Of 142 Chiari pelvic osteotomies for osteoarthritis in dysplastic hips, most performed by Chiari himself, we were able to review 82 and obtain information about 18 by questionnaire. All patients were over 30 years of age at operation; follow-up averaged 15.5 years. Twenty hips had undergone secondary total hip replacement. The outcome was good in 75%, fair in 9% and poor in 16%. High osteotomies all gave good results, and the result also depended on adequate medialisation. Statistics were worse for patients over 44 years of age at the time of operation. For osteoarthritis secondary to hip dysplasia, the Chiari pelvic osteotomy is an alternative procedure to early hip replacement. In contrast to intertrochanteric osteotomy, it has the advantage of facilitating the implantation of an acetabular prosthesis should arthroplasty become necessary at a later stage.
85 patients with 96 cementless pressfit hip implants were followed over a period of at least 5 years postoperatively. Average Harris score was 87.5 points. One socket had to be exchanged because of aseptic loosening. Additionally, 5 implants developed radiolucent lines, only one of them totally around the socket. In no case an exchange of the stem was necessary; one stem initially sank by 4 mm axially but was stable at the last follow-up investigation. Only one patient personally is dissatisfied with the outcome of the operation. In no case, implant specific complications such as breakage of the implant, breakage or crack of the stem, or shattering of the pelvic girdle by acetabular-screwing could be observed.
Ruptures of the Achilles tendon mainly occur on the ground of predisposing destruction of tendon structure. The aim of this retrospective US study was to evaluate the location and extent of tendon abnormalities. 62 patients (49 male, 13 female; 19 to 57 years, mean 38) with achillodynia of short duration and/or clinically suspected tendon abnormalities were evaluated sonographically. Together with a review of the literature, US findings (location, extent, and echo pattern) were compared with clinical findings. With US, abnormalities could be detected with a sensitivity of 0,76 and a specificity of 0.9. Pathologic lesions could be grouped as follows: (1) pain without any clinical signs or US findings (tenalgia); (2) nodular tendinitis which in 52% appeared in the form of a tiny hypoechoic lesion in the ventromedial part of the tendon 2-3 cm proximal to the os calcis; (3) peritendinal oedema; (4) circumscribed tendon swelling, (5) extensive inhomogeneities of tendon structure. With US, abnormalities of the Achilles tendon may be detected at an early stage of the disease and hence the risk of tendon rupture may be predicted to better advantage.
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