ORTHOPAEDICS Patients Deteriorate Awaiting Treatment

Press, Volume CIV, Issue 30763, 29 May 1965, Page 16

ORTHOPAEDICS Patients Deteriorate Awaiting Treatment

Patients with hip or knee joints in the early stages of arthritis often deteriorated “immeasurably” during their two or three years on the hospital waiting-list, Mr A. B. Mackenzie, visiting orthopaedic surgeon to the North Canterbury Hospital Board, told the annual conference of the Orthopaedic Technicians’ Association.

Those whose joints were only just starting to give trouble should be brought into hospital with “some degree of priority," otherwise the joint could deteriorate beyond repair, Mr Mackenzie said.

' This was particularly imi portant for the hip joint, (where patients often had only [a cyst or two on, the bones at the joint when first seen. | By the time they had been a year or two on the waitinglist, deterioration might be ! irreversible. [ “If course, we can usually do something even where I deterioration has gone a long | way. but we can do a lot more I if we get in early.” he said. The cost of hospital beds—l now £7 7s a day—had become an important consideraI tion for the surgeon. The (emphasis was to help patients get up as early as possible. In cases of spinal arthritis, for example, where adjacent vertebrae were often secured by putting a bone graft between the spiny processes I which stick out from the main [section of the bone, it had formerly been necessary to keep patients in bed for many weeks for fear of disturbing the graft. This was now often overcome by fixing the graft with vitalium metal screws which allowed the patient to get up within three or four weeks and leave hospital soon afterwards. Best Patients In general, the patients who healed fastest after a bone operation were those who worried least. A mentally handicapped person whom he had operated on recently had proved an ideal patient because he had no inhibitions about using the affected limb. Mr Mackenzie said there had been a “swing of the pendulum” away from plastic and metal materials in joint surgery. The sculpture of bone (ostetomy), not long ago thought old-fashioned, had come back into its own again, supplemented by “Kiel

i bone,” which was deprotein ised animal bone.

Plastic or metal insertion had not proved generally satisfactory in cases of arthritis because, although they were usually extremely comfortable for six months or a year, they often started to give trouble after two or three years and commonly came adrift from the bone to which they were fixed. Supports of vitalium were ;still widely used, however, sometimes in conjunction with a vitalium ball which took the place of the top end of a [a thigh bone. The supports were fixed to the bone by screws. A new drilling I machine for bone had re[cently arrived at Christchurch Hospital. It was about the size and shape of a large cylindrical torch, and was run by a nickel-cadmium battery. Swedish Method A Swedish surgeon had recently been using a metal knee-joint which took the place of the ends of the adjacent bones. “We don't know whether it would work loose in time, but at any rate it could be valuable where patients are confined to a wheelchair,” said Mr Mackenzie. “1 wouldn’t like to try it on anyone else at the moment.” ) He said that where toes were completely stiff from arthritis, the position was often best met by removing the toes and some of the bone from the underside of the metatarsals (the bones of the central part of the foot). “This sounds a bad operation, but often gives immeasurable comfort and the foot looks no worse than it does with callosities and bunions and stiff toes,” he added.

Another operation involving the bones of the foot was the realignment of a big toe which stuck out at an angle. The condition was a throwback to man’s pre-human ancestors whose big toes were splayed out in that way.