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During his last year in Germany buy kamagra effervescent 100 mg without a prescription erectile dysfunction quotes, France order 100mg kamagra effervescent overnight delivery erectile dysfunction drugs in canada, and England; in England he 252 Who’s Who in Orthopedics made the acquaintance of Hugh Owen Thomas as orthopedic surgeon, was soon at work. The and his nephew Robert Jones, whose work made experience, brief as it was, was enough to con- a deep impression on him. On his return he vince Bob Osgood of the frequency and impor- became associated with Dr. Painter in the practice of ortho- skeletal structures caused by machine-gun fire pedic surgery. He was made assistant orthopedic and high-explosive shells and of the need for surgeon at the Carney Hospital and, in 1906, experienced orthopedic surgeons to provide the assistant orthopedic surgeon at the Massachusetts necessary expert care. Painter in the writing of one evident that American troops would be in action of the first American books on orthopedic surgery in the European theater of war. He was not alone in foreseeing the need for the immedi- deeply interested in research; his work at that time ate training and preparation of American ortho- included studies of metabolism in patients with pedic surgeons to meet the responsibilities of rheumatoid arthritis and, later, in association with providing care for American casualties. Lucas, studies of the transmission the initiative and support of other American of the virus of poliomyelitis. They demonstrated orthopedic surgeons and particularly to the coop- that the virus of poliomyelitis might remain latent eration of Robert Jones, who at this time held the in the nasopharyngeal lymphoid tissue of rank of Colonel in the Royal Army Medical Corps monkeys for 6 months after the acute symptoms and who had been made responsible for the care of the disease had disappeared and that it still of all those with injuries of the musculoskeletal could be transmitted to other monkeys. Later they system in the British Army, arrangements were were able to demonstrate for the first time a case made so that it was possible, as soon as the United of a human carrier of poliomyelitis by means of States entered the war, to enrol a group of ortho- the recovery of virus from the nasal washing of a pedic surgeons in the American Army and to send patient who had experienced an attack of them to Great Britain to assist in the care of poliomyelitis 4 months previously. There they learned the methods With the development of an orthopedic of treatment that had proved most successful. In inpatient service at the Massachusetts General due course, after the arrival of American troops in Hospital in 1911, following the successful efforts France and their introduction into combat, these of Dr. Goldthwait in raising funds to build ward American orthopedic surgeons were relieved of I, Bob Osgood’s clinical work was centered in the their duties in Britain and were transferred for Massachusetts General Hospital. At about this active duty with the American Expeditionary time he became instructor of surgery at the Forces. Bob Osgood obtained his commission in the In 1910, in collaboration with Dr. This operation forecast the pattern of the Expeditionary Forces, he was transferred to the operation that has since been followed, only the British Medical War Office in London, where he silk suture has been replaced by stainless-steel served 6 months as deputy to Major General Sir wire and fusion has been combined with the Robert Jones, chief of the orthopedic section of fixation. This assignment brought him into The First World War presented a great chal- close personal relationship with Sir Robert Jones, lenge to medical science in meeting the emergen- whom he quickly learned to love. Indeed, it was cies and needs of caring for thousands of because of the friendly relations he established wounded. When the French and British armies with the British orthopedic surgeons that he was were locked in trench warfare with the Germans able, at the end of the war, to help in the found- along the Belgian and French frontiers in 1915, ing of the British Orthopedic Association, which there was formed a Harvard surgical unit to work had seemed impossible previously, largely in rotation with other American university units because of local rivalries and failure to attain at the American Ambulance in Neuilly. Full headed by Harvey Cushing, with Robert Osgood acknowledgment has been made by some of the 253 Who’s Who in Orthopedics founding members of this Association of the ship because it brought together for the first time unique role played by Robert Osgood in its for- general surgeons who were interested in fractures mation. In February 1918, Robert Osgood was attended by 50 or more general and orthopedic attached to the office of the chief surgeon of the surgeons of great individuality and reputation. It American Expeditionary Forces at Tours, where seemed impossible that such men as Ashley he served as a deputy to Colonel Goldthwait, who Ashurst of Philadelphia, William Sherman of was then responsible for development of the army Pittsburgh, Charles Scudder of Boston, Kellogg orthopedic service under the chief surgeon. Later Speed of Chicago, to name only a few, could get Bob Osgood was recalled to the United States to together with a group of orthopedic surgeons and serve as orthopedic consultant to the Surgeon achieve a meeting of the minds on the treatment General. In this position he did valuable work of fractures; yet, this was accomplished and through periodic visits to the large base hospitals the results were published in a bulletin of the in the United States, where he was able not only American College of Surgeons entitled A Primer to examine the quality of the work being done but of Fracture Treatment. This was reprinted many also, because of his large experience, to help in times and was later translated into many foreign the solving of individual problems. From this first meeting emerged the charged in 1919 with the rank of Colonel in the Fracture Committee of the American College of Medical Reserve Corps. Surgeons, an organization on a national scale, Upon returning to Boston and upon the retire- which was established to improve both the ment of Dr. Elliott Brackett, Bob Osgood was emergency care and the final treatment of frac- promoted to head of the orthopedic service of the tures. His weekly expanded to become the Committee on Trauma of orthopedic rounds were stellar performances, not the American College of Surgeons. Ultimately he summarized the pedic Service at the Boston Children’s Hospital; discussions, which clearly guided the final deci- this carried with it the title of Professor of Ortho- sions as to treatment. In enough to maintain his technical skill, feeling 1924, he was made John B. In accepting this himself to his residents, learning to know them appointment, Bob Osgood insisted upon and and their families personally, so that he was famil- obtained a concession from the Dean and Faculty iar with all their problems.

Three hips needed total hip arthroplasty and 1 hip needed hemiprosthetic arthroplasty discount kamagra effervescent 100mg line erectile dysfunction cure. The JOA hip score increased from a preoperative average of 71 points (range cheap kamagra effervescent 100 mg on line erectile dysfunction doctor philippines, 28–78 points) to 85 points (range, 50–100 points) at the most recent follow-up. The average postoperative LHI was 48% in the excellent or good groups and 23% in the fair or poor groups (Mann–Whitney U test, P = 0. In 28 hips with equal to or greater than 25% of postoperative LHI, 24 (86%) hips showed good or excellent results. One patient underwent reoperation 1 year after the initial osteotomy Varus Intertrochanteric Osteotomy 23 a Fig. Radiographic findings of a 47-year-old man with steroid-induced osteonecrosis of the right hip. Reduction in the size of necrotic lesions was found (arrows), and the clinical result was excellent a Fig. Radiographic findings of a 27-year-old man with steroid-induced osteonecrosis of the left hip. The patient reported no hip pain; however, a limp due to limb shortening was observed with placement of a bone graft that later showed radiographic union. In the group of 6 hips with varus correction greater than 25°, the rate of limping at the final outcome (4 of 6) was significantly higher than that of the remaining 34 hips with varus correction less than 25° (6 of 34) (Fisher’s exact test, P < 0. There were no other significant complications such as deep infection or pulmonary embolism. Discussion Several studies have advocated varus intertrochanteric osteotomy in hips in which a lateral intact area of the femoral head can be placed into the acetabular weight- bearing portion by osteotomy [1,14,15,19–21]. They reported that when the superolateral and posterior surfaces of the femoral head remained normal, good results were obtained. Our findings indicate that if necrotic lesions are limited medially and the lateral part of the femoral head remains intact, good long-term results can be obtained by simple varus osteotomy, which supports the results of Kerboul et al. Excessive varus correction is related to a high incidence of postoperative limp because of abductor muscle weakness and limb shortening. Our results indicated that excessive varus correction should be avoided and that the correction angle should be planned up to 25°. In hips with correction angles within 25°, postoperative limp was sometimes found several months after the osteotomy, but this usually improved within 1 or 2 years. Sugioka reported a technique of transtrochanteric anterior rotational osteotomy for osteonecrosis in 1978. Successful results by this technique were described by several other Japanese surgeons [10,18,23]. In the United States, however, successful results were not obtained with this technique [11,12,13]. Sugioka’s osteotomy has sometimes been described as a technically demanding procedure [11–13,19]. In the surgical technique of intertrochanteric osteotomy, it is often difficult to obtain precise correction angles as preoperatively planned. Varus-valgus angulation correction is relatively easy by measuring the angle of the guided Kirschner wires in relation to the femur shaft. Flexion-extension correction is sometimes difficult because the intra- operative lateral views of intertrochanteric regions are sometimes slightly oblique when the patient is in the operative lateral decubitus position, and corrective guides such as Kirschner wires on the true lateral view sometimes do not depict true flexion- extension correction angles. We therefore prefer simple varus osteotomy in which flexion-extension correction does not have to be considered. In the radiographic follow-up, a demarcation line and sclerotic change in the necrotic area were found during the follow-up period in successfully treated hips. Demarcation lines and sclerotic changes in the necrotic lesions that gradually reduce in size represent the repair process of osteonecrosis. Varus intertrochanteric osteotomy may be indicated if the intact area occupies a Varus Intertrochanteric Osteotomy 25 larger area in the superolateral portion, an assertion that coincides with the findings of the present study. In conclusion, hips with a small-to-medium necrotic lesion, a medial necrotic location, postoperative LHI greater than 25%, and a thick demarcation line seen on radiography with sclerotic change in the necrotic lesion are the best indications for osteotomy. Merle d’Aubigné R, Postel M, Mazabraud A, et al (1965) Idiopathic necrosis of the femoral head in adults. Ohzono K, Saito M, Takaoka K, et al (1991) Natural history of nontraumatic avascular necrosis of the femoral head.

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A representative case (case 1) that had advanced osteoarthritis (OA) 28 years after operation buy cheap kamagra effervescent 100mg on line erectile dysfunction treatment costs. A representative case (case 2) that had no OA changes 27 years after operation effective 100mg kamagra effervescent erectile dysfunction patient.co.uk doctor. A representative case (case 3) that had no OA changes 26 years after operation. Cases operated on at an early stage are apt to experience good prognosis. Stage at operation is another important factor to influence the clinical outcome. When osteotomy is carried out at an early stage and prevents progression of collapse, this could prevent disease dete- rioration or maintain hip function without clinical symptoms even more than 25 years after operation. Experience of Osteotomy in Kyushu University Between 1980 and 1988 Previously, we examined 125 cases that had undergone operations between 1980 and 1988. Twenty-eight hips had collapse progression more than 10 years after opera- tion. We found that the postoperative intact ratio in the nonprogression group was significantly larger than that in the progression group. A minimum postoperative intact ratio to prevent collapse progression over a 10-year period was 34% (Fig. According to that study, the aim of osteotomy is to achieve more than 34% of the Long-Term Experience of Osteotomy for Femoral Head Osteonecrosis 85 Fig. Kaplan–Meier survival curve of groups with a postoperative intact ratio of more than 34% and with a ratio less than 34%. A Current Representative Case Sugioka has reported good clinical outcome of osteotomy for ONFH. However, there are many reports that show poor clinical outcome, especially as concerns rotational osteotomy [6–8]. The most important issue about osteotomy treatment may be whether osteotomy could be carried out successfully by others than Sugioka. In our department, osteotomy treatment has been carried out according to the principles based on our long experience. A current representative case is shown, a 33-year-old woman who had bilateral steroid-induced osteonecrosis. Radiographs and magnetic resonance imaging (MRI) show a wide osteonecrosis area, and the intact area was limited to the posterior surface of the femoral head (Fig. According to the preoperative planning, ARO with 20° varus position was expected to result in more than 34% of the ratio of the intact articular in both the joints. The osteotomy was carried out in the right hip joint, and then in the left hip 2 months after the first operation. Four years after operations, collapse has not progressed in either of the hip joints, and no OA changes are observed in the postoperative radiographs (Fig. She has no problems in walking, squatting, and going up and down the stairs (Fig. Clinical scores of both hip joints are 100 points, and she has returned to work. Preoperative radiographs and magnetic resonance (MR) images of a current representa- tive case. Radiographs of bilat- eral hip joints just after oste- otomy (a) or 4 years after osteotomy (b) Long-Term Experience of Osteotomy for Femoral Head Osteonecrosis 87 Fig. Osteotomy is a promising treatment option for ONFH, especially for young patients. We believe that experienced hip surgeons can perform osteotomy, including ARO, successfully once they understand the indica- tions and techniques. Sugioka Y (1978) Transtrochanteric anterior rotational osteotomy of the femoral head in the treatment of osteonecrosis affecting the hip. Sugioka Y, Hotokebuchi T, Tsutsui H (1992) Transtrochanteric anterior rotational osteotomy for idiopathic and steroid-induced necrosis of the femoral head. Nishio A, Sugioka Y (1971) A new technique of the varus osteotomy at the upper end of the femur. Hosokawa A, Mohtai M, Hotokebuchi T, et al (1997) Transtrochanteric rotational oste- otomy for idiopathic and steroid-induced osteonecrosis of the femoral head: indica- tions and long-term follow-up. In: Urbaniak JR, Jones JP Jr (eds) Osteonecrosis, etiology, diagnosis and treatment.

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