We investigated the preliminary results of femoral head necrosis treated by modified femoral neck osteotomy through surgical hip dislocation in young adults.

33 patients with femoral head osteonecrosis received modified femoral neck osteotomy through surgical hip dislocation from March 2015. 14 patients who had minimal 12 months of follow-up were reviewed radiographically and clinically (mean follow-up:16 months, 12–36 months). The mean age of the patients 32 years at the time of surgery (ranged from 16 to 42years). There were 6 women and 8 men. The cause of the osteonecrosis was steroid administration in 6, alcohol abuse in 4, trauma in 3, and no apparent risk factor in 1. According to the Ficat staging system, 1 hips was stage II, 9 hips III, and 4 hips stage IV. The posterior or anterior rotational angle was 90–180° with a mean of 143°. Clinical evaluation was performed in terms of pain, walk and range of motion on the basis of Merle d'Aubigné hip scores: 17–18 points are excellent, 15–16 are good, 13–14 are fair, 12 or less are poor.

Recollapse of the final follow-up anteroposterior radiograph was prevented in 13 hips. One patient got 1 mm recollapse 18 months after surgery. No patient got progressive joint space narrowing. The Merle d'Aubigné score was excellent in 7 hips, good in 5, fair in 2.

The preliminary results suggest that modified femoral neck osteotomy through surgical hip dislocation is in favor of young patients. But longer term follow-up is necessary.

Objectives

Recent studies have shown that systemic injection of rapamycin can prevent the development of osteoarthritis (OA)-like changes in human chondrocytes and reduce the severity of experimental OA. However, the systemic injection of rapamycin leads to many side effects. The purpose of this study was to determine the effects of intra-articular injection of Torin 1, which as a specific inhibitor of mTOR which can cause induction of autophagy, is similar to rapamycin, on articular cartilage degeneration in a rabbit osteoarthritis model and to investigate the mechanism of Torin 1’s effects on experimental OA.

Introduction: Elastin is a structural protein forming a highly organised network in the annulus and nucleus of the intervertebral disc (IVD). It appears important in maintaining annulus structure as it is densely located in the interlamellar space and forms cross-bridges between lamellae. Here we have investigated elastin fibre organisation in degenerate discs and compared it to that seen in normal human and bovine discs.

Methods: Human lumbar IVD were obtained from consented patients undergoing surgery either for disc degeneration, tumour or trauma. The disc segments were collected from operating theatre and graded. A radial profile of the specimen was dissected and snap-frozen. Sections of 20μm in thickness were cut with a cryostat microtome and mounted on slides. To visualize elastin fibres, sections were digested with hyaluronidase after fixation with 10% of formalin. Elastin fibres were immunostained and fibre organisation mapped.

Results: In degenerate disc, the elastin fibre network appeared sparse and disorganised in comparison to that seen in non-degenerate human or in bovine discs in which elastin fibres are well organised. In addition, in degenerate discs the elastin fibres appear fragmented. Fragmentation of the elastin network within lamellae of the annulus in particular increased with both degeneration grade and with age.

Discussion: The loss of elastic network integrity observed in degenerate discs could contribute to loss of annulus integrity and affect disc mechanical properties adversely. Furthermore, our initial results have suggested fragmented elastin degradation products could upregulate MMP expression by disc cells thus stimulating a degenerative cascade.