Göran Sundén

Intracapsular pressure in transient synovitis of the hip

Fourteen consecutive children with symptoms of transient synovitis of the hip were examined with sonography regarding intracapsular effusion, with scintimetry regarding blood-flow in the proximal femoral epiphysis (PFE) and with intracapsular pressure recording and aspiration. All patients had an intracapsular effusion. Intracapsular pressure was found to depend on the position of the hip. The mean pressure with hips in extension and inward rotation was 22.6 kPa (170 mm Hg) whereas in 45 degrees of flexion it was 2.3 kPa. In two cases scintimetry demonstrated reduced blood flow to the PFE; after aspiration, isotope uptake returned to normal, indicating that increased intracapsular pressure has a harmful effect on circulation to the PFE. Children with transient synovitis should be treated with the hips in 45 degrees of flexion to reduce intracapsular pressure. Forcing the hip in extension causes a risk of ischaemia of the PFE.

Computed tomography and ultrasonography for diagnosis of hip joint effusion in children

Nineteen consecutive children with transient synovitis of the hip were examined for intracapsular joint effusion using computed tomography (CT) and ultrasonography (US). The two techniques were highly correlated in measurements of the anterior displacement of the joint capsule, indicating both to be reliable diagnostic tools. Such an effusion is clinically important because of the increase in intracapsular pressure with ensuing disturbance in the vascular supply to the proximal femoral epiphysis, as demonstrated experimentally and clinically in transient synovitis.

PYROPHOSPHATE ARTHROPATHY: A CLINICAL STUDY OF FIFTY CASES

1. A systematic collection of the clinical findings in fifty patients with pyrophosphate synovitis,among some 300 patients with obscure disorder of the knee, has been made over a period of eighteen months. The numbers of men and women were equal, the mean age being seventy years (range thirty-seven to ninety), and the mean age at the onset of symptoms fifty-nine years. 2. A difference in the clinical picture between the sexes was found. In men an acute synovitis predominated, in women chronic joint complaints. 3. A high incidence of accompanying disease was found, but none had a significant relationship to the arthropathy, although the high frequency (20 per cent) of synovitis following an acute severe illness of some other kind was striking. 4. No specific radiological sign except for calcifications in articular cartilage and menisci was found in these patients, and no relationship to osteoarthrosis could be established. 5. The great variability of symptoms and the surprisingly high incidence attracts attention to pyrophosphate synovitis as a cause of joint symptoms, especially in elderly patients.

Early intensive treatment of clubfoot : 75 feet followed for 6-11 years

47 consecutive children with 28 bilateral and 19 unilateral clubfeet were treated during the neonatal period according to a strict protocol including physiotherapy and bracing from the first 2 weeks of life; further, in most of the children, an operation was performed at 3 (2-5) months of age. Physiotherapy was continued during the first year of life and bracing for 3 years. 27 feet had repeat operations. No peroperative or postoperative complications were seen. At follow-up at aged 8 (6-11) years, the cosmetic result was good in 62 feet, acceptable in 12 feet, and poor in 1 foot, whereas the functional result was excellent in 51 feet, good in 21 feet, and fair in 3 feet. The radiographs showed a higher lateral talocalcaneal angle in the control feet than in the treated feet; but in other radiographic aspects, no differences were seen. The need of a secondary or even tertiary operation did not indicate a poor result.

A Roentgen Stereophotogrammetric Investigation of Innominate Osteotomy (Salter)

The effect of the innominate osteotomy according to Salter was investigated by a roentgen stereophotogrammetric method in a 17-year-old girl with hip dysplasia as a part of the tricho-rhino-phalangeal (Giedion) syndrome. The osteotomy resulted in a total rotation of 32 degrees about an axis passing cranially to the pubic symphysis and the osteotomy. The acetabulum rotated 22 degrees forwards about a transverse axis, 9 degrees laterally about a longitudinal axis and 24 degrees laterally about a sagittal axis. The acetabulum was translated 2 mm laterally along a transverse axis, 21 mm caudally along a longitudinal axis and 19 mm dorsally along a sagittal axis. The position of the screw axis indicates that some motion also took place in one or both of the sacroiliac joints. The correction as measured with the CE-angle was 25 degrees which was almost the same as the correction about the sagittal axis. It is, however, noted that the CE-angle was also dependent upon the rotations about the transverse and longitudinal axes.

Synovectomy in Bacterial Arthritis

Twenty patients with bacterial arthritis with either delay in diagnosis or no response to treatment are presented. Synovectomy, even when performed after 5 days and up to 4 weeks later, could prevent joint destruction in the knee but not in the hip. The average follow-up time was 5 (2-9) years.

Ilizarov Technique in the Correction of Knee Flexion Contracture: Report of Four Cases

The Ilizarov technique was used in five knees for the correction of a flexion contracture that had not responded to nonoperative treatment. Preoperative contractures of 25–75° were reduced to 0–15°. Three months after frame removal the knees had almost the same range of extension as immediately after frame removal, and all except one patient with severe arthritis had the same range of flexion as before treatment. Compared with alternative operative methods, the Ilizarov technique has the advantage of minor operative trauma with a gradually controlled correction, permitting the soft tissues to regenerate. There is also the possibility of simultaneous correction of leg length.

CDH diagnosed at 2 to 12 months of age: treatment and results

A treatment program for late-diagnosed CDH included skin traction, arthrography, tenotomy of adductor and psoas tendons, and immobilization of the hips in the “frog leg” position with a plaster cast for 8–12 weeks, followed by an abduction frame until the acetabular dysplasia normalized. Follow-up of 40 children with nonteratological CDH performed 2–12 years after diagnosis revealed 38 normal hips and 2 patients with coxa magna, one of whom had intermittent hip pain.