[Tibial hockey stick osteoetomy. Treatment of open chondromalacia and femoropatellar arthrosis with offsetting of the extensor system].
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Biomedical subjects
Publications and source records attributed to G Lord.
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The authors have treated 71 cases of patello-femoral arthrosis by anterior displacement of the tibial tuberosity to diminish pressure of the patella. In most cases, an osteotomy of the tibial crest was made and forward displacement maintained by the addition of a bone graft. The medial and lateral patellar retinacula were divided, the patellar articular cartilage was shaved and fine drill holes made in chondromalacic cartilage. The results were satisfactory in 75% of cases but the follow-up was short (about one year). It was concluded that the tibial tuberosity should be displaced forward by about 2 centimetres. The surgical technique is fully described.
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The authors have treated two cases of severe genu-recurvatum after poliomyelitis by a locking operation. They fused the patella to the tibia by grafting, realising an anterior shelf-operation. Full flexion was preserved, hyper-extension was decreased. The indications of this operation are discussed and compared with these of tibial osteotomies and capsulorraphies.
The authors have reviewed 14 cases of Chiari pelvic osteotomy performed in adults and followed up during more than one year. They describe the bio-mechanical properties of this procedure, and a surgical technique with some original modifications. They conclude that this operation may be contra-indicated in young women for obstetrical reasons. It is indicated in degenerative arthritis of the hip at an early stage when acetabulum is dysplasic or the femoral head subluxated.
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By suppressing certain articular sensory receptors, the reconstructive surgery of joints using total prostheses modifies tonic postural activity and, by this means, alters the regulation of balance in the subjects of operation. This doubtless explains certain discrepancies between the apparently excellent results in respect of joint movement and muscle strength and poor utilisation of the joint in every day life (instability, use of sticks or failure to use the joint in walking). Drawing on the experience and basic work of specialists in posture, the authors have undertaken a study of tonic postural activity in patients who had received a total prosthesis in the lower limb, both from the clinical aspect and by graphic measurement using an electronic apparatus, the statokinesiometer. Fourteen normal subjects were tested to calibrate the apparatus and 8 patients suffering from established osteoarthritis of the hip were studied as controls. Analysis of tonic postural activity was made in 66 patients who had received total prostheses in the lower limb. The results showed significant disturbance in balance in ankle prostheses, minimal disturbance in knee prostheses and not significant disturbance in hip prostheses. Certain therapeutic implications are derived from this study.