Sung Taek Jung

Osteolysis in Association with a Total Hip Arthroplasty with Ceramic Bearing Surfaces

The results of 103 total hip arthroplasties performed with insertion of a ceramic femoral head and acetabular component in ninety-six patients were reviewed to determine the radiographic prevalence of osteolysis. After a mean duration of follow-up of ninety-two months (range, sixty to 125 months), femoral osteolysis was observed in twenty-three hips (22 per cent), in one of two distinct patterns: linear osteolysis (twelve hips) or scalloping expansile-type osteolysis (eleven hips). The most common locations of osteolysis in the femur were in zones I and VII as described by Gruen et al. Serial radiographs demonstrated that the extent of the osteolysis progressed over time. Osteolysis of the pelvis, noted in forty-nine hips, was always associated with migration of the acetabular socket. No focal osteolysis was observed in association with the stable sockets. Ten patients (ten hips) had a revision because of loosening and migration of the acetabular component. In three of these patients, the femoral stem also was revised. Gross examination revealed evidence of wear of the ceramic bearing surface in all ten patients. Scanning electron microscopy showed cracking and wear marks on the weight-bearing surface. Histological evaluation of the tissue in the periprosthetic membrane demonstrated abundant ceramic wear particles. The interface membrane was composed of a vascularized fibrous connective tissue with macrophages. Ultrastructurally, the macrophages contained numerous phagosomes of various sizes, with electron-dense material within the cytoplasm of the cell. The mean size of the ceramic particles, as determined with scanning electron microscopy, was 0.71 micrometer (range, 0.13 to 7.20 micrometers). This study supports the concept that ceramic wear particles can stimulate a foreign-body response and periprosthetic osteolysis.

Significance of laboratory and radiologic findings for differentiating between septic arthritis and transient synovitis of the hip.

Although significant differences exist in the methods of treatment and prognoses of septic coxitis and transient synovitis in children complaining of acute hip pain, similar symptoms are present in these two diseases at the early stages, and differential diagnosis is difficult. To differentiate between these two diseases, the authors evaluated the clinical, serologic, and radiologic findings and tried to determine factors that could be used as diagnostic criteria. The authors performed a retrospective study by evaluating medical records, plain hip radiographs, and clinical findings in 97 patients with transient synovitis and 27 patients with septic arthritis. Univariate analysis showed significant differences in body temperature, serum WBC count, and ESR and CRP levels of the two patient groups. Plain radiographs showed a displacement or blurring of periarticular fat pads in all patients with acute septic arthritis, and multivariate regression analysis showed that body temperature >37°C, ESR >20 mm/h, CRP >1 mg/dL, WBC >11,000/mL, and an increased hip joint space of >2 mm were independent multivariate predictors of acute septic arthritis. The authors conclude that the independent multivariate predictors are effective indices for the differential diagnosis of acute septic coxitis and transient synovitis.

Subtalar Arthroscopy for Sinus Tarsi Syndrome: Arthroscopic Findings and Clinical Outcomes of 33 Consecutive Cases

PURPOSE The purposes of this study were to identify the pathologic findings of sinus tarsi syndrome (STS) by subtalar arthroscopy and to evaluate the results of arthroscopic treatments in 33 consecutive cases. METHODS A retrospective review was performed in 31 consecutive patients (33 cases) who underwent subtalar arthroscopic treatment for STS. The mean follow-up duration was 24 months (range, 18 to 36 months). Patients were evaluated by use of arthroscopic findings (recorded on videotapes and photographs) and clinical outcomes, which included visual analog scale and American Orthopaedic Foot and Ankle Society ankle-hindfoot scores. RESULTS Arthroscopic findings showed partial tear of the interosseous talocalcaneal ligament in 29 cases (88%), synovitis in 18 (55%), partial tear of the cervical ligament in 11 (33%), arthrofibrosis in 8 (24%), and soft-tissue impingement in 7 (21%). The mean visual analog scale score improved from 7.3 points (range, 6 to 9 points) preoperatively to 2.7 points (range, 1 to 4 points) postoperatively (P < .005), and the mean American Orthopaedic Foot and Ankle Society ankle-hindfoot score improved from 43.1 points (range, 21 to 65 points) preoperatively to 86.2 points (range, 72 to 100 points) postoperatively (P < .005). Of the cases, 16 (48%) had an excellent result, 13 (39%) had a good result, and 4 (12%) had a fair result. CONCLUSIONS Subtalar arthroscopy identified pathologies in the subtalar joint in patients with STS and showed that treatment of these pathologies led to improved function. LEVEL OF EVIDENCE Level IV, therapeutic case series.

Comparison of minimally invasive unicompartmental knee arthroplasty with or without a navigation system.

The authors investigated the hypothesis that navigation system-assisted minimally invasive unicompartmental knee arthroplasty (NA-MIS UKA) produces better short-term clinical results than MIS UKA without a navigation system. After a minimum 2-year follow-up, short-term functional results and component alignment accuracies of 31 knees that underwent NA-MIS UKA (the NA-MIS group) were compared with those of 33 knees that underwent MIS UKAs without a navigation system (the MIS group). The Hospital for Special Surgery and Western Ontario and McMaster Universities Osteoarthritis Index scores of 2 groups showed significant improvement at final follow-ups, but no significant intergroup differences were observed (P = .071 and P = .096, respectively). However, NA-MIS UKA produced more improvement in the desired mechanical axis and a lower percentage of prosthetic alignment outliers than MIS UKA.

Clinical and radiographic outcome of femoral head fractures: 30 patients followed for 3-10 years

The aim of this study was to evaluate the outcome of 30 femoral head fractures. We modified Pipkins classification into 4 types: I (5 cases) small fracture of head distal to fovea centralis, which was too small or too fragmented to be fixed with screws; II (18 cases), larger fracture of head distal to fovea centralis; III (4 cases), large fracture of head proximal to fovea centralis, and IV (3 cases), comminuted fracture of head. Excision of the head fragment was done in all 5 cases of type I and in 9 type II fractures. Fixation of the head fragment was performed in 9 type II and in all 4 type III cases. The femoral head was replaced in all 3 type IV fractures. After a mean follow-up of 3-10 years, the clinical outcome, according to Epstein et al.s critieria, were excellent in 7, good in 15, fair in 4 and poor in 1, except in type IV, and the radiographic outcome was excellent in 15, good in 7, fair in 4 and poor in 1. On the basis of our findings, we conclude that excision of the small fragment is a good choice of treatment in type 1. Early accurate reduction with stable internal fixation in type II or III permits bony union. Arthroplasty seems to be indicated in type IV.

Expression and Significance of TGF-β Isoform and VEGF in Osteosarcoma

This article demonstrates that the degree of VEG expression could be used as a clinically signific prognostic factor in osteosarcoma.

Outcome of Cheilectomy in Legg-calve-perthes Disease: Minimum 25-year Follow-up of Five Patients

Abstract: The authors report minimum 25-year follow-up results of cheilectomy performed in five hips affected by Legg-Calve-Perthes disease (LCPD) with hinged abduction. All five hips had a poor prognosis in terms of age at disease onset, treatment delay, hinged abduction, subluxation, and extensive head involvement. Cheilectomy, partial capital resection, was made along the indentation groove on the articular surface of the femoral head. Only the extruded portion of the femoral head was excised. Patients were placed in balanced suspension traction before and after surgery. Cheilectomy results were satisfactory during the early postoperative period (2-3 years) in terms of pain, range of motion, and limping. However, long-term results with a minimum follow-up of 25 years were unsatisfactory and showed poor hips in three, fair in one, and good in one. In addition, all five hips showed early evidence of osteoarthritic change (when patients were in their 30s). These results show that cheilectomy is not effective at preventing the early appearance of osteoarthritic change in LCPD hips with a deformed head and hinged abduction.

Total Ankle Arthroplasty following Revascularization of Avascular Necrosis of the Talar Body: Two Case Reports and Literature Review

Total ankle arthroplasty (TAA) has emerged as another solution to ankle arthritis, as it provides reliable pain relief, preserves motion, and facilitates recovery as compared with fusion. However, the use of cementless TAA to treat ankle osteoarthritis with avascular necrosis (AVN) of the talar body is contraindicated because the potential for good ingrowth and component fixation is low.2,3,9,10 The authors describe two cases of end-stage ankle arthritis combined with AVN of the talar body, in which cementless TAA was performed to preserve ankle mobility because magnetic resonance (MR) images and radionuclide bone scanning showed revascularization of the talus.

Acetabular revision using acetabular roof reinforcement ring with a hook

This study evaluated the clinical and radiographic results of 37 acetabular revisions using an acetabular roof reinforcement ring with a hook (ARRRH). The average age of the patients was 52.4 years, and the mean follow-up period was 4.5 years. The mean Harris hip score had improved from 49 points preoperatively to 87 points at the final follow-up. The bone graft was radiographically incorporated in all cases. The postoperative complications were a hip dislocation in 3 cases, nonunion of the greater trochanter in 1, infection in 1, discomfort at the autograft donor site in 3, and 2 cases of hook failure. An ARRRH combined with a morsellized bone graft is a useful treatment particularly in moderate-to-severe acetabular bone deficiencies.

The effects of subluxation of the femoral head with avascular necrosis in growing rabbits.

Abstract: To validate the adverse effects of subluxation of the femoral head in Legg-Calvé-Perthes disease, the authors made an experimental model of Perthes disease with subluxation in growing rabbits by interrupting the epiphyseal artery (devascularization) and immobilizing the knee in extension (immobilization). Seventy-two rabbits, 4 to 5 weeks old, were divided into three groups: group A with both devascularization and immobilization (25 rabbits), group B with devascularization only (25 rabbits), and group C with immobilization only (22 rabbits). In each experimental group, four to six rabbits each were killed at 1, 2, 4, 8, and 12 weeks. After reviewing the serial radiographs and gross specimens, the authors found six radiologic and six macroscopic abnormalities. The incidence and the severity of deformity in group A rabbits were higher than that of groups B or C in terms of the overall incidence of deformities (P < 0.001), head deformity scores (P < 0.001), and the incidence of a total collapse of the capital femoral epiphysis. In conclusion, subluxation of the immature femoral head with avascular necrosis in rabbits increased femoral head deformities.