Frans C. van Biezen

Impaction bone-grafting of severely defective femora in revision total hip surgery: 21 hips followed for 41-85 months.

We performed a prospective study to evaluate the application of impacted allograft bone particles at revision surgery of severely defective femora. According to the Endo-Klinik classification, 21 hips had grade III or IV femoral defects, of which 4 had a preoperative fracture. No femoral re-revisions had been necessary after a mean follow-up of 60 (41-85) months. The mean Harris Hip Score improved by 39 points to 78 points. 2 fractures occurred postoperatively, 1 of which needed reoperation with osteosynthesis. 1 patient needed a closed reduction after dislocation. 4 stems showed significant subsidence (> 10 mm) in the follow-up radiographs. In total hip revision surgery, even severely damaged femora can be successfully treated by impaction allografting.

Health-related quality of life in patients with adolescent idiopathic scoliosis after treatment: short-term effects after brace or surgical treatment

For treatment of teenagers with progressive adolescent idiopathic scoliosis in an early stage, two options are generally considered: treatment with a brace or observation followed by surgery if necessary. Many doctors and patients prefer conservative treatment (i.e. brace treatment) to surgical treatment, because surgery of the spine is generally considered a drastic intervention. Because potential differences in health-related quality of life (HRQoL) after treatment between braced and surgically treated patients are not well explored, this study aimed to determine whether short-term differences exist in HRQoL between adolescents treated with a brace or treated surgically. A cross-sectional analysis of HRQoL was made of 109 patients with adolescent idiopathic scoliosis who, after completing treatment, filled out the Dutch SRS-22 Patient Questionnaire. All patients had been treated either with a brace or surgery, or with a brace followed by surgery. Patients treated surgically had significantly higher mean scores in the satisfaction with management domain than those treated with a brace. No other consistent differences in HRQoL were found between patients treated with a brace and patients treated surgically. Gender, curve type and curve size had no relevant effect on HRQoL. We conclude that short-term differences in HRQoL after treatment in adolescent patients with idiopathic scoliosis are negligible and cannot support preference of one treatment above the other.

Estimating the Effectiveness of Screening for Scoliosis: A Case-Control Study

OBJECTIVE. The aim of this study was to test the hypothesis that screening for scoliosis is effective in reducing the need for surgical treatment. METHODS. The study was a case-control study. A total of 125 consecutive patients who were treated surgically for idiopathic scoliosis between January 2001 and October 2004 and who were born on or after January 1, 1984, were invited; 108 agreed to participate. A total of 216 control subjects were selected randomly and anonymously, matched with respect to age and gender. For 279 adolescents, exact screening exposure and outcomes could be analyzed. Case subjects were recruited from 4 university and 6 nonuniversity Dutch hospitals; control subjects were recruited from all 37 municipal health services in the Netherlands. RESULTS. Screen-detected patients received diagnoses at a significantly younger age than did otherwise-detected patients (10.8 ± 2.6 vs 13.4 ± 1.7 years). In total, 32.8% of the surgically treated patients had been screened between 11 and 14 years of age, compared with 43.4% of the control subjects. The odds ratio for being exposed to screening was 0.64. In total, 28% of the patients were diagnosed as having scoliosis before 11 years of age. CONCLUSIONS. Our results showed no evidence that screening for scoliosis reduced the need for surgery. Abolishing screening seems justified, especially because the effectiveness of early treatment with bracing is still strongly debated. A randomized, controlled trial on the effectiveness of treating patients with idiopathic scoliosis with bracing is urgently needed.

Screening for scoliosis: Do we have indications for effectiveness?

Objective: The effectiveness of screening for scoliosis has not been established. This study investigated whether patients with adolescent idiopathic scoliosis detected by screening are detected in an earlier stage of the clinical course, and whether these patients have better outcome than otherwise detected patients. Setting: The study is a retrospective follow-up study of patients with adolescent idiopathic scoliosis who had completed treatment with a brace, by surgery, or with a brace followed by surgery. Of the 143 patients (born on or after 1 January 1984) consecutively recruited from 12 hospitals in the Netherlands, 125 (87%) agreed to participate. Of these, 51 patients were treated with a brace only and 74 patients were operated on. Screening for scoliosis is carried out in 80% of Dutch children. Methods: Data on being screen detected or otherwise detected and Cobb angle at diagnosis were collected using youth health-care files, medical files and interviews by telephone with the patients. Results: About 55% of the patients were detected by screening (programme sensitivity). Screen-detected patients had a significantly smaller Cobb angle at diagnosis (28° versus 40°; P<0.01) and had a 73% lower chance of having had surgery (45% versus 75%; P<0.01) than otherwise-detected patients. Conclusion: In the present study, two essential prerequisites necessary for a screening programme for scoliosis to be effective have been met. However, definite proof of the effectiveness of screening still needs to be established because length bias and over-treatment bias cannot be ruled out using this design.

Living cells in 1 of 2 frozen femoral heads

Allogeneic, frozen bone is now the most commonly grafted tissue (Norman-Taylor and Villar 1997). Tissue banks collect bone material according to protocols developed with the aim of maintaining osseoinductive properties of grafts as well as preventing transmission of viral or bacterial diseases (Standards from the American Association of Tissue Banks (AATB) or from the European Association for Musculo-skeletal Transplanting (EAMST)). Standard procedures include cryopreservation of tissue at -80°C, which is generally considered to devitalize the bone by killing all cells present, resulting in reduced immunogenicity of the graft. The osseoinductive properties of frozen, allogeneic bone grafts have therefore mainly been attributed to the dead bone matrix, that may provide osteoblast-stimulating growth factors and other essential proteins, and/or an osteoclast substrate to direct bone remodeling (Aspenberg et al. 1996, Kingsmill et al. 1999). Recently however, it was suggested that some cells in bone biopsies may survive standard bone bank freezing procotols. It is unclear whether vital cells are present in other bone banks and whether these cells can contribute to the clinical outcome of frozen allogeneic bone grafting. In this report, we show that frozen bone biopsies, obtained from the Erasmus Medical Center bone bank may contain living cells that can be cultured in vitro. These cultured cells were found to originate from the donor by genotyping.

Femoral Component Neck Fracture After Failed Hip Resurfacing Arthroplasty

Failure on the femoral side after third-generation metal-on-metal hip resurfacing arthroplasty is suggested to be easily treated with conversion to conventional total hip arthroplasty. Clinical results of conversion for failed hip resurfacing arthroplasty with the use of primary femoral implants confirmed this for a short-term follow-up. We present a case of the occurrence of a stemmed femoral implant neck fracture in a patient who was earlier treated for a failed hip resurfacing. We advise to consider acetabular revision in case of (suspected) acetabular metal damage and to use a stem component with a relative large neck diameter.

Failure of tibial bone grafting for femoral head necrosis

We treated 20 hips with femoral head necrosis in 16 patients using the Phemister tibial bone grafting procedure. After a mean follow-up of 3 years, the Harris hip score had improved in 15 out of 18 hips, however without radiographic improvement. In 2 hips, an arthrodesis and an arthroplasty were performed. We concluded that the aim of our treatment was not achieved.

Trochanteric osteotomy versus posterolateral approach: function the first year post surgery. A pilot study

BackgroundAlthough no prospective studies have compared functional results of trochanteric osteotomy and a non-trochanteric approach, most surgeons feel that trochanteric osteotomy is outdated in simple hip arthroplasty. Reasons not to perform an osteotomy include the fear of longer rehabilitation and worse (final) functional outcome.MethodThis prospective study examines differences in rehabilitation between posterolateral and trochanteric approach one year post-surgery using questionnaires (WOMAC, SF-36, HHS) and functional tests (walking, climbing stairs, rising from sitting, and strength tests). Of the 109 patients 24 had a trochanteric osteotomy: the selected approach was based on the surgeons preference. The trochanteric osteotomy group included more patients with developmental dysplasia of the hip. Before the start of the study no power analysis was performed.ResultsData from the questionnaires showed no significant differences between the two groups at 3, 6 and 12-months follow-up. At 3-months follow-up patients in the trochanteric osteotomy group scored lower on the functional tests. This difference had disappeared at 6 and 12-months follow-up, except for abduction force which remained lower in the trochanteric osteotomy group in patients with a non union of the TO.ConclusionFor simple hip arthroplasty an approach without osteotomy seems a logical choice. Although the power of this study is low, in experienced hands trochanteric osteotomy seems to give good functional results at 6-12 months post surgery if trochanteric union is obtained. Therefore, one should not hesitate to perform an osteotomy in difficult cases.