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PubMed1987

Long-term results and survivorship of the McKee-Farrar total hip prosthesis.

Five hundred and eleven McKee-Farrar prostheses implanted at the Orthopedic Hospital of the Invalid Foundation (Helsinki, Finland) between 1967 and 1973 were analyzed for long-term survivorship, clinical results, and the risk factors leading to aseptic loosening of the prosthesis. Reoperation was necessary for aseptic loosening of 91 prostheses and for septic loosening of 19 prosthesis. Ten-year survivorship was 76% and the annual failure rate 2.3%. The failure rate correlated with time. Acetabular cup loosening occurred 1.2 times more often than stem loosening. The retained prostheses remained clinically stable with respect to pain and mobility, but some deterioration was observed in walking ability. In addition to the follow-up period, prosthetic design, right-sided prosthesis, and lengthening of the operated leg proved to be significant factors for aseptic loosening in multiple stepwise regression analysis. After exclusion of the unmeasured leg length inequalities, the lengthening of the operated leg proved to be the most important factor explaining aseptic loosening of the prosthesis. Surgeon's inexperience, operation time, post-traumatic coxarthrosis, and previous operations were correlated to aseptic loosening of the prosthesis.

Adult↗
PubMed1989

A 37-year follow-up evaluation of multiple-stage femur and tibia lengthening in dyschondroplasia (enchondromatosis) with a net gain of 23.3 centimeters.

This case report presents the rare combination of circumstances of a child with (a) dyschondroplasia (enchondromatosis) limited to all the major epiphyseal plates of one lower extremity, (b) unusual capacity to cooperate, and (c) parents who refused permission to treat the limb by amputation but allowed the child to participate in a long-term clinical experiment. In dyschondroplasia (Ollier's disease), the long bones grow in diameter but not in length. In this condition, it was possible (by fasciotomy, osteotomy, and interposition of wedge blocks or hemicylindrical bone implants (stabilized by an intramedullary rod) to lengthen the leg 23.3 cm in ten stages, during the period between five and 14 years of age. With the additional procedure of epiphyseal arrest of the contralateral distal end of the femur at age 11, the eventual correction of discrepancy in leg length was 25.6 cm. Intraoperative and postoperative skin temperature recordings, toe plethysmography, and electromyography show that there were no deleterious changes in the circulatory or neurological functions of the extremity.

Adult↗
PubMed2005

Leg length inequality in total hip arthroplasty.

Postoperative leg length inequality after total hip arthroplasty frequently leads to medical liability issues because no standard exists regarding the acceptable disparity. Modular stems allow control of offset, independent sizing of the distal femoral anatomy, as well as proximal medullary sizing. The authors compared the restoration of leg length in two cohort protocols. In the 2001 cohort, tapered stems were exclusively used, giving priority to fit and fill of the medullary canal. In the 2004 cohort, porous-tapered stems, or an S-ROM modular stem (DePuy Orthopaedics Inc., Warsaw, Ind) when needed, were used based on preoperative templating to restore the center of femoral head rotation. Prior to and after surgery, length from center measurements were taken (center of rotation of the femoral head to the top of the lesser trochanter) and the vertical vector to compare the difference in actual leg length. In the 2001 cohort, the mean increase of length from center was 9 mm (7 mm leg length). In the 2004 cohort, 25% of the hips were inappropriate for tapered stems. S-ROMs were used because a tapered stem would lengthen the leg. In the standard offset tapered stem, the mean increase of length from center was 6 mm (4 mm leg length). In the high offset tapered stem, the mean increase of length from center was 7 mm (5 mm leg length). In the S-ROM stem with varying offsets, the mean increase of length from center was 6 mm (4 mm leg length). Only the S-ROM consistently avoids overlengthening in the majority of patients.

Arthroplasty, Replacement, Hip↗
PubMed2006

Biomechanical reconstruction of the hip: a randomised study comparing total hip resurfacing and total hip arthroplasty.

We have compared the biomechanical nature of the reconstruction of the hip in conventional total hip arthroplasty (THA) and surface replacement arthroplasty (SRA) in a randomised study involving 120 patients undergoing unilateral primary hip replacement. The contralateral hip was used as a control. Post-operatively, the femoral offset was significantly increased with THA (mean 5.1 mm; -2.8 to 11.6) and decreased with SRA (mean -3.3 mm; -8.9 to 8.2). Femoral offset was restored within sd 4 mm in 14 (25%) of those with THA and in 28 (57%) of the patients receiving SRA (p < 0.001). In the THA group, the leg was lengthened by a mean of 2.6 mm (-6.04 to +12.9), whereas it was shortened by a mean of 1.9 mm (-7.1 to +2.05) in the SRA group, compared with the contralateral side. Leg-length inequality was restored within sd 4 mm in 42 (86%) of the SRA and 33 (60%) of the THA patients. The radiological parameters of acetabular reconstruction were similar in both groups. Restoration of the normal proximal femoral anatomy was more precise with SRA. The enhanced stability afforded by the use of a large-diameter femoral head avoided over-lengthening of the limb or increased offset to improve soft-tissue tension as occurs sometimes in THA. In a subgroup of patients with significant pre-operative deformity, restoration of the normal hip anatomy with lower pre-operative femoral offset or significant shortening of the leg was still possible with SRA.

Acetabulum↗
PubMed1996

Vascularized bone grafts for congenital pseudarthrosis of the tibia.

Eight vascularized fibula grafts and two vascularized rib grafts were used for the treatment of 10 Boyd's Type II congenital pseudarthrosis of the tibia. All but one vascularized fibula graft united within 4 months. The two vascularized rib grafts did not unite until receiving a conventional bone graft. Nine spontaneous fractures were seen in four patients; all were subsequently treated successfully with cast or conventional bone graft. Corrective osteotomies were done in two patients. Follow-up averaged 8 years and 5 months (range, 5 years and 1 month to 14 years and 4 months). Average age at end of follow-up was 13 years and 6 months (range, 7 years and 10 months to 20 years and 4 months). After bony union was achieved, shortening of the affected leg averaged 3.8 centimeters, flexion deformity averaged 20 degrees, and valgus deformity averaged 24 degrees. In three patients, whose leg discrepancy averaged 4.9 centimeters, the leg was lengthened at an average patient age of 13 years and 9 months (age range, 11 years and 7 months to 15 years and 2 months). The resulting limb length discrepancy averaged 2.2 centimeters. Vascularized bone grafting is a reliable technique for achieving bony union in congenital pseudarthrosis of the tibia. Residual shortening may be corrected later by limb lengthening.

Adolescent↗
PubMed1984

Microvascular gastrocnemius muscle transfer to the distal leg using saphenous vein grafts.

The gastrocnemius muscle has been transferred to the distal leg by lengthening its vascular pedicle with interposition saphenous vein grafts. This procedure is presented as an alternative to free-flap transfers requiring vein grafts to the proximal leg. By increasing the arc of rotation of the gastrocnemius muscle with vein grafts, the full dimensions of the muscle can be used to cover large prepatellar, suprapatellar, and distal leg defects.

Adolescent↗
PubMed2000

Endoscope-assisted calf reduction in Orientals.

In general, Oriental women have shorter legs and thicker calves than Caucasian women. Moreover, the thicker their calves, the shorter their legs appear to be. As a result, they might be reluctant to adopt certain fashion styles (shorter skirts) or they may feel conspicuous in beachwear. To date, no practical aesthetic method of lengthening the legs or thinning the calves exists, with the exception of liposuction. However, liposuction does not solve the problem of muscularly prominent calves, because the shape and size of the calves are determined mainly by gastrocnemius muscle rather than by subcutaneous fat. The authors have devised a method of contouring the calf by partially shaving the calf muscle. Through two horizontal incisions (less than 2 cm) in the popliteal fossa, dissection is deepened to the crural fascia, and the fascia is incised. The fascia is easily separated from the gastrocnemius muscle with an endoplastic retractor (Emory Endoplastic or Byrd Endoplasic Retractor, Snowden-Pencer, Tucker, Ga.). Medially and laterally, prominent muscle bellies are shaved in proper volume. Care should be taken not to injure the medial cutaneous nerve and the saphenous vein in the midline. Between October of 1994 and June of 1998, 115 calf reductions were done. The differences between preoperative and postoperative circumferences in the most prominent regions of the calves were 3.0 to 7.0 cm, and prominent muscular contours disappeared. There were no major complications and only a few transient minor complications, such as localized hematoma and surface irregularity. A postoperative Cybex test of ankle power showed strength near the preoperative normal level from 6 months to 1 year after the operation.

Adolescent↗
PubMedDate not supplied

Intermediate crural overlay in rhinoplasty: a deprojection technique that shortens the medial leg of the tripod without lengthening the nose.

OBJECTIVE: To review the indications for, surgical techniques of, and results of intermediate crural overlay of the alar cartilages in rhinoplasty. DESIGN: Prospective study of patients undergoing intermediate crural overlay of the lower lateral cartilages. The setting was a facial plastic surgery private practice. Patients included 10 primary rhinoplasty patients and 1 revision rhinoplasty patient who underwent intermediate crural overlay of the lower lateral cartilages. The main outcome measures were postoperative photographs and patient records, which were reviewed for tip projection and rotation, preservation of the double break, bossae, and knuckling. RESULTS: Intermediate crural overlay decreased projection in all 11 patients and increased the nasolabial angle in 7 patients. One patient had no change in the nasolabial angle, and 3 patients had counterrotation of 1 degrees , 3 degrees , and 4 degrees . A postoperative physical examination revealed that no patient had developed bossae, tip asymmetries, or knuckling. In addition, the double break was maintained in all the study patients. CONCLUSIONS: Intermedial crural overlay is a reliable technique for achieving tip deprojection. Overall, the nasolabial angle is maintained (although in 3 patients, clinically insignificant counterrotation did occur). In addition, the length of the intermediate crura is reduced, but the double break is preserved. In the group of patients with thin skin and tip overprojection secondary to overdevelopment of the lower lateral cartilages, intermediate crural overlay achieves tip deprojection while controlling the nasolabial angle and preserving the natural curvature of the dome.

Adolescent↗
PubMedDate not supplied

Experience with 141 tibial lengthenings in poliomyelitis and comparison of 3 different methods.

Three different distraction devices were investigated for the treatment of leg-length discrepancy caused by poliomyelitis in 144 patients. The average leg-length discrepancy was 5.2 cm and lengthening obtained 4.8 cm. For tibial leg-lengthening. Anderson's apparatus was used in 50 patients; an external fixator device (developed in Shafa Rehabilitation Hospital) was used in 40 patients; and the Wagner apparatus was used in 51 patients. The incidence of major complications was low in all 3 groups. The overall failure rate was 4%. There were no significant differences in the final results among the 3 groups. However, preference is given to the Wagner device because of its practical advantages.

Adolescent↗
PubMed1993

The correction of complex foot deformities using Ilizarov's distraction osteotomies.

Twenty-five very complex foot deformities were treated by Ilizarov distraction osteotomies. The osteotomy types included supramalleolar, U, V, posterior calcaneal, talocalcaneal neck, midfoot, and metatarsal osteotomies. In addition, the leg was lengthened and widened in most cases. The mean treatment time was 6.4 months. There were 20 minor or major complications related to the foot osteotomies in 18 feet, including deep pin-tract infection in three, failure of osteotomy separation in nine, acute postoperative tarsal tunnel syndrome in two, toe contractures in three, wire breakage or cutout in two, and buckle fracture in one. Nineteen secondary procedures were required in 13 patients to treat these complications. The final result was a plantigrade foot in 22 in late follow-up evaluation. The three nonplantigrade feet were attributable to unrecognized heel varus in one, ball and socket ankle joint in one, and partial growth arrest progressive deformity in one. Gait was improved in all cases. Pain was eliminated in all but two patients. Based on these criteria, the results were judged to be satisfactory in 22 and unsatisfactory in three. The Ilizarov method can successfully correct complex foot deformities despite complications.

Adult↗
PubMed1998

[A case of infected tibial pseudoarthrosis treated by Ilizarov method complicated by supracondylar traumatic fracture of the femur].

A case of 45 years old male with infected pseudoarthrosis of the tibia, 4 cm shortening of the limb involved, complicated with ipsilateral distal femur fracture is reported. Ilizarov apparatus was used to address whole pathology. At 8 months follow-up good clinical and radiological result is achieved--the fracture and pseudoarthrosis united, the leg is lengthened by 4 cm.

Femur↗
PubMed2005

[Combined external skeletal fixation instrumentation with locked intramedullary nailing for tibia lengthening].

OBJECTIVE: To shorten the time of external skeletal fixation on legs, and enhance quality of limb lengthening, avoid complications of shortening, bending, twisting and etc. METHODS: Insert pin transcortical to attack external skeletal fixation simultaneously, put un-reaming locked intramedullary nail (do not insert distal locked screw) into endosteum of lengthening bone. After the legs achieved predetermined length, insert distal locked screw and then remove external skeletal fixation, locked intramedullary nail, then maintain consolidation of rehabilitation. RESULTS: The group lengthened legs for 412 cases. The range of lengthening was 3 to 18 cm. Mean length was 7.6 cm. The mean time for needed external skeletal fixation was 20 d/cm. The mean time of osteogenesis was 56 d/cm. For complications, there were 3 tibias ununion cases and 1 varus ankle. All cases were treated undergoing twice. CONCLUSIONS: The method reduces the time for needed external skeletal fixation visibly, enhances the quality of limb lengthening remarkably, prevents complications of shortening new bone, deformity, bending and re-fracture which do not effect the healing time. This is a new choice of limb lengthening.

Adult↗