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1.  A life without pain: a case report 
Abstract
Congenital insensitivity to pain is a rare condition with an abnormality of interpretation of painful stimuli. This case report illustrates how a sequence of injuries after no or trivial trauma incapacitated a young boy. Especially the bilateral collapse and dislocation of the hip is an unusual sequela of this disorder.
doi:10.1007/s11751-007-0014-8
PMCID: PMC2321726  PMID: 18427916
Congenital; Insensitivity; Pain; Charcot
2.  A life without pain: a case report 
Abstract
Congenital insensitivity to pain is a rare condition with an abnormality of interpretation of painful stimuli. This case report illustrates how a sequence of injuries after no or trivial trauma incapacitated a young boy. Especially the bilateral collapse and dislocation of the hip is an unusual sequela of this disorder.
doi:10.1007/s11751-007-0014-8
PMCID: PMC2321726  PMID: 18427916
Congenital; Insensitivity; Pain; Charcot
3.  Acetabular augmentation ring for recurrent dislocation of total hip arthroplasty: 60% stability rate after an average follow-up of 74 months 
International Orthopaedics  2007;33(1):49-52.
Between 1988 and 2002, 47 patients (50 hips) were treated with acetabular shell augmentation arthroplasty for recurrent idiopathic dislocation of their total hip arthroplasty. Apparent causes for dislocation such as deep infection, component malposition, or polyethylene wear were excluded. Follow-up averaged 74 months (range, 12–178 months), and clinically, 30 hips (60%) did not present a subsequent dislocation at most recent follow-up. In five hips (10%), deep infection after the augmentation procedure necessitated removal of the entire prosthesis. In our opinion, this technique cannot be recommended as it has an unacceptable failure and high infection rate.
doi:10.1007/s00264-007-0456-0
PMCID: PMC2899253  PMID: 17952437
4.  Poor accuracy of freehand cup positioning during total hip arthroplasty 
Several studies have demonstrated a correlation between the acetabular cup position and the risk of dislocation, wear and range of motion after total hip arthroplasty. The present study was designed to evaluate the accuracy of the surgeon’s estimated position of the cup after freehand placement in total hip replacement. Peroperative estimated abduction and anteversion of 200 acetabular components (placed by three orthopaedic surgeons and nine residents) were compared with measured outcomes (according to Pradhan) on postoperative radiographs. Cups were placed in 49.7° (SD 6.7) of abduction and 16.0° (SD 8.1) of anteversion. Estimation of placement was 46.3° (SD 4.3) of abduction and 14.6° (SD 5.9) of anteversion. Of more interest is the fact that for the orthopaedic surgeons the mean inaccuracy of estimation was 4.1° (SD 3.9) for abduction and 5.2° (SD 4.5) for anteversion and for their residents this was respectively, 6.3° (SD 4.6) and 5.7° (SD 5.0). Significant differences were found between orthopaedic surgeons and residents for inaccuracy of estimation for abduction, not for anteversion. Body mass index, sex, (un)cemented fixation and surgical approach (anterolateral or posterolateral) were not significant factors. Based upon the inaccuracy of estimation, the group’s chance on future cup placement within Lewinnek’s safe zone (5–25° anteversion and 30–50° abduction) is 82.7 and 85.2% for anteversion and abduction separately. When both parameters are combined, the chance of accurate placement is only 70.5%. The chance of placement of the acetabular component within 5° of an intended position, for both abduction and anteversion is 21.5% this percentage decreases to just 2.9% when the tolerated error is 1°. There is a tendency to underestimate both abduction and anteversion. Orthopaedic surgeons are superior to their residents in estimating abduction of the acetabular component. The results of this study indicate that freehand placement of the acetabular component is not a reliable method.
doi:10.1007/s00402-007-0294-y
PMCID: PMC1914284  PMID: 17297597
Freehand cup positioning; Accuracy; Total hip arthroplasty
5.  Minimally invasive ankle arthrodesis with a retrograde locking nail after failed fusion 
Abstract
A retrograde nail with posterior-to-anterior (PA) locking into os calcis, talus and tibia was used to correct deformity and achieve fusion after failed fusion. A variety of methods have been published to achieve union of the ankle and subtalar joint in a failed fusion situation. We have studied a retrograde locking nail technique through a 2.5-cm incision in the non-weightbearing part of the sole of the foot. Remaining cartilage in the ankle joint, where necessary, was percutaneously removed through an anterior approach and the locking nail was inserted after reaming of os calcis, talus and tibia. Locking screw insertion was in the sagittal plane (p.a. direction), in talus os calcis and tibial diaphysis using a nail mounted jig. Ten patients were entered in the study (age 27-60 years). The initial aetiology for attempted fusion was post-traumatic in nine cases and rheumatic in one case. There were 25 previous operations in the cohort not leading to fusion. An additional temporary external fixator was used in four cases to reach and maintain the optimum position for the procedure. The intervention time was 30-75 min. Dynamisation of the nail was performed after four months under local anaesthesia. The mean duration of follow-up was 4 years (3-5.5 years). Radiologically and clinically, fusion was achieved in 16 weeks (range, 12-20 weeks). There was no loosening of the implant or implant failure. A leg length discrepancy was avoided using this technique. There was one complication with varus malunion in a heavy smoker which united after corrective osteotomy, revision nailing and bone grafting. Patient satisfaction was measured on a scale (not visual analogue) of 0 (not satisfied) to 10 (completely satisfied); overall satisfaction averaged 9.5 points (range, 6-10 points). The postoperative ankle-hindfoot score of the American Orthopedic Foot and Ankle Society averaged 73.5 points (range, 61-81 points). Retrograde locked nailing with locking in the sagittal plane is a reliable minimally invasive procedure to achieve fusion of the ankle and the subtalar joint after failed fusion.
doi:10.1007/s11751-007-0018-4
PMCID: PMC2321722  PMID: 18427914
Ankle arthrodesis; Failed fusion; Retrograde nail; Calcaneotalotibial arthrodesis
6.  Minimally invasive ankle arthrodesis with a retrograde locking nail after failed fusion 
Abstract
A retrograde nail with posterior-to-anterior (PA) locking into os calcis, talus and tibia was used to correct deformity and achieve fusion after failed fusion. A variety of methods have been published to achieve union of the ankle and subtalar joint in a failed fusion situation. We have studied a retrograde locking nail technique through a 2.5-cm incision in the non-weightbearing part of the sole of the foot. Remaining cartilage in the ankle joint, where necessary, was percutaneously removed through an anterior approach and the locking nail was inserted after reaming of os calcis, talus and tibia. Locking screw insertion was in the sagittal plane (p.a. direction), in talus os calcis and tibial diaphysis using a nail mounted jig. Ten patients were entered in the study (age 27-60 years). The initial aetiology for attempted fusion was post-traumatic in nine cases and rheumatic in one case. There were 25 previous operations in the cohort not leading to fusion. An additional temporary external fixator was used in four cases to reach and maintain the optimum position for the procedure. The intervention time was 30-75 min. Dynamisation of the nail was performed after four months under local anaesthesia. The mean duration of follow-up was 4 years (3-5.5 years). Radiologically and clinically, fusion was achieved in 16 weeks (range, 12-20 weeks). There was no loosening of the implant or implant failure. A leg length discrepancy was avoided using this technique. There was one complication with varus malunion in a heavy smoker which united after corrective osteotomy, revision nailing and bone grafting. Patient satisfaction was measured on a scale (not visual analogue) of 0 (not satisfied) to 10 (completely satisfied); overall satisfaction averaged 9.5 points (range, 6-10 points). The postoperative ankle-hindfoot score of the American Orthopedic Foot and Ankle Society averaged 73.5 points (range, 61-81 points). Retrograde locked nailing with locking in the sagittal plane is a reliable minimally invasive procedure to achieve fusion of the ankle and the subtalar joint after failed fusion.
doi:10.1007/s11751-007-0018-4
PMCID: PMC2321722  PMID: 18427914
Ankle arthrodesis; Failed fusion; Retrograde nail; Calcaneotalotibial arthrodesis

Results 1-6 (6)