Clinical and radiologic evaluation was performed every year for the ﬁrst 5 postop- erative years and every 2–3 years thereafter order 250 mg meldonium free shipping. Hip functional results were rated accord- ing to the d’Aubigné grading system and the Harris hip score order 500 mg meldonium amex. The hip score was classiﬁed into six categories: excellent, 18 points; very good, 17 points; good, 16 points; fair, 15 points; poor, 14 points; and bad, ≤13 points. Radiologic analysis was performed on serial anteroposterior radiographs of the pelvis. On the pelvic side, the position of the socket relative to the horizontal and vertical teardrop lines according to De Lee and Charnley were noted. Linear wear was measured according to the technique described by Livermore et al. On the femoral side, parameters inves- tigated included the evolution of radiolucent lines in the seven zones of the femur and stem subsidence. A long-standing radiograph of the lower part of the body was performed 1 year postoperatively to assess the result of the THA pelvic tilt, leg lengthening, and residual length discrepancy. Finally, correction of the lordosis and lateral curvature of the spine were evaluated on anteroposterior and lateral radiographs of the lumbar spine. A survivorship analysis was performed to determine the overall success of the THA. Failure was deﬁned as an implant that had been revised or that was radiologically loosened at the time of follow-up. The survival curve was derived from the cumulative survival rate over time, as calculated from the actuarial life table. At the last follow-up evaluation, 41 patients (48 hips) had died and 7 patients (9 hips) were lost to follow-up. The follow-up of 48 patients ranged from 1 to 10 years for 14 and 10 to 27 years for the remaining 34. Forty patients (61 hips) were still alive with a mean follow-up of 22 years (range, 18–32 years). One intraoperative fracture of the femur was treated with cerclage wires and healed with no further complication.
In the early years he contributed erudite papers on the pathology of carpal tunnel syn- drome and of Morton’s metatarsalgia buy meldonium 500 mg on line, but soon developed his special interest in osteoarthritis of the hip—or “primary coxarthrosis buy 500mg meldonium,” as he pre- ferred to call it. Early on, he was quick to embrace the novel technique of replacement of the femoral head pioneered by the Judet brothers of Paris in 1950, and he wrote a book on the subject. The operation, however, failed to pass the test of time and was abandoned. From then on, Nissen championed the cause of minimal displacement intertrochanteric Karl Iversen NISSEN osteotomy of the femur, a development of the original McMurray osteotomy. He saw in this a 1906–1995 means of promoting natural healing through the medium of “tufts” of cartilage that sprouted from Karl Nissen began his career in England only 2 the articular surfaces. In many cases he was years after that great pioneer, Sir Robert Jones, indeed able to show the reappearance of a sub- had died. He was almost contemporary with such stantial cartilage space after the operation, which surgeons as Watson-Jones, Osmond-Clarke and could persist for 20 years or more. He added luster to the orthope- for this “conservative” operation with character- dic scene. Nissen and Charnley each fying in 1932 from the University of Otago, he performed his chosen operation before the ﬁrst went into general practice before deciding to cameras for a notable television program some 30 specialize. A research project followed, in which years ago: Nissen was always keen to show later he studied in great detail several generations radiographs of his patient, who had gained lasting of a family affected with brachydactyly. In another project he Royal National Orthopedic Hospital he organized studied that ancient reptile, the tuatara—almost and convened annual postgraduate courses for unchanged in 130 million years and unique to young surgeons from European countries. He brought him many lasting friendships among never returned to New Zealand. After a period in European colleagues and led to his being elected general surgery, he trained in orthopedics at the as corresponding member of most of the ortho- newly established Princess Elizabeth Orthopedic pedic societies of Western Europe—honors that Hospital in Exeter, under the tutelage of Norman he greatly cherished. Capener, and later at the Royal National Ortho- He had a natural aptitude for the English lan- pedic Hospital. During the Second World War he guage and a rare capacity for critical assessment served in the Royal Naval Volunteer Reserve, of scientiﬁc papers, which led to his being drawn mainly in South Africa and St.
If the AHI is less than 60% with inadequate formation of the roof osteophyte generic meldonium 250 mg, it should be combined with Chiari’s pelvic osteotomy for valgus [10–13] purchase meldonium 250 mg with mastercard. Most OA patients have adduction contracture, which must be ﬁrst corrected. The osteotomy line is drawn at the lesser trochanter level; the tracing for the femur will then be brought into adduction position. If the distal fragment is adapted to the proximal osteotomy line, there is a risk of causing genu valgum, and therefore the distal fragment must be moved laterally [5,9,12]. The increased length that results from the transposition will be resected to shorten that to the correct length. The patient’s preoperative radiologic image, the ﬁnal drawing, and images imme- diately after VFO and at 10-year follow-up are shown in Fig. If the osteotomy is performed exactly as planned, there is a substantial widening of the lateral joint space. The patient had an operation on the contralateral side 2 years after the index surgery and had enjoyed very good results at 8 years. I am always asked the question of why ﬂexion rather than extension, or how I determine the ﬂexion angle. We always look at motion with a ﬂuoroscope to decide whether to use ﬂexion or extension. In Bombelli’s (valgus-extension) position, on the other hand, widening of the joint space is not enough when comparing it with that in valgus-ﬂexion. For this patient, we decided to perform VFO with 35° of valgus and 20° of ﬂexion. Hinge adduction must be observed with passive adduction under anesthesia before surgery; the lateral joint space must open wide in the shape of a wedge. Preoperative planning and results of valgus-ﬂexion osteotomy (VFO) for 34-year-old woman at surgery. For the right hip, the same procedure was indicated 2 years after index osteotomy a b Fig. How to decide whether to perform ﬂexion or extension using dynamic ﬂuoroscopic examination under anesthesia. Substantial widening of lateral joint space is shown OA Joint Reconstruction Without Replacement Surgery 169 Clinical and Radiologic Results For 229 hips in advanced- and terminal-stage OA, we have performed either VFO or VEO, mainly valgus-ﬂexion.