Ten-year assessment of primary rotator cuff repairs

A review of 30 patients who underwent a primary repair of their rotator cuff 10 years previously was performed. The average age of the patients at the time the operation was performed was 51 years (range 20 to 65 years). Twenty-seven men and three women were reviewed. An acromioplasty was performed in all patients. No patient had a distal clavicle excision. There were 12 small, 11 medium, five large, and two massive tears. A significant decrease in pain after surgery and a return to preinjury activities occurred in 82% of the patients. Subjective results were excellent or good in 70% of the patients. Good or excellent results were achieved in 80% of the 25 patients with objective data. In the overall results (subjective and objective), 64% of the patients had a good or excellent outcome. By Neer's criteria, 72% satisfactory results were achieved. No significant prognostic indicators were identified in this study, although a trend toward better results occurred in patients less than 55 years old and in those patients with smallor medium-sized tears. The findings of this study confirm the view that the results of rotator cuff repairs do not deteriorate, with follow-up extending to 10 years.     

Polycentric total knee arthroplasty: a prognostic assessment

Polycentric total knee arthroplasty has been performed at the Mayo Clinic on more than 1,600 knees since July 1970. Two groups of 106 and 101 knee arthroplasties performed between July 1970 and July 1971 and June 1971 and January 1972, respectively, were compared at 5 and 7 years. The technique used exposed the joint to methacrylate particles, yet, despite this, wear did not prove to be a problem. Failures occurred because of infection, loosening of the tibial components, settling of the tibial components, subluxation or dislocation, ligamentous laxity, progression of patellofemoral arthritis, and persistence of pain. We did not encounter patellar problems in our patients with osteoarthritis. In the first group with 106 knees, 45 patients with 58 rheumatoid knees survived 7 years; 79% of knees had good results at 5 years and 72% had good results at 7 years. Twenty-one patients with 28 osteoarthritic knees survived 7 years; 75% of knees had good results at 5 years and 61% had good results at 7 years. In group 2 with 101 knees, 43 patients with 64 rheumatoid knees survived 7 years. The results were good in 83% at 5 years and in 64% at 7 years. Among the 20 patients with osteoarthritic knees who survived 7 years, 92% of knees had good results at 5 years and 62.5% had good results at 7 years. This figure is somewhat misleading because 7 patients were lost to follow up in group 2 after 5 years. There is still a need for a well-tolerated resurfacing procedure by means of a nonconstrained prosthesis.     

Total hip arthroplasties in patients younger than 45 years. A nine- to ten-year follow-up study

Eighty-one cemented total hip arthroplasties in patients younger than 45 years were reviewed with an average 9.2-year follow-up interval. The results were compared with the same group previously reported at an average follow-up time of 4.5 years. Clinically satisfactory results were 58% compared with 78% at 4.5 years. The revision rate almost tripled to 33%. Impending failure was present in 56% of those hips not yet revised. In the first study, technique was a primary determinant of success. In this report there was no influence of technique on the incidence of revision. Age did not influence revision rates either, with 35% in patients younger than 30 years and 32% in patients aged 30-45 years. Patients younger than 30 years had fewer satisfactory clinical results and a higher rate of impending failure. As in the first study, the best results were obtained in patients with inflammatory collagen disease aged from 30 to 45 years.     

Outcome of Silicone Ring Vertical Gastroplasty in Patients Aged 50 Years and Older

Background: The authors studied the results of silicone ring vertical gastroplasty (SRVG) in patients aged 50 years and older. Methods: The early and late postoperative results in 28 patients aged 50 years or older undergoing SRVG were reviewed retrospectively. The results were compared to those of 370 patients younger than 50 years operated during the same period. Results: There was no postoperative mortality among patients aged 50 years and older. There was a significantly higher incidence of pulmonary embolus and wound infection among patients aged 50 years and older (p < 0.05). The weight loss did not differ significantly between the two studied age groups. Conclusion: SRVG may be performed on patients aged 50 years or older with acceptable complication rate and favourable postoperative results.     

Synovectomy of the elbow in rheumatoid arthritis. Long-term results

We reviewed 61 elbow synovectomies in 50 patients with rheumatoid arthritis, with follow-up varying from 4 to 10 years (mean 6.5 years). The results were graded as satisfactory in 70%, with no significant difference in the results between joints which were radiologically good before operation and those which had been destroyed. Longer term results were analysed of 27 elbow synovectomies in 22 patients followed up for over six years. The results were satisfactory in 67% of the patients in both 1981 and in 1987, with no deterioration over this period.     

干扰电疗法治疗腰椎间盘突出症疗效的对照研究

目的:评价牵引加干扰电疗法治疗腰椎间盘突出症的临床效果,并与单纯牵引治疗相比较。方法:对180例腰椎间盘突出症患者分为牵引加干扰电疗法治疗(B组)和单纯牵引治疗(A组)。A组89例,男45例,女44例,采用持续牵引,牵引力300～400N;B组91例,男46例,女45例,使用干扰电作疼痛区局部刺激。各病程分级(<2个月、2个月～2年、>2年),A组为29、30、30例,B组有31、30、30例;各年龄段(<40岁、40～55岁、>55岁)两组分别为30、29、30例及30、29、32例。对治疗前及治疗中期、治疗后分别以日本矫形外科学会制订的“腰椎疾患治疗成绩评分表”进行评分,对其评测结果进行比较分析。结果:两组不同病程疗效结果比较,对于病程<2个月和2个月～2年的患者评分显示牵引加干扰电疗组较牵引组疗效好(P<0.01)。两组不同年龄段中,对于年龄<40岁和40～55岁的患者评分显示牵引组加干扰电疗组较牵引组疗效好(P<0.01)。结论:对于病程<2年、年龄<55岁患者,牵引加干扰电疗法治疗腰椎间盘突出症较单纯牵引治疗疗效佳。     

Long-term results of cemented total hip arthroplasty in patients 45 years old or younger: A 16-year follow-up study

Forty-nine cemented total hip arthroplasties in patients younger than 45 years were reviewed, with an average follow-up period of 16.2 years. The results were compared with the same group previously reported at average follow-up periods of 4.5 and 9.2 years. Clinically satisfactory results were 27% at 16.2 years compared with 78% at 4.5 years and 58% at 9.2 years. The revision rate increased from 12% at 4.5 years to 33% at 9.2 years to 67% in this study. The revision rate for patients younger than 30 at the time of the index arthroplasty was 82% compared with 56% for those over 30. Impending failure was present in 81% of the 16 unrevised hips compared with 56% at 9.2 years and 29% at 4.5 years. Patients younger than 30, in Charnley category A or B, and with a diagnosis of osteonecrosis or osteoarthritis had the poorest clinical results. As in the previous two studies, the best results were obtained in category C patients who were over 30 years of age with inflammatory collagen disease. The purpose of this study is to report the long-term (average, 16.2 years) follow-up results of patients under the age of 45 who underwent cemented total hip arthroplasty at Rancho Los Amigos Medical Center between 1972 and 1978. The 4.5-year and 9.2-year results form the basis for comparison.     

Long-term results of conventional surgical treatment for epilepsy. Delayed recurrence after a period of 10 years

The results of the surgical treatment of epilepsy were studied in 44 patients 10 or more years after operation. Thirty-seven patients underwent operation only once; these patients were observed 11–26 years postoperatively. Seven patients had a recurrence within 5 years after operation and required a second operation; these patients were observed 11–17 years after the second operation. Recovery persisted for 15–27 years in 32 patients. There was a recurrence in 12 cases 11–19 years after operation. With one exception, these recurrences were satisfactorily treated medically.     

Radiological outcome of proximal femoral varus osteotomy for the treatment of lateral pillar group-C Legg-Calvé-Perthes disease

Results from 26 hips of 24 Legg-Calvé-Perthes disease patients were evaluated retrospectively. There were 22 male and two female patients in the study group. The mean age of the patients was 8.3 years and the mean follow-up was 13.03 years. All the patients were older than 6 years of age and all of them had lateral pillar group C hips. The patients were treated with intertrochanteric uniplanar varus osteotomy. All the patients were mature at the time of the last evaluation. Radiological end results were evaluated according to Stulberg's classification. Six hips healed with spherical congruency (Stulberg class 1 or 2), 19 with aspherical congruency (Stulberg class 3 or 4) and one with aspherical incongruency (Stulberg class 5). Six of 14 hips treated before 9 years of age healed with spherical congruency but all hips treated after 9 years of age healed with Stulberg class 3, 4 or 5 results. Trochanteric overgrowth was evident in 20 hips. The results of this radiological outcome study showed that Herring class C hips treated with proximal femoral varus osteotomy had a poor outcome, especially after 9 years of age in this group of patients.     

Evaluation of clinical and radiological results of operative treatment of patellar fractures]

The paper presents the clinical and radiological evaluation of surgical treatment of patellar fractures in the years 1984-1999. Th study group included 45 patients (18 female and 27 males). The observation period ranged from 2 to 6 years; on average 6 years. The most common procedure was tension band fixation (20 patients), followed by hemipatellectomy (14 patients) and patellectomy (11 patients). Radiological assessment revealed the highest number of excellent and very good results in patients treated with tension band fixation. No excellent results and 50% food results were noted in patients treated by partial patellectomy. The worst radiological resulted were noted in patients treated by total patellectomy. Clinical results were similar to radiological results: 75% of patients treated by tension band fixation had no pain, while the group treated by total patellectomy revealed only 27.3% excellent and very good results.     

Heart injuries

Operations were carried out on 32 patients with injuries to the heart and pericardium during a period of 14 years. The pericardium was injured in 7 patients. All fatal cases were brought to the clinic in the first 30 minutes after the accident. Seven patients died after operation. The late results were studied in 22 patients in follow-up periods of 12 months to 14 years. The results were excellent and good in 20 patients and satisfactory in 2 patients. Poor results were not encountered. The capacity for work was restored in 21 patients.     

Traumatic dislocation of the hip

Of 125 patients with traumatic dislocation of the hips treated, 96 were reviewed retrospectively; 80 were males and 16 females with an age range from seven to 81 years (mean, 33.5 years). Motorcycle accidents were the leading cause of traumatic dislocation in this series (40 cases, 42%). Associated injuries were found in 68 cases (70.8%). Seventy-seven hips (80%) were reduced within 24 hours. In follow-up periods ranging from 15 months to 18 years (mean, 7.5 years), 56 patients had excellent or good results (58.3%). Statistical analysis of the clinical results showed that those patients with simple dislocations had better functional recovery. The earlier the reduction, the better the results. Associated injuries affected prognoses. Good results were obtained in patients with early, stable, and accurate reductions by either closed or open methods.     

Congenital muscular torticollis: long-term follow-up of thirty-eight partial resections of the sternocleidomastoid muscle

Summary Thirty-eight patients with muscular torticollis were treated by a partial resection of the sternocleidomastoid muscle between 1970 and 1981. Clinical evaluations were performed on 35 of these patients who were followed up for 10 years (average of 11.3 years). Of 31 patients under 5 years of age at operation, good results according to Canale's criteria were obtained in 28 (90%). In four patients aged 6 years or more at operation, three showed good results. Postoperatively, massive cotton bandaging was applied with the neck in the neutral position for 3 weeks. A plaster cast, brace, or physiotherapy involving active motion training was not necessary.     

Ten to 20-year clinical results after short esophagomyotomy without an antireflux procedure (modified Heller operation) for esophageal achalasia.

To determine the long-term clinical results after modified esophagomyotomy without an antireflux procedure for esophageal achalasia, the status of all patients undergoing this operation with a minimum follow-up time of 10 years was reviewed; 81 such patients were operated on between January 1970 and January 1981. Thirteen patients were lost to follow-up review permitting clinical evaluation during the past year of 68 patients (84%) observed for a median of 13.6 years. Fifty-nine patients (87%) were improved by operation; 90% of the patients who underwent a primary procedure were improved, whereas only 73% of patients undergoing reoperation benefited. Kaplan-Meier analysis of the results of all 81 patients disclosed an improvement rate of 98.5% at 5 years, 95.6% at 10 years, 85.8% at 15 years, and 67.3% at 20 years. When the level of improvement or lack thereof was analyzed, the percentage of excellent results decreased from 54% to 32% (P = 0.02). The percentage of good results remained the same, whereas fair or poor results together increased from 20% to 37% (P = 0.05). Neither age, sex, esophageal caliber, duration of symptoms, or previous therapy appeared to influence these results. We conclude that limited esophagomyotomy without an antireflux procedure results in persistent long-term improvement for the patient with esophageal achalasia. The level of improvement, however, decreases with the passage of time, presumably because of persistent disease in the body of the esophagus leading to impaired esophageal emptying in some patients and late reflux esophagitis in other patients owing to poor esophageal clearance.     

Repair of massive rotator cuff tears in patients older than 70 years

Major ruptures of the rotator cuff are common in elderly patients, and their management has been a challenge for orthopaedic surgeons. This study was undertaken to evaluate the results obtained in patients older than 70 years who were treated with open surgical repair for massive ruptures of the rotator cuff tendons and to correlate the functional outcomes with the quality of the repairs. Between January 1991 and November 1994, 69 patients older than 70 years of age underwent rotator cuff repairs of massive tears with a minimum follow-up of 2 years (mean of 3 years). These patients were evaluated before and after surgery with the University of California at Los Angeles score. The mean age was 75 years (range 70 to 90 years), and female sex and right shoulder were predominant. A good bone-tendon repair was achieved in 55 patients, a fair bone-tendon repair in 5 patients, a poor bone tendon-repair in 8 patients, and 1 patient had no repair. The mean University of California at Los Angeles rating score before surgery was 9.4 points, and the mean postoperative score at final follow-up was 30.9 points, with an average improvement of 21.5 points (P = .0001). Satisfactory results were achieved in 78.2% of the patients (University of California at Los Angeles score equal or over 28). The patients' clinical results and postoperative arthrograms are evaluated with regard to the quality of cuff repair. Painful massive rotator cuff tears can be repaired in patients older than 70 years with satisfactory results.     

Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study comparing decompression with decompression and intertransverse process arthrodesis

Fifty patients who had spinal stenosis associated with degenerative lumbar spondylolisthesis were prospectively studied clinically and radiographically to determine if concomitant intertransverse-process arthrodesis provided better results than decompressive laminectomy alone. There were thirty-six women and fourteen men. The mean age of the twenty-five patients who had had an arthrodesis was 63.5 years and that of the twenty-five patients who had not had an arthrodesis, sixty-five years. The level of the operation was between the fourth and fifth lumbar vertebrae in forty-one patients and between the third and fourth lumbar vertebrae in nine patients. The patients were followed for a mean of three years (range, 2.4 to four years). In the patients who had had a concomitant arthrodesis, the results were significantly better with respect to relief of pain in the back and lower limbs.     

Auto-venous femoral-popliteal bypass in patients of different age groups

The results of autovenous femoro-popliteal shunting performed in 106 patients with infrainguinal atherosclerotic arterial occlusion were investigated. All the patients were divided into 3 groups: younger than 50, from 50 to 60 and older than 60 years of age. The most favorable results were registered in the group of patients aged from 50 to 60. In 3 years these results made up 52.2%, in 5 years--17.4%. The lowest indices of shunt functioning were noted in patients younger than 50, and 3 and 5 years later they were 38.5 and 7.7% respectively. In 70% of this age group patients there were injuries of the main crural arteries and significant changes in the phospholipid fraction level. The main cause of unsatisfactory results of shunting operations in the femoro-popliteal area is though to be the injuries of the main crural arteries and the progressing course of the atherosclerotic process.     

Ileal pouch anal anastomosis for ulcerative colitis is feasible for septuagenarians

OBJECTIVE: Proctocolectomy and ileal pouch anal anastomosis (IPAA) has become the standard surgery for patients with mucosal ulcerative colitis (MUC). Although there is no absolute age limitation, there are concerns as to its use in elderly patients due to the risks of potential complications and poor function. The aim of this study was to assess the complications and outcome of patients over the age of 70 years with MUC who underwent IPAA. Results in these patients were compared to the results in a group of patients aged less than 70 years who had IPAA. METHODS: After Institutional Review Board approval, a retrospective review of the medical records of patients with MUC who underwent IPAA was undertaken. These patients were divided into four age groups: <30 years of age, 30-49 years, 50-69 years, >or=70 years. RESULTS: From 1989 to 2001, 330 patients underwent IPAA for preoperative clinical and histopathological and postoperative histopathologically confirmed MUC; 17 were aged>or=70 years. The mean hospital stay was 5.8 (SEM 0.7) days in the patients aged<70 years and 6.0 (SEM 0.4) days in the patients aged>or=70 years (P=0.911). Postoperative complications occurred in 39% of patients>or=70 years and in 40% in the <70 years group (P=0.08). Pouch failure occurred in two (11.8%) patients>or=70 years and in 6 (1.9%)<70 (P=0.2). CONCLUSION: IPAA is a safe and feasible option in MUC patients over the age of 70 with functional results similar to results seen in younger patients.     

Arthroscopic synovectomy

This study was undertaken to evaluate the efficacy of knee synovectomy with arthroscopic technique. Nineteen patients with 25 operated knees were studied. All 25 knees had 6-month follow-up, 21 knees had 2-year follow-up, and 14 knees were evaluated at least 4 years after operation. After operation, patients were evaluated using clinical data including pain relief, functional capacity, range of motion, recurrent synovitis, and presence of effusion. Preoperative as well as follow-up weight-bearing radiographs were also studied to assess the results of this procedure. At 6 months' postoperative clinical evaluation, 96% of patients showed good results. At 2 years, 90% of patients were considered to have good results, and at 4 years, 57% of patients continued to do well. Of those knees studied radiographically, 81% showed no progressive radiographic changes at 2 years and 61.5% showed no deterioration at 4 years. Clinical results correlated well with radiographic results. Arthroscopic synovectomy yielded results similar to those previously published for open synovectomy, with less operative and postoperative morbidity.     

Mini-incision rotator cuff repair: a longitudinal assessment with no deterioration of result up to nine years

The reported short- and intermediate-term results of mini-incision rotator cuff repair have been satisfactory. This study was carried out to assess whether these results are sustained in the long term. Seventy-nine consecutive mini-incision cuff repairs were initially reviewed and the results analyzed at a mean of 2 years after surgery by use of a subjective self-scoring system in which patients scored pain, function, active forward flexion, and strength, as well as patient satisfaction. Subsequently, 74 of the initial 79 patients were available for the second review at a mean of 7 years (range, 5-9 years). At 2 years, there were 74% good to excellent results, which improved to 84% at 7 years. Six patients had a poor result at 2 years, compared with 5 patients at 7 years. Within this group of 5 with a poor result, there were 4 who had subsequent trauma and markedly deteriorated to score as poor. Sixty-five percent of the compensation group had good to excellent results at a mean of 7 years compared with ninety percent of the non-compensation group. The manual workers within the workers' compensation subgroup did worse than the sedentary workers at 2 years; however, at the 7-year review, this difference was statistically no longer apparent. This study found that, in the absence of reinjury, there is no deterioration in the results of mini-incision cuff repair in up to 9 years' follow-up.