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The Journal of Bone & Joint Surgery British Volume
Vol. 76-B, Issue 6 | Pages 975 - 981
1 Nov 1994
Field R Buchanan J Copplemans M Aichroth P

Between 1980 and 1988, displacement bone-marrow transplantation was performed on 25 children with Hurler's syndrome (type-1 mucopolysaccharidosis). We describe the musculoskeletal development of 11 of the 12 surviving children and the orthopaedic procedures undertaken to treat progressive thoracolumbar kyphosis, hip subluxation and carpal tunnel syndrome. We found abnormal bone modelling, focal failures of ossification and an avascular disorder of the femoral head in every patient and offer an explanation for these phenomena. Increasing valgus deformity of the knees and progressive generalised myopathy caused loss of mobility as the children entered adolescence. The benefit of bone-marrow transplantation as a treatment for the skeletal disorders of Hurler's syndrome is limited by the poor penetration of the musculoskeletal tissues by the enzyme derived from the leucocytes


The Bone & Joint Journal
Vol. 101-B, Issue 1 | Pages 92 - 95
1 Jan 2019
Harris IA Cuthbert A de Steiger R Lewis P Graves SE

Aims

Displaced femoral neck fractures (FNF) may be treated with partial (hemiarthroplasty, HA) or total hip arthroplasty (THA), with recent recommendations advising that THA be used in community-ambulant patients. This study aims to determine the association between the proportion of FNF treated with THA and year of surgery, day of the week, surgeon practice, and private versus public hospitals, adjusting for known confounders.

Patients and Methods

Data from 67 620 patients in the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) from 1999 to 2016 inclusive were used to generate unadjusted and adjusted analyses of the associations between patient, time, surgeon and institution factors, and the proportion of FNF treated with THA.


The Journal of Bone & Joint Surgery British Volume
Vol. 75-B, Issue 2 | Pages 254 - 258
1 Mar 1993
Kabo J Gebhard J Loren G Amstutz H

Polyethylene acetabular cups retrieved at revision surgery were measured by a shadowgraph technique to determine linear wear, and the values were compared with those obtained from radiographs. There was a close correlation between them, although the radiographic measurements slightly underestimated the true wear. Average linear wear rates for surface-replacement components were much greater than those for conventional prostheses with femoral heads up to 32 mm in diameter. Volumetric wear, calculated using a new formula, was found to be less than previously reported in vivo, and similar in magnitude to the results of experimental wear tests in vitro. The volumetric wear rates were greatest for the surface-replacement components and, for conventional components, were found to increase in a linear manner with component diameter


The Journal of Bone & Joint Surgery British Volume
Vol. 86-B, Issue 2 | Pages 244 - 250
1 Mar 2004
Maxwell SL Lappin KJ Kealey WD McDowell BC Cosgrove AP

We have examined the effect of arthrodiastasis on the preservation of the femoral head in older children with Perthes’ disease. We carried out a prospective trial in boys over the age of eight years and girls over seven years at the time of the onset of symptoms. The patients had minimal epiphyseal collapse and were compared with a conventionally treated, consecutive, historical control group. Arthrodiastasis was applied for approximately four months. The primary outcome measure was the extent of epiphyseal collapse at the end of the fragmentation phase. One of the 15 treated hips and nine of the 30 control hips showed a loss of height of 50% or more of the lateral epiphyseal column on the anteroposterior radiographs (Herring grade-C classification). On a Lauenstein view, one of the treated hips and 19 of the control hips showed at least a loss of height of 50% of the anterior epiphyseal column. The complications of arthrodiastasis included pin-site infection in most hips, transient joint stiffness in two, and breakage of a pin in two. The final outcome will be known when all the patients and the control group reach skeletal maturity


The Journal of Bone & Joint Surgery British Volume
Vol. 80-B, Issue 2 | Pages 267 - 272
1 Mar 1998
Morscher EW Hefti A Aebi U

One concern about the fixation of HA-coated implants is the possible disintegration of the surface, with the migration of HA granules into the joint space, producing third-body wear. We report a study of six revisions of HA-coated polyethylene RM cups at 9 to 14 years after successful primary arthroplasty. In all six hips, we found HA granules embedded in the articulating surface of the polyethylene, with abrasive wear of the cup and the metal femoral head. The cup had loosened in four hips and three showed severe osteolysis of the proximal femur. Third-body wear due to HA particles from implant coating may produce severe clinical problems with few early warning signs. Further clinical, radiological and histological observations are needed to determine the possible incidence of this late complication in the various types of coating of a variety of substrates


The Journal of Bone & Joint Surgery British Volume
Vol. 44-B, Issue 3 | Pages 562 - 564
1 Aug 1962
Morris ML McGibbon KC

A case of osteochondritis dissecans complicating Legg-Calvé-Perthes' disease is reported. Despite four years of conservative treatment in an ischial-bearing caliper a part of the fragmented femoral head failed to unite with the rest of the epiphysis and has persisted as an intra-articular loose body. Freehafer (1960) listed the indications for surgical removal of this fragment in such cases: 1) persisting symptoms; 2) dislocation of the loose fragment into the joint with secondary arthritic changes inevitable; 3) a mechanical block to movement of the hip. Since our patient had a relatively symptomless hip with a full range of movement, surgical removal of the loose body was not advised. The prognosis for this hip is nevertheless guarded, and surgery can be reserved for the above indications or for reconstructive procedures should they be required in the future


The Bone & Joint Journal
Vol. 101-B, Issue 2 | Pages 132 - 139
1 Feb 2019
Karczewski D Winkler T Renz N Trampuz A Lieb E Perka C Müller M

Aims

In 2013, we introduced a specialized, centralized, and interdisciplinary team in our institution that applied a standardized diagnostic and treatment algorithm for the management of prosthetic joint infections (PJIs). The hypothesis for this study was that the outcome of treatment would be improved using this approach.

Patients and Methods

In a retrospective analysis with a standard postoperative follow-up, 95 patients with a PJI of the hip and knee who were treated with a two-stage exchange between 2013 and 2017 formed the study group. A historical cohort of 86 patients treated between 2009 and 2011 not according to the standardized protocol served as a control group. The success of treatment was defined according to the Delphi criteria in a two-year follow-up.


The Bone & Joint Journal
Vol. 100-B, Issue 10 | Pages 1289 - 1296
1 Oct 2018
Berliner JL Esposito CI Miller TT Padgett DE Mayman DJ Jerabek SA

Aims

The aims of this study were to measure sagittal standing and sitting lumbar-pelvic-femoral alignment in patients before and following total hip arthroplasty (THA), and to consider what preoperative factors may influence a change in postoperative pelvic position.

Patients and Methods

A total of 161 patients were considered for inclusion. Patients had a mean age of the remaining 61 years (sd 11) with a mean body mass index (BMI) of 28 kg/m2 (sd 6). Of the 161 patients, 82 were male (51%). We excluded 17 patients (11%) with spinal conditions known to affect lumbar mobility as well as the rotational axis of the spine. Standing and sitting spine-to-lower-limb radiographs were taken of the remaining 144 patients before and one year following THA. Spinopelvic alignment measurements, including sacral slope, lumbar lordosis, and pelvic incidence, were measured. These angles were used to calculate lumbar spine flexion and femoroacetabular hip flexion from a standing to sitting position. A radiographic scoring system was used to identify those patients in the series who had lumbar degenerative disc disease (DDD) and compare spinopelvic parameters between those patients with DDD (n = 38) and those who did not (n = 106).


The Journal of Bone & Joint Surgery British Volume
Vol. 82-B, Issue 4 | Pages 555 - 557
1 May 2000
Felix NA Mazur JM Loveless EA

Hereditary multiple exostoses is an autosomal dominant disorder characterised by multiple osteochondromata, most commonly affecting the forearm, knee and ankle. Osteochondromata of the proximal femur have been reported to occur in 30% to 90% of affected patients with coxa valga in 25%. Acetabular dysplasia is rare but has been described. This is the first report of a patient requiring surgical intervention. A girl was seen at the age of nine with hereditary multiple exostoses and when 12 developed bilateral pain in the groin. Radiographs showed severely dysplastic acetabula with less than 50% coverage of the femoral heads and widening of the medial joint space. Large sessile osteochondromata were present along the medial side of the femoral neck proximal to the lesser trochanter, with associated coxa valga. The case illustrates the importance of obtaining initial skeletal surveys in children with hereditary multiple exostoses to identify potential problems such as acetabular dysplasia and subluxation of the hip


The Journal of Bone & Joint Surgery British Volume
Vol. 72-B, Issue 4 | Pages 653 - 657
1 Jul 1990
Maistrelli G Gerundini M Fusco U Bombelli R Bombelli M Avai A

We reviewed the results of 277 intertrochanteric valgus-extension osteotomies performed between 1973 and 1975 for primary or secondary osteoarthritis. The average age of the patients was 51 years and follow-up varied from 11 to 15 years. At the latest evaluation 67% of the hips were good or excellent on the Merle D'Aubigne scale. Better results were obtained in patients under 40 years of age with unilateral involvement and a mechanical (secondary) aetiology. An elliptical femoral head, minimal subluxation and an adequate pre-operative range of motion were also favourable. There was radiographic evidence of regression of the arthritic changes in 39% of the hips at final review. Valgus-extension osteotomy is effective for secondary osteoarthritis of the hip in selected younger patients, but not for those with primary hip disease or a poor range of movement


The Journal of Bone & Joint Surgery British Volume
Vol. 71-B, Issue 2 | Pages 173 - 177
1 Mar 1989
Rehnberg L Olerud C

We measured the stability of fixation in femoral neck fractures treated with von Bahr screws, investigated the influence of impaction and correlated peroperative stability with the clinical results. Stability was measured at operation using a metal probe fitted with strain gauges. Its tip was anchored in the subchondral bone of the femoral head and its lateral end was fixed in the lateral femoral cortex. The shearing force produced by longitudinal compression applied to the foot of the operated leg was recorded. The results in 41 consecutive patients all followed for 30 months, showed that fractures with early loosening or nonunion had all had significantly poorer stability than the fractures that had healed. Impaction improved stability in only 23 out of the 41 fractures; in the others stability had deteriorated or was unchanged


The Bone & Joint Journal
Vol. 100-B, Issue 7 | Pages 867 - 874
1 Jul 2018
Makarewich CA Anderson MB Gililland JM Pelt CE Peters CL

Aims

For this retrospective cohort study, patients aged ≤ 30 years (very young) who underwent total hip arthroplasty (THA) were compared with patients aged ≥ 60 years (elderly) to evaluate the rate of revision arthroplasty, implant survival, the indications for revision, the complications, and the patient-reported outcomes.

Patients and Methods

We retrospectively reviewed all patients who underwent primary THA between January 2000 and May 2015 from our institutional database. A total of 145 very young and 1359 elderly patients were reviewed. The mean follow-up was 5.3 years (1 to 18). Logistic generalized estimating equations were used to compare characteristics and the revision rate. Survival was evaluated using Kaplan–Meier curves and hazard rates were created using Cox regression.


The Bone & Joint Journal
Vol. 100-B, Issue 7 | Pages 831 - 838
1 Jul 2018
Ibrahim MM Poitras S Bunting AC Sandoval E Beaulé PE

Aims

What represents clinically significant acetabular undercoverage in patients with symptomatic cam-type femoroacetabular impingement (FAI) remains controversial. The aim of this study was to examine the influence of the degree of acetabular coverage on the functional outcome of patients treated arthroscopically for cam-type FAI.

Patients and Methods

Between October 2005 and June 2016, 88 patients (97 hips) underwent arthroscopic cam resection and concomitant labral debridement and/or refixation. There were 57 male and 31 female patients with a mean age of 31.0 years (17.0 to 48.5) and a mean body mass index (BMI) of 25.4 kg/m2 (18.9 to 34.9). We used the Hip2Norm, an object-oriented-platform program, to perform 3D analysis of hip joint morphology using 2D anteroposterior pelvic radiographs. The lateral centre-edge angle, anterior coverage, posterior coverage, total femoral coverage, and alpha angle were measured for each hip. The presence or absence of crossover sign, posterior wall sign, and the value of acetabular retroversion index were identified automatically by Hip2Norm. Patient-reported outcome scores were collected preoperatively and at final follow-up with the Hip Disability and Osteoarthritis Outcome Score (HOOS).


The Journal of Bone & Joint Surgery British Volume
Vol. 77-B, Issue 5 | Pages 739 - 742
1 Sep 1995
Farsetti P Tudisco C Caterini R Potenza V Ippolito E

We reviewed the radiographs of 49 patients with Perthes' disease at the stage of fragmentation and also after the end of skeletal growth to assess the value of the lateral pillar classification of Herring. The average age of the patients at diagnosis was 7 years 6 months and the mean follow-up was 24 years. Ten of the 11 Herring group-A hips showed good reconstruction of the femoral head. There were good results in group-B hips when the patients were less than nine years of age at diagnosis. All 11 group-C patients showed hip deformity at follow-up. The Herring classification provides a valid long-term prognosis in Perthes' disease, although age at diagnosis is also an important prognostic factor. The classification is relatively easy to apply, is reliable, and requires only an anteroposterior radiograph taken during the fragmentation stage of the disease


The Journal of Bone & Joint Surgery British Volume
Vol. 62-B, Issue 3 | Pages 332 - 336
1 Aug 1980
Heywood A

A high percentage of hips in patients with rheumatoid arthritis presenting for total joint replacement have protrusio deformity with extremely thin medial acetabular walls. Biomechanical principles suggest that, to prevent inward migration of the acetabular component, the prosthesis should be positioned laterally near the acetabular rim. To reinforce the medial wall, the femoral head is fashioned into a solid graft which is anchored against the medial wall as a plug, minimising the amount of cement used and making the use of wire mesh and restraining rings about the acetabulum unnecessary. A series of nine operations on seven patients is presented. Serial radiographs, tomograms and scintigrams taken after operation suggest satisfactory incorporation of the grafts, and no complications have been encountered in a follow-up period ranging from three months to two years


The Journal of Bone & Joint Surgery British Volume
Vol. 76-B, Issue 6 | Pages 912 - 917
1 Nov 1994
Karrholm J Borssen B Lowenhielm G Snorrason F

Roentgen stereophotogrammetry was used to measure the migration of the centre of the femoral head in 84 cemented Lubinus SP I hip arthroplasties (58 primary operations, 26 revisions). Four to seven years later, seven femoral components had been revised because of painful loosening. These implants showed greater subsidence, medial migration and posterior migration during the first two postoperative years than did the hips which had not been revised. Six months after operation, subsidence of more than 0.33 mm combined with a total migration of more than 0.85 mm predicted an increased risk of subsequent revision; the amount of subsidence at two years was an even better predictor. The probability of revision was greater than 50% if the subsidence at two years was 1.2 mm or more


The Journal of Bone & Joint Surgery British Volume
Vol. 76-B, Issue 5 | Pages 728 - 734
1 Sep 1994
Marti R Schuller H van Steijn M

Dysplastic acetabula were augmented during total hip replacement by superolateral autografts. In cases of primary arthroplasty these were taken from the excised femoral head and in revision surgery from the iliac crest. Two or (usually) three small grafts were used to facilitate revascularisation; they were fixed with lag screws to the roughened iliac bone above the acetabulum. We reviewed 84 hips (63 primary arthroplasties and 21 revisions) more than five years (mean 10.1) after operation. All but one of the grafts showed consolidation within three months and they had become structurally integrated with the iliac bone, as evidenced by the trabecular reorientation. Resorption, which has caused early socket failure when large bone grafts have been used, did not occur


The Journal of Bone & Joint Surgery British Volume
Vol. 76-B, Issue 4 | Pages 534 - 538
1 Jul 1994
Marks D Clegg J al-Chalabi A

We have undertaken routine ultrasound screening for neonatal hip instability in Coventry since June 1989. Of the 14,050 babies scanned during the first three years, 847 (6%) had ultrasound abnormalities. A grading system, based on the percentage of femoral head coverage, is presented. The proportion of abnormal hips decreased gradually so that by nine weeks, 90% had normal ultrasound appearances. Abnormality was more common in babies with a family history of CDH and in breech presentations. All babies with clinically abnormal hips had an abnormal first ultrasound examination. Five babies not diagnosed by clinical examination and with no risk factors had abnormal ultrasound appearances and were subsequently found to have clinically abnormal hips. Routine ultrasound screening has detected cases which would otherwise have presented late


The Journal of Bone & Joint Surgery British Volume
Vol. 83-B, Issue 5 | Pages 751 - 759
1 Jul 2001
Sato M Sugano N Ohzono K Nomura S Kitamura Y Tsukamoto Y Ogawa S

Using in situ hybridisation and the terminal deoxynucleotidyl transferase-mediated biotin-dUTP nick end-labelling (TUNEL) reaction in rats with osteonecrosis of the femoral head we have studied the effect of ischaemia on the gene expression of the stress proteins oxygen-regulated protein 150 (ORP150) and haemoxygenase 1 (HO1) and the death mechanism of the cells involved in osteonecrosis. Both ORP150 and HO1 have been reported to have important roles in the successful adaptation to oxygen deprivation. ORP150 and HO1 mRNA expression was induced by ischaemia in osteoblasts and osteocytes. In proliferative chondrocytes, these signals were detected constitutively. During the development of ischaemic osteonecrosis, the mechanism of cell death was apoptosis as indicated by DNA fragmentation and the presence of apoptotic bodies in osteocytes, chondrocytes and bone-marrow cells. After the initial ischaemic event, expression of ORP150 and HO1 mRNA, the TUNEL-positive reaction and empty lacunae were found sequentially. These findings were exclusive and may be considered to be markers for each stage in the development of osteonecrosis


The Journal of Bone & Joint Surgery British Volume
Vol. 73-B, Issue 6 | Pages 911 - 915
1 Nov 1991
Maruno H Shimizu T Kawai K Hirohata K

We studied the effect of a lipid clearing agent (clinofibrate) on the osteocytes of rabbits treated with corticosteroids. Thirty-one rabbits were divided into four groups: (A) steroid-treated with a normal diet, (B) steroid-treated and one a diet with added clinofibrate, (C) non-steroid-treated, on a diet with clinofibrate; and (D) non-steroid-treated on a normal diet. All the steroid-treated animals demonstrated hyperlipidaemia and fatty degeneration of the liver. Lipid-containing osteocytes were seen in the femoral heads of these animals. However, those which received clinofibrate (group B) had less severe lipidaemia, and less severe degeneration of the liver. In them, only the osteocytes around the haversian canals exhibited lipid inclusions. Clinofibrate appears to modify lipid metabolism, diminishing the steroid induced accumulation of lipids within osteocytes. This effect may protect against steroid-mediated osteonecrosis