International orthopaedics
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A total of 29 consecutive knee joint arthroplasties in 24 patients who underwent previous high tibial osteotomy (HTO) for medial unicompartment osteoarthritis of the knee and followed up for a mean of 97 months were compared with a control group of 28 patients with 29 primary total knee arthroplasty (TKA) without previous HTO. Results for the osteotomy group were satisfactory in 96.5% of cases. ⋯ Three patients underwent a further operation of secondary patella resurfacing for patella pain. The group without osteotomy reported a similar percentage of satisfactory results.
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A retrospective analysis of patients who underwent knee arthroscopy was undertaken to determine the accuracy of clinical diagnosis when compared with arthroscopic findings, and to see whether any specific pathologies were difficult to diagnose. The preoperative diagnosis was compared with the operative findings and the accuracy, sensitivity and specificity of the clinical diagnosis calculated. Six hundred ninety-eight patients were included. ⋯ Ninety percent of patients underwent a beneficial procedure, while 10% had a normal knee diagnosed at operation. Medial meniscal tear was the hardest pathology to diagnose with accuracy, sensitivity and specificity rates of 82%, 92% and 79%, respectively. Clinical examination remains an accurate method of assessing whether patients would benefit from an arthroscopy, although the correct diagnosis may not be determined preoperatively, particularly if pain was located in the medial tibio-femoral joint.
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Pyomyositis is a commonly encountered condition in the tropics. It was not described in the UK until 1998. The reason for the increasing incidence is not understood. ⋯ To our knowledge, this is the first UK series of pyomyositis, reflecting its increasing Western incidence. Early diagnosis and treatment with antibiotics is all that is needed in the majority of cases. A greater awareness of this emerging condition is necessary to prevent misdiagnosis and unnecessary surgical intervention by all surgeons.
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We describe the development of a new device that permits handy intraoperative measurement of lumbar segmental instability. The subjects comprised 80 patients with lumbar degenerative disease. Relationships between preoperative radiological assessments and extended distance as measured using our new device were investigated. ⋯ Correlation coefficients between angular motion and extended distance, and translational motion and extended distance were 0.76 and 0.66, respectively, revealing significant positive relationships between these values (p < 0.01 each). The correlation coefficient between the intervertebral endplate angle on the flexion film and extended distance was -0.78, showing a significant negative relationship (p < 0.01). In conclusion, the device for intraoperative measurement of lumbar segmental instability that we have developed appears to permit simple measurement of intervertebral instability and provides operators with valuable information for selecting operative methods of spinal fusion or instrumentation.
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Sulcus deepening trochleoplasty is a technically demanding procedure with precise indications: high grade trochlear dysplasia with patellar instability and/or abnormal tracking. The main goal is to decrease the prominence of the trochlea and to create a new groove with normal depth, thus optimising patellar tracking. Associated abnormalities should be specifically treated. ⋯ Although results seem very good in terms of instability, further evidence is still needed since the groups of patients in the published series are heterogeneous. Trochleoplasty is not indicated for patellofemoral arthritis or pain. As any surgical procedure, sulcus deepening trochleoplasty is liable to complications.