Eiji Suenaga

Intraarticular findings in symptomatic developmental dysplasia of the hip

Background: The purpose of this study was to examine intraarticular pathology in patients younger than 20 years with symptomatic developmental dysplasia of the hip. Methods: We performed hip arthroscopy during corrective osteotomy in 23 hips in 22 patients. All patients were female, and the average age at operation was 16.4 years. Eighteen hips were in a prearthritic stage, and 5 hips were in an early stage. The presence and location of cartilage degeneration and labral tears were evaluated. Second-look arthroscopy was performed in 13 hips in 12 patients. Results: Fourteen hips (77.8%) in the prearthritic stage had cartilage degeneration. Cartilage lesions were more frequent in the acetabulum than in the femoral head (72.2% vs 16.7%). Sixty-one percent of acetabular lesions were located at the anterosuperior area. Labral tears were observed in 77.8% of hips in prearthritic stages located at the anterosuperior (72.2%) and superior (44.4%) areas. The degree of cartilage and labral lesions in the early stage was more severe than in the prearthritic stage. On second-look arthroscopy, there were no changes in the state of the cartilage and labrum in the majority (84.6%) of hips. Conclusions: The incidence of intraarticular lesions in developmental dysplasia of the hip was high, even in the prearthritic stage. These lesions tended to originate in the anterosuperior area of the acetabulum and were generally progressive. Level of evidence: Therapeutic study, level IV.

Prediction of the outcome of transtrochanteric rotational osteotomy for osteonecrosis of the femoral head.

We have studied the correlation between the prevention of progressive collapse and the ratio of the intact articular surface of the femoral head, after transtrochanteric rotational osteotomy for osteonecrosis. We used probit analysis on 125 hips in order to assess the ratio necessary to prevent progressive radiological collapse over a ten-year period. The results show that a minimum postoperative intact ratio of 34% was required. This critical ratio may be useful for surgical planning and in assessing the natural history of the condition.

Prediction of the outcome of transtrochanteric rotational osteotomy for osteonecrosis of the femoral head

We have studied the correlation between the prevention of progressive collapse and the ratio of the intact articular surface of the femoral head, after transtrochanteric rotational osteotomy for osteonecrosis. We used probit analysis on 125 hips in order to assess the ratio necessary to prevent progressive radiological collapse over a ten-year period. The results show that a minimum postoperative intact ratio of 34% was required. This critical ratio may be useful for surgical planning and in assessing the natural history of the condition.

Prevalence of Torn Posterior Horn of the Medial Meniscus in Middle Age and Elderly Patients

内側半月断裂型および後角横断裂の占める割合について検討した．平成20年7月までの過去5年9ヶ月間に当院にて半月処置の目的で関節鏡を行った50歳以上の内側半月損傷188例201膝を対象とした．平均年齢63歳（50-86歳），男性49例51膝，女性139例150膝であった．半月断裂型，部位は鏡視所見により分類した．横断裂は111膝（55％），横断裂と水平断裂の合併は33膝（16.4％），水平断裂は30膝（15.9％），弁状断裂は21膝（10％）に認めた．横断裂のうち89膝（80％）は後角に認めた．近年，後角断裂の占める割合が高くなった理由として，後角横断裂が周知されてきたこと，疾患そのものの増加，MRI診断精度の向上などが考えられる．後角横断裂の場合は手術療法として，半月切除だけでなく，半月温存治療であるラスピングも選択肢に含まれるために，後角横断裂の認識と診断は重要である．

Operative Treatment of Psychiatric Patients with Fractures

In the past 3 years from 1994 to 1997, we treated 21 patients with pychiatric disorder. 9 patients were male and 12 were female, and their mean age was 56.9 years. There were many problems which could not be managed with in the orthopedic ward. Preoperatively, all patient received intensive phychiatric medication. Minor wound infection in 3 patients and pseudoarthrosis in 1 patient were obserred.At the time of operation, the pre-operative period and pre-operative management of tranquilizers imposed various effects on the results of operations and rehabilitation. Moreover, post-operative care proved difficult as the patients did not recognize their disorders.As 3 patients were predisposed to infections and wound related complications, it suggested the importance of cooperation between the phychiatrist and orthopaedic surgeon during the pre- and post-operative periods in the orthopedic treatment of patients with psychiatric disorders.