Preventive cobalt therapy in heterotopic ossification consequent to prosthetic hip reimplantation.

Prosthetic hip reimplantation is considered to be a procedure at risk for the development of periprosthetic heterotopic ossification, which may be responsible for functional limitations of the hip operated on. Preventive treatment may be carried out with radiation or drug therapy. The authors report the results of 54 cases submitted to prosthetic reimplantation and treated by cobalt therapy, as compared to the results of 76 reimplantations (control group) that did not undergo any kind of treatment: the occurrence of high grade ossification (exceeding Brooker grade III) was 2% in cases treated, as compared to 9% in those not treated.

Diastematomyelia in congenital scoliosis. A review of the literature and description of one clinical case.

The authors present a case of diastematomyelia, a malformation of the neurospinal axis, frequently associated with congenital vertebral deformities. Often asymptomatic, its site different from that of the vertebral deformity, it may go unrecognized if specific imaging diagnosis is not used, thus exposing the patient who is then submitted to surgery for the correction of vertebral deformity to a high risk of neurological complications.

The use of cobalt therapy to prevent heterotopic ossification after total hip arthroplasty.

The occurrence of heterotopic ossification after total hip arthroplasty may be prevented by radiation or medical therapy. The authors report the results obtained in 96 cases treated by cobalt therapy: the occurrence of high grade ossification (Brooker III and IV) is equal to 1% in cases treated, as compared to 9% in cases not treated. Male patients of advanced age and who are characterized by primary arthrosis are more at risk for ossification.

The use of ceramic in prosthetic hip surgery. The state of the art.

The authors review current knowledge regarding the use of ceramic materials in prosthetic hip surgery, both as constituents of prosthetic components, and as materials used to coat metallic surfaces. A review of the literature defines the advantages and disadvantages to using ceramic-polyethylene or ceramic-ceramic combinations, based on the possibility that alumina coating may favor localized bone demineralization, and on the first promising clinical results of the use of hydroxyapatite coating.

Techniques for removal of the stem: transfemoral or intramedullary?

Since 1981 a total of 76 reimplantations of the prosthetic stem have been performed, substituting 52 cemented stems and 24 cementless ones. Only 7 patients (9%) required transcortical access, 3 of these stems (43%) were not osteointegrated, while of the 69 reimplantations performed by intramedullary approach, only 4% of the stems did not achieve skeletal stabilization. A total of 43% of the stems reimplanted using an intramedullary approach were short (12-13 cm).