Keller's arthroplasty in adults with hallux valgus and hallux rigidus

BACKGROUND

The role of Keller's resection arthroplasty in the management of adult hallux valgus with hallux rigidus is debatable. There are no studies addressing this particular problem.

METHODS

This study is a retrospective review of 32 patients (49 feet), conducted by an independent assessor. Subjective and objective criteria were used to assess the results of surgery. There were 30 women and 2 men with an average age at surgery of 62.5years.

RESULTS

The results of surgery in terms of relief of pain, cosmesis and use of regular footwear were satisfactory. Excellent and good subjective results were obtained in 39% and 37% of cases respectively. Radiological analysis revealed decrease in the intermetatarsal and first metatarsophalangeal angle in a significant number of cases. Final results assessed by Vallier's modification of Bonney and MacNab criteria, revealed excellent to good results in 87% of feet. A significant number of complications were noted but there was no association between the occurrence of complications and the final result or the subjective functional grade. There was no association between the amount of resection of proximal phalanx and occurrence of metatarsalgia or the final outcome.

CONCLUSION

The results of this study suggest that Keller's arthroplasty has a role in patients with adult hallux valgus associated with degenerative changes in the first metatarsophalangeal joint.

Primary total knee arthroplasty in the elderly

In a retrospective study, the authors investigated the outcome of primary total knee arthroplasty in patients aged 75 years or older. There is an increased risk of perioperative mortality and medical morbidity, but not surgical morbidity. The results were equal to the younger control group in terms of patient satisfaction, pain relief, stability, range of motion, residual degree of flexion contracture, and extension lag. Mobility was less impressive in the elderly group; factors included were ability to walk, use of walking aids, gait, ability to get out of a chair, and ability to climb stairs.

Outcome after flap cover for exposed total knee arthroplasties. A report of 25 cases

The long-term functional result of exposed total knee arthroplasty, treated by flap cover, is presented and the results compared with those of a randomly selected control group. The wound was successfully covered and the prosthesis was preserved in 76% of cases, but the final functional score was not as good as in those with primary wound healing.

Outcome after flap cover for exposed total knee arthroplasties. A report of 25 cases

The long-term functional result of exposed total knee arthroplasty, treated by flap cover, is presented and the results compared with those of a randomly selected control group. The wound was successfully covered and the prosthesis was preserved in 76% of cases, but the final functional score was not as good as in those with primary wound healing.

The incidence of gout in patients with Dupuytren's disease

In a retrospective study we found that the incidence of gout in patients with Dupuytren's disease is 3.5%. The mean serum uric acid was 330 mumol/l. (5.5 mg./100 ml.) in men and 240 mumol./l. (4.0 mg./100 ml.) in women. The rate of hyperuricaemia was 7%. These are not significantly higher than the expected figures in Britain.

Prognosis in Dupuytren's disease

This is a retrospective study of 85 patients with Dupuytren's disease who were treated surgically and followed up for 1 to 7 years (average, 41 months). The overall recurrence after surgery was 34%.