No abstract

In 1988 we reported a ten-year review of 83 surviving patients from a group of 135 (146 prostheses) who had undergone primary hip replacement using the Stanmore prosthesis. We have now reviewed 44 of these patients at 15 to 16 years. Four patients had undergone revision, but the other 40 were all satisfied with the result of their hip replacement, 36 having little or no pain. Functional activities had decreased, but were still adequate for their average age of 81 years. There had been definite migration of the cup and/or femoral component in three hips, wear of the cup in ten and resorption of the calcar in six. Of the 24 hips inserted with radiopaque cement, eight showed an increase in radiolucent lines at the acetabular interface. The cumulative survival rate of the prosthesis was 91% at 15 to 16 years.

PurposeAlthough non-idiopathic clubfeet were long thought to be resistant to non-surgical treatment methods, more studies documenting results on treatment of these feet with the Ponseti method are being published. The goal of this systematic review is to summarize current evidence on treatment of non-idiopathic clubfeet using the Ponseti method.MethodsPubMed and Limo were searched, reference lists of eligible studies were screened and studies that met the inclusion criteria were included. Data on average number of casts, Achilles tendon tenotomy (ATT), initial correction, recurrence, successful treatment at final follow-up and complications were pooled. The Methodological Index for Non-Randomized Studies was used to assess the methodological quality of the selected studies.ResultsIn all, 11 studies were included, yielding a total of 374 non-idiopathic and 801 idiopathic clubfeet. Non-idiopathic clubfeet required more casts (7.2 versus 5.4) and had a higher rate of ATT (89.4% versus 75.7%). Furthermore, these feet had a higher recurrence rate (43.3% versus 11.5%) and a lower rate of successful treatment at final follow-up (69.3% versus 95.0%). Complications were found in 20.3% of the non-­idiopathic cohort. When comparing results between clubfeet associated with myelomeningocele and arthrogryposis, the first group presented with a lower number of casts (5.4 ­versus 7.2) and a higher rate of successful treatment at final follow-up (81.8% versus 58.2%).ConclusionThe Ponseti method is a valuable and non-invasive option in the primary treatment of non-idiopathic clubfeet in young children. Studies with longer follow-up are necessary to evaluate its long-term effect.Level of EvidenceLevel III – systematic review of Level-III studies.This work meets the requirements of the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and ­Meta-Analyses).

Between February 1975 and August 1976, 195 total hip replacements using Stanmore components were performed; of these, 146 were in 135 patients who had not had previous hip surgery. At review 52 had died, but none of the others was lost to follow-up. Of the 52, two had had a second operation, one for infection and one for recurrent dislocation. In the remaining 83 patients (92 hips) five revisions were necessary: four for aseptic loosening, and one for stem fracture. The remaining 78 patients had little or no pain and little restriction of activity. After a follow-up period of at least nine years, the survival rate of the prosthesis was 95%. There had been migration of the femoral component in five cases and migration of the acetabular cup in one case, but no wear of the acetabular component could be demonstrated.