Faculty Bibliography

Thirteen patients (14 hips) underwent revision from conventional cemented total hip arthroplasty to uncemented acetabular threaded screw-in components and cementless femoral press-fit stems by means of the Autophor, Biofit, and Ti-Thread designs. The patients suffered from all forms of primary hip disease except rheumatoid arthritis; their average age was 34 years. The average preoperative Harris hip score was 39.4; the average postoperative score was 71.2 at six months, 90.6 at one year, and 91.6 at two years. Complications included two femoral shaft fractures, one femoral nerve palsy, and one dislocation. No signs have been observed of loosening or migration as of an early (6-24 months) follow-up.

Total joint replacement has significantly improved the treatment of patients with severe, disabling arthritis. Following replacement of the hip, knee, shoulder, or elbow, the vast majority of patients can expect excellent pain relief and functional improvement. The components of a successful total joint replacement include proper patient selection, optimal preoperative and postoperative management of associated medical problems, meticulous surgical technique, a comprehensive rehabilitation program, and proper prophylaxis against infection

Proximal humeral fractures are commonly seen in orthopedic practice. The vast majority of these fractures are nondisplaced. Infrequently, displaced proximal humeral fractures have associated neurovascular injuries. Injury to the brachial plexus is uncommon; axillary artery injury is rare. This is a report of two displaced proximal humeral fractures in elderly, intoxicated patients following low-energy trauma. Both fractures resulted in axillary artery injury requiring vascular reconstruction. Only nine similar cases were found in a review of the literature. Displaced proximal humeral fractures should be carefully evaluated for vascular injury, and arteriography should be used when necessary. If vascular reconstruction is indicated, the fracture must be internally fixed to prevent redisplacement and potential compromise of the vascular repair. Serial postoperative Doppler examinations are necessary to detect thrombus formation. With prompt diagnosis and treatment, prolonged limb ischemia and its sequelae can be prevented

Between 1969 and 1981, 20 acetabular augmentations were performed on 17 cerebral palsied patients with progressive hip instability. Average follow-up was 41.5 months, with a range from 24 to 147 months. Evaluation of results was based on assessment of hip stability, center edge (CE) angle, range of motion, and postoperative complications. Eighteen hips were rated good, one fair, and one poor. Stability was achieved in 19 hips. The CE angle was increased from a preoperative mean of -17 degrees to a follow-up mean of 50 degrees. There was no significant difference between preoperative and follow-up hip range of motion. The only complication encountered was a supracondylar femur fracture sustained after spica cast immobilization. Acetabular augmentation can be used effectively in the treatment of progressive hip instability in patients with cerebral palsy

Screws and staples are used frequently in the surgical treatment of glenohumeral joint problems. We analyzed a series of thirty-seven patients with complications related to the use of these implants. Twenty-one patients had problems related to the use of screws for affixing a transferred coracoid process to the glenoid. Sixteen patients had problems related to the use of staples: ten had undergone capsulorrhaphy, four had had advancement of the subscapularis, and two had had repair of a rotator cuff tear. The complaints at examination were shoulder pain (thirty-six patients), decreased glenohumeral motion (nineteen patients), crepitus with glenohumeral motion (sixteen patients), and radiating paresthesias (four patients). The time between placement of the implant and the onset of symptoms ranged from four weeks to ten years. The screws or staples had been incorrectly placed in ten patients, had migrated or loosened in twenty-four, and had fractured in three. Thirty-four patients required a second surgical procedure specifically for removal of the implant. At operation fourteen patients (41 per cent) were noted to have sustained a significant injury to the articular surface of the glenoid or humerus. The results in this group of patients indicated that screws and staples can produce complications that require reoperation and are capable of causing a permanent loss of joint function. Adequate surgical exposure and careful placement of the implant appear to be essential when these devices are used about the glenohumeral joint

The results of bunion surgery on 50 feet in 31 adolescents are reviewed. Average follow-up was 3 years 2 months. The failure rate was 36%. Fifty-one percent of the children had hypermobile flatfeet, and 32% had a long first ray. The recurrence rate in these groups was 56 and 50%, respectively. There were 20 reoperations for either recurrence (12) or hardware removal (eight). Elective bunion surgery in adolescents should only be performed in the face of progressive, painful deformity where both the patient and the patient's parents fully understand the goals and risks of surgery

Anterior glenohumeral instability is an important cause of shoulder disability in athletes. Recurrent glenohumeral instability can seriously impair the athlete's performance. Since the surgical repair of recurrent instability may result in a loss of flexibility, particularly in the thrower and gymnast, the physician must optimize both joint stability and joint flexibility