Effect of modern cement technique on acetabular fixation total hip arthroplasty. A retrospective study in matched pairs

The modern cement technique has significantly reduced the bone-cement interface radiolucency and, therefore, it is suggested that the results of the cemented socket with this technique should be the basis for comparison with other methods of fixation.     

Failure of operative treatment in a fast bowler with bilateral spondylolysis

Modern day fast bowling places immense strain on the spine. Stress fractures of the lumbar region are common. If a period of conservative treatment fails to return a fast bowler to professional sport, surgery is considered. Good results have been reported using a direct screw repair of the spondylolytic defect. A case is presented of a failed surgical intervention with an alternative technique.     

In vivo kinematics for fixed and mobile-bearing posterior stabilized knee prostheses

This is the first in vivo kinematic study to compare mobile-bearing with fixed-bearing prostheses in patients who had total knee arthroplasties. Femorotibial contact positions for 40 patients implanted with either a fixed-bearing or mobile-bearing prosthesis were analyzed using videofluoroscopy. Femorotibial contact paths were determined using a computer automated model-fitting technique. Nineteen of 20 patients in each group experienced posterior femoral rollback of their lateral condyles, with a mean of 3.6 and 3.7 mm for fixed-bearing and mobile-bearing prostheses respectively. Eighteen patients who had mobile-bearing prostheses and 17 patients with fixed-bearing knee prostheses experienced a normal pattern of axial rotation of 7.3 degrees and 4.1 degrees respectively. Eleven of 20 (55%) patients who had mobile-bearing prostheses implanted and eight of 20 (40%) patients who had fixed-bearing prostheses implanted did not experience femoral condylar lift-off. The remaining knees had condylar lift-off less than 2.4 mm for fixed-bearing prostheses and 1.7 mm for mobile-bearing prostheses, respectively. Patients who had mobile-bearing prostheses implanted experienced greater axial rotation and less condylar lift-off than patients who had fixed-bearing prostheses implanted. Both cruciate ligaments are sacrificed for the mobile and fixed-bearing total knee replacements. The results from the current study showed that, in both groups, the majority of patients experienced kinematics similar to those of a normal knee. However, the extent of lateral femoral condyle posterior rollback and the extent of axial rotation were less.     

Stress fractures of the lumbar pars interarticularis in athletes: a review based on long-term results of 18 professional cricketers

The physical demand of the modern game of cricket on the fast bowler is known to cause stress fractures of the lumbar spine. Between 1983 and 2001, we diagnosed pars interarticularis defects in 18 professional cricketers contracted to a single English County Cricket Club. Eight of these players were treated conservatively, with rest, supervised rehabilitation, bowling action analysis and re-education where necessary. The remaining 10 were treated operatively, 9 by Buck’s repair of the spondylolytic lesion. All 18 players returned to professional sport.

We recommend treatment of this select group of sportsmen in a unit consisting of a specialist physiotherapist, a bowling coach and a spinal surgeon. Should conservative measures fail, we recommend Buck’s repair as the operation of choice.     

Improvement in driving reaction time after total hip arthroplasty

Decisions made regarding resumption of driving after total hip arthroplasty may be determined by a combination of factors including driving reaction time and when postsurgical precautions need no longer be adhered to. Ninety patients, ranging in age from 34 to 85 years old were recruited after total hip arthroplasty to measure driving reaction time preoperatively and from 1 to 52 weeks postoperatively. Driving reaction time worsened 1 week postoperatively for patients who had a right hip arthroplasty. The driving reaction time then improved up to 1 year postoperatively. Patients who had a left arthroplasty improved from 1 week postoperative. In general, patients reach their preoperative driving reaction time 4 to 6 weeks postoperatively and continue to improve.     

Treatment of osteoid osteoma of the proximal phalanx by use of cryosurgery

A case report of an osteoid osteoma of the proximal phalanx is presented in which radioisotope counting was employed as an intraoperative diagnostic aid and cryosurgery was combined with resection for tumor control.     

Conventional total hip arthroplasty for degenerative joint disease in patients between the ages of forty and sixty years

We analyzed the records of 103 conventional hip arthroplasties in seventy-five active patients who were between the ages of forty and sixty years. After five to ten years of follow-up, an excellent or good clinical result was evident in 90 per cent. The radiographic appearance of the cement-bone interface of the acetabular component was stable in those hips, and no progressive acetabular radiolucency was found in 80 per cent of the hips. Of twenty hips with a complete acetabular radiolucency (Grade III or IV), only three had a secondary revision operation, two in conjunction with a fracture of the stem of the prosthesis and one for migration (Grade IV). Eight additional hips showed migration. Seventy per cent of the femoral components were well fixed, without radiographic evidence of loosening. A fracture of the femoral stem occurred in eight hips, all of which had a revision operation. One revision operation was done for loosening of the femoral stem. Seven femoral stems showed either shift or subsidence. An isolated radiolucency in the superolateral zone was present in four hips and an isolated lucency in other zones, measuring one millimeter or less, was present in ten hips. Thus, radiographic evidence of loosening, including the hips with a fractured stem, was present in 29.9 per cent. One additional revision, making ten in all, was done for symptomatic acetabular loosening. Based on this study, we concluded that conventional hip arthroplasty is a highly successful treatment in active patients between forty and sixty years old who have osteoarthritis of the hip.