Boaz Liberman

The value of hip aspiration in pediatric transient synovitis.

Introduction: Hip transient synovitis (TS) is a common pediatric orthopaedic problem. Although a self-limiting illness, it often makes the patient temporarily disabled and poses a diagnostic difficulty because of its similarity to septic arthritis in clinical manifestations. The aim of this study was to evaluate the use of a single ultrasound-guided hip aspiration as a treatment modality for TS. Methods: Between the years 1984 and 1989, 112 children with TS were treated through bed rest and using nonsteroidal anti-inflammatory drugs (group 1). Between the years 1990 and 1999, 119 children diagnosed with TS were treated using hip aspiration, bed rest, and nonsteroidal anti-inflammatory drugs (group 2). Recovery parameters were compared between these patient groups. Results: Twenty-four hours after admission, limping was noted in 92% and 10% of the patients in groups 1 and 2, respectively, (P<0.001). Refusal to bear weight was observed in 14% and 1% in groups 1 and 2, respectively, (P<0.001), and hip joint pain was reported in 81% and 6% in groups 1 and 2, respectively, (P<0.001). Larger joint effusions were found to be the reason behind the inability to bear weight. Conclusions: Pain due to TS may be because of capsule stretching owing to the accumulation of joint effusion. Ultrasound-guided hip aspiration relieves pain and limitation in movement and provides rapid differential diagnosis from septic arthritis of the hip joint.

Osteoid osteoma—the CT vessel sign

ObjectiveTo evaluate whether the presence of a feeding vessel in proximity to osteoid osteomas of long bones on multidetector CT (MDCT) can be an adjuvant clue for the diagnosis of osteoid osteoma.Materials and methodsForty-nine CT scans of patients with radiological and clinical diagnosis of osteoid osteoma of long bones and a control group of 20 CT scans of patients with cortical-based lesions other then osteoid osteoma were analyzed. Two radiologists evaluated the CT images in consensus for the presence of a blood vessel in the same axial slices in which the nidus of osteoid osteoma was seen and to determine the incidence.ResultsIn 39 cases (79.6%) of osteoid osteoma, a blood vessel either entered the nidus (23 patients) or was seen in proximity to it (16 patients). This was significantly different (P < 0.05) from the cortical-based lesions, in which only two CT scans (10%) showed a blood vessel in the lesion’s proximity.ConclusionIn the majority of osteoid osteoma lesions in long bones, a blood vessel can be seen on MDCT either entering the nidus itself or in its proximity. The role of this vessel in the lesion pathogenesis and whether it improves diagnostic accuracy need further evaluation.

Biomechanical properties of bone treated by magnetic resonance-guided focused ultrasound — an in vivo porcine model study

The magnetic resonance-guided focused ultrasound (MRgFUS) system uses MR imaging for real-time aiming of thermal ablation of bone and soft tissue tumors. Past clinical studies showed no increase in fracture rate after MRgFUS treatment. The purpose of this study was to determine the effect of MRgFUS treatment on mechanical properties of bone and correlate the effect to histological findings of treated bone. Four fully grown mini-pigs were treated by MRgFUS. Six consecutive right normal ribs were treated in each animal, and the left corresponding ribs served as controls. The animals were sacrificed at pre-set intervals (0, 2, 6 and 12weeks after treatment), and the treated and control bones were extracted. Mechanical properties of each bone were examined using three points bending studies for comparing treated bones to the corresponding controls. Histologic properties using Masson and hematoxylin-eosin stains were also compared. The ratio between treated and control biomechanical properties showed reduction in bone biomechanical properties at 6weeks post-MRgFUS treatment. The mean±SD yield load ratio and maximum ratios were 0.69±0.11 and 0.71±0.13, respectively (both p=0.031). These findings showed some recovery trend at 12weeks after treatment. Histological analysis showed a reduction in mean osteon size at 2weeks after treatment (0.58×10(-3)±0.1×10(-3)mm and 0.16×10(-3)±0.017×10(-3)mm) in control vs. treated bones, respectively (p=0.005). Treatment with the MRgFUS system resulted in a ~30% reduction in mechanical strength at 6weeks post-treatment. The reduction showed a reversible trend, with a 25%-20% decrease in strength at 12weeks post-treatment.

Uncemented Arthroplasty for Metastatic Disease of the Hip Preliminary Clinical Experience

Improved longevity among patients with metastatic bone disease led to increasing incidence of pathologic and impending fractures around the hip. Cemented hip arthroplasty is considered to be the standard of care for this condition. The purpose of this study is to evaluate the outcome of uncemented hip arthroplasty in those patients. We performed a retrospective review of clinical and radiologic data of 57 consecutive patients (60 hips) who underwent an uncemented hip arthroplasty due to metastatic hip disease. Mean follow-up was 18.6 months (range, 5-60 months); overall 1-year survival and mortality rates were 58.5% and 38.3%, respectively. Multiple myeloma and metastatic prostate carcinoma patients had better outcome over other metastasis origin. At last follow-up, no prosthesis failure or operation-related major complication has been recorded.

Quantification of human serum procollagen C-proteinase enhancer (hsPCPE) glycopattern

BACKGROUND Procollagen C-proteinase enhancer 1 (PCPE1), a glycoprotein secreted from differentiating osteoblast, enhances the rate-limiting step of collagen type I fibrillar formation. It is expressed and secreted by cells that produce collagen type I and has the potential to be a marker for bone pathologies. METHODS We developed an assay to quantify PCPE glycopattern based on isoelectric focusing (IEF) and detection with a bio-imaging camera (coefficient of variation within and between assays, 15% and 20%, respectively). RESULTS PCPE was quantified in 39 serum samples from healthy subjects (17 females and 22 males). The concentration in the serum was 305(274) ng/ml, median(IQR). The level of the PCPE isoforms and their relative distribution were altered in patients with bone disorders. CONCLUSIONS The data generated by our system, support our hypothesis that combined data on PCPE concentration and isoforms may be useful for the diagnosis and follow-up of bone diseases. Further research, on larger cohorts of both normal subjects and patients, must be done.

Magnetic resonance arthrography of the hip: prevalence of diagnoses not suspected by the referring physician and correlation with clinical examination and pain score

Background Magnetic resonance arthrography (MRA) of the hip is the most sensitive imaging modality for intra-articular pathologies such as labral tears. Purpose To evaluate the prevalence of non-suspected pathologies revealed by hip MRA and correlate them to physical examination/pain level. Material and Methods All hip MRAs (2011–2013) were retrospectively evaluated for intra- and extra-articular pathologies in consensus by two readers. A clinical score (0–7)/pain score (0–10) was calculated for each patient based on orthopedic test results extracted from referral forms/a telephone questionnaire. Patients were divided into four groups according to MRA findings: intra-articular expected (targeted) pathology only; intra-articular targeted and additional non-targeted (unexpected) pathology; non-targeted pathology; and no pathology. Pathologies prevalence/clinical score/pain score were compared between the groups. Results A total of 229 MRAs were included (127 men, 102 women; mean age, 36.5 ± 14.17 years): 111(48.4%) patients had solely intra-articular targeted pathology. Significant non-targeted pathologies were detected in 76 (33%) patients (targeted and non-targeted, 51; non-targeted only 25). No significant pathology was detected in 42 patients (18%). Mean physical examination score was 2.77 ± 1.77, range 0–7. There was no significant difference or correlation (r = 0.017, P = 0.804) between the clinical scores of the different MRA pathology groups. Pain score (143 patients) was significantly higher in the non-targeted pathology group compared to the targeted and non-targeted group (P = 0.04) and to the no pathology group (P = 0.04). There was no correlation between the physical examination score and the pain score (r = 0.017, P = 0.804). Conclusion Unsuspected non-targeted pathologies were detected in 33% of hip MRA. Physical examination/pain level could not differentiate between patients.

Concomitant findings and clinical significance of a fluid crescent between the iliacus muscle and iliac bone on MRI.

Background Some routine magnetic resonance imaging (MRI) examinations show a thin line of fluid signal intensity along the iliac crest (“fluid crescent”) between the iliacus muscle and the iliac bone. This fluid crescent has not been described before. Purpose To evaluate the clinical context and significance of the fluid crescent. Material and Methods MRI examinations of the abdomen and pelvis performed over 1 year were retrospectively reviewed twice for the presence of a fluid crescent. The relationship between the presence of a fluid crescent and associated abnormal findings, including ascites, iliopsoas compartment, and bone and soft tissue pathologies, was evaluated. Results Forty-one out of 254 MRI studies (male:female ratio, 136:118; mean age, 42 years) demonstrated a fluid crescent (16%). Thirty-eight of them had associated MRI pathologies: edema of the hip muscles = 24, ascites = 11, iliac bone = 21, and iliopsoas compartment = 7. Correlations between the presence of a fluid crescent and pathological findings were highly significant (P < 0.0001), except for the presence of fluid in the hip joint. Conclusion A fluid crescent is an abnormal MRI finding strongly associated with iliopsoas compartment pathology, ascites, hip muscle edema, and pelvic bone abnormalities. The nature of this fluid crescent is yet to be determined.