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Repair of critical long bone defects using frozen bone allografts coated with an rhBMP-2-retaining paste

Abstract Background Massive frozen stocked allogeneic bone grafts are often used to reconstruct large bone defects caused by trauma or tumor resections. However, the long-term failure rate of such massive allografts was reported to be 25% because of infection, fracture, and nonunion. In this study, we evaluated the ability of a recombinant human bone morphogenetic protein (rhBMP)-2-retaining paste to promote the osteogenic potential of frozen stocked allogeneic bone grafts to repair intercalated femoral shaft defects in a rat model. Methods After confirming the transplantation intolerance between two rat strains (Wistar and Lewis) by skin transplantation from Lewis rats to Wistar rats, an 8-mm-long bone segment was removed from the Wistar rats, and a frozen stocked allograft coated with the rhBMP-2-retaining paste from the Lewis rats was placed into the defect and subjected to intramedullary fixation with an 18-gauge injection needle pin. The allografted femurs were evaluated by radiographic, histologic, and biomechanical examinations at specified time points. Results The results revealed successful repair of critical-size cortical bone defects by implanting frozen stocked allografts coated with the rhBMP-2-retaining synthetic biodegradable carrier paste from an immunologically intolerant host. Conclusions This experimental study suggest that allogeneic bone grafting in combination with rhBMP-2 and its local delivery system may represent an innovative approach to the reconstruction of bone defects. Content Type Journal ArticleCategory Original ArticlePages 1-9DOI 10.1007/s00776-012-0196-xAuthors Hiroyuki Yasuda, Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, 545-8585 JapanKoichi Yano, Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, 545-8585 JapanShigeyuki Wakitani, Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, 545-8585 JapanTomiya Matsumoto, Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, 545-8585 JapanHiroaki Nakamura, Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, 545-8585 JapanKunio Takaoka, Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, 545-8585 Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658

Consecutive multilevel vertebral Paget’s disease of the lumbar spine: a rare Asian case and the differential diagnosis

Consecutive multilevel vertebral Paget’s disease of the lumbar spine: a rare Asian case and the differential diagnosis Content Type Journal ArticleCategory Case ReportPages 1-5DOI 10.1007/s00776-011-0181-9Authors Guang-Sheng Li, Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-Sen University, 183 Huangpu East Road, 510700 Guangzhou, ChinaHou-Qing Long, Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-Sen University, 183 Huangpu East Road, 510700 Guangzhou, ChinaEr-Jian Lin, Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, 183 Huangpu East Road, 510700 Guangzhou, ChinaHao-Miao Li, Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-Sen University, 183 Huangpu East Road, 510700 Guangzhou, ChinaShao-Yu Liu, Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-Sen University, 183 Huangpu East Road, 510700 Guangzhou, China Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658

The use of the Lima reverse shoulder arthroplasty for the treatment of fracture sequelae of the proximal humerus

Abstract Background Experience treating proximal humerus fracture sequelae with reverse total shoulder arthroplasty is limited. We report our results. Patients Forty-four patients with sequelae of a proximal humeral fracture were treated with a reverse total shoulder prosthesis. There were 26 women and 18 men, with a mean age of 77 years (range, 74–84 years). The mean follow-up after reverse arthroplasty was 48 months (range, 40–84 months). Results The mean Constant score increased from 28 preoperatively to 58 postoperatively (p < 0.0001). The average anterior elevation increased from 40° to 100° (p < 0.0001), abduction from 41° to 95° (p < 0.0001), external rotation from 15° to 35° (p < 0.0001) and internal rotation from 25° to 60° (p < 0.0001). The average subjective shoulder score increased from 13% preoperatively to 56% postoperatively (p < 0.0001). All but six patients would undergo the same procedure again if faced with the same problem. Twenty-four patients were very satisfied, 14 satisfied and 6 unhappy with the operation. Six prosthetic dislocations occurred (13.6%). Two of them were successfully treated by adding an extension to the humeral neck component to increase the offset and tension. In the other four dislocations this procedure failed, and the prosthesis was revised and converted to a hemiarthroplasty. There was one case of glenoid component loosening that was converted to a hemiarthroplasty. Conclusions The reverse total shoulder arthroplasty improves function and motion in patients with proximal humeral fracture sequelae. However, the dislocation rate is high. Content Type Journal ArticleCategory Original ArticlePages 1-7DOI 10.1007/s00776-011-0185-5Authors Angel Antonio Martinez, Department of Orthopaedic and Trauma Surgery, Miguel Servet University Hospital, C/Calamita s/n, Avda. Juan Pablo II, 48, 9°G, 50009 Zaragoza, SpainAngel Calvo, Department of Orthopaedic and Trauma Surgery, Miguel Servet University Hospital, C/Calamita s/n, Avda. Juan Pablo II, 48, 9°G, 50009 Zaragoza, SpainCarlos Bejarano, Department of Orthopaedic and Trauma Surgery, Miguel Servet University Hospital, C/Calamita s/n, Avda. Juan Pablo II, 48, 9°G, 50009 Zaragoza, SpainIgnacio Carbonel, Department of Orthopaedic and Trauma Surgery, Miguel Servet University Hospital, C/Calamita s/n, Avda. Juan Pablo II, 48, 9°G, 50009 Zaragoza, SpainAntonio Herrera, Department of Orthopaedic and Trauma Surgery, Miguel Servet University Hospital, C/Calamita s/n, Avda. Juan Pablo II, 48, 9°G, 50009 Zaragoza, Spain Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658

The effects of rotator cuff tears, including shoulders without pain, on activities of daily living in the general population

Abstract Background Few reports have so far evaluated the possible restrictions of activities of daily living (ADL) in patients with asymptomatic rotator cuff tears (RCTs). The purpose of this study was to examine the effects of RCTs, including shoulders without pain, on ADL in the general population. Methods We performed medical checkups on 462 individuals (924 shoulders). All participants completed a questionnaire regarding their background and medical history. We then assessed their shoulder functions with the Simple Shoulder Test (SST) and performed US (US) examinations of both shoulders to diagnose RCTs. We divided participants into tear and nontear groups and performed statistical analysis to compare total SST scores and each SST item between groups. Furthermore, we performed the same examinations for participants identified as having shoulders without pain. Results Among participants, those in the tear group showed significantly lower total SST scores than those in the nontear group. After examining each SST item, a significant difference was observed regarding the ability to sleep comfortably and to lift 3.6 kg to shoulder level. In shoulders without pain, the tear group showed significantly lower total SST scores than the nontear group. A significant difference was observed only regarding the ability to lift 3.6 kg to shoulder level. Conclusions In the general population, ADL were restricted in participants with RCTs; they experienced night pain in the shoulder and muscle weakness during shoulder elevation. Furthermore, participants with RCTs, even if the condition itself did not induce any pain, tended to experience muscle weakness during shoulder elevation, thus resulting in restrictions of ADL. Content Type Journal ArticleCategory Original ArticlePages 1-5DOI 10.1007/s00776-011-0186-4Authors Daisuke Nakajima, Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511, JapanAtsushi Yamamoto, Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511, JapanTsutomu Kobayashi, Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511, JapanToshihisa Osawa, Department of Orthopaedic Surgery, National Hospital Organization Takasaki Hospital, 36, Takamatsu-machi, Takasaki, Gunma 370-8537, JapanHitoshi Shitara, Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511, JapanTsuyoshi Ichinose, Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511, JapanEiji Takasawa, Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511, JapanKenji Takagishi, Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511, Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658

A case of selective arterial embolization for recurrent hemarthrosis after total knee arthroplasty

A case of selective arterial embolization for recurrent hemarthrosis after total knee arthroplasty Content Type Journal ArticleCategory Case ReportPages 1-4DOI 10.1007/s00776-011-0192-6Authors Yasunobu Takezawa, Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566 JapanYuji Arai, Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566 JapanShinya Fujita, Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566 JapanTakuji Yamagami, Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566 JapanOsamu Tanaka, Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566 JapanToshikazu Kubo, Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566 Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658

Myositis ossificans of the rotator cuff muscle

Myositis ossificans of the rotator cuff muscle Content Type Journal ArticleCategory Case ReportPages 1-4DOI 10.1007/s00776-011-0187-3Authors Taku Hatta, Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574 JapanMasahito Hatori, Department of Orthopaedic Surgery, Tohoku Kosai Hospital, 2-3-11 Kokubuncho, Aoba-ku, Sendai, 980-0803 JapanHirotaka Sano, Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574 JapanMunenori Watanuki, Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574 JapanKoshi N. Kishimoto, Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574 JapanMasami Hosaka, Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574 JapanEiji Itoi, Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574 Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658

Preliminary study of the biomechanical behavior and physical characteristics of tantalum (Ta)-coated prostheses

Abstract Background Use of Ta biomaterials in medicine started in the middle of the last century. The good biocompatibility and chemical stability, and the unique physical characteristics of Ta metal have resulted in many possible developments of Ta biomaterials. Methods In this study, histopathological observation, histomorphometric analysis, scanning electron microscope (SEM) observation, energy-dispersive X-ray spectroscopy (EDX) analysis, biomechanical testing, and examination of the coating’s mechanical strength have been used to evaluate the value of clinical application of Ta-coated prostheses prepared by a plasma-spraying process. Results Histopathological observation has demonstrated that the periprosthetic new bone tissues tightly and stably adhere to the Ta coating after the implantation, with no signs of loosening. Early after implantation, there is no significant difference in periprosthetic bone volume and ultimate shear strength between Ta-coated and Ti-coated prostheses (P > 0.05). EDX analysis suggests that the ultimate shear stress does not damage Ta coating. Mechanical strength testing shows that the adhesive strength and Vicker’s surface hardness (HV) of the Ta coating are significantly higher than those of the Ti coating (P < 0.01). Conclusions Ta coating has good stability and bone biocompatibility; the extraordinary physical characteristics of Ta coating have great significance in maintaining prosthetic stability and surface porosity after implantation. Content Type Journal ArticleCategory Original ArticlePages 1-13DOI 10.1007/s00776-011-0191-7Authors Yonghong Duan, Orthopedic Institute of Chinese People’s Liberation Army, Xijing Hospital, Fourth Military Medical University, 710032 Xi’an, Shaanxi, People’s Republic of ChinaLie Liu, Department of Orthopaedic Surgery, Baoji Central Hospital, 721008 Baoji, Shaanxi, ChinaLing Wang, Institute of Health Statistics, Chinese People’s Liberation Army, Fourth Military Medical University, 710032 Xi’an, Shaanxi, ChinaFei Guo, Department of Orthopaedic Surgery, Linton Sanitarium of Chinese People’s Liberation Army, 710600 Xi’an, Shaanxi, ChinaHaoping Li, Department of Stomatology, 451 Hospital of Chinese People’s Liberation Army, 710061 Xi’an, Shaanxi, ChinaLei Shi, Orthopedic Institute of Chinese People’s Liberation Army, Xijing Hospital, Fourth Military Medical University, 710032 Xi’an, Shaanxi, People’s Republic of ChinaMao Li, Orthopedic Institute of Chinese People’s Liberation Army, Xijing Hospital, Fourth Military Medical University, 710032 Xi’an, Shaanxi, People’s Republic of ChinaDayu Yin, Orthopedic Institute of Chinese People’s Liberation Army, Xijing Hospital, Fourth Military Medical University, 710032 Xi’an, Shaanxi, People’s Republic of ChinaChi Jiang, Sichuan Institute of Materials and Technology, 621900 Mianyang, Sichuan, ChinaQingsheng Zhu, Orthopedic Institute of Chinese People’s Liberation Army, Xijing Hospital, Fourth Military Medical University, 710032 Xi’an, Shaanxi, People’s Republic of China Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658

Galeazzi’s modified technique for recurrent patella dislocation in skeletally immature patients

Abstract Background A large number of surgical techniques have been proposed for the treatment of recurrent patellar dislocation in adolescents, one of the most famous being Galeazzi’s semitendinosus tenodesis as modified by Baker. The aim of this study was to verify the mid-term results of this technique, the effectiveness of restoring the patellofemoral congruency, by both static and dynamic computed tomography (CT), and to determine whether the preoperative type of patellofemoral relationship affects the results. Methods The study included 14 patients (16 knees), with a mean age of 11.6 years, Tanner stage ≤3, with at least two to three episodes of patellar dislocation. The patients underwent surgery using Baker's modification of Galeazzi’s technique. All 14 patients were evaluated preoperatively and at least 4 years afterward by static and dynamic CT. Clinical evaluation at follow-up was performed using the criteria described by Crosby and Insall. Results Clinical results at follow-up were excellent in 62.5% and good in 37.5%. As preoperative evaluation showed a high patella in 7 out of 16 knees, two groups were considered: A, high patella; B, not high patella. The data obtained with static CT show that the patella reached a satisfactory congruence in all knees. The data obtained with dynamic CT showed different results between group A and B. A preoperative high patella remains high with quadriceps contraction and again shows the change of tilt and subluxation. In group B, the data obtained with dynamic CT are comparable with those obtained with static CT. Conclusions This technique produces good mid-term clinical results. However, the dynamic CT showed that in those patients with high patellas, semitendinosus tenodesis alone is not enough to stabilize the patella. Content Type Journal ArticleCategory Original ArticlePages 1-8DOI 10.1007/s00776-011-0189-1Authors Angelo Gabriele Aulisa, Orthopaedics and Traumatology Department, Bambino Gesù Children’s Hospital, Institute of Scientific Research, Piazza San Onofrio 4, 00165 Rome, ItalyFrancesco Falciglia, Orthopaedics and Traumatology Department, Bambino Gesù Children’s Hospital, Institute of Scientific Research, Piazza San Onofrio 4, 00165 Rome, ItalyMarco Giordano, Orthopaedics and Traumatology Department, Bambino Gesù Children’s Hospital, Institute of Scientific Research, Piazza San Onofrio 4, 00165 Rome, ItalyPietro Savignoni, Orthopaedics and Traumatology Department, Bambino Gesù Children’s Hospital, Institute of Scientific Research, Piazza San Onofrio 4, 00165 Rome, ItalyVincenzo Guzzanti, Orthopaedics and Traumatology Department, Bambino Gesù Children’s Hospital, Institute of Scientific Research, Piazza San Onofrio 4, 00165 Rome, Italy Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658

Development of a screening tool for risk of locomotive syndrome in the elderly: the 25-question Geriatric Locomotive Function Scale

Abstract Objective To evaluate the reliability and validity of a new questionnaire, the 25-question Geriatric Locomotive Function Scale (GLFS-25), for early detection of locomotive syndrome. Methods This new screening tool was designed to detect Japanese individuals under high-risk conditions who may soon require care services because of problems of the locomotive organs. Content validity, construct validity, criterion validity, internal-consistency reliability, and reproducibility (test-retest reliability) were examined using psychometric analysis, and a cutoff score to detect locomotive syndrome was determined. To investigate construct validity of the GLFS-25 and determine the cutoff score, the Akaike Information Criteria (AIC) were used. Results Study 1 analyzed 711 Japanese elderly people ≥65 years old. No floor or ceiling effects were included in the GLFS-25. Internal consistency was confirmed by a Cronbach’s α reliability coefficient of 0.961. As for the association between the GLFS-25 and European Quality of Life Scale-5 Dimensions (EQ-5D), Spearman’s correlation coefficient was 0.85 (P < 0.001), showing excellent concurrent validity of the GLFS-25. Categorical principal component analysis showed that the construct structure consisted of one item cluster or the GLFS-25 was unifactorial. The AIC showed that one cluster of seven items was located in the center, with significant associations with the other five clusters. In study 2, 205 individuals were analyzed, and the test-retest interclass correlation was satisfactory (range 0.712–0.924). The cutoff score for identifying locomotive syndrome was set at 16. Validity and reliability of this new measurement were psychometrically confirmed as sufficient. Conclusions The GLFS-25 offers a valid and reliable questionnaire scale for detecting locomotive syndrome in elderly Japanese individuals. Content Type Journal ArticleCategory Original ArticlePages 1-10DOI 10.1007/s00776-011-0193-5Authors Atsushi Seichi, Department of Orthopedics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, JapanYuichi Hoshino, Department of Orthopedics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, JapanTokuhide Doi, Fukuoka Clinic, Tokyo, JapanMasami Akai, National Rehabilitation Center for Persons with Disabilities, Tokorozawa, JapanYoshiko Tobimatsu, National Rehabilitation Center for Persons with Disabilities, Tokorozawa, JapanTsutomu Iwaya, National Rehabilitation Center for Persons with Disabilities, Tokorozawa, Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658

Incidence of venous thromboembolism after spine surgery

Abstract Background The incidence of venous thromboembolism (VTE) has varied among studies of patients undergoing elective spine surgery. This may be because of differences in prophylaxis for VTE and differences in methods of observation. Furthermore, some studies have reported symptomatic deep vein thrombosis (DVT) or pulmonary thromboembolism (PE), whereas others have included asymptomatic DVT or PE, making comparisons difficult. Therefore, the objective of this study was to determine the incidence of symptomatic and asymptomatic PE in patients undergoing elective spine surgery and to evaluate therapeutic methods for these conditions. Methods The subjects were 1975 patients who underwent spine surgery in our hospital from 1990 to 2011. Patients treated from January 1990 to November 1996 (n = 541, Group A) did not receive prophylaxis whereas those treated from January 2000 to February 2011 (n = 1,434, Group B) used a foot pump during and after surgery and subsequently wore elastic stockings. All subjects in Group A began ambulation ≥2 weeks after surgery whereas those in Group B began to walk earlier—within 3 days for patients who underwent decompression and within 1 week for those treated with fusion. From June 2010 to February 2011, contrast-enhanced computed tomography (CT) was performed 1 week after surgery for 100 patients to evaluate the presence of DVT and PE. Since March 2004, D-dimer was measured 1 week after surgery and patients with a level ≥10 μg/mL were followed up. Results The incidence of symptomatic PE was significantly higher in Group A than in Group B (8/541, 1.5% vs. 3/1,434, 0.2%). In 3 patients in Group B, PE developed within 1 week postoperatively and D-dimer values at onset were ≤10 μg/mL. In the 100 cases examined by contrast-enhanced computed tomography (CT), asymptomatic PE and VTE were detected in 18 and 19%, respectively. The D-dimer level 1 week after surgery was ≥10 μg/mL in 105 of 841 patients; however, none of these patients had clinically symptomatic VTE for at least 3 months postoperatively. Conclusions Mechanical prophylaxis and early ambulation may be effective in reducing the incidence of symptomatic PE after spine surgery. Asymptomatic PE developed in 18% of patients who received mechanical prophylaxis, but the incidence of symptomatic PE was only 0.2%. Prompt diagnosis and treatment are required for patients who develop symptomatic PE. Content Type Journal ArticleCategory Original ArticlePages 1-4DOI 10.1007/s00776-011-0188-2Authors Hiroshi Takahashi, Department of Orthopaedic Surgery, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541 JapanYuichiro Yokoyama, Department of Orthopaedic Surgery, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541 JapanYasuaki Iida, Department of Orthopaedic Surgery, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541 JapanFumiaki Terashima, Department of Orthopaedic Surgery, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541 JapanKeiji Hasegawa, Department of Orthopaedic Surgery, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541 JapanTakashi Saito, Department of Orthopaedic Surgery, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541 JapanToru Suguro, Department of Orthopaedic Surgery, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541 JapanAkihito Wada, Department of Orthopaedic Surgery, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541 Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658

Characteristic shape of the lateral femoral condyle in patients with osteochondritis dissecans accompanied by a discoid lateral meniscus

Abstract Background There are various indirect signs of a discoid lateral meniscus in radiographs, for example lateral joint space widening, hypoplasia of the LFC, etc. There has, however, been no previous report of the characteristic shape of the lateral femoral condyle (LFC) in patients with osteochondritis dissecans (OCD) accompanied by a discoid lateral meniscus. The purpose of this study was to evaluate the characteristic shape of the LFC in patients with OCD accompanied by a discoid lateral meniscus, and sex differences associated with the shape of the LFC in those patients. Methods This study included 29 males (31 knees) and 29 females (32 knees) of average age 17.7 years. There were 15 knees in 15 patients that were accompanied by OCD of the LFC (9 males, 9 knees; 6 females, 6 knees; average age 14.9 years; OCD group). There were 48 knees in 43 patients that were not accompanied by OCD of the LFC (20 males, 22 knees; 23 females, 26 knees; average age 17.6 years; non-OCD group). Standardized Rosenberg view radiographs of the knee were obtained for all patients. We evaluated the shape of LFC using the Rosenberg view and measured the condylar prominence ratio of the medial and lateral condyles adjacent to the intercondylar notch, in accordance with Ha’s procedure. Results The OCD group had a significantly larger prominence ratio than the non-OCD group. The prominence ratio for males was significantly larger than that for females. Conclusion We clearly demonstrated that the prominence ratio in the OCD group was significantly larger than that in the non-OCD group, indicating that the shape of the LFC and OCD in the LFC may be associated with the development of these lesions. Content Type Journal ArticleCategory Original ArticlePages 1-5DOI 10.1007/s00776-011-0190-8Authors Goki Kamei, Department of Orthopaedic Surgery, Graduate School of Biomedical Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551 JapanNobuo Adachi, Department of Orthopaedic Surgery, Graduate School of Biomedical Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551 JapanMasataka Deie, Department of Physical Therapy and Occupational Therapy, Graduate School of Health Science, Hiroshima University, Hiroshima, JapanAtsuo Nakamae, Department of Orthopaedic Surgery, Graduate School of Biomedical Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551 JapanTomoyuki Nakasa, Department of Orthopaedic Surgery, Graduate School of Biomedical Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551 JapanHayatoshi Shibuya, Department of Orthopaedic Surgery, Graduate School of Biomedical Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551 JapanAtsushi Okuhara, Department of Orthopaedic Surgery, Graduate School of Biomedical Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551 JapanTakuya Niimoto, Department of Orthopaedic Surgery, Graduate School of Biomedical Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551 JapanHiromi Kazusa, Department of Orthopaedic Surgery, Graduate School of Biomedical Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551 JapanShingo Ohkawa, Department of Orthopaedic Surgery, Graduate School of Biomedical Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551 JapanKobun Takazawa, Department of Orthopaedic Surgery, Graduate School of Biomedical Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551 JapanAkio Eguchi, Department of Orthopaedic Surgery, Graduate School of Biomedical Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551 JapanMitsuo Ochi, Department of Orthopaedic Surgery, Graduate School of Biomedical Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551 Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658

Outcomes of Charnley total hip arthroplasty using improved cementing with so-called second- and third-generation techniques

Abstract Background Techniques of cemented total hip arthroplasty have developed over time. We present the outcomes of Charnley total hip arthroplasty performed using improved second- and third-generation cementing techniques. Methods We reviewed the radiologic results of 91 Charnley total hip arthroplasties performed using second- and third-generation cementing techniques. Second-generation techniques involved making multiple anchor holes, a double-cementing method on the acetabular side and an intramedullary plug, and retrograde filling with a cement gun on the femoral side in 57 hips. Third-generation techniques involved additional vacuum mixing and cement pressurization in 34 hips. Results Joint survival rates at 20 years when using second-generation techniques were 89% for the socket and 94% for the stem with aseptic loosening as the end point; the survival rates at 10 years when using third-generation techniques were 97 and 100%, respectively. According to our radiographic evaluation system for the clear zone at 5 years, there was less clear zone in the acetabular side with the third-generation techniques than with second-generation techniques. In the femoral side, there was very little development of the clear zone, but the difference between generations was not significant. Conclusions Second- and third-generation cementing techniques showed excellent survivorship. The clear zone scores at 5 years indicated that third-generation techniques were effective, especially in the acetabular side, and may produce better long-term results than second-generation techniques. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s00776-011-0180-xAuthors Shiro Hirose, Department of Orthopaedic Surgery, School of Medicine, Aichi Medical University, 21 Karimata Yazako, Nagakute-cho, Aichi 480-1195, JapanHiromi Otsuka, Department of Orthopaedic Surgery, School of Medicine, Aichi Medical University, 21 Karimata Yazako, Nagakute-cho, Aichi 480-1195, JapanTakkan Morishima, Department of Orthopaedic Surgery, School of Medicine, Aichi Medical University, 21 Karimata Yazako, Nagakute-cho, Aichi 480-1195, JapanKeiji Sato, Department of Orthopaedic Surgery, School of Medicine, Aichi Medical University, 21 Karimata Yazako, Nagakute-cho, Aichi 480-1195, Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658

Reoperation for recurrent lumbar disc herniation: a study over a 20-year period in a Japanese population

Abstract Background Many studies have been reported on recurrent lumbar disc herniations covering several pathological conditions. In those studies, reoperation rate of revised disc excisions was calculated by simple division between the number of reoperations and that of the total primary disc excisions. To determine the real reoperation rate, strict definition of pathologies, a large number of patients, a long observation period, and survival function method are necessary. Methods Between 1988 and 2007, 5,626 patients with disc excision were enrolled by the spine registration system of the Department of Orthopaedic Surgery, Tohoku University, Japan. Among them, 192 had revised disc surgery, and we obtained data of 186 patients whose clinical features were assessed and reoperation rates analyzed using the Kaplan–Meier method. Results In total, 205 disc herniations were excised in the revision surgery (including contralateral herniation at the same level and new herniation at a different level), and 101 were real recurrent herniations (recurrence at the same level and side as the primary herniation). The kappa coefficient of the spinal level and side between the primary and revision surgeries was 0.41, indicting moderate correlations. Real recurrent herniations showed shorter intervals between primary and revision surgeries. Male patients with surgery at a younger age carried a higher risk of reoperation. In the revision surgery, transligamentous extrusion was significantly more common than other types of herniation. On Kaplan–Meier analysis, the reoperation rate of overall revised excisions was 0.62% at 1 year, 2.4% at 5 years, 4.4% at 10 years, and 5.9% after 17 years. That of real recurrent herniations was 0.5%, 1.4%, and 2.1%, respectively, and 2.8% after 15.7 years. Conclusion Reoperation rate of real recurrent herniations calculated using survival function method gradually increased year by year, from 0.5% at 1 year after primary surgery to 2.8% at 15.7 years. Content Type Journal ArticleCategory Original ArticlePages 1-7DOI 10.1007/s00776-011-0184-6Authors Toshimi Aizawa, Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574 JapanHiroshi Ozawa, Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574 JapanTakashi Kusakabe, Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574 JapanTakeshi Nakamura, Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574 JapanAkira Sekiguchi, Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574 JapanAtsushi Takahashi, Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574 JapanTatsuro Sasaji, Department of Orthopaedic Surgery, Tohoku Rosai Hospital, Sendai, JapanShigeyuki Tokunaga, Department of Orthopaedic Surgery, Sendai Orthopaedic Hospital, Sendai, JapanTomonori Chiba, Department of Orthopaedic Surgery, Sen-en General Hospital, Tagajo, JapanNaoki Morozumi, Department of Orthopaedic Surgery, Nishitaga National Hospital, Sendai, JapanYutaka Koizumi, Department of Orthopaedic Surgery, Nishitaga National Hospital, Sendai, JapanEiji Itoi, Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574 Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658

Supination stress of the great toe for assessing intraoperative correction of hallux valgus

Abstract Background We have devised a new intraoperative technique (supination stress of the great toe) in which correction of hallux valgus and metatarsus primus varus, and reduction of the sesamoids could be simultaneously obtained at hallux valgus surgery. The purpose of this study was to prospectively investigate the efficacy of supination stress for assessing intraoperative correction of hallux valgus. Methods Thirty patients (31 feet) with an average age of 59.8 years who had hallux valgus were treated with a proximal metatarsal osteotomy. Supination stress under traction was manually applied to the great toe after release of the distal soft tissues and a proximal metatarsal osteotomy. C-arm fluoroscopy was used to verify correction of hallux valgus and to obtain dorsoplantar non-weightbearing images under supination stress. The dorsoplantar non-weightbearing fluoroscopic images were assessed preoperatively and at the time of intraoperative supination stress. The hallux valgus and intermetatarsal angles were measured. The position of the medial sesamoids was classified with a grading system ranging from I to VII as described by Hardy and Clapham. We defined a grade of IV or less as the normal position of the sesamoids and grade V or greater as lateral displacement of the sesamoids. Results The average hallux valgus angle was 34.3° preoperatively and 11.9° at the time of intraoperative supination stress. The average intermetatarsal angle was 16.4° preoperatively and 5.5° at the time of intraoperative supination stress (p < 0.0001, p < 0.0001, respectively). At the time of intraoperative supination stress, the hallux valgus angle was 20° or less in all feet, and the intermetatarsal angle was 10° or less in all feet. Preoperatively, all feet were classified as having lateral displacement of the sesamoids. At the time of intraoperative supination stress, all feet were classified as having normal positioning of the sesamoids. Conclusions Supination stress of the great toe was an effective maneuver for assessing intraoperative correction of hallux valgus and metatarsus primus varus, and reduction of the sesamoids. Content Type Journal ArticleCategory Original ArticlePages 1-7DOI 10.1007/s00776-011-0182-8Authors Ryuzo Okuda, The Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, JapanToshito Yasuda, The Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, JapanTsuyoshi Jotoku, The Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, JapanHiroaki Shima, The Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658

Osteomyelitis of the spine caused by mycobacterium avium complex in an immunocompetent patient

Osteomyelitis of the spine caused by mycobacterium avium complex in an immunocompetent patient Content Type Journal ArticleCategory Case ReportPages 1-6DOI 10.1007/s00776-011-0183-7Authors Tetsuya Suzuki, Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543 JapanHajime Murai, Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543 JapanNaohisa Miyakoshi, Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543 JapanMichio Hongo, Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543 JapanEiji Itoi, Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574 JapanYoichi Shimada, Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543 Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658

Spontaneous femoral neck fracture associated with a low serum level of vitamin D

Spontaneous femoral neck fracture associated with a low serum level of vitamin D Content Type Journal ArticleCategory Case ReportPages 1-4DOI 10.1007/s00776-011-0171-yAuthors Hirotaka Ohishi, Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaihu-cho, Hirosaki, Aomori 036-8562, JapanYoshihide Nakamura, Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaihu-cho, Hirosaki, Aomori 036-8562, JapanMasaki Kishiya, Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaihu-cho, Hirosaki, Aomori 036-8562, JapanSatoshi Toh, Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaihu-cho, Hirosaki, Aomori 036-8562, Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658

Multifocal extramedullary spinal sarcoid lesions mimicking leptomeningeal metastasis

Multifocal extramedullary spinal sarcoid lesions mimicking leptomeningeal metastasis Content Type Journal ArticleCategory Case ReportPages 1-4DOI 10.1007/s00776-011-0164-xAuthors Yasuyuki Shiraishi, Department of Orthopaedics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, JapanAtsushi Kimura, Department of Orthopaedics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, JapanAtsushi Seichi, Department of Orthopaedics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, JapanHirokazu Inoue, Department of Orthopaedics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, JapanKenichi Yamamuro, Department of Orthopaedics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, JapanMasahiro Kojima, Department of Orthopaedics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, JapanYuichi Hoshino, Department of Orthopaedics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658

Cervical intramedullary ependymoma masquerading as cervical spondylotic myelopathy on MRI analysis

Cervical intramedullary ependymoma masquerading as cervical spondylotic myelopathy on MRI analysis Content Type Journal ArticleCategory Case ReportPages 1-4DOI 10.1007/s00776-011-0165-9Authors Osahiko Tsuji, Department of Orthopaedic Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582 JapanMasaya Nakamura, Department of Orthopaedic Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582 JapanKanehiro Fujiyoshi, Department of Orthopaedic Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582 JapanKen Ishii, Department of Orthopaedic Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582 JapanKota Watanabe, Department of Advanced Therapy for Spine and Spinal Cord Disorders, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo, JapanNaobumi Hosogane, Department of Orthopaedic Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582 JapanTakashi Tsuji, Department of Orthopaedic Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582 JapanSuketaka Momoshima, Department of Radiology, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo, JapanYoshiaki Toyama, Department of Orthopaedic Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582 JapanKazuhiro Chiba, Department of Orthopaedic Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582 JapanMorio Matsumoto, Department of Orthopaedic Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582 Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658

Hematoma of the ligamentum flavum in the thoracic spine: report of two cases and possible role of the transforming growth factor beta-vascular endothelial growth factor signaling axis in its pathogenesis

Hematoma of the ligamentum flavum in the thoracic spine: report of two cases and possible role of the transforming growth factor beta-vascular endothelial growth factor signaling axis in its pathogenesis Content Type Journal ArticleCategory Case ReportPages 1-8DOI 10.1007/s00776-011-0150-3Authors Yoshihiro Matsumoto, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 JapanToshifumi Fujiwara, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 JapanRyuta Imamura, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 JapanYuko Okada, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 JapanKatsumi Harimaya, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 JapanToshio Doi, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 JapanKenichi Kawaguchi, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 JapanSeiji Okada, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 JapanYuichi Yamada, Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 JapanYoshinao Oda, Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 JapanYukihide Iwamoto, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658

Intraarticular epidermal cyst of knee

Intraarticular epidermal cyst of knee Content Type Journal ArticleCategory Case ReportPages 1-3DOI 10.1007/s00776-011-0151-2Authors Jung Ho Noh, Department of Orthopaedic Surgery, National Police Hospital, 58 Garakbon-dong, Songpa-gu, Seoul, 138-708 KoreaYoung Hak Roh, Department of Orthopaedic Surgery, National Police Hospital, 58 Garakbon-dong, Songpa-gu, Seoul, 138-708 KoreaHyo Jin Lee, Department of Pathology, National Police Hospital, Seoul, KoreaKyung Nam Ryu, Department of Radiology, Kyung Hee University Medical Center, Seoul, KoreaWoo Kim, Department of Orthopaedic Surgery, National Police Hospital, 58 Garakbon-dong, Songpa-gu, Seoul, 138-708 Korea Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658

Acromio-clavicular dislocation with coraco-clavicular ligament clavicular avulsion fracture

Acromio-clavicular dislocation with coraco-clavicular ligament clavicular avulsion fracture Content Type Journal ArticleCategory Case ReportPages 1-3DOI 10.1007/s00776-011-0140-5Authors Po-Ting Wu, Department of Orthopaedic Surgery, National Cheng Kung University Hospital, 138 Sheng Li Road, Tainan, 704 TaiwanEric P. Chiang, Department of Anesthesiology, George Washington University, Washington, DC, USAChii-Jeng Lin, Department of Orthopaedic Surgery, National Cheng Kung University Hospital, 138 Sheng Li Road, Tainan, 704 TaiwanWei-Ren Su, Department of Orthopaedic Surgery, National Cheng Kung University Hospital, 138 Sheng Li Road, Tainan, 704 Taiwan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658

Angiomatosis of the thoracic wall

Angiomatosis of the thoracic wall Content Type Journal ArticleCategory Case ReportPages 1-4DOI 10.1007/s00776-011-0129-0Authors Jelena Stojsic, Department for Respiratory and Thoracic Pathology, Service for Pathology, Clinical Centre of Serbia, Pasterova 2, 11000 Belgrade, SerbiaJelena Markovic, Department for Respiratory and Thoracic Pathology, Service for Pathology, Clinical Centre of Serbia, Pasterova 2, 11000 Belgrade, SerbiaDragan Subotic, Clinic for Thoracic Surgery, Clinical Centre of Serbia, Belgrade, SerbiaMilica Kontic, Clinic for Pulmonology, Clinical Centre of Serbia, Belgrade, SerbiaJelica Jovanovic, Institute of Biology and Human Genetics, School of Medicine, University of Belgrade, Belgrade, Serbia Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658

Synovial hemangioma of the hip joint with pathological femoral neck fracture and extra-articular extension

Synovial hemangioma of the hip joint with pathological femoral neck fracture and extra-articular extension Content Type Journal ArticleCategory Case ReportPages 1-5DOI 10.1007/s00776-011-0126-3Authors Satoshi Abe, Department of Orthopaedic Surgery, School of Medicine, Teikyo University, 2-11-1, kaga, Itabashi-ku, Tokyo, 173-8605 JapanAsako Yamamoto, Department of Radiology, School of Medicine, Teikyo University, Tokyo, JapanMasuhiro Tamayama, Department of Orthopaedic Surgery, School of Medicine, Teikyo University, 2-11-1, kaga, Itabashi-ku, Tokyo, 173-8605 JapanMakoto Kobayashi, Department of Orthopaedic Surgery, School of Medicine, Teikyo University, 2-11-1, kaga, Itabashi-ku, Tokyo, 173-8605 JapanYoshinobu Watanabe, Department of Orthopaedic Surgery, School of Medicine, Teikyo University, 2-11-1, kaga, Itabashi-ku, Tokyo, 173-8605 JapanYuji Miki, Department of Orthopaedic Surgery, School of Medicine, Teikyo University, 2-11-1, kaga, Itabashi-ku, Tokyo, 173-8605 JapanToru Tokizaki, Department of Orthopaedic Surgery, School of Medicine, Teikyo University, 2-11-1, kaga, Itabashi-ku, Tokyo, 173-8605 JapanTetsuo Imamura, Department of Surgical Pathology, School of Medicine, Teikyo University, Tokyo, JapanToru Motoi, Department of Pathology, School of Medicine, Teikyo University, Tokyo, JapanTakashi Matsushita, Department of Orthopaedic Surgery, School of Medicine, Teikyo University, 2-11-1, kaga, Itabashi-ku, Tokyo, 173-8605 Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658

Multiple huge subchondral cysts associated with pseudogout in the bilateral knees: a case report and review of the literatures

Multiple huge subchondral cysts associated with pseudogout in the bilateral knees: a case report and review of the literatures Content Type Journal ArticleCategory Case ReportPages 1-5DOI 10.1007/s00776-011-0110-yAuthors Masaya Minoda, Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 JapanTomoyuki Matsumoto, Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 JapanSeiji Kubo, Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 JapanTakehiko Matsushita, Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 JapanKoji Takayama, Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 JapanYukiko Morinaga, Department of Diagnostic Pathology, Kobe University Hospital, Kobe, JapanMasahiro Kurosaka, Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 JapanRyosuke Kuroda, Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658

Contiguous sagittal split fractures of cervical vertebrae bodies with no neurological impairment

Contiguous sagittal split fractures of cervical vertebrae bodies with no neurological impairment Content Type Journal ArticleCategory Case ReportPages 1-6DOI 10.1007/s00776-011-0125-4Authors Yoshiro Musha, Department of Second Orthopaedic Surgery, Toho University School of Medicine, Tokyo, JapanTakao Kaneko, Department of Second Orthopaedic Surgery, Toho University School of Medicine, Tokyo, JapanSayuri Yoshizawa, School of Pharmacy and Pharmaceutical Sciences, Hoshi University, Tokyo, JapanTakahide Sunakawa, Department of Second Orthopaedic Surgery, Toho University School of Medicine, Tokyo, JapanTakahiro Otani, Department of Second Orthopaedic Surgery, Toho University School of Medicine, Tokyo, JapanKazuhiro Mizutani, Department of Second Orthopaedic Surgery, Toho University School of Medicine, Tokyo, JapanKeisuke Ito, Department of Second Orthopaedic Surgery, Toho University School of Medicine, Tokyo, Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658

Treatment for primary spinal atypical teratoid/rhabdoid tumor

Treatment for primary spinal atypical teratoid/rhabdoid tumor Content Type Journal ArticleCategory Case ReportPages 1-6DOI 10.1007/s00776-011-0122-7Authors Shiro Imagama, Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi 466-8550, JapanNorimitsu Wakao, Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi 466-8550, JapanKei Ando, Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi 466-8550, JapanKenichi Hirano, Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi 466-8550, JapanRyoji Tauchi, Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi 466-8550, JapanAkio Muramoto, Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi 466-8550, JapanHiroki Matsui, Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi 466-8550, JapanTomohiro Matsumoto, Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi 466-8550, JapanJunichi Ukai, Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi 466-8550, JapanKazuyoshi Kobayashi, Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi 466-8550, JapanRyuichi Shinjo, Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi 466-8550, JapanHiroaki Nakashima, Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi 466-8550, JapanKiyoko Maruyama, Department of Orthopaedic Surgery, Kamiiida Daiichi General Hospital, 2-70 Kamiiidakita, Kita-ku, Nagoya, Aichi 455-8530, JapanYukihiro Matsuyama, Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka 431-3192, JapanNaoki Ishiguro, Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi 466-8550, Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658

Cementless total hip arthroplasty for avascular necrosis of the femoral head following cardiac transplantation: report of two cases

Cementless total hip arthroplasty for avascular necrosis of the femoral head following cardiac transplantation: report of two cases Content Type Journal ArticleCategory Case ReportPages 1-5DOI 10.1007/s00776-011-0116-5Authors Athanasios Antonopoulos, 3rd Orthopedic Department, Trauma Rehabilitation Center (K.A.T.), Athens, GreeceTheofani Antoniou, Department of Anesthesiology, Onassis Cardiac Surgery Center, Athens, GreeceAthanasios Pollalis, 3rd Orthopedic Department, Trauma Rehabilitation Center (K.A.T.), Athens, GreeceFilio Sklitsi, Department of Anesthesiology, Trauma Rehabilitation Center (K.A.T.), Athens, GreeceAlexandros Economou, 3rd Orthopedic Department, Trauma Rehabilitation Center (K.A.T.), Athens, GreeceKassiani Theodoraki, Department of Anesthesiology, Areteion University Hospital, Lambaki 61-63, 111 43 Athens, Greece Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658

Extensor digiti minimi transfer for thumb extension in a patient with hypoplastic thumb extensor tendons and absent extensor indicis proprius

Extensor digiti minimi transfer for thumb extension in a patient with hypoplastic thumb extensor tendons and absent extensor indicis proprius Content Type Journal ArticleCategory Case ReportPages 1-4DOI 10.1007/s00776-011-0111-xAuthors Hyun Sik Gong, Department of Orthopaedics, Hand and Upper Extremity Service, Seoul National University Bundang Hospital, Gumi-dong 300, Seongnam, Gyeonggi-do 463-707, KoreaDo Hoon Kim, Department of Orthopaedics, Hand and Upper Extremity Service, Seoul National University Bundang Hospital, Gumi-dong 300, Seongnam, Gyeonggi-do 463-707, KoreaJung Kyu Huh, Department of Orthopaedics, Hand and Upper Extremity Service, Seoul National University Bundang Hospital, Gumi-dong 300, Seongnam, Gyeonggi-do 463-707, KoreaCheol Ho Song, Department of Orthopaedics, Hand and Upper Extremity Service, Seoul National University Bundang Hospital, Gumi-dong 300, Seongnam, Gyeonggi-do 463-707, KoreaGoo Hyun Baek, Department of Orthopaedics, Hand and Upper Extremity Service, Seoul National University Bundang Hospital, Gumi-dong 300, Seongnam, Gyeonggi-do 463-707, Korea Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658

Dangerous cervical radiculopathy by Lemierre’s syndrome

Dangerous cervical radiculopathy by Lemierre’s syndrome Content Type Journal ArticleCategory Case ReportPages 1-4DOI 10.1007/s00776-011-0105-8Authors Tatsunori Ikemoto, Department of Orthopaedic Surgery, Kochi Medical School, Kohasu, Okoh-cho, Nankoku Kochi, 783-8505 JapanMotohiro Kawasaki, Department of Orthopaedic Surgery, Kochi Medical School, Kohasu, Okoh-cho, Nankoku Kochi, 783-8505 JapanTomonari Kato, Department of Orthopaedic Surgery, Kochi Medical School, Kohasu, Okoh-cho, Nankoku Kochi, 783-8505 JapanRyuichi Takemasa, Department of Orthopaedic Surgery, Kochi Medical School, Kohasu, Okoh-cho, Nankoku Kochi, 783-8505 JapanTakahiro Ushida, Multidisciplinary Pain Center, Aichi Medical University, Aichi, JapanToshikazu Tani, Department of Orthopaedic Surgery, Kochi Medical School, Kohasu, Okoh-cho, Nankoku Kochi, 783-8505 JapanKeisuke Taniuchi, Department of Gastroenterology, Kochi Medical School, Nankoku Kochi, Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658

Pelvic hemophilic pseudotumor presenting as severe sciatic pain in a patient with no history of hemophilic symptoms

Pelvic hemophilic pseudotumor presenting as severe sciatic pain in a patient with no history of hemophilic symptoms Content Type Journal ArticleCategory Case ReportPages 1-5DOI 10.1007/s00776-011-0094-7Authors Szu Han Ying, Department of Orthopaedics, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou District, Taipei, 11217 Taiwan, ROCWei Ming Chen, Department of Orthopaedics, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou District, Taipei, 11217 Taiwan, ROCPo Kuei Wu, Department of Orthopaedics, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou District, Taipei, 11217 Taiwan, ROCCheng Fong Chen, Department of Orthopaedics, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou District, Taipei, 11217 Taiwan, ROCChien Lin Liu, Department of Orthopaedics, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou District, Taipei, 11217 Taiwan, ROCTain Hsiung Chen, Department of Orthopaedics, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou District, Taipei, 11217 Taiwan, ROC Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658

Single-stage treatment of lumbar fracture–dislocation using a combined anterior and posterior approach

Single-stage treatment of lumbar fracture–dislocation using a combined anterior and posterior approach Content Type Journal ArticleCategory Case ReportPages 1-4DOI 10.1007/s00776-011-0104-9Authors Shujie Tang, Department of Orthopaedics Surgery, Medical College of Wisconsin, Milwaukee, WI 53213, USABrandon J. Rebholz, Department of Orthopaedics Surgery, Medical College of Wisconsin, Milwaukee, WI 53213, USA Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658

Endoscopic excision of a ganglion cyst in an infrapatellar fat pad extending into the subcutaneous layer

Endoscopic excision of a ganglion cyst in an infrapatellar fat pad extending into the subcutaneous layer Content Type Journal ArticleCategory Case ReportPages 1-5DOI 10.1007/s00776-011-0099-2Authors Jae-Hyuk Yang, Department of Orthopedic Surgery, Seoul Veterans Hospital, 6-2 Dunchon-dong, Kangdong-gu, Seoul, KoreaTaik-Sun Kim, Department of Orthopedic Surgery, Seoul Veterans Hospital, 6-2 Dunchon-dong, Kangdong-gu, Seoul, KoreaHong-Chul Lim, Department of Orthopedic Surgery, Korea University College of Medicine, Guro Hospital, Seoul, KoreaHak-Jun Kim, Department of Orthopedic Surgery, Korea University College of Medicine, Guro Hospital, Seoul, KoreaYoon-Jung Kim, Department of Pathology, Seoul Veterans Hospital, Seoul, KoreaChi-Hun Oh, Department of Orthopedic Surgery, Seoul Veterans Hospital, 6-2 Dunchon-dong, Kangdong-gu, Seoul, KoreaJung-Ro Yoon, Department of Orthopedic Surgery, Seoul Veterans Hospital, 6-2 Dunchon-dong, Kangdong-gu, Seoul, Korea Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658

Spontaneous recurrent hemarthrosis of the knee joint in the elderly: a report of two cases

Spontaneous recurrent hemarthrosis of the knee joint in the elderly: a report of two cases Content Type Journal ArticleCategory Case ReportPages 1-5DOI 10.1007/s00776-011-0098-3Authors Kanto Nagai, Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 JapanTomoyuki Matsumoto, Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 JapanTakehiko Matsushita, Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 JapanSeiji Kubo, Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 JapanKoji Takayama, Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 JapanDaisuke Araki, Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 JapanHiroshi Sasaki, Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 JapanShinya Oka, Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 JapanToshihiro Akisue, Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 JapanMasahiro Kurosaka, Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 JapanRyosuke Kuroda, Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658

A case of thoracic myelopathy secondary to alkaptonuric spondylosis

A case of thoracic myelopathy secondary to alkaptonuric spondylosis Content Type Journal ArticleCategory Case ReportPages 1-5DOI 10.1007/s00776-011-0095-6Authors Akira Onda, Department of Orthopaedic Surgery, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima 960-1295, JapanShin-ichi Kikuchi, Department of Orthopaedic Surgery, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima 960-1295, JapanShoji Yabuki, Department of Orthopaedic Surgery, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima 960-1295, JapanKoji Otani, Department of Orthopaedic Surgery, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima 960-1295, JapanShin-ichi Konno, Department of Orthopaedic Surgery, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima 960-1295, Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658

Severe genu valgum deformity and slipped capital femoral epiphysis with renal osteodystrophy: a report of two cases

Severe genu valgum deformity and slipped capital femoral epiphysis with renal osteodystrophy: a report of two cases Content Type Journal ArticleCategory Case ReportPages 1-7DOI 10.1007/s00776-011-0097-4Authors Hisateru Niki, Department of Orthopaedic Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, JapanHaruhito Aoki, Department of Orthopaedic Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, JapanTakaaki Hirano, Department of Orthopaedic Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, JapanMoroe Beppu, Department of Orthopaedic Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658

Revision total hip replacement using a cementless interlocking distal femoral stem with allograft-cemented composite and the application of intramedullary and onlay cortical strut allografts: two case reports

Revision total hip replacement using a cementless interlocking distal femoral stem with allograft-cemented composite and the application of intramedullary and onlay cortical strut allografts: two case reports Content Type Journal ArticleCategory Case ReportPages 1-5DOI 10.1007/s00776-011-0084-9Authors Katsufumi Uchiyama, Department of Orthopaedic Surgery, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, JapanNaonobu Takahira, Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0373, JapanHideyuki Narahara, Kitasato Institute Medical Center Hospital, Kitasato University, 6-100 Arai Kitamoto, Saitama, 364-8501 JapanKensuke Fukushima, Department of Orthopaedic Surgery, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, JapanTakeaki Yamamoto, Department of Orthopaedic Surgery, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, JapanMitsutoshi Moriya, Department of Orthopaedic Surgery, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, JapanTadashi Kawamura, Department of Orthopaedic Surgery, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, JapanKen Urabe, Department of Orthopaedic Surgery, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, JapanRina Sakai, Department of Biomedical Engineering, School of Allied Health Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0373, JapanMoritoshi Itoman, Kyushu Rosai Hospital, 1-3-1 Kuzuharatakamatsu, Kokuraminami-ku, Kitakyushu, 800-0296 JapanMasashi Takaso, Department of Orthopaedic Surgery, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658

Solitary epidural amyloidoma of C2–4 without osteolysis of the spine in a multiple myeloma patient

Solitary epidural amyloidoma of C2–4 without osteolysis of the spine in a multiple myeloma patient Content Type Journal ArticleCategory Case ReportPages 1-4DOI 10.1007/s00776-011-0086-7Authors Tetsuo Hayashi, Department of Orthopaedic Surgery, Spinal Injuries Center, Igisu 550-4, Iizuka, Fukuoka 820-8508, JapanKenzo Shirasawa, Department of Orthopedic Surgery, Shimonoseki City Central Hospital, Yamaguchi, JapanTakeshi Maeda, Department of Orthopaedic Surgery, Spinal Injuries Center, Igisu 550-4, Iizuka, Fukuoka 820-8508, JapanTakayoshi Ueta, Department of Orthopaedic Surgery, Spinal Injuries Center, Igisu 550-4, Iizuka, Fukuoka 820-8508, JapanKeiichiro Shiba, Department of Orthopaedic Surgery, Spinal Injuries Center, Igisu 550-4, Iizuka, Fukuoka 820-8508, JapanYukihide Iwamoto, Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658

Histological finding of atypical subtrochanteric fracture after long-term alendronate therapy

Histological finding of atypical subtrochanteric fracture after long-term alendronate therapy Content Type Journal ArticleCategory Case ReportPages 1-6DOI 10.1007/s00776-011-0085-8Authors Yoshitomo Kajino, Department of Orthopaedics Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8641, JapanTamon Kabata, Department of Orthopaedics Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8641, JapanKoji Watanabe, Department of Orthopaedics Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8641, JapanHiroyuki Tsuchiya, Department of Orthopaedics Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8641, Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658

Ligamentum flavum hematoma in the lumbar spine

Ligamentum flavum hematoma in the lumbar spine Content Type Journal ArticleCategory Case ReportPages 1-5DOI 10.1007/s00776-011-0083-xAuthors Masahito Takahashi, Department of Orthopaedic Surgery, Kyorin University, School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, JapanKazuhiko Satomi, Department of Orthopaedic Surgery, Kyorin University, School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, JapanAtsushi Hasegawa, Department of Orthopaedic Surgery, Kyorin University, School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, JapanMasaichi Hasegawa, Department of Orthopaedic Surgery, Kyorin University, School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, JapanNorimune Taki, Department of Orthopaedic Surgery, Kyorin University, School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, JapanShoichi Ichimura, Department of Orthopaedic Surgery, Kyorin University, School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658

Dorsoepitrochlearis muscle: an unknown cause of shoulder motion limitation and axilla deformity

Dorsoepitrochlearis muscle: an unknown cause of shoulder motion limitation and axilla deformity Content Type Journal ArticleCategory Case ReportPages 1-3DOI 10.1007/s00776-011-0079-6Authors Konstantinos Natsis, Interbalkan Medical Center, Thessaloniki, GreeceTrifon Totlis, Department of Anatomy, Medical School, Aristotle University of Thessaloniki, P.O. Box 300, 541 24 Thessaloniki, GreeceKonstantinos Vlasis, Department of Anatomy, Medical School, Aristotle University of Thessaloniki, P.O. Box 300, 541 24 Thessaloniki, GreeceGeorge Sofidis, Department of Anatomy, Medical School, Aristotle University of Thessaloniki, P.O. Box 300, 541 24 Thessaloniki, GreeceNikolaos Lazaridis, Department of Anatomy, Medical School, Aristotle University of Thessaloniki, P.O. Box 300, 541 24 Thessaloniki, GreeceIoannis Tsitouridis, Department of Diagnostic and Interventional Radiology, Papageorgiou General Hospital, Thessaloniki, Greece Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658

A case report of Gorham–Stout syndrome remission

A case report of Gorham–Stout syndrome remission Content Type Journal ArticleCategory Case ReportPages 1-6DOI 10.1007/s00776-011-0080-0Authors Toru Shimizu, Department of Rehabilitation Medicine, Gunma University Graduate School of Medicine, Maebashi, JapanKaori Sato, Course of Health Sciences, Gunma University Graduate School of Medicine, Maebashi, JapanTomomi Yoshida, Department of Laboratory Sciences, Gunma University Graduate School of Health Sciences, Maebashi, Gunma, JapanAtsushi Takahashi, Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, JapanTakashi Yanagawa, Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, JapanNaoki Wada, Department of Rehabilitation Medicine, Gunma University Graduate School of Medicine, Maebashi, JapanMakoto Sohmiya, Department of Rehabilitation Medicine, Gunma University Graduate School of Medicine, Maebashi, JapanKenji Shirakura, Department of Rehabilitation Medicine, Gunma University Graduate School of Medicine, Maebashi, JapanHideomi Watanabe, Department of Rehabilitation Sciences, Gunma University Graduate School of Health Sciences, 3-39-22 Showa, Maebashi, Gunma 371-8514, Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658

Osteochondral autograft for medial femoral condyle chondral lesions in a patient with multiple epiphyseal dysplasia: long-term result

Osteochondral autograft for medial femoral condyle chondral lesions in a patient with multiple epiphyseal dysplasia: long-term result Content Type Journal ArticleCategory Case ReportPages 1-5DOI 10.1007/s00776-011-0096-5Authors Shuji Taketomi, Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033 JapanHisatada Hiraoka, Department of Orthopaedic Surgery, Saitama Medical Center, Saitama Medical University, 1981 Kamoda-Tsujido, Kawagoe, Saitama, 350-8550 JapanTakumi Nakagawa, Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033 JapanYoshinari Miyamoto, Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033 JapanSo Kuribayashi, Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033 JapanAkira Fukuda, Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033 JapanHideki Takeda, Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033 JapanAtsushi Fukai, Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033 JapanJinso Hirota, Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033 JapanKohei Nakajima, Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033 JapanNobuhiko Haga, Department of Rehabilitation, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033 JapanKozo Nakamura, Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658

Recurrent epithelioid hemangioma: therapeutic potential of tranilast and indomethacin

Recurrent epithelioid hemangioma: therapeutic potential of tranilast and indomethacin Content Type Journal ArticleCategory Case ReportPages 1-5DOI 10.1007/s00776-011-0081-zAuthors Koichi Ogura, Department of Orthopaedic Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655 JapanYusuke Shinoda, Department of Orthopaedic Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655 JapanTomotake Okuma, Department of Orthopaedic Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655 JapanTetsuo Ushiku, Department of Pathology, The University of Tokyo Hospital, Tokyo, JapanToru Motoi, Department of Pathology, Teikyo University School of Medicine, Tokyo, JapanHirotaka Kawano, Department of Orthopaedic Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655 Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658

A rare case of spinal injury: bilateral facet dislocation without fracture at the lumbosacral joint

A rare case of spinal injury: bilateral facet dislocation without fracture at the lumbosacral joint Content Type Journal ArticleCategory Case ReportPages 1-5DOI 10.1007/s00776-011-0082-yAuthors Kei Shinohara, Department of Orthopaedic Surgery, Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461 JapanShigeru Soshi, Department of Orthopaedic Surgery, Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461 JapanYoshikuni Kida, Department of Orthopaedic Surgery, Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461 JapanAkira Shinohara, Department of Orthopaedic Surgery, Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461 JapanKeishi Marumo, Department of Orthopaedic Surgery, Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461 Japan Journal Journal of Orthopaedic ScienceOnline ISSN 1436-2023Print ISSN 0949-2658

Necrobiosis and T-lymphocyte infiltration in retrieved aseptically loosened metal-on-polyethylene arthroplasties.

Necrobiosis and T-lymphocyte infiltration in retrieved aseptically loosened metal-on-polyethylene arthroplasties. Acta Orthop. 2011 Oct;82(5):596-601 Authors: von Domarus C, Rosenberg JP, Rüther W, Zustin J Abstract BACKGROUND AND PURPOSE: Soft tissue necrobiosis and T-lymphocyte infiltration within the periprosthetic soft tissue have been linked to a suggested hypersensitivity reaction of the delayed-type following the metal-on-metal arthroplasty. While we observed both synovial necrobiosis and lymphocyte infiltrates in synovial tissues with failed metal-on-polyethylene prostheses, we hypothesized that both findings are unspecific for metal-on-metal bearing coupes. Thus, we wished to quantify the extent of necrobiosis and the amount of T-lymphocyte infiltration in aseptically loosened metal-on-polyethylene prostheses. MATERIALS AND METHODS: We analyzed 28 consecutive synovial biopsy specimens obtained at revision surgery of aseptically loosened metal-on-polyethylene prostheses (19 hips and 9 knees) and quantified both the extent of necrobiosis vertically and the density of CD3+, CD4+, and CD8+ lymphocytes within the joint capsular tissue. We excluded patients with inflammatory skeletal disease or with a history of metal hypersensitivity. RESULTS: We found necrobiosis in 23 of 28 cases and it was most often connected with the superficial portions of the synovium. Necrobiosis of deeper tissues was seen in 8 specimens and it was strongly associated with superficial necrobiosis. While CD3+ lymphocytes were detected in each biopsy, 4 cases with more than 300 CD3+ lymphocytes were identified in the group of 26 cases that presented with more than 100 CD3+ lymphocytes within one high-power field. 16 cases with more than 100 CD3+ lymphocytes also showed concomitant superficial necrobiosis of the synovium. In the inflammatory infiltration of periprosthetic synovium, CD8+ lymphocytes predominated over CD4+ cells. INTERPRETATION: Synovial necrobiosis and infiltration of T-lymphocytes are common findings in tissues around aseptically loosened metal-on-polyethylene arthroplasty in patients without a clinically suspected metal hypersensitivity reaction. Thus, neither necrobiosis nor infiltration of T-lymphocytes should be considered to be specific for failed metal-on-metal bearings or metal hypersensitivity reaction. PMID: 22112191 [PubMed - indexed for MEDLINE]

Total hip replacement in young adults with hip dysplasia.

Total hip replacement in young adults with hip dysplasia. Acta Orthop. 2011 Oct;82(5):635-6 Authors: George H, Nikolaos T, Engessster IØ PMID: 22103282 [PubMed - indexed for MEDLINE]

Outcome of the cementless Taperloc stem.

Outcome of the cementless Taperloc stem. Acta Orthop. 2011 Oct;82(5):633-4 Authors: Labek G PMID: 22103281 [PubMed - indexed for MEDLINE]

Metal ion levels and functional results after either resurfacing hip arthroplasty or conventional metal-on-metal hip arthroplasty.

Metal ion levels and functional results after either resurfacing hip arthroplasty or conventional metal-on-metal hip arthroplasty. Acta Orthop. 2011 Oct;82(5):559-66 Authors: Smolders JM, Hol A, Rijnberg WJ, van Susante JL Abstract BACKGROUND: Modern metal-on-metal hip resurfacing was introduced as a bone-preserving method of joint reconstruction for young and active patients; however, the large diameter of the bearing surfaces is of concern for potentially increased metal ion release. PATIENTS AND METHODS: 71 patients (< 65 years old) were randomly assigned to receive either a resurfacing (R) hip arthroplasty (n = 38) or a conventional metal-on-metal (C) hip arthroplasty (n = 33). Functional outcomes were assessed preoperatively and at 6, 12, and 24 months. Cobalt and chromium blood levels were analyzed preoperatively and at 3, 6, 12, and 24 months. RESULTS: All functional outcome scores improved for both groups. At 12 and 24 months, the median UCLA activity score was 8 in the R patients and 7 in the C patients (p < 0.05). At 24 months, OHS was median 16 in C patients and 13 in R patients (p < 0.05). However, in spite of randomization, UCLA scores also appeared to be higher in R patients at baseline. Satisfaction was similar in both groups at 24 months. Cobalt concentrations were statistically significantly higher for R patients only at 3 and 6 months. Chromium levels remained significantly higher for R patients until 24 months. No pseudotumors were encountered in either group. One R patient was revised for early aseptic loosening and in 2 C patients a cup insert was exchanged for recurrent dislocation. INTERPRETATION: R patients scored higher on UCLA, OHS, and satisfaction at some time points; however, as for the UCLA, preoperative levels were already in favor of R. The differences, although statistically significant, were of minor clinical importance. Chromium blood levels were statistically significantly higher for R patients at all follow-up measurements, whereas for cobalt this was only observed up to 6 months. The true value of resurfacing hip arthroplasty over conventional metal-on-metal hip arthroplasty will be determined by longer follow-up and a possible shift of balance between their respective (dis)advantages. PMID: 22103280 [PubMed - indexed for MEDLINE]

The long-term in vivo behavior of polymethyl methacrylate bone cement in total hip arthroplasty.

The long-term in vivo behavior of polymethyl methacrylate bone cement in total hip arthroplasty. Acta Orthop. 2011 Oct;82(5):553-8 Authors: Oonishi H, Akiyama H, Takemoto M, Kawai T, Yamamoto K, Yamamuro T, Oonishi H, Nakamura T Abstract BACKGROUND AND PURPOSE: The long-term success of cemented total hip arthroplasty (THA) has been well established. Improved outcomes, both radiographically and clinically, have resulted mainly from advances in stem design and improvements in operating techniques. However, there is concern about the durability of bone cement in vivo. We evaluated the physical and chemical properties of CMW1 bone cements retrieved from patients undergoing revision THA. METHODS: CMW1 cements were retrieved from 14 patients who underwent acetabular revision because of aseptic loosening. The time in vivo before revision was 7-30 years. The bending properties of the retrieved bone cement were assessed using the three-point bending method. The molecular weight and chemical structure were analyzed by gel permeation chromatography and Fourier-transform infrared spectroscopy. The porosity of the bone cements was evaluated by 3-D microcomputer tomography. RESULTS: The bending strength decreased with increasing time in vivo and depended on the density of the bone cement, which we assume to be determined by the porosity. There was no correlation between molecular weight and time in vivo. The infrared spectra were similar in the retrieved cements and in the control CMW1 cements. INTERPRETATION: Our results indicate that polymer chain scission and significant hydrolysis do not occur in CMW1 cement after implantation in vivo, even in the long term. CMW1 cement was stable through long-term implantation and functional loading. PMID: 22103279 [PubMed - indexed for MEDLINE]

Correlation between disability and MRI findings in lumbar spinal stenosis.

Correlation between disability and MRI findings in lumbar spinal stenosis. Acta Orthop. 2011 Oct;82(5):637; author reply 637-8 Authors: Haig AJ PMID: 22103278 [PubMed - indexed for MEDLINE]

Anti-sclerostin antibody and mechanical loading appear to influence metaphyseal bone independently in rats.

Anti-sclerostin antibody and mechanical loading appear to influence metaphyseal bone independently in rats. Acta Orthop. 2011 Oct;82(5):628-32 Authors: Agholme F, Isaksson H, Li X, Ke HZ, Aspenberg P Abstract BACKGROUND AND PURPOSE: Sclerostin is produced by osteocytes and is an inhibitor of bone formation. Thus, inhibition of sclerostin by a monoclonal antibody increases bone formation and improves fracture repair. Sclerostin expression is upregulated in unloaded bone and is downregulated by loading. We wanted to determine whether an anti-sclerostin antibody would stimulate metaphyseal healing in unloaded bone in a rat model. METHODS: 10-week-old male rats (n = 48) were divided into 4 groups, with 12 in each. In 24 rats, the right hind limb was unloaded by paralyzing the calf and thigh muscles with an injection of botulinum toxin A (Botox). 3 days later, all the animals had a steel screw inserted into the right proximal tibia. Starting 3 days after screw insertion, either anti-sclerostin antibody (Scl-Ab) or saline was given twice weekly. The other 24 rats did not receive Botox injections and they were treated with Scl-Ab or saline to serve as normal-loaded controls. Screw pull-out force was measured 4 weeks after insertion, as an indicator of the regenerative response of bone to trauma. RESULTS: Unloading reduced the pull-out force. Scl-Ab treatment increased the pull-out force, with or without unloading. The response to the antibody was similar in both groups, and no statistically significant relationship was found between unloading and antibody treatment. The cancellous bone at a distance from the screw showed changes in bone volume fraction that followed the same pattern as the pull-out force. INTERPRETATION: Scl-Ab increases bone formation and screw fixation to a similar degree in loaded and unloaded bone. PMID: 22103277 [PubMed - indexed for MEDLINE]

Adverse events in spine surgery in Sweden: a comparison of patient claims data and national quality register (Swespine) data .

Adverse events in spine surgery in Sweden: a comparison of patient claims data and national quality register (Swespine) data . Acta Orthop. 2011 Dec;82(6):727-31 Authors: Ohrn A, Olai A, Rutberg H, Nilsen P, Tropp H Abstract BACKGROUND AND PURPOSE: Our knowledge of complications and adverse events in spinal surgery is limited, especially concerning incidence and consequences. We therefore investigated adverse events in spine surgery in Sweden by comparing patient claims data from the County Councils' Mutual Insurance Company register with data from the National Swedish Spine Register (Swespine). METHODS: We analyzed patient claims (n = 182) to the insurance company after spine surgery performed between 2003 and 2005. The medical records of the patients filing these claims were reviewed and compared with Swespine data for the same period. RESULTS: Two-thirds (119/182, 65%) of patients who claimed economic compensation from the insurance company were registered in Swespine. Of the 210 complications associated with these 182 claims, only 74 were listed in Swespine. The most common causes of compensated injuries (n = 139) were dural lesions (n = 40) and wound infections (n = 30). Clinical outcome based on global assessment, leg pain, disability, and quality of health was worse for patients who claimed economic compensation than for the total group of Swespine patients. INTERPRETATION: We found considerable under-reporting of complications in Swespine. Dural lesions and infections were not well recorded, although they were important reasons for problems and contributed to high levels of disability. By analyzing data from more than one source, we obtained a better understanding of the patterns of adverse events and outcomes after spine surgery. PMID: 22066564 [PubMed - indexed for MEDLINE]

No improvement in long-term wear and revision rates with the second-generation Biomet cup (RingLoc) in young patients: 141 hips followed for median 12 years.

No improvement in long-term wear and revision rates with the second-generation Biomet cup (RingLoc) in young patients: 141 hips followed for median 12 years. Acta Orthop. 2011 Dec;82(6):664-8 Authors: Boesenach B, van der Heide HJ, Nelissen RG Abstract BACKGROUND: A number of excellent results with the cementless titanium femoral component of the Mallory Head Total Hip Replacement have been published. Unfortunately, these excellent results have been counteracted by the poor performance of the cementless titanium acetabular components. In 1994, the HexLoc acetabular component was replaced with a second-generation design, the RingLoc. We hypothesized that the new generation would have improved the results. METHODS: We retrospectively studied 111 consecutive patients (150 hips) younger than 55 years. Median follow-up time was 14 (6-18) years for the HexLoc and 10 (1-14) years for the RingLoc. 7 patients were lost to follow-up and 7 patients died. The 10-year survival rate, radiographic liner wear, and radiographic signs of prosthesis failure were compared between the 2 acetabular components. RESULTS: The Kaplan-Meier survival estimate with revision for any reason as the endpoint showed a 10-year survival of 89% (95% CI: 81-97) for the HexLoc and 92% (CI: 85-98) for the RingLoc. The mean annual wear rate for the HexLoc was 0.16 (SD 0.16) mm and it was 0.15 (0.1) mm for the RingLoc (p = 0.3). The radiographic signs of failure were equally distributed between the 2 groups. INTERPRETATION: Compared to the HexLoc type, the RingLoc system did not improve the mean percentage survival at 10 years; nor did it reduce the liner wear. Despite correction of the known design flaws in the HexLoc design, the RingLoc system did not show a clinically relevant improvement compared to its predecessor. PMID: 22066563 [PubMed - indexed for MEDLINE]

Infection after primary hip arthroplasty: a comparison of 3 Norwegian health registers.

Infection after primary hip arthroplasty: a comparison of 3 Norwegian health registers. Acta Orthop. 2011 Dec;82(6):646-54 Authors: Dale H, Skråmm I, Løwer HL, Eriksen HM, Espehaug B, Furnes O, Skjeldestad FE, Havelin LI, Engesaeter LB Abstract BACKGROUND AND PURPOSE: The aim of the present study was to assess incidence of and risk factors for infection after hip arthroplasty in data from 3 national health registries. We investigated differences in risk patterns between surgical site infection (SSI) and revision due to infection after primary total hip arthroplasty (THA) and hemiarthroplasty (HA). MATERIALS AND METHODS: This observational study was based on prospective data from 2005-2009 on primary THAs and HAs from the Norwegian Arthroplasty Register (NAR), the Norwegian Hip Fracture Register (NHFR), and the Norwegian Surveillance System for Healthcare-Associated Infections (NOIS). The Norwegian Patient Register (NPR) was used for evaluation of case reporting. Cox regression analyses were performed with revision due to infection as endpoint for data from the NAR and the NHFR, and with SSI as the endpoint for data from the NOIS. RESULTS: The 1-year incidence of SSI in the NOIS was 3.0% after THA (167/5,540) and 7.3% after HA (103/1,416). The 1-year incidence of revision due to infection was 0.7% for THAs in the NAR (182/24,512) and 1.5% for HAs in the NHFR (128/8,262). Risk factors for SSI after THA were advanced age, ASA class higher than 2, and short duration of surgery. For THA, the risk factors for revision due to infection were male sex, advanced age, ASA class higher than 1, emergency surgery, uncemented fixation, and a National Nosocomial Infection Surveillance (NNIS) risk index of 2 or more. For HAs inserted after fracture, age less than 60 and short duration of surgery were risk factors of revision due to infection. INTERPRETATION: The incidences of SSI and revision due to infection after primary hip replacements in Norway are similar to those in other countries. There may be differences in risk pattern between SSI and revision due to infection after arthroplasty. The risk patterns for revision due to infection appear to be different for HA and THA. PMID: 22066562 [PubMed - indexed for MEDLINE]

Risk of periprosthetic femur fracture after anterior cortical bone windowing: a mechanical analysis of short versus long cemented stems in pigs.

Risk of periprosthetic femur fracture after anterior cortical bone windowing: a mechanical analysis of short versus long cemented stems in pigs. Acta Orthop. 2011 Dec;82(6):674-8 Authors: Wilson LJ, Richards CJ, Irvine D, Tillie A, Crawford RW Abstract BACKGROUND AND PURPOSE: Removal of distal cement at femoral implant revision is technically challenging and is associated with complications such as cortical perforations. A technique that can reduce the risks and operating time is to make a small cortical window in the distal femur for enhanced access. We wanted to determine whether the use of long, bridging, cemented femoral stems is necessary to reduce the risk of postoperative periprosthetic fractures after using an anterior cortical bone window. METHODS: 66 fresh pig femurs underwent mechanical testing. Steel rods were implanted at 3 locations: (1) at the distal window edge, (2) 15 mm proximally to the cortical window edge, and (3) 15 mm distally. 54 femurs were tested using a 3-point bending setup and 12 femurs were tested using a torsional load setup. RESULTS: Load to fracture ratio and bending stiffness ratio were similar in the 3 groups, for either the 3-point bending test or the torsional load test. INTERPRETATION: Our findings suggest that bypass of cortical windows with a revision femoral component may not reduce the risk of periprosthetic fracture. PMID: 22066561 [PubMed - indexed for MEDLINE]

Why still in hospital after fast-track hip and knee arthroplasty?

Why still in hospital after fast-track hip and knee arthroplasty? Acta Orthop. 2011 Dec;82(6):679-84 Authors: Husted H, Lunn TH, Troelsen A, Gaarn-Larsen L, Kristensen BB, Kehlet H Abstract BACKGROUND AND PURPOSE: Length of stay (LOS) following total hip and knee arthroplasty (THA and TKA) has been reduced to about 3 days in fast-track setups with functional discharge criteria. Earlier studies have identified patient characteristics predicting LOS, but little is known about specific reasons for being hospitalized following fast-track THA and TKA. PATIENTS AND METHODS: To determine clinical and logistical factors that keep patients in hospital for the first postoperative 24-72 hours, we performed a cohort study of consecutive, unselected patients undergoing unilateral primary THA (n = 98) or TKA (n = 109). Median length of stay was 2 days. Patients were operated with spinal anesthesia and received multimodal analgesia with paracetamol, a COX-2 inhibitor, and gabapentin-with opioid only on request. Fulfillment of functional discharge criteria was assessed twice daily and specified reasons for not allowing discharge were registered. RESULTS: Pain, dizziness, and general weakness were the main clinical reasons for being hospitalized at 24 and 48 hours postoperatively while nausea, vomiting, confusion, and sedation delayed discharge to a minimal extent. Waiting for blood transfusion (when needed), for start of physiotherapy, and for postoperative radiographic examination delayed discharge in one fifth of the patients. INTERPRETATION: Future efforts to enhance recovery and reduce length of stay after THA and TKA should focus on analgesia, prevention of orthostatism, and rapid recovery of muscle function. PMID: 22066560 [PubMed - indexed for MEDLINE]

Similar TKA designs with differences in clinical outcome: a randomized, controlled trial of 77 knees with a mean follow-up of 6 years.

Similar TKA designs with differences in clinical outcome: a randomized, controlled trial of 77 knees with a mean follow-up of 6 years. Acta Orthop. 2011 Dec;82(6):685-91 Authors: Meijerink HJ, Verdonschot N, van Loon CJ, Hannink G, de Waalmalefijt MC Abstract BACKGROUND AND PURPOSE: To try to improve the outcome of our TKAs, we started to use the CKS prosthesis. However, in a retrospective analysis this design tended to give worse results. We therefore conducted a randomized, controlled trial comparing this CKS prosthesis and our standard PFC prosthesis. Because many randomized studies between different TKA concepts generally fail to show superiority of a particular design, we hypothesized that these seemingly similar designs would not lead to any difference in clinical outcome. PATIENTS AND METHODS: 82 patients (90 knees) were randomly allocated to one or other prosthesis, and 39 CKS prostheses and 38 PFC prostheses could be followed for mean 5.6 years. No patients were lost to follow-up. At each follow-up, patients were evaluated clinically and radiographically, and the KSS, WOMAC, VAS patient satisfaction scores and VAS for pain were recorded. RESULTS: With total Knee Society score (KSS) as primary endpoint, there was a difference in favor of the PFC group at final follow-up (p = 0.04). Whereas there was one revision in the PFC group, there were 6 revisions in the CKS group (p = 0.1). The survival analysis with any reoperation as endpoint showed better survival in the PFC group (97% (95% CI: 92-100) for the PFC group vs. 79% (95% CI: 66-92) for the CKS group) (p = 0.02). INTERPRETATION: Our hypothesis that there would be no difference in clinical outcome was rejected in this study. The PFC system showed excellent results that were comparable to those in previous reports. The CKS design had differences that had considerable negative consequences clinically. The relatively poor results have discouraged us from using this design. PMID: 22066559 [PubMed - indexed for MEDLINE]

Maximum temperatures of 89°C recorded during the mechanical preparation of 35 femoral heads for resurfacing.

Maximum temperatures of 89°C recorded during the mechanical preparation of 35 femoral heads for resurfacing. Acta Orthop. 2011 Dec;82(6):669-73 Authors: Baker R, Whitehouse M, Kilshaw M, Pabbruwe M, Spencer R, Blom A, Bannister G Abstract BACKGROUND AND PURPOSE: We noticed that our instruments were often too hot to touch after preparing the femoral head for resurfacing, and questioned whether the heat generated could exceed temperatures known to cause osteonecrosis. PATIENTS AND METHODS: Using an infra-red thermal imaging camera, we measured real-time femoral head temperatures during femoral head reaming in 35 patients undergoing resurfacing hip arthroplasty. 7 patients received an ASR, 8 received a Cormet, and 20 received a Birmingham resurfacing arthroplasty. RESULTS: The maximum temperature recorded was 89°C. The temperature exceeded 47°C in 28 patients and 70°C in 11. The mean duration of most stages of head preparation was less than 1 min. The mean time exceeded 1 min only on peripheral head reaming of the ASR system. At temperatures lower than 47°C, only 2 femoral heads were exposed long enough to cause osteonecrosis. The highest mean maximum temperatures recorded were 54°C when the proximal femoral head was resected with an oscillating saw and 47°C during peripheral reaming with the crown drill. The modified new Birmingham resurfacing proximal femoral head reamer substantially reduced the maximum temperatures generated. Lavage reduced temperatures to a mean of 18°C. INTERPRETATION: 11 patients were subjected to temperatures sufficient to cause osteonecrosis secondary to thermal insult, regardless of the duration of reaming. In 2 cases only, the length of reaming was long enough to induce damage at lower temperatures. Lavage and sharp instruments should reduce the risk of thermal insult during hip resurfacing. PMID: 22066558 [PubMed - indexed for MEDLINE]

Atypical fracture of the ulna associated with alendronate use.

Atypical fracture of the ulna associated with alendronate use. Acta Orthop. 2011 Dec;82(6):761-3 Authors: Bjørgul K, Reigstad A PMID: 22066557 [PubMed - indexed for MEDLINE]

Improved spinal fusion efficacy by long-term delivery of bone morphogenetic protein-2 in a rabbit model.

Improved spinal fusion efficacy by long-term delivery of bone morphogenetic protein-2 in a rabbit model. Acta Orthop. 2011 Dec;82(6):756-60 Authors: Lee JW, Lee S, Lee SH, Yang HS, Im GI, Kim CS, Park JH, Kim BS Abstract BACKGROUND AND PURPOSE: Various new delivery systems for recombinant human bone morphogenetic protein-2 (rhBMP-2) have been introduced to improve its efficacy in osteogenesis. Of these, we have previously developed heparin-conjugated PLGA nanospheres (HCPN) as a long-term delivery system for BMP-2. In vitro studies have shown that the BMP-2 long-term delivery system enhances the level of bone formation. However, the long-term effects of BMP-2 on spinal fusion have not been assessed. Therefore, we now tested the hypothesis that the long-term delivery of BMP-2 using HCPN improves spinal fusion compared to short-term delivery in a rabbit fusion model. METHODS: 24 adult New Zealand White rabbits underwent posterolateral fusion (6 animals in 4 groups). The autograft group received an autologous iliac chip bone graft as a positive control. The BMP-2-PN group received rhBMP-2 (20 μg per implant) and PLGA nanospheres (PN) suspended in fibrin gel, and served as a short-term release group. The HCPN group received HCPN suspended in fibrin gel without BMP-2 as a negative control. The BMP-2-HCPN group received rhBMP-2 (20 μg per implant)-bound HCPN suspended in fibrin gel and served as a long-term release group. All animals were killed 12 weeks after surgery. Manual palpation, axial tensile tests, radiography, and histological evaluations were then performed. RESULTS: The spinal fusion rate and Young's modulus of the fusion mass were better in the BMP-2 long-term delivery group than in the short-term delivery group at an equivalent dose. However, the outcome of the long-term delivery was inferior to that of the autograft group. INTERPRETATION: The HCPN system showed potential as an effective carrier that might improve the osteogenic efficacy of BMP-2 for spinal fusion. PMID: 22066556 [PubMed - indexed for MEDLINE]

High degree of kinesiophobia after lumbar disc herniation surgery: a cross-sectional study of 84 patients .

High degree of kinesiophobia after lumbar disc herniation surgery: a cross-sectional study of 84 patients . Acta Orthop. 2011 Dec;82(6):732-6 Authors: Svensson GL, Lundberg M, Ostgaard HC, Wendt GK Abstract BACKGROUND AND PURPOSE: Several studies have investigated outcomes after disc surgery. However, the occurrence of kinesiophobia has not been investigated previously in patients after disc herniation surgery. In this cross-sectional study, we investigated kinesiophobia in patients who had been treated surgically for lumbar disc herniation, and we related the results to established outcome measures. PATIENTS AND METHODS: 10-34 months after surgery, questionnaires were sent to 97 patients who had undergone standardized open discectomy. Outcome measures included Tampa scale for kinesiophobia (TSK); Oswestry disability index (ODI); European quality of life in 5 dimensions (EQ-5D); visual analog scale (VAS) for leg and back pain, work disability, and patient satisfaction; Zung self-rating depression scale (ZDS); pain catastrophizing scale (PCS); and a self-efficacy scale (SES). RESULTS: 36 of 80 patients reported having kinesiophobia. There were statistically significant differences in ODI, EQ-5D, VAS leg and back pain, ZDS, PCS, and SES between patients with and without kinesiophobia. INTERPRETATION: Half of the patients suffered from kinesiophobia 10-34 months after surgery for disc herniation. These patients were more disabled, had more pain, more catastrophizing thoughts, more symptoms of depression, lower self-efficacy, and poorer health-related quality of life than patients without kinesiophobia. PMID: 22066555 [PubMed - indexed for MEDLINE]

Low infection rates after 34,361 intramedullary nail operations in 55 low- and middle-income countries: validation of the Surgical Implant Generation Network (SIGN) online surgical database.

Low infection rates after 34,361 intramedullary nail operations in 55 low- and middle-income countries: validation of the Surgical Implant Generation Network (SIGN) online surgical database. Acta Orthop. 2011 Dec;82(6):737-43 Authors: Young S, Lie SA, Hallan G, Zirkle LG, Engesaeter LB, Havelin LI Abstract BACKGROUND: The Surgical Implant Generation Network (SIGN) supplies intramedullary (IM) nails for the treatment of long bone fractures free of charge to hospitals in low- and middle-income countries (LMICs). Most operations are reported to the SIGN Online Surgical Database (SOSD). Follow-up has been reported to be low, however. We wanted to examine the pattern of follow-up and to assess whether infection rates could be trusted. PATIENTS AND METHODS: The SOSD contained 36,454 IM nail surgeries in 55 LMICs. We excluded humerus and hip fractures, and fractures without a registered surgical approach. This left 34,361 IM nails for analysis. A generalized additive regression model (gam) was used to explore the association between follow-up rates and infection rates. RESULTS: The overall follow-up rate in the SOSD was 18.1% (95% CI: 17.7-18.5) and national follow-up rates ranged from 0% to 74.2%. The overall infection rate was 0.7% (CI: 0.6-0.8) for femoral fractures and 1.2% (CI: 1.0-1.4) for tibial fractures. If only nails with a registered follow-up visit were included (n = 6,224), infection rates were 3.5% (CI: 3.0-4.1) for femoral fractures and 7.3% (CI: 6.2-8.4) for tibial fractures. We found an increase in infection rates with increasing follow-up rates up to a level of 5%. Follow-up above 5% did not result in increased infection rates. INTERPRETATION: Reported infection rates after IM nailing in the SOSD appear to be reliable and could be used for further research. The low infection rates suggest that IM nailing is a safe procedure also in low- and middle-income countries. PMID: 22066554 [PubMed - indexed for MEDLINE]

High rate of complications and radiographic loosening of the biaxial total wrist arthroplasty in rheumatoid arthritis: 32 wrists followed for 6 (5–8) years.

High rate of complications and radiographic loosening of the biaxial total wrist arthroplasty in rheumatoid arthritis: 32 wrists followed for 6 (5–8) years. Acta Orthop. 2011 Dec;82(6):721-6 Authors: Harlingen D, Heesterbeek PJ, J de Vos M Abstract BACKGROUND AND PURPOSE: The third generation of total wrist arthroplasty (TWA) was designed to solve the early loosening problem, but there have been few long-term follow-ups. We present the outcome of the biaxial total wrist prosthesis (no longer available) after 5-8 years of follow-up. PATIENTS AND METHODS: 40 biaxial wrist prostheses were implanted uncemented in 36 patients with rheumatoid arthritis. 32 wrists were followed clinically and radiographically. 7 prostheses had been revised at median 21 (8-71) months; 1 patient died from an unrelated cause. Mean follow-up of the remaining 32 wrists was 6 (5-8) years. Kaplan-Meier survival analysis was performed with revision defined as failure. RESULTS: Survival after 7 years was 81% (95% CI: 64-91). There were 31 complications. 22 wrists showed radiographic loosening. Range of motion improved, except for pronation. The mean DASH score improved and the median postoperative pain score (from 0 to 10) was 0 (0-6) at rest and 0 (0-7) during activity. INTERPRETATION: One quarter of the prostheses had been revised and radiographic loosening had occurred in two thirds of the cases. Radiographic and clinical follow-up is therefore necessary for patients with this implant. PMID: 22066553 [PubMed - indexed for MEDLINE]

Survival and prognostic factors in chondrosarcoma: results in 115 patients with long-term follow-up.

Survival and prognostic factors in chondrosarcoma: results in 115 patients with long-term follow-up. Acta Orthop. 2011 Dec;82(6):749-55 Authors: Andreou D, Ruppin S, Fehlberg S, Pink D, Werner M, Tunn PU Abstract BACKGROUND AND PURPOSE: There have been few long-term studies on the outcome of chondrosarcoma and the findings regarding prognostic factors are controversial. We examined a homogeneous group of patients with primary central chondrosarcoma of bone who were treated according to a uniform surgical protocol at our institution, in order to determine the factors that influence survival and identify potential improvements to our therapeutic algorithm. PATIENTS AND METHODS: We performed a retrospective analysis of 115 patients with primary central chondrosarcoma of bone who presented with localized disease and who had a minimum follow-up of 5 years after diagnosis. 68 tumors were localized in the extremities and 47 in the axial skeleton or pelvis. 59 patients had a high-grade (II and III) and 56 a low-grade (I) tumor. 94 patients underwent surgical resection with adequate (wide or radical) margins, while 21 patients had inadequate (marginal or intralesional) margins. RESULTS: Tumor grade and localization were found to be statistically significant independent predictors of disease-related deaths in multivariate analysis. The quality of surgical margins did not influence survival. The AJCC staging system was able to predict prognosis in patients with chondrosarcoma of the extremities, but not in those with tumors of the axial skeleton and pelvis. Long-term survival after secondary metastatic disease was only observed when metastases were resected with wide margins. Patients with metastases who received further treatment with conventional chemotherapy, radiotherapy, and/or further surgery had significantly better survival compared to those who received best supportive care. INTERPRETATION: The outcome in patients with primary central chondrosarcoma of bone who present with localized disease is mostly affected by tumor-related parameters. PMID: 22066552 [PubMed - indexed for MEDLINE]

10-year survival of total ankle arthroplasties: a report on 780 cases from the Swedish Ankle Register.

10-year survival of total ankle arthroplasties: a report on 780 cases from the Swedish Ankle Register. Acta Orthop. 2011 Dec;82(6):655-9 Authors: Henricson A, Nilsson JÅ, Carlsson A Abstract BACKGROUND AND PURPOSE: There is an ongoing need to review large series of total ankle replacements (TARs) for monitoring of changes in practice and their outcome. 4 national registries, including the Swedish Ankle Register, have previously reported their 5-year results. We now present an extended series with a longer follow-up, and with a 10-year survival analysis. PATIENTS AND METHODS: Records of uncemented 3-component TARs were retrospectively reviewed, determining risk factors such as age, sex, and diagnosis. Prosthetic survival rates were calculated with exchange or removal of components as endpoint-excluding incidental exchange of the polyethylene meniscus. RESULTS: Of the 780 prostheses implanted since 1993, 168 (22%) had been revised by June 15, 2010. The overall survival rate fell from 0.81 (95% CI: 0.79-0.83) at 5 years to 0.69 (95% CI: 0.67-0.71) at 10 years. The survival rate was higher, although not statistically significantly so, during the latter part of the period investigated. Excluding the STAR prosthesis, the survival rate for all the remaining designs was 0.78 at 10 years. Women below the age of 60 with osteoarthritis were at a higher risk of revision, but age did not influence the outcome in men or women with rheumatoid arthritis. Revisions due to technical mistakes at the index surgery and instability were undertaken earlier than revisions for other reasons. INTERPRETATION: The results have slowly improved during the 18-year period investigated. However, we do not believe that the survival rates of ankle replacements in the near future will approach those of hip and knee replacements-even though improved instrumentation and design of the prostheses, together with better patient selection, will presumably give better results. PMID: 22066551 [PubMed - indexed for MEDLINE]

Intraarticular vs. extraarticular ropivacaine infusion following high-dose local infiltration analgesia after total knee arthroplasty: a randomized double-blind study.

Intraarticular vs. extraarticular ropivacaine infusion following high-dose local infiltration analgesia after total knee arthroplasty: a randomized double-blind study. Acta Orthop. 2011 Dec;82(6):692-8 Authors: Dobrydnjov I, Anderberg C, Olsson C, Shapurova O, Angel K, Bergman S Abstract BACKGROUND AND PURPOSE: Ropivacaine infusion following high-volume local infiltration analgesia has been shown to be effective after total knee arthroplasty, but the optimum site of administration of ropivacaine has not been evaluated. We compared the effects of intraarticular and extraarticular adminstration of the local anesthetic for postoperative supplementation of high-volume local infiltration analgesia. PATIENTS AND METHODS: In this double-blind study, 36 rheumatic patients aged 51-78 years with physical status ASA 2-3 who were scheduled for total knee arthroplasty were randomized into 2 groups. All patients received wound infiltration at the end of surgery with 300 mg ropivacaine, 30 mg ketorolac, and 0.5 mg epinephrine (total volume 156 mL). A tunneled catheter was randomly placed either extraarticularly or intraarticularly. Continuous infusion of ropivacain (0.5%, 2 mL/h) was started immediately and was maintained during the next 48 h. Pain intensity at rest, on movement, and with mobilization was estimated by the patients and the physiotherapist; rescue morphine consumption was recorded. RESULTS: As estimated by the patients, ropivacaine administered intraarticularly did not improve analgesia relative to extraarticular infusion, but improved the first mobilization. The incidence of high intensity of pain (VAS 7-10) was less in the group with intraarticular infusion. Analgesic requirements were similar in the 2 groups (47 mg and 49 mg morphine). No complications of postoperative wound healing were seen and there were no toxic side effects. INTERPRETATION: Continuous infusion of ropivacaine intraarticulary did not improve postoperative analgesia at rest relative to extraarticular administration, but it appeared to reduce the incidence of high pain intensity during first exercises, and could therefore be expected to improve mobilization up to 24 h after total knee arthroplasty. PMID: 22026413 [PubMed - indexed for MEDLINE]

Visualization of postoperative anterior cruciate ligament reconstruction bone tunnels: reliability of standard radiographs, CT scans, and 3D virtual reality images.

Visualization of postoperative anterior cruciate ligament reconstruction bone tunnels: reliability of standard radiographs, CT scans, and 3D virtual reality images. Acta Orthop. 2011 Dec;82(6):699-703 Authors: Meuffels DE, Potters JW, Koning AH, Brown CH, Verhaar JA, Reijman M Abstract BACKGROUND AND PURPOSE: Non-anatomic bone tunnel placement is the most common cause of a failed ACL reconstruction. Accurate and reproducible methods to visualize and document bone tunnel placement are therefore important. We evaluated the reliability of standard radiographs, CT scans, and a 3-dimensional (3D) virtual reality (VR) approach in visualizing and measuring ACL reconstruction bone tunnel placement. METHODS: 50 consecutive patients who underwent single-bundle ACL reconstructions were evaluated postoperatively by standard radiographs, CT scans, and 3D VR images. Tibial and femoral tunnel positions were measured by 2 observers using the traditional methods of Amis, Aglietti, Hoser, Stäubli, and the method of Benereau for the VR approach. RESULTS: The tunnel was visualized in 50-82% of the standard radiographs and in 100% of the CT scans and 3D VR images. Using the intraclass correlation coefficient (ICC), the inter- and intraobserver agreement was between 0.39 and 0.83 for the standard femoral and tibial radiographs. CT scans showed an ICC range of 0.49-0.76 for the inter- and intraobserver agreement. The agreement in 3D VR was almost perfect, with an ICC of 0.83 for the femur and 0.95 for the tibia. INTERPRETATION: CT scans and 3D VR images are more reliable in assessing postoperative bone tunnel placement following ACL reconstruction than standard radiographs. PMID: 21999625 [PubMed - indexed for MEDLINE]

Is reverse hybrid hip replacement the solution?

Is reverse hybrid hip replacement the solution? Acta Orthop. 2011 Dec;82(6):639-45 Authors: Lindalen E, Havelin LI, Nordsletten L, Dybvik E, Fenstad AM, Hallan G, Furnes O, Høvik O, Röhrl SM Abstract BACKGROUND AND PURPOSE: Reverse hybrid hip replacement uses a cemented all-polyethylene cup and an uncemented stem. Despite increasing use of this method in Scandinavia, there has been very little documentation of results. We have therefore analyzed the results from the Norwegian Arthroplasty Register (NAR), with up to 10 years of follow-up. PATIENTS AND METHODS: The NAR has been collecting data on total hip replacement (THR) since 1987. Reverse hybrid hip replacements were used mainly from 2000. We extracted data on reverse hybrid THR from this year onward until December 31, 2009, and compared the results with those from cemented implants over the same period. Specific cup/stem combinations involving 100 cases or more were selected. In addition, only combinations that were taken into use in 2005 or earlier were included. 3,963 operations in 3,630 patients were included. We used the Kaplan-Meier method and Cox regression analysis for estimation of prosthesis survival and relative risk of revision. The main endpoint was revision for any cause, but we also performed specific analyses on different reasons for revision. RESULTS: We found equal survival to that from cemented THR at 5 years (cemented: 97.0% (95% CI: 96.8-97.2); reverse hybrid: 96.7% (96.0-97.4)) and at 7 years (cemented: 96.0% (95.7-96.2); reverse hybrid: 95.6% (94.4-96.7)). Adjusted relative risk of revision of the reverse hybrids was 1.1 (0.9-1.4). In patients under 60 years of age, we found similar survival of the 2 groups at 5 and 7 years, with an adjusted relative risk of revision of reverse hybrids of 0.9 (0.6-1.3) compared to cemented implants. INTERPRETATION: With a follow-up of up to 10 years, reverse hybrid THRs performed well, and similarly to all-cemented THRs from the same time period. The reverse hybrid method might therefore be an alternative to all-cemented THR. Longer follow-up time is needed to evaluate whether reverse hybrid hip replacement has any advantages over all-cemented THR. PMID: 21999624 [PubMed - indexed for MEDLINE]

Reduction of blood loss in primary hip arthroplasty with tranexamic acid or fibrin spray.

Reduction of blood loss in primary hip arthroplasty with tranexamic acid or fibrin spray. Acta Orthop. 2011 Dec;82(6):660-3 Authors: McConnell JS, Shewale S, Munro NA, Shah K, Deakin AH, Kinninmonth AW Abstract BACKGROUND AND PURPOSE: Previous studies have shown that either fibrin spray or tranexamic acid can reduce blood loss at total hip replacement, but the 2 treatments have not been directly compared. We therefore conducted a randomized, controlled trial. PATIENTS AND METHODS: In this randomized controlled trial we compared the effect of tranexamic acid and fibrin spray on blood loss in cemented total hip arthroplasty. 66 patients were randomized to 1 of 3 parallel groups receiving (1) a 10 mg/kg bolus of tranexamic acid prior to surgery, (2) 10 mL of fibrin spray during surgery, or (3) neither. All participants except the surgeon were blinded as to treatment group until data analysis was complete. Blood loss was calculated from preoperative and postoperative hematocrit. RESULTS: Neither active treatment was found to be superior to the other in terms of overall blood loss. Losses were lower than those in the control group, when using either tranexamic acid (22% lower, p = 0.02) or fibrin spray (32% lower, p = 0.02). INTERPRETATION: We found that the use of tranexamic acid at induction, or topical fibrin spray intraoperatively, reduced blood loss compared to the control group. Blood loss was similar in the fibrin spray group and in the tranexamic acid group. ClinicalTrials.gov identifier: NCT00378872. EudraCT identifier: 2006-001299-19. Regional Ethics Committee approval: 06/S0703/55, granted June 6, 2006. PMID: 21999623 [PubMed - indexed for MEDLINE]

Simultaneous bilateral total ankle replacement using a 3-component prosthesis: outcome in 26 patients followed for 2–10 years.

Simultaneous bilateral total ankle replacement using a 3-component prosthesis: outcome in 26 patients followed for 2–10 years. Acta Orthop. 2011 Dec;82(6):704-10 Authors: Barg A, Henninger HB, Knupp M, Hintermann B Abstract BACKGROUND AND PURPOSE: Total ankle replacement is an established surgical procedure in patients with end-stage ankle osteoarthritis. We analyzed complications and medium-term results in patients with simultaneous bilateral total ankle replacement. PATIENTS AND METHODS: 10 women and 16 men, mean age 60 (SD 13) years, were followed for a median of 5 (2-10) years. RESULTS: There were no intraoperative or perioperative complications, with the exception of 1 patient with prolonged wound healing. Major revision surgery was necessary in 6 of the 52 ankles, including 4 revisions of prosthetic components. The average pain score decreased from 6.9 (4-10) to 1.8 (0-4) points. The American Orthopaedic Foot and Ankle Society hindfoot score increased from 32 (SD 14) points preoperatively to 74 (SD 12) points postoperatively. The average range of motion increased from 28° (SD 12) preoperatively to 38° (SD 9) postoperatively. All 8 categories of SF-36 score improved. INTERPRETATION: Simultaneous bilateral total ankle replacement is a suitable method for restoration of function and attainment of pain relief in patients with bilateral end-stage ankle osteoarthritis. The results of this procedure, including complication rates, revision rates, and functional outcome, are comparable to those reported in patients with unilateral total ankle replacement. PMID: 21999622 [PubMed - indexed for MEDLINE]

Patients with shoulder impingement remain satisfied 6 years after arthroscopic subacromial decompression: a prospective study of 46 patients.

Patients with shoulder impingement remain satisfied 6 years after arthroscopic subacromial decompression: a prospective study of 46 patients. Acta Orthop. 2011 Dec;82(6):711-3 Authors: Lunsjö K, Bengtsson M, Nordqvist A, Abu-Zidan FM Abstract BACKGROUND: Although arthroscopic subacromial decompression (ASD) is a common procedure for treatment of shoulder impingement, few long term results have been published. In this prospective study, we determined whether the high degree of patient satisfaction at 6 months postoperatively reported by us earlier remained at the 6-year follow-up. PATIENTS AND METHODS: We originally reported high patient satisfaction 6 months after ASD for shoulder impingement in 50 prospectively studied patients using the Disability of the Arm Shoulder and Hand questionnaire (DASH) and the Visual Analog Scale (VAS). Patients with associated shoulder disorders were excluded. The surgeons were experienced shoulder arthroscopists. 6 years after surgery, the DASH questionnaire and the VAS were sent to these 50 patients. 2 patients had other medical problems of the upper extremity that affected the DASH and VAS scores, 1 patient was lost to follow-up, and another refused to participate. Thus, 46 patients with a mean age of 55 (33-78) years were included in this 6-year evaluation. RESULTS: The considerable improvement in both the DASH score and the VAS that was observed 6 months after surgery persisted or had even improved 6 years after surgery. INTERPRETATION: Properly selected patients with shoulder impingement treated with ASD remain satisfied 6 years after surgery. PMID: 21999621 [PubMed - indexed for MEDLINE]