A patient in his thirties developed synovitis with grade 4 chondrolysis and a stiff knee with a fixed flexion deformity between three and six years following PLC and PCL reconstruction using LARS (Ligament Augmentation and Reconstruction System, Corin). There was histologic evidence of
Millions of medical devices made of synthetic or modified natural materials all trigger a similar reaction—the
[Introduction]. In 1995, Muller reported on the improvement of metal-on-metal (MOM) bearing over the existing metal-on-polyethylene (MOP) articulations which demonstrated more rapid wear together with granulomatous
Innominate Osteotomy first described by Salter is one of the commonest procedures performed for treatment of Developmental Dysplasia of the Hip (DDH) in children. We recently described a less invasive technique for Innominate Osteotomy, which significantly reduces the operation time without compromising outcome (J Pediatr Orthop B. 2010 Jul;19(4):318–22). As part of the evolution of this procedure we now routinely use bioabsorbable pins (INION OTPS PIN, made from co-polymers of L-lactic acid, D-lactic acid and trimethylene carbonate) instead of K-wires to secure the graft. We prospectively followed-up 120 consecutive cases done using bioabsorbale pins over a 2 year period. The surgical technique was as described in our less invasive innominate osteotomy paper. Average age at surgery was 24 months (18–52) with mean follow-up period of 15 months (6–24 months). The mean preoperative acetabular index was 36.2. o. Our results show a mean acetabular index of 18.7. o. (P< 0.0001) at latest follow-up with no loss of correction. We recorded three superficial wound infections (one MRSA), all resolved uneventfully. There was no
Cobalt-chrome alloys are widely used in dentistry and Orthopaedic implant industry. Vitallium is a similar alloy which contains 60% cobalt, 20% chromium, 5% molybdenum along with traces of other substances. It has been in use along with stainless steel for the last century because of its lightweight, favourable mechanical properties and resistance to corrosion. We present an unusual case of synovial cyst formation following Vitallium plating mimicking a sarcoma. To our knowledge, we are the first to report a delayed tissue reaction to Vitallium plating 40 years after its implantation. A 78 yrs old man had a right femoral intertrochanteric fracture 40 years ago, which was fixed with a Vitallium nail plate. His postoperative recovery was uneventful and he regained full function of his leg. 3 years prior to excision, he presented with a painless swelling around his right upper thigh to our unit. Aspiration of the swelling and investigations were requested but patient was lost to follow up due to social reasons. Seven months prior to excision, he represented as the swelling had increased to the extent that it was involving the anterior and posterior aspect of the upper thigh with pressure necrosis of skin posteriorly. Examination revealed painless, transilluminable, fluctuant multilobular swelling over the right proximal femur overlying the healed surgical scar. Compression of the larger lobe in the buttock clearly forced fluid into the anterior compartment of the thigh where again swelling was extensive. Surprisingly he had full range of movements at the hip joint. Radiograph of the hip showed a soft tissue swelling with a healed fracture and Vitallium implant insitu. Cytology was negative. MRI scan showed multiloculated cystic lesions extending anteriorly, laterally and posteriorly into the intermuscular and subcutaneous planes around the right proximal femur. Multiple small dependent foci likely representing debris or synovial proliferation was seen within loculations. Excision of the cystic lesions with removal of metal work was performed. The old incision was reopened in the lateral position and a large cystic lesion with a thick capsule was dissected down to the metal work. The lesion was lying superficial to the vastus lateralis but was communicating with metal work. The metal work was removed with difficulty, no visible metallosis. A second cystic lesion was located more posteriorly but its neck was communicating with the thin hole into the first lesion. The lesion was excised completely. Macroscopic examination showed two cysts 9×8×5.5cm and 20×10×7.5cm with a smooth external surface and the lumen appeared trabecular containing numerous loose (rice) bodies. Microscopy showed a dense fibrotic cyst wall with lumen with multiple small nodules containing organised fibrinous and eosinophilic material. Several foci of cellular debris including lymphocytes and macrophages were scattered in nodules best representing a synovial cyst with loose/rice bodies. No malignancy was seen. We recommend early removal of metal work if it shows any signs of local reaction provided fracture is united. Be aware of large
The number of arthroplasties being undertaken
is expected to grow year on year, and periprosthetic joint infections will
be an increasing socioeconomic burden. The challenge to prevent
and eradicate these infections has resulted in the emergence of
several new strategies, which are discussed in this review. Cite this article: