The evolving structure of orthopaedic residency education.

Orthopaedic residency has undergone continual evolution since the early 1900s. Training has evolved from a preceptorship to a highly evolved and structured educational system which largely standardizes training throughout the United States. Approval and accreditation of training programs, as well as content, is now overseen by a hierarchical group of organizations with representations from a variety of medical societies and boards.

Gross polyethylene failure in total knee arthroplasty.

A total of 12 total knee replacements in nine patients with evidence of gross polyethylene failure at the time of revision surgery were identified. There were nine tibial and three patellar component failures. The average time from index to revision arthroplasty was 6 years (range: 0.

Recertification in orthopedics.

Will the recertification process always remain the same or is there room for change? Almost certainly the process will change with experience and newer technology, particularly as it relates to clinical policies, outcome studies, and increased computerization of patient data. Even the addition of the practice-based oral exam in 1989 represented a change. The American Board of Orthopaedic Surgery will continue to study and review the experience and methods of other boards with recertification and will continue the dialogue with orthopedic surgeons.

Degenerative arthritis of the knee secondary to fracture malunion.

Degenerative arthritis of the knee is a complication of femoral or tibial fractures potentially avoidable by the correction of various degrees of malalignment. To better clarify the malalignment problem, the records of 14 patients (15 limbs), with degenerative arthritis of the knee and a history of tibial or femoral fracture were retrospectively reviewed. The average follow-up was 31.

General considerations in total knee arthroplasty.

Total knee replacement is a powerful but complex surgical procedure. Recognizing and addressing all planes of motion at the knee is mandatory for good results. Accurate alignment of the prosthetic component and the limb is crucial.

Saphenous nerve entrapment. A cause of medial knee pain.

Saphenous nerve entrapment is a seldom recognized cause of pain along the medial side of the knee and proximal calf. We are reporting our experience with 15 saphenous nerve entrapments in 14 patients between 1978 and 1981.

Analysis of patterns of knee motion walking for four types of total knee implants.

The pattern of normal knee joint motion was compared with the pattern of knees after arthroplasty operations with: (a) variable axis, (b) geometric, (c) Herbert and (d) Shiers implants. The pattern of motion during walking was not implant-specific. Considerable variation in the transverse and coronal planes occurs in normal and postimplant knees.

Results of proximal tibial osteotomy. The effects of tibiofemoral angle, stance-phase flexion-extension, and medial-plateau force.

Forty-eight knees were evaluated after proximal tibial osteotomy, performed for varus deformity to determine the desired amount of correction of the deformity, the effect of osteotomy on knee motion during gait and one medial-plateau force during standing, and the relationships between these factors and the result. Correction of the tibiofemoral angle to 5 degrees of genu valgum or more produced the best and most lasting results. Stance-phase flexion-extension increased the rotation decreased in knees with good results while the other gait parameters were not significantly changed.

The effect of patellectomy on knee function.

Thirty-three patients were evaluated after patellectomy for subjective complaints, objective physical findings, quadriceps strength, and knee motion during activities of daily living. Partial and complete patellectomy caused an equal loss of active and passive range of motion. Complete patellectomy resulted in greater ligament instability, quadriceps atrophy, and loss of quadriceps strength compared with partial patellectomy.

Development of a knee scoring scale.

Two knee scoring scales have been tested against post-osteotomy knees for degeneration arthritis and post-arthroplasty knees (McIntosh Operation) and were found to be acceptable for both conditions. Scoring Scale I was slightly better than Scale II. This scale should be tested on other types of knee reconstruction.

Pitfalls of proximal tibial osteotomy.

Proximal tibial osteotomy for degenerative genu varus and valgus has an excellent success rate with proper patient selection and technical proficiency. The following are some infrequently recognized pitfalls. Excessive bone loss prevents two plateau weight-bearing after osteotomy, introduces a "teeter effect," and is therefore a contraindication.