Significantly reduced leg length discrepancy and increased femoral offset by application of a head-neck adapter in revision total hip arthroplasty.

Head-neck adapters in total hip arthroplasty (THA) promise the reconstruction of optimal femoral offset and leg length in revision THA while retaining stable implants. Radiological parameters after adapter implantation in THA revision were determined in 37 cases. Significant reduction of leg length discrepancy and improvement of femoral offset (P < 0.

Reduced head-neck offset in nontraumatic osteonecrosis of the femoral head.

Introduction: Risk factors for nontraumatic osteonecrosis of the femoral head have in common that they trigger intravascular coagulation and thus lead to devascularization of the femoral head. In part of the patients, however, no risk factors seem to be evident. Mechanical reasons contributing to nontraumatic osteonecrosis have not been discussed so far.

The aetiology of total knee arthroplasty failure influences the improvement in knee function.

Background: Some indications for revision total knee arthroplasty (TKA), e.g. arthrofibrosis, have been identified to yield inferior results.

Femoral head-neck offset measurements in 339 subjects: distribution and implications for femoroacetabular impingement.

Purpose: The α-angle is a frequently used measurement to quantify head-neck offset pathology in cam-type femoroacetabular impingement. However, diverging norm values and reference intervals have been described, especially in men.

Methods: The α-angle, the head-neck offset ratio and the triangular index were measured on anteroposterior and lateral radiographs of 339 (170 men and 169 women) subjects without evident underlying hip pathology.

The asymptomatic contralateral hip in unilateral slipped capital femoral epiphysis: morbidity of prophylactic fixation.

Prophylactic contralateral fixation in unilateral slipped capital femoral epiphysis (SCFE) remains a controversial issue. In this study, 66 patients treated for unilateral SCFE (July 1997-April 2009) were screened for complications with need for surgical reintervention in the asymptomatic contralateral hip. Except for one patient, prophylactic fixation was performed in all cases.

Radiographic risk factors for labral lesions in femoroacetabular impingement.

Background: Tears of the acetabular labrum can lead to pain, disability, and osteoarthritis. Several pathomechanisms have been proposed, including femoroacetabular impingement (FAI). Labral tears have been reported to occur in the presence of even subtle deformities of the acetabulum and femoral head-neck junction.

Can femoroacetabular impingement and hip dysplasia be distinguished by clinical presentation and patient history?

Purpose: Hip dysplasia and femoroacetabular impingement may both lead to disability and hip osteoarthritis. The purpose of the current study was to compare the two entities in order to define differences in their clinical presentation.

Methods: The clinical presentation and WOMAC items, subscales and overall sum score were compared between 37 patients with femoroacetabular impingement and 37 patients with hip dysplasia.

[Radial MRI of the hip joint for evaluation of degenerative changes in the young adult: a comparison of different sequences].

Aim: Femoroacetabular impingement has been shown to be an important cause for the development of osteoarthritis of the hip joint. Radial MRI of the hip has proven to be the diagnostic procedure of choice to differentiate which patient to operate. While examinations after instillation of contrast agents have been described, new papers have shown high accuracy without contrast medium.

Corrosion at the stem-sleeve interface of a modular titanium alloy femoral component as a reason for impaired disengagement.

Modularity in sleeved femoral components allows the exchange of the stem without disruption of the fixation between the sleeve and the surrounding bone at revision surgery. Failure to disengage the stem from the sleeve would represent an unnecessary compromise from the intended usefulness of the modular design. We report the results of an examination of 22 modular titanium alloy femoral components retrieved after 0.

[Transfixation in slipped capital femoral epiphysis: long-term evidence for femoro-acetabular impingement].

Aim: It was the aim of this study to reveal whether and to what extent femoro-acetabular impingement (FAI) was present 10 to 20 years after transfixation of the gliding epiphysis in patients treated for unilateral slipped capital femoral epiphysis (SCFE).

Method: Clinical and radiological evaluations were undertaken of 20 patients who were treated with a bilateral transfixation of the epiphysis with screws or Kirschner wires because of mild unilateral SCFE. The Harris hip score, the activity level according to Tegner and Lysholm and the range of motion of both hip joints were noted.

Index level mobility after total lumbar disc replacement: is it beneficial or detrimental?

Study Design: Analysis of segmental and total lumbar range of motion (ROM) before and after total lumbar disc replacement.

Objective: To examine the relationship between absolute segmental and total lumbar ROM and evolution of ROM on clinical outcome.

Summary Of Background Data: At the moment, data are scarce with regard to the evolution of total lumbar ROM (t-ROM) and segmental ROM (s-ROM) after total lumbar disc replacement.

Time course of biological activity in fresh murine osteochondral allografts paralleled to the recipient's immune response.

The use of fresh osteochondral allografts is a popular approach to treat articular cartilage lesions. Immunological reactions of the recipient elicited by the allograft's osseous portion, however, frequently result in their deterioration. So far, little emphasis has been put on describing morphology and biological activity in fresh allografts and paralleling these to the immunological processes triggered in the host.

Radiological evidence of femoroacetabular impingement in mild slipped capital femoral epiphysis: a mean follow-up of 14.4 years after pinning in situ.

Conventional treatment of mild slipped capital femoral epiphysis consists of fixation in situ with wires or screws. Recent contributions to the literature suggest that even a mild slip may lead to early damage of the acetabular labrum and adjacent cartilage by abutment of a prominent femoral metaphysis. It has been suggested that the appropriate treatment in mild slipped capital femoral epiphysis should not only prevent further slipping of the epiphysis, but also address potential femoroacetabular impingement by restoring the anatomy of the proximal femur.

[Differential diagnoses of avascular necrosis of the femoral head. Articular groin pain in adults].

Early diagnosis and therapy of hip joint complaints in the young adult are often crucial for the prognosis of the joint. Besides avascular necrosis of the femoral head several differential diagnoses are possible, which if left untreated frequently lead to early osteoarthritis. The necessity of joint replacement in middle age often could be avoided by initiating adequate therapy as early as possible.

Histopathology of cryopreserved bone allo- and isografts: pretreatment with dimethyl sulfoxide.

Partial graft cell survival and enhanced graft revascularization have suggested fast freezing using the cryoprotective substance dimethyl sulfoxide (DMSO) as a promising means to improve the biologic function and immune tolerance of allograft bone. This study determines the presence of osteoblasts (cola(1)(I) mRNA), osteoclasts (TRAP), and cytotoxic T cells (CTLs; GrA mRNA) within pretreated bone grafts 12 days after transplantation. The grafts were transplanted either as isografts, allografts, or allografts in presensitized recipients.

[Reliability of transcutaneous measurement of oxygen tension on the lower leg].

Aim: Measurement of transcutaneous oxygen tension is increasingly used to determine the appropriate level of amputation in patients with vascular disease. The purpose of the present study was to analyze the intra- and interrater reliability of transcutaneous oxygen [tcpO (2)] measurements in a homogeneous study group.

Method: Five investigators assessed the transcutaneous oxygen tension of both lower legs of seven persons in a fixed setting.

[Outcome assessment in total knee arthroplasty: is the clinical measurement of range of motion a reliable measurable outcome variable?].

Aim: The aim of this clinical study was to investigate the reliability of the clinical assessment (visual and goniometric) of the range of motion of the knee joint.

Method: 30 patients were assessed concerning the range of motion of their knee joints by visual and goniometric measurements. Assessment was performed by three investigators.

Potential role of pre-existing blood vessels for vascularization and mineralization of osteochondral grafts: an intravital microscopic study in mice.

Background: The aim of this study was to develop an experimental model that allows to elude the potential role of the preexisting graft microvasculature for vascularization and mineralization of osteochondral grafts.

Animals And Methods: For that purpose, the II-IV metatarsals of fetal DDY-mice known to be nonvascularized at day 16 of gestation (M16) but vascularized at day 18 (M18) were freshly transplanted into dorsal skin fold chambers of adult DDY mice. Using intravital microscopy angiogenesis, leukocyte-endothelium interaction and mineralization were assessed for 12 days.

[Analysis of validity and reliability of three radiographic classification systems for preoperative assessment of bone stock loss in revision total hip arthroplasty].

Aim: It was the purpose of this prospective study to analyze validity and reliability of three different radiographic classification systems, which are used to assess bone stock loss prior to revision total hip arthroplasty.

Method: Investigation was performed using the classification systems according to 1) Paprosky et al., 2) Hungerford et al.

Cryopreservation with dimethyl sulfoxide sustains partially the biological function of osteochondral tissue.

The clinical routine use of bone allograft transplants dates back to the discovery that grafts devitalized by freezing bear a reduced antigenicity. Graft failures, caused by a host versus graft reaction, however, remain a clinical problem. Previous investigations on pancreatic islet allografts revealed improved survival and biological function when fast cryopreservation (-70 degrees C/min) was performed in the presence of dimethyl sulfoxide (DMSO).

Reperfusion injury in free bone grafts after tourniquet-induced ischemia.

For successful revascularization, incorporation, and survival of fracture fragments or free nonpedicled bone grafts, the first days after surgery seem to be most critical. Using intravital fluorescence microscopy, the effects of 3 hours of tourniquet-induced ischemia were assessed on newly formed angiogenic microvessels 4, 8, and 12 days after isogeneic transplantation of metatarsal bones into dorsal skin fold chambers of adult inbred C57BL/6 mice. The microvascular perfusion index of newly formed microvessels was quantified 30 and 120 minutes after initiation of reperfusion.

[Early damage to the acetabular cartilage in slipped capital femoral epiphysis. Therapeutic consequences].

Epiphyseolysis capitis femoris represents the most common disorder of the adolescent hip, which is followed by a significant rate of early osteoarthrosis. Based on intraoperative findings during the surgical management of 23 hips with epiphyseolysis, early acetabular cartilage abrasion by a cam effect and acetabular rim impingement elicited by the prominent femoral metaphysis have been identified. Both phenomena cause direct damage to the hip joint, especially during flexion and flexion/internal rotation of the hip.

Development of transplanted fetal bones: differences between isografts and allografts in mice.

Allogeneic bone from bone banks frequently is used when large skeletal defects have to be bridged in orthopaedic surgery. Beside immunologic rejection of the graft, the loss in osteogenic potential caused by bone banking procedures may be a major reason for limited clinical success. Similar problems as described for bone have occurred with cartilage and osteochondral transplants.

Quantitative assessment of angiogenesis and osteogenesis after transplantation of bone: comparison of isograft and allograft bone in mice.

We performed a vital microscopic study in mice bearing dorsal skinfold chambers to characterize microvascular perfusion and leukocyte/endothelium interaction and their effects on elongation and mineralization of neonatal isograft and allograft bone. Isograft (C57/BL to C57/BL) and allograft bone (C57/ BL to BALB/C) revascularized simultaneously. However, vascular perfusion and density were lower in allograft bone than in isograft bone.

The connective-tissue envelope in revascularisation of patellar tendon grafts.

Free patellar tendon grafts used for the intra-articular replacement of ruptured anterior cruciate ligaments (ACL) lack perfusion at the time of implantation. The central core of the graft undergoes a process of ischaemic necrosis which may result in failure. Early reperfusion of the graft may diminish the extent of this process.