dislocation may be related to surgeon skill rather than an inherent failure of the system. If the early dislocators are removed from consideration, the complication rate drops to equal that of monopolar and bipolar implants. Total hip arthroplasty also is cost effective. Total hip arthroplasty may be the only option if pre-existing arthritis, significant osteoporosis, or Pagets disease of the pelvis is present.

Examining the Elbow during Functional Activities

Elbow range of motion during functional activities was investigated using electrogoniometry, telemetry, and computer analysis. Five subjects awaiting elbow arthroplasty on rheumatoid arthritic elbows were compared to a control group. Differences (p ≤ .05) were found between the two groups on standing and telephone tests. The minimum angle (extreme extension) and the total arc of motion were significantly less in the group with arthritis. During the standing test the median extension angle was 35° for the group with rheumatoid arthritis and 15° for the control group, and for the telephone test the angles were 95° and 75°, respectively. The experimental group did not consistently use their available range, but used movement patterns in a limited range. The information generated in the study has implications in the treatment of clients with rheumatoid arthritis.

Resurfacing elbow prosthesis: Shape and sizing of the humeral component

The sizing and dimensioning of a new unconstrained elbow prosthesis makes use of a geometric axis for humeral articulating surface definition, an axis which is precisely positioned with respect to extra-articular anatomical landmarks. The geometry of the joint was determined by a slicing and digitization technique. It was found that for the humerus an axisymmetric surface is evident and that there exists a centroidal axis which is mostly linear except for a portion at the posterior lateral flange of the trochlea. Sizing studies were carried out on dry bone anatomical specimens and, using a standardized X-ray technique, on the elbows of volunteer subjects. Seven dimensions were chosen for statistical analysis of the joint. A multi-variate normal distribution model, using only the first principal component was found to account for 70% of the variance; components 2 and 3 explained a further 19%. From this analysis, one series of three and five sizes of prosthetic dimensions were established for 95% overall coverage of population.

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