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PubMed2006

Anatomic reconstructive surgery for posterolateral instability of the knee.

PURPOSE: We describe an anatomic reconstructive surgical procedure that simultaneously reconstructs the fibular collateral ligament, popliteal tendon, and popliteofibular ligament using split Achilles allograft, and compare the clinical results of this technique with those of the posterolateral corner sling procedure for posterolateral instability of the knee. TYPE OF STUDY: Case series. METHODS: Forty-six patients were treated for posterolateral instability of the knee between 1998 and 2002. The posterolateral corner sling procedure was performed in 25 patients (group A) and anatomic reconstructive surgery in 21 patients (group B). The minimum follow-up was 12 months. In all cases, arthroscopic evaluation was performed. Clinical review included the Lysholm knee scores and varus laxity and tibial external rotation assessment. RESULTS: The mean Lysholm knee scores were 54.8 points in group A and 54.4 points in group B before surgery, and 86.9 and 93.6 points at the time of the latest follow-up, respectively (P < .05). Tibial external rotation of 5 degrees more than the contralateral uninjured knee was present in 12% of group A and in 5% of group B (P < .05). Varus laxity of 5 mm greater than the contralateral knee was observed in 28% of group A and in 14% of group B (P < .05). CONCLUSIONS: Anatomic reconstruction of the posterolateral corner resulted in less varus laxity and tibial external rotation than did the posterolateral corner sling procedure. LEVEL OF EVIDENCE: Type IV, case series, no or historical control group.

Adult↗

PubMed2004

The role of selected extrinsic foot muscles during running.

OBJECTIVE: To determine the kinematic, kinetic and EMG responses to perturbations of the foot by running in varus, neutral, and valgus-wedged shoes. DESIGN: Within-subjects study comparing kinematics, kinetics and EMG while running in three different shoe conditions. BACKGROUND: Excessive pronation has been cited as a key contributor to many types of running injuries. However, the roles of the extrinsic foot muscles (those that control motion of the foot) during the stance phase of running have not been adequately identified, which is critical to determining the relationship between pronation and injury. METHODS: Ten males ran in varus, valgus, and neutral-wedged shoes while three-dimensional kinematic and kinetic data and EMG data were collected. Surface EMG data were collected from the tibialis anterior, peroneus longus, medial and lateral gastrocnemius, and soleus. Indwelling EMG was obtained from the tibialis posterior. The net joint moment, power, and total positive and negative work was calculated in the frontal plane. EMG onset, offset, and integrated values were reported. RESULTS: The maximum eversion angle, maximum inversion moment and total negative work done in the frontal plane were greatest while running in the valgus shoe and least in the varus shoe. The greater joint moment was not accompanied by changes in muscle activation patterns, although the tibialis posterior data were inconclusive in this respect. CONCLUSIONS: Greater pronation leads to greater energy absorption in the foot invertor muscles and tendons. While not conclusive, the EMG data suggest that for these muscles there was not a neuromuscular adaptation to the perturbation.

Adult↗

PubMed2005

Computerized gait analysis in Legg Calvé Perthes disease--analysis of the frontal plane.

OBJECTIVE: Current follow-up and outcome studies of Legg Calvé Perthes disease (LCPD) are based on subjective measures of function, clinical parameters and radiological changes [Herring JA, Kim HT, Browne RH. Legg-Calvé-Perthes disease. Part II: prospective multicenter study of the effect of treatment on outcome. J Bone Joint Surg 2004;86A:2121-34; Aksoy MC, Cankus MC, Alanay A, Yazici M, Caglar O, Alpaslan AM. Radiological outcome of proximal femoral varus osteotomy for the treatment of lateral pillar group-C. J Pediatr Orthop 2005;14 B:88-91; Kitakoji T, Hattori T, Kitoh H, Katho M, Ishiguro N. Which is a better method for Perthes' disease: femoral varus or Salter osteotomy? Clin Orthop 2005;430:163-170; Joseph B, Rao N, Mulpuri K, Varghese G, Nair S. How does femoral varus osteotomy alter the natural evolution of Perthes' disease. J Pediatr Orthop 2005;14B:10-5; Ishida A, Kuwajima SS, Laredo FJ, Milani C. Salter innominate osteotomy in the treatment of severe Legg-Calvé-Perthes disease: clinical and radiographic results in 32 patients (37 hips) at skeletal maturity. J Pediatr Orthop 2004;24:257-64.]. The objective of this study was to evaluate the frontal plane kinematics and the effect on hip joint loading on the affected side in children with a radiographic diagnosis of LCPD. MATERIAL AND METHOD: Computerized, three-dimensional gait analysis was performed in 33 individuals aged > or =5 years (mean 8.0+/-2 years) with unilateral LCPD and no history of previous surgery to the hip or any disorder leading to gait abnormality. Frontal plane kinematics and kinetics were compared to a group of healthy children (n=30, mean age 8.1+/-1.2 years). Hip joint loading was estimated as a function of the hip abductor moment. RESULTS: Subjects with LCPD demonstrated two distinct frontal plane gait patterns, both deviating from normal. Type 1 (n=3) was characterized by a pelvic drop of the swinging limb, a trunk lean in relation to the pelvis towards the stance limb and hip adduction during stance phase and corresponded well to the description of Trendelenburg gait caused by abductor insufficiency. Type 2 (n=12) is characterized by a trunk lean toward the affected stance limb with the pelvis stable or elevated on the swinging limb during single stance phase. The abductor moment of the involved side during single stance was significantly reduced in type 2 compared to the controls (p=0.004) indicating a hip-unloading mechanism. These results may influence the physiotherapy regimen, which may require to work towards a hip-unloading gait pattern.

Biomechanical Phenomena↗

PubMed2006

Valgus bracing in patients with medial compartment osteoarthritis of the knee. A gait analysis study of a new brace.

A new valgus brace was evaluated in 15 patients with medial osteoarthritis of the knee and a varus leg axis. Significant improvement of pain and function were found after 6 weeks of brace treatment. Gait analysis showed that the brace had a tendency of lowering the peak varus moment about the knee. This effect was more profound in the presence of higher initial varus deformity angle of the knee. Furthermore, bracing led to a small decrease of knee extension at the end of the swing phase and an increase of walking velocity. The mechanisms identified by gait analysis in this study may be of clinical importance for future developments in brace treatment.

Braces↗

PubMed2005

A correction for axis misalignment in the joint angle curves representing knee movement in gait analysis.

This paper derives a simple mathematical model relating changes in the orientations of the two Cartesian coordinate systems involved in recording knee movement and the varus-valgus and the internal-external rotation angles for describing the knee's motion. Rotation matrices are given for changing the orientations of the two Cartesian coordinate systems in such a way that the quadratic variations in the varus-valgus and in the external-internal angles are minimal. These estimated rotation matrices are used to correct for axis misalignment. The correction is calibrated by considering the impact of the new orientation of the thigh Cartesian coordinate system on the hip joint angles. The procedure is applied to kinematic data collected on normal subjects. The uncertainty about the specification of the thigh Cartesian coordinate system is shown to explain some of the between subject variability in the varus-valgus and in the internal-external rotation angles curves.

Artifacts↗

PubMed2006

The mechanical consequences of dynamic frontal plane limb alignment for non-contact ACL injury.

This study investigated the mechanical consequences of differences in dynamic frontal plane alignment of the support limb and the influence of anticipatory muscle activation at the hip and ankle on reducing the potential for non-contact ACL injury during single-limb landing. A frontal plane, three-link passive dynamic model was used to estimate an ACL non-contact injury threshold. This threshold was defined as the maximum axial force that the knee could sustain before the joint opened 8 degrees either medially or laterally, which was deemed sufficient to cause injury. The limb alignment and hip and ankle muscle contractions were varied to determine their effects on the ACL injury threshold. Valgus or varus alignment reduced the injury threshold compared to neutral alignment, but increasing the anticipatory contraction of hip abduction and adduction muscle groups increased the injury threshold. Increasing anticipatory ankle inversion/eversion muscle contraction had no effect. This study provides a mechanical rationale for the conclusion that a neutral limb alignment (compared to valgus or varus) during landing and increasing hip muscle contraction (abductors/adductors) prior to landing can reduce the possibility of ACL rupture through a valgus or varus opening mechanism.

Ankle Joint↗

PubMed2006

Ligament balancing in TKA: evaluation of a force-sensing device and the influence of patellar eversion and ligament release.

Ligament balancing in total knee arthroplasty may have an important influence on joint stability and prosthesis lifetime. In order to provide quantitative information and assistance during ligament balancing, a device that intraoperatively measures knee joint forces and moments was developed. Its performance and surgical advantages were evaluated on six cadaver specimens mounted on a knee joint loading apparatus allowing unconstrained knee motion as well as compression and varus-valgus loading. Four different experiments were performed on each specimen. (1) Knee joints were axially loaded. Comparison between applied and measured compressive forces demonstrated the accuracy and reliability of in situ measurements (1.8N). (2) Assessment of knee stability based on condyle contact forces or varus-valgus moments were compared to the current surgical method (difference of varus-valgus loads causing condyle lift-off). The force-based approach was equivalent to the surgical method while the moment-based, which is considered optimal, showed a tendency of lateral imbalance. (3) To estimate the importance of keeping the patella in its anatomical position during imbalance assessment, the effect of patellar eversion on the mediolateral distribution of tibiofemoral contact forces was measured. One fourth of the contact force induced by the patellar load was shifted to the lateral compartment. (4) The effect of minor and major medial collateral ligament releases was biomechanically quantified. On average, the medial contact force was reduced by 20% and 46%, respectively. Large variation among specimens reflected the difficulty of ligament release and the need for intraoperative force monitoring. This series of experiments thus demonstrated the device's potential to improve ligament balancing and survivorship of total knee arthroplasty.

Aged↗

PubMed2006

Coronoid fracture patterns.

PURPOSE: It has been suggested that specific types of coronoid fractures are associated strongly with specific patterns of traumatic elbow instability. This hypothesis was tested in a review of a large consecutive series of patients with a fracture of the coronoid as part of a fracture-dislocation of the elbow. METHODS: One surgeon repaired 67 coronoid fractures as part of a fracture-dislocation of the elbow over a 7-year period. Each coronoid fracture was characterized on the basis of surgical exposure. Pearson chi-square analysis was used to evaluate the association of the coronoid fracture type with 1 of 4 common patterns of elbow fracture-dislocation. RESULTS: The coronoid fracture was associated with an anterior (6 patients) or posterior (18 patients) olecranon fracture-dislocation in 24 patients, an elbow dislocation and radial head fracture in 32 patients, and a varus posteromedial rotational instability pattern injury in 11 patients. Among the 24 patients with olecranon fracture-dislocations 22 had large coronoid fractures and 2 had small (<50%) coronoid fractures. All 32 patients with terrible-triad injuries had small (<50%) coronoid fractures with 1 of these being a fracture of the anteromedial facet of the coronoid. Among patients with varus posteromedial rotational pattern injuries 9 had small fractures of the anteromedial facet and 2 had larger fractures. The association of coronoid fracture type with injury pattern was strongly statistically significant for both classification systems. CONCLUSIONS: The following strong associations were confirmed by this study: large fractures of the coronoid process with anterior and posterior olecranon fracture-dislocations, small transverse fractures with terrible-triad injuries, and anteromedial facet fractures with varus posteromedial rotational instability pattern injuries. An awareness of these associations and their exceptions may help guide the optimal management of these injuries. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.

Adolescent↗

PubMedDate not supplied

An in vitro biomechanical study of a hinged external fixator applied to an unstable elbow.

Details of the mechanical properties of hinged external fixators are essential to use the fixator properly in the clinical setting. A hinged external fixator (Dynamic Joint Distractor 2) was attached to the lateral side of 7 cadaveric elbows. Cantilever lateral bending tests were performed at 3 flexion angles in varus and valgus directions. Varied states of joint contact and axial loading were studied. Stiffness of the construct was calculated with uniaxial loading. Stiffness decreased with increased elbow flexion. Gap creation made the system less stiff. Axial loading made the system stiffer, especially in valgus testing. Stiffness in varus was approximately 4 times that in valgus. Lateral fixator application with half pins is most effective for protecting against varus-producing forces. When using the external fixator for unstable elbows, attention should be paid to the status of the articular surfaces and the integrity of the ligaments, and this should also be noted for elbow position during rehabilitation.

Aged↗

PubMed2005

The effect of radial head fracture size on elbow kinematics and stability.

This study determined the effect of radial head fracture size and ligament injury on elbow kinematics. Eight cadaveric upper extremities were studied in an in vitro elbow simulator. Testing was performed with ligaments intact, with the medial collateral (MCL) or lateral collateral (LCL) ligament detached, and with both the MCL and LCL detached. Thirty degree wedges were sequentially removed from the anterolateral radial head up to 120 degrees . Valgus angulation and external rotation of the ulna relative to the humerus were determined for passive motion, active motion, and pivot shift testing with the arm in a vertical (dependent) orientation. Maximum varus-valgus laxity was calculated from measurements of varus and valgus angulation with the arm in horizontal gravity-loaded positions. No effect of increasing radial head fracture size was observed on valgus angulation during passive and active motion in the dependent position. In supination, external rotation increased with increasing fracture size during passive motion with LCL deficiency and both MCL and LCL deficiency. With intact ligaments, maximum varus-valgus laxity increased with increasing radial head fracture size. With ligament disruption, elbows were grossly unstable, and no effect of increasing radial head fracture size occurred. During pivot shift testing, performed with the ligaments intact, subtle instability was noted after resection of one-third of the radial head. In this in vitro biomechanical study, small subtle effects of radial head fracture size on elbow kinematics and stability were seen in both the ligament intact and ligament deficient elbows. These data suggest that fixation of displaced radial head fractures less than or equal to one-third of the articular diameter may have some biomechanical advantages; however, clinical correlation is required.

Aged↗

PubMed1995

Selective muscle activation following electrical stimulation of the collateral ligaments of the human knee joint.

The objective of this study was to establish the presence of a local neurosensory reflex are from mechanoreceptors in human collateral ligaments and joint capsule to knee muscles and to determine if these muscles could be selectively activated as varus or valgus stabilizers using randomized trials. All studies were performed in the research department laboratories. Eleven subjects were recruited from the university staff and students based on no prior history of knee ailments. Subjects laid supine on an experimentation table as a current-modulated electrical stimulation was provided through the medial (MCL) or lateral collateral (LCL) knee ligaments. Latency of activation was measured for seven muscles, four by surface electrodes (semitendinosus, biceps femoris long head, vastus medialis, and lateralis), and three by intramuscular electrodes (sartorius, gracilis, tensor fascia lata). In the protocol, selective activation was defined as the relative increase in the activity of four muscles with medial moment arms following MCL stimulation compared with corresponding activity following LCL stimulation. For lateral muscles, the opposite was assumed (ie, that more activity would follow LCL than MCL stimulation). Monte Carlo simulations were performed on the data to determine significant selective muscle activation (p < .05). Statistically significant increases in activation were observed, most consistently, in the vastus medialis following MCL stimulation and in the vastus lateralis following LCL stimulation. These results suggest that a neurosensory reflex are from ligament mechanoreceptors may provide varus and valgus stabilization and knee muscles may be selectively activated to counter varus or valgus loads.

Adult↗

PubMed2000

Evaluation of the role of pin fixation versus collar and cuff immobilisation in supracondylar fractures of the humerus in children.

Long term results of children with supracondylar humeral fractures treated with manipulation and strapping and manipulation followed by pin fixation were evaluated. Forty patients were regarded as Gartland type II injuries. 33 of these were treated with closed reduction and collar and cuff immobilisation and 7 with closed reduction and percutaneous pinning. Two cases of cubitus varus were reported one from each treatment modality. Forty-four patients were included as Gartland type III injuries. Of these 14 were treated with closed reduction and collar and cuff immobilisation, 25 with closed reduction and percutaneous pinning and five with open reduction and pinning. There were two cases of cubitus varus and one case of cubitus valgus following pin fixation. In addition one case of extension lag and one significant ulnar nerve neurapraxia was recorded following pin fixation. One case of cubitus varus was seen following manipulation and collar and cuff treatment. There was no statistical difference between either treatment modality in terms of predicting a better outcome (p0.05). We conclude that pin fixation has no advantages over simple immobilisation in certain Gartland II and III type injuries. Although pin fixation is beneficial in unstable injuries collar and cuff immobilisation continues to have an important role in the treatment of stable supracondylar fractures.

Algorithms↗

PubMed1986

Foot deformities in infants and children.

Foot deformities may reflect a generalized disorder, especially a neurologic problem; thus, the child should have a brief general examination. Many infantile foot deformities, such as calcaneovalgus, are postural and self-correcting. Metatarsus varus is not referred for treatment until age 2 months and then only if the deformity is moderate or severe. Fixed forefoot equinus and heel varus characterize a clubfoot, which requires immediate treatment. Corrective shoes are not advised as the primary treatment for metatarsus varus or clubfoot but often are prescribed to maintain the corrected position after serial casts. Flexible flatfoot is a manifestation of a constitutional laxity affecting all ligaments and joints. The feet appear abnormal because of weight-bearing stresses. Most children with flatfoot achieve a partial correction spontaneously. Current research does not document that treatment with corrective shoes or inserts produces a result better than the partial correction that occurs naturally.

Clubfoot↗

PubMed2006

[Congenital club foot: treatment in childhood, outcome and problems in adulthood].

PURPOSE OF THE SYMPOSIUM: Treatment of idiopathic talipes varus, or congenital clubfoot, is designed to re-align the foot to alleviate pain and allow plantigrade weight bearing with adequate joint motion despite the subnormal radiographic presentation. This symposium was held to review current management practices for congenital clubfoot in children and to analyze outcome in adults in order to propose the most appropriate therapeutic solutions. MANAGEMENT OF CONGENITAL CLUBFOOT IN CHILDREN: Idiopathic talipes varus can be suspected from the fetal ultrasound. Parents should be given precise information concerning proposed treatment after birth. Deviations must be assessed in the newborn then revised regularly using objective scales during and after the end of treatment. This enables a better apprehension of the evolution in comparison with the severity of the initial deformation. Conservative treatment is proposed by many teams: a functional approach (rehabilitation and minimal use of orthetic material) or the Ponseti method (progressive correction using casts associated with percutaneous tenotomy of the calcaneal tendon) are currently preferred. If such methods are insufficient or unsuccessful, surgery may be performed as needed at about 8 to 11 months to achieve posteromedial release. Good results are obtained in 80% of patients who generally present minimal residual deformations (adduction of the forefoot, minimal calcaneal varus, residual medial rotation, limitation of dorsal flexion), which must be followed regularly through growth. The difficulty is to distinguish acceptable from non-acceptable deformation. At the end of the growth phase, severe articular sequelae are rare (stiff joint, recurrence of initial deformation, overcorrection) but difficult to correct surgically: osteotomy, tendon transfer, double arthrodesis, Ilizarov fixator. Gait analysis is essential to quantify function and obtain an objective assessment of the impact on higher joints, providing valuable guidance for surgical correction. OUTCOME IN ADULTHOOD: There have been very few studies evaluating the long-term functional outcome after treatment during childhood. According to two studies presented at this symposium (Brussels, Lausanne), results have been generally good but with subnormal radiographs irrespective of the type of treatment or how early treatment started in childhood. Hypoplasia of the talar dome is a constant finding and is correlated with limitation of dorsal flexion of the ankle joint. A small degree under-correction is often observed but well tolerated while overcorrection is generally less well tolerated. Functional outcome depends highly on preservation of subtalar joint motion. There have been no reports on the results of treatment of sequelae in adults. Most problems (pain, stiffness, osteoarthritis) are observed in the mid or rear foot. Indications for conservative surgery (osteotomy) of the mid or rear foot are rare compared with indications for combined arthrodesis. Talocrural decompensation is a turning point observed in the adult. Management at this point is difficult: fusion of the ankle worsens the situation by increasing the stress on the forefoot and aggravating the disability; implantation of an ankle prosthesis is technically difficult and remains to be fully developed. Treatment of the dorsal bunion of the great toe may require tendon transfer and/or fusion. CONCLUSION: A child born with clubfoot will never have a normal foot in adulthood. Sequelae present at the end of growth will intensify during adult life; under-correction is easier to treat in adulthood than overcorrection. The most difficult problems in adulthood are: neglected clubfoot, over correction, and degradation of the talocrural joint.

Adult↗

PubMed2001

The effects of partial and total interosseous membrane transection on load sharing in the cadaver forearm.

This study was performed to examine the effects of partial and total transection of the interosseous membrane (IOM) on load transfer in the forearm. Twenty fresh frozen forearms were instrumented with custom designed load cells placed in the proximal radius and distal ulna. Simultaneous measurements of load cell forces, radial head displacement relative to the capitellum, and local tension within the central band of the IOM were made as the wrist was loaded to 134 N with the forearm at 90 degrees of elbow flexion and in neutral pronation supination. For valgus elbow alignment (radial head contacting the capitellum), mean force carried by the distal ulna was 7.1% of the applied wrist force and mean force transferred from radius to ulna through the IOM was 4.4%. For varus elbow alignment (mean 2.0 mm gap between the radial head and capitellum), mean distal ulna force was 28% and mean IOM force was 51%. Section of the proximal and distal one-thirds of the IOM had no significant effect upon mean distal ulnar force or mean IOM force. Total IOM section significantly increased mean distal ulnar force for varus elbow alignment in all wrist positions tested. The mean level of applied wrist force necessary to close the varus gap (89 N) decreased significantly after both partial IOM section (71 N) and total IOM section (25 N). The IOM became loaded only when the radius displaced proximally relative to the ulna, closing the gap between the radius and capitellum. As the radius displaced proximally, the wrist becomes increasingly ulnar positive, which in turn leads to direct loading of the distal ulna. This shift of force to the distal ulna could present clinically as ulnar sided wrist pain or as ulnar impaction after IOM injury.

Aged↗

PubMed1995

A follow-up study of porous-coated anatomic knee arthroplasty.

Ninety-four patients (105 knees) having a porous-coated anatomic total knee arthroplasty were retrospectively studied. The mean follow-up period was 5.8 years. The diagnoses were osteoarthritis (90.5%) and rheumatoid arthritis (9.5%). There were 80 women and 14 men. The mean age at operation was 58.5 years. Clinical evaluation, using the Hospital for Special Surgery knee score along with radiography, was used to assess knee status before and after surgery. The postoperative mean axial alignment was 3 degrees varus compared with 11 degrees varus before surgery. Placement of the prosthetic components was acceptable, with the femoral component in 6.5 degrees of valgus and the tibial component in 1.9 degrees of varus and 1.1 degrees posterior inclination. Complications included eight aseptic loosenings, four patellar maltrackings, one patellar fracture, eight wound problems, and one extension contracture. Most of the patients' knee function improved after surgery. The initial, postoperative range of motion improved in patients receiving continuous passive motion (CPM) immediately after surgery (P = .03) compared to patients without CPM application; however, the long-term follow-up data show no significance (P = .06) whether CPM was used or not. Age, body weight, degree of arthritic change, and modes of fixation yielded no significant influence on the final outcome. The porous-coated anatomic total knee arthroplasty is a valuable alternative procedure in the advanced arthritic knee when the proper candidates are selected, accurate surgical technique is executed and a suitable fixation mode is chosen.

Arthritis, Rheumatoid↗

PubMed1991

The accuracy of tibial intramedullary alignment devices in total knee arthroplasty.

The accuracy of a tibial medullary alignment device is assessed radiographically in 30 varus and 30 valgus knees undergoing total knee arthroplasty. The results suggest that although the device is reliable and accurate for varus knees, it may lead to malalignment of up to 5 degrees in valgus knees. Overall neutral alignment was achieved in 83% of the varus knees and 37% of the valgus knees. Tibial bowing was the main source of error and was present in 66% of the valgus knees, with mean of 3 degrees. Preoperative long films or cross-checking with external alignment devices is recommended to assure neutral alignment in genu valgus deformity.

Congenital Abnormalities↗

PubMed1991

Uncemented bipolar double-cup arthroplasty of the hip in inflammatory arthropathy.

From 1979 to 1986, 42 uncemented surface arthroplasties were performed in 27 patients with an inflammatory arthropathy of the hip: median age at operation 40 years (range 19-65 ys), median follow-up period 73 months (range 36-120 mo). After 36 months, in 26 of 42 hips, the mean Harris Hip Score was excellent or good (mean 89, range 80-100). In 14 cases, the mean score was fair (76, range 70-79). Overall, those hips with the longest followup period (60-120 m) gradually improved over the years. No correlation was found between the clinical score and radiologic complications such as varus tilting of the femoral component, acetabular protrusion of the cup, or heterotopic ossification. Conversion to a conventional total hip arthroplasty was required in four patients. One patient required a total hip arthroplasty 86 months after the initial operation because of a femoral neck fracture. In two other patients, revision was performed after 60 and 32 months respectively because of a preexistent osteonecrosis and a severe foreign body response to polyethylene debris. Both patients had a varus tilting of the femoral component. In the fourth patient, in whom revision surgery was necessary 28 months after surface replacement there was no explanation for the varus shift of the femoral component. Regarding those problems that can appear after conventional total hip replacement in inflammatory arthropathy, we conclude that the uncemented surface replacement of the hip can be a reasonable alternative.

Adult↗