We describe the results of 50 operations carried out on 46 patients with medial osteoarthritis of the knee of Ahlbäck grade 1 to 3. Patients were randomised either to a closed-wedge high tibial osteotomy (HTO) or an open-wedge procedure based on the hemicallotasis technique (HCO). Their median age was 55 years (38 to 68). The preoperative median hip-knee-ankle (HKA) angle was 171 degrees (164 to 176) in the HTO group and 173 degrees (165 to 179) in the HCO group. After six weeks, the median HKA angle was 185 degrees (176 to 194) in the HTO group and 184 degrees (181 to 188) in the HCO group. In the HTO group, seven patients were within the range of 182 degrees to 186 degrees compared with 21 in the HCO group (p < 0.001). One year later, ten HTO patients were within this range while the HKA angulation in the HCO group was unchanged. At two years the numbers were 11 and 18, respectively. We evaluated the clinical results on the Hospital for Special Surgery, Lysholm and Wallgren-Tegner activity scores, and patients completed part of the Nottingham Health Profile questionnaire. An impartial observer at the two-year follow-up concluded that all scores had improved, but found no clinical differences between the groups.
Medial osteoarthritis of the knee is associated with varus deformity and an abnormal load through the medial compartment. Proximal tibial osteotomy can restore the mechanical axis and correct the abnormal load.1,2 Good long-term results depend on the ultimate correction, which is ideally 2° to 8° of valgus of the mechanical axis. [3][4][5][6] There are several reports of good results achieved by closedwedge osteotomy, 3-5,7-9 but this procedure is technically demanding. The outcome is unpredictable and the period of convalescence lengthy. 7,9-11 In addition, access to the lateral compartment may be difficult after previous tibial osteotomy, 12,13 and even in the younger age group some surgeons carry out a primary arthroplasty rather than an osteotomy. 14-16 Open-wedge osteotomy by hemicallotasis (HCO) is simpler and requires a shorter rehabilitation period.
17,18We have compared in a randomised, prospective study the results and complications of closed-wedge high tibial osteotomy (HTO) and HCO.
Patients and MethodsWe randomly allocated 46 patients (14 women and 32 men) to either HTO (n = 25) or HCO (n=25). The two groups were similar in age, gender, preoperative grade of arthritis and hip-knee-ankle angle (HKA) ( Table I). The median age was 55 years (40 to 68) in the HTO group and 55 years (38 to 64) in the HCO group. The median range of movement was 125° (105 to 140) in the HTO group and 130° (90 to 150) in the HCO group. Bilateral surgery was carried out on four patients, one of whom was randomised to HTO on both sides. The other three had HTO on one side and HCO on the other. There was a median interval of nine months (2.5 to 14) between the two operations. Surgeons of equal experience and skill carried out the procedures.The indication for surgery was pain in younger, active patients with medial arthritis of grade 1 to 3. 19 We aimed to achieve an overcorrection to an HKA of 4° of valgus in both groups. The correction of 4 ± 2° of valgus was considered optimal.
Background: The first step of handling health promotion (HP) in Diagnosis Related Groups (DRGs) is a systematic documentation and registration of the activities in the medical records. So far the possibility and tradition for systematic registration of clinical HP activities in the medical records and in patient administrative systems have been sparse. Therefore, the activities are mostly invisible in the registers of hospital services as well as in budgets and balances.
Seven hundred fourteen patients with cutaneous melanoma in clinical Stage I treated between 1964 and 1982 were included in this study. In an analysis of metastasis-free survival, thickness of the tumor, ulceration, gender, epithelioid cells as predominant cells in the tumor, and localization of the tumor were found to be independent prognostic factors. In a time trends analysis, the distributions of three of the prognostic factors (thickness of the tumor, ulceration, and inflammatory cell infiltrate) were found to shift during the last decade in the direction of improved prognosis, indicating that tumors are detected earlier than before. The distributions of two other factors (cell type and location of the tumors) shifted in the direction of deteriorated prognosis, suggesting partly that the biologic nature of the disease may have changed and partly that other behavioral factors may have played a role.
An industrially produced fibrinogen-Aprotinin and thrombin-calcium chloride 'tissue glue', Tisseel, has been tested for skin grafting. The 'take' of the graft was successful in 92% after grafting with Tisseel, and in 83% without gluing. In difficult areas, such as over mobile muscle or close to skin folds, 88% of cases were successful with tissue gluing and 44% without.
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