Sciatic nerve palsy is a proble troublesome complication of total hip arthroplasty. It may be caused by direct injury or over-traction at the time of operation. We investigated the effects of the hip and knee positions on the blood flow of the sciatic nerve of dogs. Tweyty hip joints of 10 adult mongrel dogs were examined.The blood flow in the sciatic nerve was measured using a Laser Doppler Flowmetry, at varying angles of flexion (90°, 120°, 150°) and internal rotation (0°, 30°) of the hip joint and angles of flexion of the knee (0°, 30°, 60°, 90°). This study showed that the blood flow in the sciatic nerve decreases with increasing flexion angle and increasing internal rotation angle of the hip joint, and that decreases in the flexion angle of the knee joint result in especially pronounced decreases in blood flow. We consider that the position of the hip and knee positions are considered a significant risk factor in total hip arthroplasty parformed with over-lengthening. Our results suggest that surgeons should pay attention to knee extension and the flexion and internal rotation positions of the hip tp prevent sciatic nerve palsy as a complication of total hip arthroplasty.
On seventeen hips, we performed the measurement of bone marrow pressure and the intramedullary venography in the proximal femur to study the haemodynamics of the medullary circulation.In case of bone necrosis, the baseline pressure was above 30 mmHg, or the pressure elevation by stress test was more than 10 mmHg above the baseline at five minutes after the injection of 5 ml of normal saline.
Twelve prosthetic hip and knee replacements (eight bipolar endoprosthetic replacements, three conventional total hip replacements, and one hemiarthroplasty of the knee) were implanted between 1978 and 1988 in eleven patients who underwent hemodialysis for chronic renal insufficiency. Five replacements (three conventional total hip replacements, one bipolar endoprosthetic replacement, and one hemiarthroplasty of the knee) in four patients had a failure due to the loosening of the component. In these four patients, the median age at operation was 51 years and the average length of follow-up was 6 years. One of these patients died of infection in both loosened total hip replacements seven years and four months after the operation.
Valgus intertrochanteric osteotomy is an effective treatment for osteoarthritis of the hip in younger patients. However, the disadvantage of this osteotomy is the difficult stem insertion at the time of subsequent total hip arthroplasty. Sugioka designed transtrochanteric valgus osteotomy to overcome this disadvantage. The purpose of the present study was to report the short-term results after operateion. The results of the first 10 hips in patients were prospectively studied with a minimum of 6-months follow-up. All patients had a long history of hip pain. The average age at the time of operation was 45.7 years. All patients had a flexion arc of at least 80 degrees and at least 20 degrees of passive adducion. Preoperative radiographs of the patients showed an elliptical deformity of the femoral head associated with a well-developed infermedial osteophyte and improved congruence of the articular surfaces was demonstrated in full adduction. Operatve corrections averaged 19 degrees of valgus and 6 degrees of extension. Bone union of both the femoral and trochanteric osteotomies was obtained in all hips. Hip pain was relieved in all except one hip.
Total hip arthroplasty was performed in 19 patients using the lateral approach. Laser Doppler flowmetry was used to measure the blood flow in the anterior and posterior parts of the gluteus medius. The anterior part was split and detached. The posterior part was left intact. The blood flow in the gluteus medius of the anterior part was decreased by 15.4%, while that of the posterior part remained constant during surgery. Postoperatively, the Trendelenburg sign remained positive in 3 of 16 patients. No correlations were observed between a positive Trendelenburg sign and reduction in blood flow of the gluteus medius.
Category: Arthroscopy Introduction/Purpose: The gold standard for chronic lateral ankle ligament injury is ligament repair via the modified Broström- Gould procedure. Recently, lateral ankle ligament repair has been performed arthroscopically. This requires the insertion of one to three suture anchors in the fibula from anterior to posterior via the accessory portal. It is important to insert the suture anchors completely into the fibula bone. Because the distal fibula is tapered and has a fossa on the posterior surface, unfavorable insertional direction of the suture anchor can lead to complications such as inadequate suture anchor stability or friction between the suture anchor and the peroneus tendons. This study aimed to investigate the distance between the insertion point of the suture anchors and the posterior surface of the fibula on computed tomography (CT) images. Methods: Twenty ankles from 16 patients who had undergone three-dimensional CT scans for foot or ankle disorders without deformity of the fibula were assessed (10 male, 10 female; mean age, 32 years; age range, 12–78 years). The shortest distance from the insertion point of the suture anchor to the deepest point of fossa/the top of the convex of fibula was measured on the axial planes tilting from the longitudinal axis of the fibula at 90°, 75°, 60°, and 45°. We also measured the distance from the insertion point of the suture anchor to the posterior surface of the fibula, in a direction parallel to the sagittal plane of the lateral surface of the talus on the axial planes tilting from the longitudinal axis of the fibula at 90°, 75°, 60°, and 45°. Results: The posterior fossa was observed in all cases on the 90° and 75° images. The distance from the insertion point to the posterior surface of the fibula in a parallel direction was 15.6 mm at 90°, 18.0 mm at 75°, 21.5 mm at 60°, and 24.8 mm at 45°. The posterior points in a parallel direction were located on the posterior fossa in 40% of cases at 90°, in 10% at 75°, and in 0% at 60° and 45°. Conclusion: We suggest that the suture anchor should be directed from anterior to posterior at an angle of less than 60° to the longitudinal axis of the fibula, parallel to the lateral surface of the talus, in order to avoid passing through the fibula.
