Front Matter - The Journal of Bone & Joint Surgery

Adv 32
JBJS [Br] Abstracts Now Available
Hip
Reduction of the potential for thermal damage during hip resurfacing
H. S. Gill, P. A. Campbell, D. W. Murray, and K. A. De Smet
J Bone Joint Surg Br 2007 89-B: 16-20
Resurfacing arthroplasty of the hip is being used increasingly
as an alternative to total hip replacement, especially for young
active patients. There is concern about necrosis of the femoral
head after resurfacing which can result in fracture and loosening.
Most systems use a cemented femoral component, with
the potential for thermal necrosis of the cancellous bone of the
reamed femoral head. We used thermal probes to record temperatures
close to the cement-bone interface during resurfacing
arthroplasty.
The maximum temperature recorded at the cement-bone
interface in four cases was approximately 68°C which was
higher than that reported to kill osteocytes. A modified surgical
technique using insertion of a suction cannula into the lesser
trochanter, generous pulsed lavage and early reduction of the
joint significantly reduced the maximum recorded cancellous
bone temperature to approximately 36°C in five cases (p =
0.014).
We recommend the modified technique since it significantly
reduces temperatures at the cement-bone interface.
Trauma
Conservative treatment of isolated fractures of the medial malleolus
D. Herscovici, Jr, J. M. Scaduto, and A. Infante
J Bone Joint Surg Br 2007 89-B: 89-93
Between 1992 and 2000, 57 patients with 57 isolated fractures
of the medial malleolus were treated conservatively by
immobilisation in a cast. The results were assessed by examination,
radiography and completion of the short form-36 questionnaire
and American Orthopaedic Foot and Ankle Society
ankle-hindfoot score.
Of the 57 fractures 55 healed without further treatment.
The mean combined dorsi- and plantar flexion was 52.3° (25°
to 82°) and the mean short form-36 and American Orthopaedic
Foot and Ankle Society scores 48.1 (28 to 60) and 89.8 (69 to
100), respectively. At review there was no evidence of medial
instability, dermatological complications, malalignment of the
mortise or of post-traumatic arthritis.
Isolated fractures of the medial malleolus can obtain high
rates of union and good functional results with conservative
treatment. Operation should be reserved for bi- or trimalleolar
fractures, open fractures, injuries which compromise the skin or
those involving the plafond or for patients who develop painful
nonunion.
Knee
Validation of the short-form WOMAC function scale for the evaluation
of osteoarthritis of the knee
K. G. Auw Yang, N. J. H. Raijmakers, A. J. Verbout, W. J. A. Dhert, and
D. B. F. Saris
J Bone Joint Surg Br 2007 89-B: 50-56
This study validates the short-form WOMAC function
scale for assessment of conservative treatment of osteoarthritis
of the knee. Data were collected before treatment and six and
nine months later, from 100 patients with osteoarthritis of the
knee to determine the validity, internal consistency, test-retest
reliability, floor and ceiling effects, and responsiveness of the
short-form WOMAC function scale. The scale showed high correlation
with the traditional WOMAC and other measures. The
internal consistency was good (Cronbach : 0.88 to 0.95) and an
excellent test-retest reliability was found (Lin’s concordance correlation
coefficient ( c): 0.85 to 0.94). The responsiveness was
adequate and comparable to that of the traditional WOMAC
(standardised response mean 0.56 to 0.44 and effect size 0.64 to
0.57) and appeared not to be significantly affected by floor or
ceiling effects (0% and 7%, respectively).
The short-form WOMAC function scale is a valid, reliable
and responsive alternative to the traditional WOMAC in the
evaluation of patients with osteoarthritis of the knee managed
conservatively. It is simple to use in daily practice and is therefore
less of a burden for patients in clinical trials.
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