Harry J. Griffiths

Skeletal changes following renal transplantation.

Of 225 patients who underwent renal transplantation, 100 (44%) later demonstrated osseous changes. Avascular necrosis was seen at the femoral head in 56 and at other sites in 21. Subperiosteal resorption was found in 48, osteosclerosis in 24, and pathological fractures in 30. Other osseous lesions included brown tumors, osteomyelitis, osteopenia, and periostitis. These findings represent most aspects of skeletal involvement in renal failure following renal transplantation.

Granulomatous pseudotumors in total joint replacement

Fourteen patients (15 joints) developed a foreign body reaction to methylmethacrylate, polyethylene, or metal adjacent to a total joint implan, a condition we would like to term granulomatous pseudotumors. There were eight male and six female patients. Their average age was 61 years. The hip was involved in 14 joints (femoral component 11 times, acetabulum 7, and great trochanter once). One patient presented with granulomatous pseudotumors of the knee. The principal findings included increasing pain and radiographic evidence of loosening occurring on average 2.7 years following the implant. This was followed by a characteristic and gradually developing radiographic pattern of discrete rounded lucencies. These developed into large ovoid lytic areas, destroying both methylmethacrylate and bone. Histologically, the appearances were characterized by histiocytic infiltration and the presence of multiple foreign body giant cells. Foreign material was identified in 9 of 11 cases. The pathogenesis is unknown but appears related to micromovement or loosening of the implant.

Bursitis in association with solitary osteochondromas presenting as mass lesions.

Three patients with solitary osteochondromas which were increasing in size have been recently examined. Plain films were available on all patients; two patients had MR studies, and two had CT scans. In all three cases, malignant transformation of the osteochondroma was suspected from the cross-sectional imaging studies, but pathologic examination proved that these patients all had bursa formation without any evidence of malignancy. The incidence of this rare complication of solitary osteochondroma is discussed. Ultrasound is also recommended for the evaluation of enlarging solitary osteochondromas.

The use of photon absorptiometry in the diagnosis of renal osteodystrophy.

By using a 125I collimated point source to measure bone mineral, 700 measurements were obtained from the cortical bone of the lower arm in 303 patients with renal failure representing every stage of the disease. Of these patients, 123 had received transplants. The following conclusions can be drawn: (a) Prolonged azotemia leads to severe loss of bone mineral, which, in early stages, is only detectable using photon absorptiometry. (b) Gradual loss of bone mineral occurs during dialysis, (c) Parathyroidectomy slows this loss but fails to reverse it. (d) After transplantation, the rate of bone loss will either decrease or cease, but few patients show any increase in bone mineral. (e) Preliminary biochemical data on these patients show a relationship between bone mineral and creatinine, serum phosphate and serum calcium values.

Comparison of CT scanning with photon absorptiometric measurement of bone mineral content in the appendicular skeleton.

Traditional methods of bone mineral analysis were compared to a new technique using computerized tomography (or CT scanning). The correlation between the CT values for long bones in the dog and actual calcium content was 0.9942. The correlation between two photon absorptiometric techniques and CT values were also 0.9981 and 0.9962. The precision of repeated scans was +/-2%. It is suggested that the CT scanner will allow bone mineral analysis to be performed with accuracy and precision.

The radiology of total hip replacement

The radiology of total hip replacement (THR) and its complications is reviewed in conjunction with a long-term follow-up study on 402 patients with 501 prostheses. The indications, contraindications, biomechanics, and operative management of these patients is discussed. Clinical complications such as deep vein thrombosis, pulmonary embolism, and hemorrhage are mentioned. Postoperative infections including granulomatous pseudotumors, dislocations and fractures, true loosening of the prosthesis, and heterotopic bone formation (HBF) are discussed and illustrated. The importance of differentiating the lucent line from true loosening is stressed. Mechanical and other clinical complications which are largely ignored by radiologists are also discussed. The uses of arthrography and bone scanning are included.

Computed Tomography in the Management of Acetabular Fractures

Twenty-four patients who sustained major hip trauma received computed tomography (CT) scans as well as conventional radiographs. A comparison of plain films with the CT scans showed that CT aided the diagnosis in 23 patients (96%): that CT altered the diagnosis in 14 patients (58%) and that the CT findings altered the management in eight patients (33%). It is our conclusion that CT scanning plays an essential role in the work-up and management of patients with major hip trauma.

The role of calcium and fluoride in osteoporosis in rhesus monkeys.

Twenty-two female Rhesus monkeys were fed purified diets varying in calcium and fluoride content for five years and studied, using radiographic, photon absorptiometric and histologic techniques. The results suggested that: 1) the addition of fluoride (50 ppm) to a diet containing 1 per cent calcium resulted in a reduction in bone growth rate and resorption, without affecting bone size or density nor resulting in fluorosis; 2) a diet containing 0.15 per cent calcium resulted in osteoporosis due to an increase in bone resorption; and 3) fluoride added to a similar low calcium diet prevented osteroporosis by reducing bone growth rate and resorption resulting in bones with normal density, but at the same time fluoride interfered with mineralization of osteoid leading to osteomalacia.

A Case of Lipoatrophic Diabetes

A case of lipoatrophic diabetes with atypical biochemical and radiological features is presented. Scattered areas of increased radiodensity in the region of all major joints were associated with cystic changes at the shoulders. It is postulated that this condition varies from patient to patient in severity as well as in course and progression.

Use of MRI in Evaluating Postoperative Changes in Patients With Bone and Soft Tissue Tumors

We reviewed the clinical, surgical and magnetic resonance imaging (MRI) findings in 80 patients who underwent resection of primary benign or malignant bone or soft tissue tumors. There were 18 benign and 62 malignant tumors. Although 31 patients were originally thought to have recurrence, on review only 20 patients were considered to have recurred. Of these, three were found only to have postoperative changes at surgery. Seventeen patients actually had recurrence of tumor. We believe that the presence of an actual mass lesion on MRI is the cornerstone for the correct diagnosis of recurrent tumor.