[Sugioka rotational osteotomy in ischemic osteonecrosis of the femoral head]

The treatment of ischemic necrosis of the femoral head depends on the stage and the age of the patient. Sugioka's rotational osteotomy is an alternative between the different conservative techniques. We have used this technique in 12 patient and 13 hips. The mean age of the patients was 31.8 ranging from 20 to 40. In the first 4 patients we performed the classic technique, as described by Sugioka. In the rest of the patients we used a DHS to stabilize the rotation and a maleolar screw for trochanteric osteotomy. The follow-up ranged between 24 and 67 months, average 42.46 months. The main complications were: 1 embolism, 1 trochanteric pseudoarthrosis and 1 common personal nerve lesion. The radiologic study showed progression in the majority of the cases. Clinical examination was performed following Merle D'Aubigné criteria pre and post surgery. We found 1 excellent result, 3 good, 3 fair and 6 poor (four of them needed a T.H.R.). Based on our experience, we have suggested a protocol for the treatment of ischemic necrosis of the femoral head. We believe that Sugioka's osteotomy can be indicated in patients younger than 50 and with less than 200 degrees affected (Stage III). The modifications we have made may be useful to achieve a better stabilization of the osteotomy and to improve the postoperative period. We have observed an improvement in the pain and gait in 60% of the patients. The radiologic study showed a progressive deterioration but there was no correlation between the clinical and radiological findings. Sugioka's technique allows the preservation of the femoral head delaying the total hip replacement.

Anterior cruciate ligament reconstruction with fresh-frozen patellar tendon allografts

A prospective study was performed on 30 patients who underwent an anterior cruciate ligament reconstruction with fresh-frozen patellar tendon allograft. An arthroscopic technique alone was used in 10 patients, and in the other 20 patients this was combined with a miniarthrotomy. After a mean follow up of 35 months, the overall functional results were satisfactory in 85%. There were no cases of infection, disease transmission or tissue rejection. Fresh-frozen patellar tendon allografts are a good method of anterior cruciate reconstruction.

Long term evaluation of high tibial valgus osteotomy

We present a long term evaluation of 100 high valgus tibial osteotomies with a mean follow up of 11 years. Knees with slight or moderate osteoarthritis had the best results. Slight overcorrection was beneficial, but gross overcorrection was not. There were few complications and the overall long term results were good.

[Tissue bank for the musculoskeletal system. Clinical applications]

From June 1987 to June 1990, the musculoskeletal system tissues bank of the Orthopaedics and Traumatology Department of the University Clinic of Navarra has used 310 allografts. Of this, 219 has been used in our Department, 142 of cancellous bone and 42 of cortical bone. 24 of patellar tendon and 11 of fascia lata. The other 91 grafts have been sent to other hospitals in the country. In the present work we make a retrospective study that included the patients who were operate with allograft. We observe the differences between several types of allografts comparing them with conventional surgery technics. Within the complications we distinguished a 10.52% of infection in cortical bone allografts used in patients with neoplastic treatment. In the other type of allograft we didn't present this complication. We concluded that a bone bank or a musculoskeletal system tissues bank has a great usefulness in different reconstructive surgery technics and arthrodesis. They are used more frequent in orthopaedics and traumatology surgery improving the development of this surgery.

The place of intertrochanteric osteotomy in the treatment of idiopathic necrosis of the head of the femur

The authors present their experience of the use of intertrochanteric osteotomy for the treatment of idiopathic necrosis of the head of the femur. The results obtained from 102 osteotomies performed on 81 patients with the disease are analysed. The mean follow-up is 4.2 years. The results show a statistically significant clinical improvement after operation. Patients presenting with Ficat and Arlet Stage II involvement fared much better than those with more severe changes. Better results were also seen in those with a necrosis angle of less than 200 degrees. No radiological improvement was seen although a high percentage showed no deterioration. The choice of treatment for the condition is discussed in the light of these results.

[The influence of age on the end-results of the total surgical replacement of the hip]

A revision of the first 700 total hip prostheses (operated on in the period 1969-1980) is carried out with the purpose to establish the influence of the age on the evolution of the arthroplasty. The results are very satisfactory but it is younger patients that complications related to loosening are more frequent. This fact can be explained by a longer period of evolution and a major prosthetic stress in these patients. By this reason, we do not use actually cement to fix the implants in those patients younger than sixty.

Chronic lateral instability of the ankle

The authors present 14 cases of chronic lateral instability of the ankle in 13 patients, in whom we performed ligamentoplasty using peroneus lateral brevis. The importance of careful preoperative evaluation of clinical findings as well as stress-roentgenograms and arthrographies is emphasized and a simple surgical technique is presented. We also realize an assessment of the results obtained which are very encouraging at the present.

Osteotomies in the treatment of gonarthrosis

The indications to perform an osteotomy of the knee in cases of a degenerative osteoarthritis are reviewed. The pre-, intra- and postoperative management is explained and the results of a hundred valgus osteotomies are evaluated. Our conclusions are based on the numerous indications for an osteotomy and its satisfactory results.