Wrist osteoarthritis.

Osteoarthritis of the wrist is one of the commonest conditions encountered in clinical orthopaedic practice. This article looks at our approach to this problem including clinical assessment, radiographic analysis and the management of wrist osteoarthritis.

Results of tri-ligament tenodesis: a modified Brunelli procedure in the management of scapholunate instability.

One hundred and sixty-two patients with a diagnosis of scapholunate instability underwent a modified Brunelli procedure over a 7-year period. One hundred and seventeen were assessed with the help of a questionnaire and, of these, 55 patients attended for clinical evaluation. The mean follow-up was 4 (1-8) years.

Post-traumatic instability of the trapeziometacarpal joint of the thumb. Diagnosis and the results of reconstruction of the beak ligament.

In 28 patients with a solitary diagnosis of instability of the trapeziometacarpal joint because of a rupture of the anterior oblique ligament, reconstruction was carried out using a slip of the tendon of flexor carpi radialis. We were able to review 26 patients. The results after a follow-up of four years seven months showed that most (87%) had significant relief from pain and symptoms.

The natural history of an untreated isolated scapholunate interosseus ligament injury.

The natural history of an untreated isolated scapholunate interosseus ligament injury remains unclear, although it is commonly assumed that patients continue to suffer with pain, stiffness and weakness of the wrist and ultimately develop secondary osteoarthritis (SLAC wrist). In this study, we evaluated the clinical condition of 11 patients with an arthroscopically proven interosseus scapholunate ligament injury, but without any radiological signs of either DISI deformity or scapholunate gapping, who had declined further treatment at an average follow-up of 7 years. Whilst there was on going pain and functional limitation in all cases, there was no rapid progression to degenerative change (SLAC wrist).

Total ankle replacement. The results in 200 ankles.

Between 1993 and 2000 we implanted 200 cementless, mobile-bearing STAR total ankle replacements. None was lost to follow-up for reasons other than the death of a patient. The mean follow-up was for 46 months (24 to 101).

Surface-active phospholipid in total hip arthroplasty.

This is the first report of surface-active phospholipid as the boundary lubricant in total hip arthroplasty. Aspirate and rinsings from the bearing surfaces of 25 revision operations and one primary surgery were analyzed from 3 weeks to 26 years postoperatively. All samples contained substantial amounts of surface-active phospholipids ranging from 14 to 4186 microg.

Fatal pulmonary embolism and mortality after revision of failed total hip arthroplasties.

To assess the effect of extensive surgery and delayed mobilization on postoperative incidence of fatal pulmonary embolism, we reviewed the mortality rate in 1,294 patients undergoing 1,483 revisions of failed total hip arthroplasties, in which mobilization of the patients was delayed for up to 3 weeks. There were 6 deaths (mortality rate, 0.4%).

Stem fixation in the Charnley low-friction arthroplasty in young patients using an intramedullary bone block.

We report a prospective study of the use of intramedullary bone blocks to improve the fixation of a matt-finish femoral stem in Charnley low-friction arthroplasties. There were 379 patients (441 hips), but at a minimum follow-up of ten years there were 258 arthroplasties in 221 patients including some which had been revised. The mean age at surgery was 41 years (17 to 51) and the mean follow-up was 13.

Nonsurgical management of supracondylar fracture above total knee arthroplasty. Still the nineties option.

Supracondylar fracture of the femur above a total knee arthroplasty has been reported to occur in 0.3-2.5% of all cases.

Prospective clinical and joint simulator studies of a new total hip arthroplasty using alumina ceramic heads and cross-linked polyethylene cups.

We report the findings from independent prospective clinical and laboratory-based joint-simulator studies of the performance of ceramic femoral heads of 22.225 mm diameter in cross-linked polyethylene (XLP) acetabular cups. We found remarkable qualitative and quantitative agreement between the clinical and simulator results for the wear characteristics with time, and confirmed that ceramic femoral heads penetrate the XLP cups at only about half the rate of otherwise comparable metal heads.

Cemented Charnley revision arthroplasty for severe femoral osteolysis.

We reviewed prospectively cemented stem revision in 106 patients with severe femoral endosteal bone lysis without infection. Bone grafts were not used in any of the patients. The minimum follow-up was three years (mean 6 years 4 months).

Cemented revision for aseptic acetabular loosening. A review of 387 hips.

We reviewed the records and radiographs of 387 cemented revisions of aseptic loose sockets after total hip replacement at a mean follow-up of 5.5 years. The clinical results were satisfactory, but at the last radiological assessment 38 sockets (9.

Revision for aseptic stem loosening using the cemented Charnley prosthesis. A review of 351 hips.

We reviewed 351 cemented revisions of femoral stems performed for aseptic loosening. At a mean of six years after the revision operation 72.1% of the patients were pain-free and 21.

Total knee arthroplasty after patellectomy.

We compared the outcome of total knee arthroplasty in 19 patients who had had previous patellectomy with the results in a matched series of arthroplasties performed on knees in which the patella was intact. The mean follow-up was 63 months (21 to 114). In the study group, the outcome was poor in five patients.

Cemented revision Charnley low-friction arthroplasty in patients with rheumatoid arthritis.

We assessed 41 patients with rheumatoid arthritis (47 hips) who had had revision hip arthroplasty, at an average follow-up of 7 years 4 months (2 to 19). The clinical results were excellent or satisfactory in 43 hips. Radiologically, 45 stems were secure.

Surgery for lumbar spinal stenosis in old people.

We have reviewed 31 consecutive patients, aged 65 years or more, after surgical decompression for degenerative lumbar spinal stenosis. The average follow-up was 42 months. Assessment included a standard questionnaire, a pain diagram which was completed by the patient, and clinical and radiological examination.