INTRODUCTION: Aim of this study was to analyze if, using the Austin technique for correction of hallux valgus deformity, the additional soft tissue procedure is capable to achieve better correction of the sesamoid subluxation, the hallux valgus angle and the intermetatarsal angle. PATIENTS AND METHODS: 19 patients with 20 feet operated according to the original Austin technique and 26 patients with 28 feet operated according to a modified technique with lateral soft tissue release both with a preoperative sesamoid subluxation grade 3 were compared with the help of a standardized questionnaire in respect to clinical and radiological results. RESULTS: Analyzing the clinical outcome of the two procedures, there was no statistical difference. Comparison of the radiological results revealed a significantly better correction of the sesamoid position and a better correction of hallux valgus and intermetatarsal angle by using the additional soft tissue procedure. DISCUSSION: The lateral soft tissue procedure with release of the adductor hallucis, dissection of the deep transverse plantar ligament and mobilisation of the sesamoids is capable of a significantly better correction of the sesamoid position. Only a combination of osseus and soft tissue correction is capable to correct the pathomechanism and to guarantee long lasting results.

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[Prognosis of hip endoprostheses after disorders of wound healing].

41 draining sinuses after THR were treated by debridement without exchanging the implants. Positive bacterial cultures were obtained in 23 patients-the ilio tibial tract was found open in 19 cases (82%). The bacterial cultures were negative in 18 patients-the ilio tibial tract was found open in 7 cases (38%). Revisions took place 21 days (9-43) after primary implantation. At the time of the follow up (0 72 months postoperatively) 7 patients had been revised (8-97) because of recurrence of infection. The results of debridements of contaminated sinuses depend on the ilio tibial tract. Revisions were successful in three out of four paces with an intact, and only in eight out of nineteen cases with an open ilio tibial tract. Besides proper bacterial investigation preoperative sinograms give useful information about the prognosis of revision. In cases with positive bacterial cultures debridements should be done very early to eradicate infection without removing the implants.

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[Long-term analysis of cement-free implanted PCA knee endoprostheses with 5-8 year follow-up].

A total of 54 PCA knee-joint endoprostheses were followed up over a period of 5-8 years. All the uncemented implants (52 femoral components, 52 patellar components, 54 tibial components) were subjected to radiological analysis of the anchorage zone between prosthesis and bone. The results were evaluated on the basis of the postoperative radiographs and the follow-up radiographs, which were divided into four groups. It was necessary to create a 5th group for radiographs not suitable for evaluation. The use of fluoroscopy is therefore essential in order to ensure that all radiographs can be evaluated. The best results were obtained with the uncemented femoral prosthesis. Complete "incorporation" with close contact between prosthesis and bone was observed in all cases, even if implantation was not optimal. Radiological loosening of the uncemented patella occurred in 3 patients, and it was necessary to perform one patellectomy 6 years postoperatively. In the case of the tibia implant, the follow-up showed radiological "incorporation" of the prosthesis in all cases with technically adequate implantation: the tibia implant was inadequately implanted in 8 cases. Radiological loosening of the tibia implant was observed in 4 of these 8 patients. There was a higher rate of radiological failure in the group of patients over 70 years of age, and among patients whose primary disease was primary chronic polyarthritis. However, given technically exact implantation, satisfactory results could be obtained even in these two groups. Clinical pains occurred only several years after evidence of radiological loosening. Radiological follow-up analysis therefore offers a means of obtaining early information about the prosthesis-bone interface of uncemented total knee-joint endoprosthesis.

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