Amanda F. Harding

Trabecular bone mineral density in idiopathic scoliosis

The association of idiopathic scoliosis with an osteoporotic state has been indicated previously. The present study compared the trabecular bone mineral densities of 44 adolescent idiopathic scoliotic girls with 44 age-, weight-, sex-, and race-matched controls. Their lumbar spine and femoral neck bone mineral densities were evaluated using dual-photon absorptiometry. Radiographs and scoliotic curve data were also obtained for the experimental group. The scoliotic subjects exhibited significantly lower lumbar and femoral neck bone mineral densities than the control subjects. No effect was found with respect to treatment, degree, or progression of curvature. The results of this study indicate that there is a generalized state of osteoporosis in idiopathic scoliotic girls when compared with matched controls.

Evaluation of hydroxylapatite graft materials in canine cervical spine fusions

The efficacy of ceramic hydroxylapatite implant materials as graft materials for cervical spine fusion was evaluated in canines. Bioresorbable and non-bioresorbable systems were evaluated at time periods ranging from 1 to 24 weeks. Implant interbody position and progression of fusion were evaluated radiographically and histologically. Implant fracture and extrusion into adjacent soft tissues occurred in nine of 23 cases. Implant fracture occurred in many of the remaining 14 cases, however, the implant materials remained within the interspace. Implant fracture occurred with both implant systems. Radiographically little evidence of fusion was observed at less than 6 weeks, however by 12 weeks evidence of fusion was noted and was confirmed histologically. No difference in fusion rate or degree of fusion was observed between the two implant systems.

Clinical and Metallurgical Analysis of Retrieved Internal Fixation Devices

The clinical performance, corrosion characteristics, and metallurgical properties of 82 retrieved stainless-steel bone plates have been examined. The plates had been in situ for periods ranging from one to 169 months. Only 29% of these devices (24 of 82 plates) were removed on a routine asymptomatic basis, while 62% (51 of 82 plates) were removed for cause-related reasons such as implant-related pain, infection, nonunion or malunion, and so forth; seven plates were removed for unknown reasons. Although most patients who had plates removed for pain reported some improvement in symptoms, others felt no improvement after removal. On examination, over 89% of the recovered implants displayed some degree of either surface (pitting) or screw-plate interface (crevice and fretting) corrosion or both. Statistical analyses revealed that the metallurgical properties of grain size and nonmetallic inclusion content correlated significantly with the degree of both types of corrosion.

Tissue Reaction to Implant Corrosion in 38 Internal Fixation Devices

The corrosion characteristics, metallurgical properties, and clinical performance of 38 retrieved internal fixation devices were correlated with the tissue reaction to these devices. Metallurgical parameters included thin and heavy inclusion content, Rockwell hardness, and grain size. The excised fibrous tissue strip was directly overlying each plate at removal and sectioned between screw-hole sites. The material studied from the 38 plates consisted of 201 screw-hole junctions with associated tissue biopsy sites. Clinical histories were obtained on all 38 patients with hardware removal. The average age at the time of plate insertion was 35.6 years (range, 4 to 75 years). Insertion diagnoses included acute trauma (35 patients), joint dislocations (two patients), and fracture nonunion (one patient). The devices included seven upper extremity bone plates, 19 lower extremity bone plates, and 12 hip screw plates. The devices remained in situ an average of 20.4 months (range, 3 to 60 months). Routine asymptomatic removals were performed on 17 of the patients, while the remaining 21 patients were symptomatic at the time of removal. Included in the reasons for symptomatic removal were pain associated with the implant (eight patients), nonunion (four patients), bursae prominence (three patients), and implant breakage (two patients). Significant correlations were found between average tissue reaction scores and average crevice corrosion scores; a trend of increasing average tissue reaction scores with increasing average screw surface corrosion scores also was observed for the 38 devices, although this relationship was not significant. Average crevice corrosion scores and average screw surface corrosion scores were highly correlated for all removals, and for the asymptomatic and symptomatic removal groups. The metallurgical parameters of thin inclusion content and heavy inclusion content also were significantly correlated for all removals, as well as for symptomatic removals. Similarly, significant correlations were found between the individual tissue reaction scores and crevice corrosion scores from the 201 individual sites, again for all devices and for the asymptomatic and symptomatic removal groups. Tissue reaction scores and time in situ showed significant correlation, with tissue reaction decreasing over time. Crevice corrosion and screw surface corrosion scores were not significantly related to time in situ. The results of this study indicate that there is considerable tissue reaction to the corrosion products of this material.(ABSTRACT TRUNCATED AT 400 WORDS)

Association of bone mineral density and pediatric fractures

Bone mineral density in the lumbar spine and the left femoral neck was measured for a group of 17 children, 3–14 years of age. who had sustained traumatic fractures. Children with any signs of metabolic bone disease were excluded from the study. Identical measurements were made on an age- and sex-matched control population using dual photon absorptiometry. Analysis of bone mineral measurements revealed that there were no statistically significant differences between the lumbar and femoral neck densities of the two groups. The results indicate that reduced bone density is unlikely to play a significant role in acute traumatic pediatric fractures.

Osteoporotic Correlates of Alcoholism in Young Males

A group of 22 white males (ages, 28 to 40 years) with histories of chronic alcohol abuse ranging from 1 to 21 years were evaluated for trabecular bone mineral density in the left femoral neck area. A group of age and weight-matched white males with no history of alcoholism served as controls. All participants completed medical history questionnaires regarding fracture history, dietary habits, medications, and physical activity. Singh femoral trabecular indices also were measured for the alcoholic participants. Analysis of bone mineral data as measured by dual photon absorptiometry revealed no statistically significant reduction in the bone mineral densities of the alcoholic group when compared to the controls. No differences were seen in the areas of the femoral neck, Wards triangle, and greater trochanter. Duration of alcoholism also was not correlated with the degree of osteopenia. Singh index measurements of right and left femoral heads were compared and revealed no significant differences within individual patients. Left femoral Singh index values averaged 5.5 (range, 4 to 6) for the alcoholic group and were not indicative of decreased bone mineral density. It is concluded from this study that chronic alcoholism associated with heavy smoking most likely has a debilitating effect on the trabecular bone density of white males, yet clinical and radiographic evidence is not widely manifested in men under the age of 40 years.

Effects of anticonvulsant drug therapy on bone mineral density in a pediatric population.

Twenty epileptic outpatients, aged 5–20 years and taking either phenobarbital or phenytoin for anticonvulsant therapy, were evaluated for femoral neck area bone mineral content and bone mineral density using dual photon absorptiometry. Duration of treatment averaged 51.4 months (range, 9–124 months). A group of 20 normal children who were matched for age, sex, and race served as controls. There were no statistically significant differences between the femoral neck area bone mineral densities of the epileptic patients as compared to the controls. There were also no correlations between duration of anticonvulsant therapy and bone mineral density, nor any differences in bone mineral density values when comparing epileptic patients taking phenobarbital with those patients taking phenytoin.

An evaluation of the mechanical failure modalities of a rotating hinge knee prosthesis.

The clinical and metallurgical performance of 12 retrieved Noiles total knee prostheses was investigated. Clinical histories and serial roentgenograms were used in conjunction with the American Society for Testing and Materials (ASTM) standard implant retrieval and analysis techniques to assess device performance. All of the devices were removed because of implant loosening with pain, while two devices also had a late infection. The average time in situ for all devices was four years. Roentgenographically, all of the devices showed signs of progressive radiolucencies. Ten (83%) of the devices migrated proximally within the femur. A marked varus drift was observed in eight (67%) of the retrieved prostheses. Hypertrophy of the femoral cortex was observed in eight (67%) of the cases. Seventy-three percent of the polyethylene tibial stems exhibited extensive wear on the anterior and medial aspects of the articulating surface. Extensive wear was also seen on the anterior and extreme posterior aspects in 92% of the polyethylene tibial plateau bearings. This wear was a consequence of the migration of the femoral component leading to buttressing of the plastic components against bone or bone cement. This study indicates serious design flaws in the Noiles knee prosthesis that unless corrected would question the use of the device in either primary or revision knee surgery.

Retrieval and Analysis of Intramedullary Rods: A Follow-up Study

From 1980 to 1983, 16 AO intramedullary femoral rods were retrieved and analyzed clinically, radiographically, and metallurgically. Cracking and/or fracture was observed in four of the 16 specimens. All cracks occurred at the point of maximum stress at the end of the slot. In two cases a structurally weaker weld zone coincided with this location. The weld zone and slot were also found to coincide in five of the uncracked rods. Two of the four cracked rods were removed because of pain, while only three of the 12 uncracked rods caused pain. Structural and material characteristics (i.e., the location of the weld at a point of maximum stress and significant variability in microstructure), rather than surgical technique or time in situ, were found to be responsible for the implant mechanical failures. Improvements should be made in fabrication techniques and material properties. For the present, careful assessment of a painful intramedullary rod and routine removal after healing are advisable.

A chronically dislocating prosthetic patella. A case report.

A 63-year-old white woman was evaluated for a chronically dislocating right patella 6 months following total knee arthroplasty. At the time of our initial evaluation, her knee would not extend beyond 35 degrees and her patella was dislocated and irreducible. At arthrotomy, when the patella was everted, the patellar component was oriented with the facet ridge rotated 90 degrees to the trochlear groove of the femoral component. The patellar template guide indicated that the fixation pegs had been drilled properly, and thus, the patellar component had been assembled improperly during manufacturing. After dome-type patellar prosthesis replacement and proximal and distal extensor realignments were performed, 2 months post-revision the patient had a range of motion from 5 degrees to 95 degrees and ambulated with no patellar instability or pain.