76 Abstracts

A r t h r o s c o p i c a b r a s i o n a r t h r o p l a s t y o f t h e k n e e f o l l o w - u p o f 140 Cases M. BALDOVIN, S. TOGNON AND E. TELLATIN

2nd Orthopaedic Clinic University of Padua, Padova, Italy

In this prospect ive cont ro l led s tudy us ing s ingle-bl ind methods, we eva lua ted c l in ica l resul ts and imag ing in 140 pat ients , who underwen t a r th roscopic ab ras ion a r th rop las ty accord ing to L. Johnson, for severe os teoar th r i t i c chondropa thy of the knee be tween 1985 and 1990.

One hundred and for ty pa t ien ts (85 M : 5 5 F), mean age 56± 12 years were eva lua ted as follows: os teoar th- r i t ic chondropa thy of the knee (accord ing to Outerbridge); wi thou t s igni f icant axia l devia t ion; no instabi l i ty; c l in ica l mean score (according to Lysholm) 56_+ 10; RX score (Fai rbank) : 0 = 2?/o, 1 = 387/o, 2 =~ 30%, 3 = 26%, 4 = 4?/0 pa t ien ts underwent a r thro- scopic abras ion a r t h rop l a s ty and act ive mot ion wi thou t

load bear ing for 2 months . Follow-up: c l in ica l evalua- t ions, RX, magne t ic r e sonance imaging (MRI) and some- t imes ar throscopy. Lysholm: excel len t -- 34~o, good = 40%, poor = 22?/0, bad = 4%. RX: improved = 32%, unchanged = 48%, worsened = 20~o. MRI and ar thro- scopy, showed in most cases a new r e pa ra t i ve f ibrocart i - lage appear ing t issue, t h a t had good mechan ica l qual i t ies . In 60% of cases we not iced a~total or pa r t i a l r ewiden ing of the j o in t space.

Abras ion a r th rop l a s ty is a safe and efficacious pro- cedure. We found subjec t ive and objec t ive improvement in nea r ly al l pat ients : these f indings seemed unchanged in follow-up.

P r e v e n t i o n o f s e c o n d a r y o s t e o a r t h r i t i s - - a t a s k in c h i l d h o o d and a d o l e s c e n c e STAN HAVELKA

Institute of Rheumatology, Prague, Czechoslovakia

Osteoar th r i t i s (OA) imposes heavy medical and socio- economic burdens on ind iv idua ls and socie ty today. Mos t problems of th is he te rogenous syndrome are re la ted to hip and knee joints . Among disorders l ead ing to secondary OA of load-bear ing a r t i cu la t ions , the most f requent are congen i t a l d isplas ias of jo in t s and the skeleton, Per thes disease, s l ipped femoral epiphysis , t r a u m a and chronic a r thr i t ides . A subs tan t i a l number of secondary OA has i ts or ig in in the first two decades of life. Despite this, our approaches to juveni les a t r isk

l ack a follow-up sys tem and effective ~ reven ta t ive measures . I t appears t ha t the t ime has come ~omehow to deal wi th the task. A campa ign or ien ted on" de lay and mi t iga t ion of secondary OA should be cons idered in nea r fu ture as a concer ted ac t ion of spec ia l i t ies involved, such as ped ia t r i c rheumato logy and or thope- dics. The recommended complex program has to include r e gu l a r check-ups by non invas ive methods, life s tyle modif icat ions and chondropro tec t ion , as ea r ly as possible.

O s t e o t o m y as a s u r g i c a l p r o c e d u r e for p r e v e n t i o n o f o s t e o a r t h r i t i s o f t h e hip A. MASINI AND L. DE PALMA

Clinical Orthopaedics, Catholic University of Rome, Italy

Correct ive os teotomy of an angu la r deformity of a ske le ta l por t ion is a surg ica l procedure t ha t is pa r t of the cu l tu ra l backg round of al l o r thopaedic surgeons; moreover in the r ecen t pas t i t was the lone so lu t ion for many difficult problems.

Even in modern t imes, os teotomy is a val id a l te rna- t ive surgical p rocedure to to ta l h ip replacement . I t is useful in cases where to ta l h ip rep lacement would not pred ic tab ly produce a long las t ing result . Os teo tomy al lows for the poss ib i l i ty of a t r an sp l an t a t a l a t e r stage.

The aim of os teotomy is to modify the inc l ina t ion and the dec l ina t ion angle of the proximal metaep iphys i s of the femur to al low a be t te r d i s t r ibu t ion of t ens ion and loads in the hip jo int , and to prevent (or to minimize) the development of os teoar thr i t i s . I n t e r t rochan te r i c os teotomy is used to correc t one or both these angles ,

i.e. to recen te r the epiphys is of the hip wi th in the ace tabulum. Nowadays , we a re used to fixing the surg ica l f rac ture wi th a McLaugh l in or an AO pla te and cor t i ca l screws. In the pas t we used many different devices (e.g. Weinwr igh t plate). I t is necessary to con- s ider the b io logica l effect of the opera t ion: from the os teotomy site, new a r t e r i a l vessels s t a r t to grow which supply increased blood to the subchondra l bone of the epiphysis of the femur a l lowing the ca r t i l ag inous surface new nut r i t ion .

We have opera ted on 935 hips from 1968-1988, 144 for ear ly condi t ions. At 5 years of follow-up there was 87% good response with 52?/0 good response at 20 years.

We are satisfied tha t the os teotomy procedure should be used when the age of the pa t i en t and the condi t ion of the hip are favorable.