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The aim of this study was to investigate the effectiveness of shoe inserts and plantar fascia-specific stretching vs shoe inserts and high-load strength training in patients with plantar fasciitis. Forty-eight patients with ultrasonography-verified plantar fasciitis were randomized to shoe inserts and daily plantar-specific stretching (the stretch group) or shoe inserts and high-load progressive strength training (the strength group) performed every second day. High-load strength training consisted of unilateral heel raises with a towel inserted under the toes. Primary outcome was the foot function index (FFI) at 3 months. Additional follow-ups were performed at 1, 6, and 12 months. At the primary endpoint, at 3 months, the strength group had a FFI that was 29 points lower [95% confidence interval (CI): 6-52, P = 0.016] compared with the stretch group. At 1, 6, and 12 months, there were no differences between groups (P > 0.34). At 12 months, the FFI was 22 points (95% CI: 9-36) in the strength group and 16 points (95% CI: 0-32) in the stretch group. There were no differences in any of the secondary outcomes. A simple progressive exercise protocol, performed every second day, resulted in superior self-reported outcome after 3 months compared with plantar-specific stretching. High-load strength training may aid in a quicker reduction in pain and improvements in function.

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The aim of this prospective triple-blind randomized study was to determine if a free fat transplant used in operation in lumbar disc herniation could reduce the degree of intraspinal scar tissue and to evaluate whether the scar tissue could lead to symptoms. Ninety-nine patients were subsequently examined after median 376 days. The clinical outcome was scored using the Low Back Pain Rating Scale. Enhanced CT-scanning was assessed regarding the degree of scar tissue and survival of the fat transplant. There was no difference in the clinical outcome between the two groups. Significantly fewer had dural scarring in the group who had a free fat transplantation, but there was no difference regarding the degree of radicular scarring. The transplant was shown on CT-scan at the follow-up examination in 66% of the patients who had a fat transplantation. Free fat transplantation can reduce the degree of dural scar tissue after operation for lumbal disc herniation, but does not result in a clinically better outcome.

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Twenty-eight patients (29 knees) who had revision of a failed unicompartmental knee arthroplasty to total knee arthroplasty were evaluated. All revisions were made with cementless technique using the AGC prosthesis (Biomet, Warsaw, IN). Major osseous defects were found in 20 knees, and bone-grafting was used to fill the defects. Aseptic loosening and progression of osteoarthrosis were the main reasons for revision. The median follow-up period was 38 months. Twenty knees were excellent or good, four fair, and five poor. One tibial component had been revised because of loosening. Three knees with instability had been reoperated with a thicker polyethylene component, but one of these patients still suffered from instability, and revision with a constrained prosthesis was planned. One was revised after a deep infection. Two tibial components were suspected to be loose because radiographs exposed fluoroscopically revealed a complete radiolucent line under the component. The results with cementless revision and bone-grafting are comparable to the results achieved after cemented revision, and cementless revision is recommended in young patients and in patients with major bone loss.

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We determined the long-term survival of red blood cells collected postoperatively from the surgical drains, filtered and autotransfused with the Constavac Blood Conservation System. 10 patients with knee arthrosis were treated with cementless total knee arthroplasty and postoperatively connected to the autotransfusion system. Shed blood was collected for 6 hours postoperatively and then reinfused. Before reinfusion, a fraction of the blood shed was radiolabeled with chromium-51 (51Cr). For a postoperative minimum period of 40 days the activity of 51Cr was measured in frequent venous blood samples. The time from 100% to 50% activity of the isotope (T50Cr) was 21 days, equal to that reported for banked autologous blood.

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STUDY DESIGN: This prospective triple-blind randomized study of 99 patients concerned the use of free fat transplantation for operation for lumbar disc herniation. OBJECTIVE: To subsequently examine the patients after median 376 days who were subjected to enhanced computed tomographic scan. SUMMARY OF BACKGROUND DATA: In studies on experiments with animals, the degree of intraspinal scar tissue has shown to be reduced in connection with free fat transplantation. Scar tissue is seen frequently after operation for lumbar disc herniation, but it is uncertain whether the scar tissue can lead to symptoms. METHODS: The clinical outcome was scored using the Low Back Pain Rating Scale. Enhanced computed tomographic scan was assessed regarding the degree of scar tissue and survival of fat transplant. RESULTS: There was no different in the clinical outcome between the two groups. Significantly fewer patients had dural scarring in the group who had a fat transplantation, but there was no difference regarding the degree of radicular scarring. The transplant was shown on computed tomographic scan at the follow-up examination in 66% of the patients who had a fat transplantation. CONCLUSIONS: Free fat transplantation can reduced the degree of dural scar tissue after operation for lumbar disc herniation but does not result in a clinically better outcome.

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Twenty-seven patients in whom the Ti-Bac acetabular cup (Zimmer, Warsaw, IN) was placed were examined 5 to 6 years after surgery. The cup was inserted line to line, after reaming without further fixation. In all operations, a cemented Müller straight-stem Protazul femur stem (Zimmer) was used. The patients had good pain relief and improved mobility after the operation. Radiographically, only one hip showed radiolucency in the bone-metal interface after 5 to 6 years. One patient was reoperated 3 days after surgery because of dislocation of the acetabular cup. Apart from this, there were no signs of aseptic loosening of any of these uncemented cups.

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In a prospective randomized blind study of 182 patients undergoing total hip arthroplasty, the patients per- and postoperative need for analgesics was assessed in two groups, one receiving general anesthesia and a 3-in-one block, the other group only general anesthesia. Although we found a significant reduction in analgesics per- and postoperatively in the 3-in-one block group, the difference in analgesics was small and has no clinical relevance in the patient with a healthy cardiovascular status. We conclude that 3-in-one block in combination with light general anesthesia is not the anesthetic of choice in total hip arthroplasty using the posterior approach.

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The quality of cement packing was radiographically evaluated using three different types of intramedullary plugs in 77 total hip arthroplasties. The Thackray polyethylene plug (38 mm, disc-shaped), with its large and flexible diameter, was best able to seal the femoral canal and produced significantly better cement packing compared to both the autologous bone plug and the Richard polyethylene plug (18.5 mm, bullet-shaped).

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In a prospective single-blind study, 60 patients surgically treated for lumbar disc herniation underwent clinical examination and computed tomography preoperatively and 3 months after surgery. At follow-up (58 patients; median, 31 months; range, 21-37 months), 29 patients had an excellent outcome (51%), 20 improved (33%), and 9 were unchanged or worse (16%). Dural or radicular scar tissue was present by computed tomography in 88% of the patients, but the findings could not be correlated with the clinical outcome. Recurrent or persistent disc herniation was found in 9% of the patients. The clinical outcome of patients with abnormal computed tomography did not differ significantly from patients without this finding. A relation between facet joint degeneration and less successful clinical outcome was demonstrated. Computed tomography (without contrast) 3 months after surgery gave little information which could be correlated with the clinical outcome. Patients with an excellent outcome had all degrees of intraspinal scar tissue.

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We report a study of 168 consecutive patients (171 prostheses) with a displaced femoral neck fracture and a physiologic age older than 75 years who were treated with an uncemented bipolar Monk hard-top hemiarthroplasty. Four prostheses dislocated postoperatively, but none after discharge. Two prostheses were later extracted. Five patients sustained an ipsilateral femoral fracture. Totally, 7 patients (4 percent) were reoperated on. One year after the operation, 22 percent of the patients were dead. An increased mortality rate was recorded during the first 6 months after surgery. At follow-up 6 (3-9) years after the operation, 4 of the 62 patients alive had weight-bearing pain. Three had subsidence of the prosthesis, but none had protrusion of the acetabulum. Ninety-five percent of the patients were free from complications requiring a reoperation or outpatient evaluation.

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The Partridge Cerclene system was used for femoral fractures in 15 elderly patients with osteoporotic bones who previously had a hemiarthroplasty (12) or total hip arthroplasty (3) inserted. The operation is less extensive than others have suggested in similar cases. All of the patients could immediately be mobilized out of bed. Weight bearing was not allowed and a splint was required in most cases for the first 3 months. Six fractures around the prosthesis healed uneventfully. One distally located fracture was reoperated due to loosening of the nylon plates. Two patients with distally located fractures showed no signs of osseous healing at follow-up evaluation 12 and 17 months after the operation. They were painless but still dependent on external support. It is concluded that the method is an important alternative treatment in this group of patients, especially in fractures around a hip prosthesis.

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A 25-year-old hairdresser presented with a fluctuant lump in the palm of her right hand that was intermittently painful and made control of her right thumb difficult. She had no sensory loss. At operation a cystic swelling was found 8 mm in diameter distal to the carpal ligament and compressing the median nerve. The cyst ruptured during dissection, and it was not possible to localise the pedicle. Histological examination showed that it was a ganglion, and nine weeks after the operation the patient had regained normal use of her hand and resumed her work.

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The need for, expenses of and consequences of one year follow-up after total cemented hip replacements with posterior access are reviewed. A total of 150 patients were registered prospectively and consecutively with Charnley scores preoperatively, three months and one year after operation. The Charnley scores increased significantly from the preoperative values till the follow-up at three months and from the follow-up at three months till follow-up at one year (p less than 0.001). In five patients, (3%) follow-up examination after one year was of significance. Anisomelia was corrected in all three by means of adjustment of footwear. The cost of follow-up examination after one year is estimated to be 630 Danish crowns (approximately 53 pounds) per patient. It is concluded that follow-up examination after total cemented hip replacement is not necessary. Alteration of follow-up examination after one year to follow-up examination after five years for patients who were under 60 years at the time of operation in order to reveal aseptic loosening would imply that only 10% of the patients in this material should be followed-up.

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During a 12-year period there were 15 patients with proximal tibial epithyseal fractures. Eleven were examined at follow-up with a mean observation time of 7 years (range 3.5-12.5). Five patients with type IV or type V lesions had concomitant avulsion fractures of the tibial insertion of the anterior cruciate ligament, two being displaced. Eight out of twelve patients had concomitant ligamentous injuries. At follow-up two patients complained of instability, confirmed by clinical examination. Another two patients had symptom-free anterior laxity. Serious angular deformity was found in two patients, while important leg length discrepancy was observed in one. Degenerative changes of the knee joint were found in three patients. An active reconstructive approach is recommended, and attention is drawn to concomitant ligamentous injuries which, it seems, in the past have tended to be underestimated.

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After exclusion of delayed unions and pseudoarthroses in teenagers, the time required for union of 275 consecutive fractures of the femoral diaphysis in children followed a log-normal pattern with a constant 10 percent coefficient of variation and a geometric mean increasing uniformly by 0.7 weeks per year. Multiple injuries increased, and operative treatment reduced the geometric mean time for fracture healing.

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Only a few cases of Rhesus blood-type immunization after bone allografting have been reported (Hill et al. 1974, Johnson et al. 1985). Rhesus immunization in girls or fertile women may have severe consequences. We report a case of Rhesus-antibody production after bone allografting for an aneurysmal bone cyst.

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