Biomedical subjects
Publications and source records attributed to B Levack.
The authors report seven cases of unconstrained knee arthroplasty with excision of both cruciate ligaments, after previous patellectomy. Six of these seven cases were completely painfree and function was satisfactory in all cases. The reasons for previously reported pain and instability after total unconstrained knee arthroplasty with excision of the cruciate ligaments and a previous patellectomy are discussed.
Thirty-seven patients with extensive acetabular defects due to loose implants had revisions with uncemented components, the acetabulum being augmented with homograft bone. In six of these, a histological study of graft incorporation was made. At a mean follow-up of 1.5 years 34 patients were free of pain and 35 could walk for 30 minutes or longer. No graft had obviously sequestrated. Two components had radiological evidence of migration but remain asymptomatic. We conclude that cementless revision surgery with homograft supplementation of the acetabulum is clinically successful in the short-term. The long-term outcome is unknown.
Conventional systems of assessing the hip before and after surgery use the range of movement as an indicator of functional results. We found that the range of movement, defined as the flexion arc or the total range, is a poor indicator of function as measured by ability to reach the feet. A different and more direct basis for assessing function is proposed.
A new prosthesis for the metcarpo-phalangeal joint is presented. Its advantageous design features and the early results following its use suggest that it is of value in treating the painful, stiff and ulnar deviated metacarpo-phalangeal joint in the rheumatoid hand.
The bone cement interface of four clinically stable hip-joint prosthetic components was examined histologically for the presence of macrophages using routine staining and a histochemical technique for acid phosphatase. Macrophages were found in the absence of wear debris in all four cases. Because these cells are capable of bone resorption, their presence at a well-fixed interface must give cause for concern.
The concentration of the platelet specific protein B-thromboglobulin, (BTG) was measured in salivary samples obtained pre and postoperatively from 30 patients without evidence of renal disease and having total hip replacement arthroplasty. When postoperative deep-vein thrombosis (DVT) was detected using percutaneous ascending phlebography there was total correlation with elevated salivary BTG levels taking 0.33 micrograms/1 or greater on 2 consecutive occasions or more as indicating a deep venous thrombus. Eight of nine patients with a positive diagnosis of DVT on urokinase scanning would have been diagnosed using the same criterion. However BTG was elevated in a further 5 patients in whom labelled urokinase failed to demonstrate a DVT. These may have been localised in the calf and thus missed by, or lysed prior to, the scanning technique.
Three cases of adamantinoma of the tibia, seen in one hospital over a period of 7 years, are described. They illustrate the difficulty in differentiating this lesion from fibrous dysplasia on radiographic and histological grounds. Thermography may help in the differential diagnosis.
British surgeons and engineers contributed various types of knee prostheses, including hinged, unconstrained, and semiconstrained prostheses, in the development of total knee arthroplasty. Methods of implant fixation, the place of stems, pegs, the use of special instrumentation, and alignment procedures ensure both intrinsic and extrinsic prosthetic stability.
In the past ten years, three related prostheses (Freeman-Swanson, ICLH, Freeman-Samuelson) have been used at the London Hospital. The new findings reported in this article are the result of cementless fixation of the ICLH prosthesis has not deteriorated with time; the patellofemoral complications and postoperative limitation of movement seen with the ICLH prosthesis has been resolved by the Freeman-Samuelson design; and cementless press-fit fixation of all three components of the Freeman-Samuelson design resulted in a 1.6% (tibial) revision rate in the first four years.
Observations were made on the growth rate of proximal and distal tibial epiphyseal growth plates in three children treated by free vascularized fibular grafts for congenital pseudarthrosis of the tibia. Postoperative measurements show that the distal tibial epiphysis can grow faster than the proximal epiphysis; the successful transfer of vascularized fibula may increase blood supply to the distal tibial epiphyseal plate, thus stimulating its growth.
Forty-nine patients older than 35 years of age (mean, 45 years) undergoing arthrotomy for clinically diagnosed meniscal tears had preoperative double-contrast arthrograms. Fifty of 53 meniscii were visualized as torn and treated by surgical excision. At the time of operation the incidence of transverse tears was high (34%). In only 72% of cases was there complete correlation between the preoperative arthrographic diagnosis and the definitive surgical diagnosis. This diagnostic disparity was most marked on the lateral side (53% correlation) and unrelated to the high incidence of transverse tears (66% correlation). In this age group, arthrography is not a reliable indicator to the diagnosis of torn meniscii.
Entrapment of the superficial peroneal nerve is an unusual cause of pain in the ankle and foot. In such cases decompression of the nerve at the point of exit from the deep fascia will produce a good result. Three cases are described.
Five cases of congenital pseudarthrosis of the tibia successfully treated by a free vascularised fibular graft are described. Follow-up ranged from 5 to 34 months with a mean of 17.5 months. The technique, which includes radical excision of abnormal bone and soft tissue around the pseudarthrosis, also permits primary bone lengthening, and correction of deformity. The early results indicate that satisfactory bony union is achieved in a relatively short period of time.
Sixty-four patellar fractures treated either by internal fixation or by patellectomy were reviewed retrospectively from 3.5 to 10.1 years (average 6.2 years) after operation. Results were assessed subjectively and objectively. Of the 64 patients, 45% had a good result, 27% fair and 28% poor. On the whole, patellectomy produced better results (60% good, 20% fair, 20% poor), than internal fixation (31% good, 33% fair, 36% poor). Nevertheless, the best results of all were achieved by precise anatomical reduction of the patellar fracture and fixation with K-wires and a tension band. Where this could not be achieved, however, patellectomy gave the best results.
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A metastasis in a terminal phalanx which presented with the clinical features of a pulp space infection is described. The primary was a carcinoma of the esophagus.
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