Niels Egund

Function after tibial osteotomy for medial gonarthrosis below aged 50 years.

Twenty-seven patients (28 knees), with a median age of 42 (27-50) years treated with a high tibial osteotomy for early medial gonarthrosis (Ahlbäcks Stage I) were examined after 11 (7-18) years. Twenty-four were men; 18 knees had had previous meniscus and ligament lesions. At follow-up, 22 knees were satisfactory and 9 patients managed high-activity sports or heavy work. In 25/28 knees, the arthrotic process had not progressed radiographically.

Proximal Closing Wedge Osteotomy and Adductor Tenotomy for Treatment of Hallux Valgus

After 2 to 4 years, 25 patients (27 feet) who had a proximal closing wedge osteotomy of the first metatarsal and an adductor tenotomy were reviewed. A total of 20 patients (22 of 27 feet) were completely satisfied; 5 patients not completely satisfied had metatarsalgia because of dorsal displacement of the first metatarsal head. Radiographic measurements showed a narrowing of the forefoot rather than a large change in the intermetatarsal angle. The recovery period was long, an average of 11 weeks. Pin inflammation occurred in 5 patients and incisional neuromas in 2 patients. The risk of these complications must be taken into consideration when using this operation.

Cup arthroplasty of the rheumatoid shoulder

Hemiarthroplasty of the humeral head, using a stainless steel cup, was performed in 26 shoulders of patients with rheumatoid arthritis who had severe pain and loss of function. All the shoulders were Larsens radiographic Grade 4 or 5. After 2 (1-5) years, all the shoulders were painless and had satisfactory function. Partial radiolucent zones exceeding 1 mm were seen in three shoulders.

Instability and wear of total hip prostheses determined with roentgen stereophotogrammetry.

SummaryA roentgen stereophotogrammetric analysis of hip prostheses was made in four patients with rheumatoid arthritis during a postoperative period of 2 years.Implanted tantalum balls, prosthetic femoral head, and ends of the wire in the acetabular socket were used as measurement points.The migration of the prosthetic head and the acetabular socket in relation to the pelvic bone was determined. The difference between the cranial migration of the head and the socket is a measure of the postoperative instability of the hip joint and deformation of the prosthetic components. This deformation occurs in the plastic acetabular socket and is mainly due to wear.The roentgen stereophotogrammetric method can be applied to standard hip prostheses with a metal femoral head and a plastic or a metal acetabular socket to study migration or loosening of the prosthesis in relation to the supporting bone, prosthesis instability, and deformation of the prosthetic components.

Tibial osteotomy in medial gonarthrosis

SummaryIn a prospective series of 52 knees selected for high tibial osteotomy because of early medial arthrosis, special care was taken to obtain a final over-correction in valgus. The operative procedure and the pre- and post-operative radiographic examinations were standardized and the follow up was 1–3 years. 49 of the 52 knees had obtained a normal or over-corrected mechanical axis. 45 of these had improved painfree walking distance, and 31 were painfree. In 45 knees the arthrotic condition had not progressed, and in 5 of these there were signs of cartilage restitution.It is concluded that precise correction of medial gonarthrosis can be achieved, and this provides a rational basis for definitive treatment of early stages of this condition; for the majority an endoprothesis operation should not be needed in the future.

Roentgen stereophotogrammetry in high tibial osteotomy for gonarthrosis

SummaryIn three cases operated with high tibial osteotomy for medial gonarthrosis the exact method of roentgen stereophotogrammetry with tantalum balls as bone markers (Selvik 1974) was used to study angular and translational movements in three dimensions at the operation and during the healing period. Tibial osteotomy caused angular and translational movements even in planes where correction was not intended, and the stereo technique revealed that stability was not present when knee mobilisation started. Correlation between the stereo values and conventional radiographic measurements were best in the frontal plane (root mean square value of discrepancies 1.3°). Roentgen stereophotogrammetry gives superior information compared with the conventional radiographic technique, but it is concluded that the latter has sufficient accuracy for the clinical assessment of corrections in the frontal plane.

Growth disturbance after physial injury of distal femur and proximal tibia studied by roentgen stereophotogrammetry

SummaryLongitudinal growth determined by roentgen stereophotogrammerry was registered in three patients with physial injuries in distal femur and in two patients with physial injuries in proximal tibia during 18 months. The injuries in distal femur were classified as Type I, Type I + III and Type IV and in proximal tibia as Type I + III and Type IV in the different cases according to Salter and Harris. Markers of tantalum balls were implanted into the metaphysis and bony epiphysis of distal femur and proximal tibia permitting regular determination of longitudinal growth.Significant growth disturbances was registered in four patients. The Salter-Harris classification was difficult to use to predict growth disturbance after physial injuries around the knee.The roentgen stereophotogrammetric method was found useful to determine normal growth rate and after physial injuries to reveal growth disturbance leading to complete or partial growth arrest resulting in leg length discrepancy or angular deformity. This method facilitates preoperative planning if surgery is needed.ZusammenfassungÜber 18 Monate wurde mit Hilfe der Röntgenstereophotogrammetrie das Längenwachstum geschädigter Wachstumsfugen am distalen Femur (3 Fälle) sowie der proximalen Tibia (2 Fälle) verfolgt. Dabei handelte es sich am Femur um Schädigungstypen I, I + III und IV (nach Salter/Harris), an der Tibia um die Typen I + III und IV.Um eine exakte Messung des Längenwachstums durchführen zu können, wurden Tantalkugeln als „Markören” sowohl in die Metaphyse als auch in die Epiphyse des distalen Femurs und der proximalen und distalen Tibia eingebracht. In vier Fällen waren signifikante Wachstumsstorungen zu registrieren, ohne daß aufgrund der Salter-Harris-Einteilung zu-vor eine abartige Wachstumsstörung zu erwarten gewesen wäre. - Die Röntgenstereophotogrammetrie kann somit nicht nur als Methode zur Bestimmung des normalen Wachstums angesehen werden, sondern ist gleichfalls geeignet, Wachstumsstorungen bei traumatisch bedingten Fugenschädigungen aufzuzeigen.

Improved positioning of the femoral stem with a centralizing device.

Two series of patients operated on with total hip replacements for arthrosis are reported. The same prosthesis and operative and cementing techniques were used in both series, except that in Series 2 a centralizing device consisting of four triangular fins passed over the tip was also used to improve the positioning of the femoral stem. It was found that the position of the tip was more central in Series 2. No drawbacks were associated with the use of the device. We concluded that the centralizing device facilitated the positioning of the femoral stem tip.

Early knee mobilization after osteotomy for gonarthrosis

In a prospective study, 32 knees in 32 patients were randomized to either a cylinder plaster cast (17 knees) or hinged cast-brace (15 knees) after high tibial osteotomy for medial gonarthrosis. At 6 weeks, 3 months, and still 1 year after surgery, the range of motion was better in the cast-brace group. There was no difference in the other clinical results at 3 months and at 1 year after surgery, nor in changes of osseous correction or in the final knee alignment. All the patients in the cast-brace group were satisfied with early motion.

A guide instrument for high tibial osteotomy

Fifty-two patients (52 knees) with medial gonarthrosis were subjected to high tibial osteotomy using the Tjörnstrand guide instrument. The intended wedge was calculated from a whole lower limb radiograph. The correction aimed at was an overcorrection of 4 degrees in valgus of the hip-knee-ankle angle. All but 1 case were corrected to +/- 3 degrees of the intended angle. All but two cases healed within +/- 3 degrees of the achieved surgical correction, i.e., a substantial improvement compared with our previous freehand technique where one fifth were outside this interval. We conclude that in knee surgery a guide is as important for osteotomies as for arthroplasties.