Combined interdisciplinary treatment of metastatic bone lesions using 3D robot-assisted image-guided navigation : Embolization, biopsy, ablation, and surgery in one operative session.

Objective: To maximize local tumor control, stabilize affected bones, and preserve or replace joints with minimal interventional burden, thereby enhancing quality of life for empowered living.

Indications: Suitable for patients with bone metastases, particularly those with severe pain and/or fractures and appropriate life expectancy.

Contraindications: In primary bone tumors, refer to the sarcoma surgery team for evaluation of wide resection.

Does the dGEMRIC Index Recover 3 Years After Surgical FAI Correction and an Initial dGEMRIC Decrease at 1-Year Follow-up? A Controlled Prospective Study.

Background: Delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) allows objective and noninvasive assessment of cartilage quality. An interim analysis 1 year after correction of femoroacetabular impingement (FAI) previously showed that the dGEMRIC index decreased despite good clinical outcome.

Purpose: To evaluate dGEMRIC indices longitudinally in patients who underwent FAI correction and in a control group undergoing nonoperative treatment for FAI.

Intraoperative imaging in hip arthroplasty: a meta-analysis and systematic review of randomized controlled trials and observational studies.

Background: Intraoperative fluoroscopy (IFC) is gaining popularity in total hip arthroplasty (THA), with the aim to achieve better component positioning and therefore eventually reduced revision rates. This meta-analysis investigated the benefit of IFC by comparing it to intraoperative assessment alone. The primary outcome was component positioning and the secondary outcomes included complications and revision rates.

Impact of Anterior Malposition and Bone Cement Augmentation on the Fixation Strength of Cephalic Intramedullary Nail Head Elements.

: Intramedullary nailing of trochanteric fractures can be challenging and sometimes the clinical situation does not allow perfect implant positioning. The aim of this study was (1) to compare in human cadaveric femoral heads the biomechanical competence of two recently launched cephalic implants inserted in either an ideal (centre-centre) or less-ideal anterior off-centre position, and (2) to investigate the effect of bone cement augmentation on their fixation strength in the less-ideal position. : Fourty-two paired human cadaveric femoral heads were assigned for pairwise implantation using either a TFNA helical blade or a TFNA screw as head element, implanted in either centre-centre or 7 mm anterior off-centre position.

Trochanteric Femur Fractures: Application of Skeletal Traction during Surgery Does Not Alter Soft-Tissue Microcirculation.

: Wound infections provoked by alterations in microcirculation are major complications in the treatment of trochanteric femur fractures. Surgical fracture fixation on a traction table is the gold standard for treatment, but the effect on tissue microcirculation is unknown. Microcirculation could be impaired by the pull on the soft-tissue or by a release of vasoactive factors.

Reduced pre-operative skin oxygen saturation predicts revision after open reduction and internal fixation in calcaneal fractures : A reduced pre-operative oxygen saturation as measured by laser-Doppler spectrophotometry in 8 mm depth is associated with revision surgery after open reduction and internal fixation of calcaneal fractures through an extended lateral approach.

Purpose: To assess which pre-operative parameters correlate with wound revisions after an extended lateral approach to the calcaneus.

Methods: Pre-operative laser-Doppler spectrophotometry was applied in patients undergoing open reduction and internal fixation. The number of wound revisions was recorded during pos-toperative follow-up.

Good Outcome Scores and Low Conversion Rate to THA 10 Years After Hip Arthroscopy for the Treatment of Femoroacetabular Impingement.

Background: Arthroscopic treatment of symptomatic femoroacetabular impingement (FAI) has promising short-term to mid-term results. In addition to treating acute pain or impaired function, the goal of hip-preserving surgery is to achieve a lasting improvement of hip function and to prevent the development of osteoarthritis. Long-term results are necessary to evaluate the effectiveness of surgical treatment and to further improve results by identifying factors associated with conversion to THA.

Biochemical MRI With dGEMRIC Corresponds to 3D-CT Based Impingement Location for Detection of Acetabular Cartilage Damage in FAI Patients.

Background: Anterior femoroacetabular impingement (FAI) is associated with labral tears and acetabular cartilage damage in athletic and young patients. Delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) is an imaging method for detecting early damage to cartilage.

Purpose: We evaluated the following questions: (1) What is the sensitivity and specificity of morphological magnetic resonance imaging (MRI) and dGEMRIC for detecting cartilage damage? Do the mean acetabular and femoral dGEMRIC indices differ between (2) superior acetabular clock positions with and without impingement and (3) between cam- and pincer-type FAI?

Study Design: Cohort study (diagnosis); Level of evidence, 2.

Improved Cartilage Quality on Delayed Gadolinium-Enhanced MRI of Hip Cartilage after Subchondral Drilling of Acetabular Cartilage Flaps in Femoroacetabular Impingement Surgery at Minimum 5-Year Follow-Up.

Objective: To assess whether subchondral drilling of acetabular cartilage flaps during femoroacetabular impingement (FAI) surgery improves (1) acetabular dGEMRIC indices and (2) morphologic magnetic resonance imaging (MRI) scores, compared with hips in which no additional treatment of cartilage lesions had been performed; and (3) whether global dGEMRIC indices and MRI scores correlate.

Design: Prospective cohort study of consecutive patients with symptomatic FAI treated with open surgery between 2000 and 2007. Patients with subchondral drilling of acetabular cartilage flaps were allocated to the study group, those without drilling to the control group.

Ultrasonic cartilage thickness measurement is accurate, reproducible, and reliable-validation study using contrast-enhanced micro-CT.

Background: Ultrasonography is a fast and patient-friendly modality to assess cartilage thickness. However, inconsistent results regarding accuracy have been reported. Therefore, we asked what are (1) the accuracy, (2) reproducibility, and (3) reliability of ultrasonographic cartilage thickness measurement using contrast-enhanced micro-CT for validation?

Methods: A series of 50 cartilage-bone plugs were harvested from fresh bovine and porcine joints.

The Ganz acetabular reinforcement ring shows excellent long-term results when used as a primary implant: a retrospective analysis of two hundred and forty primary total hip arthroplasties with a minimum follow-up of twenty years.

Purpose: The acetabular reinforcement ring with a hook (ARRH) has been designed for acetabular total hip arthroplasty (THA) revision. Additionally, the ARRH offers several advantages when used as a primary implant especially in cases with altered acetabular morphology. The implant facilitates anatomic positioning by placing the hook around the teardrop and provides a homogenous base for cementing the polyethylene cup.

Subchondral drilling for chondral flaps reduces the risk of total hip arthroplasty in femoroacetabular impingement surgery at minimum five years follow-up.

Introduction:: The best treatment of acetabular chondral flaps during surgery for femoroacetabular impingement (FAI) is unknown. We asked if subchondral drilling improves clinical and radiographic outcome and if there are factors predicting failure.

Methods:: We treated 79 patients with symptomatic FAI and acetabular chondral flaps with surgical hip dislocation between January 2000 and December 2007.

Imaging appearance and distribution of intra-articular adhesions following open FAI surgery.

Objectives: To evaluate the appearance and distribution of intra-articular adhesions on direct MR arthrograms (MRA) in symptomatic patients after surgical hip dislocation (SHD) for the treatment of femoroacetabular impingement (FAI).

Methods: All 18 patients (19 hips) who underwent arthroscopic debridement for treatment of symptomatic adhesions after open surgery of FAI between 2003 and 2012 and that had a complete set of pre- and postoperative direct MRA were evaluated. On radial PD-w images, pre- and postoperative osseous alpha angles were measured.

What Are the Risk Factors for Revision Surgery After Hip Arthroscopy for Femoroacetabular Impingement at 7-year Followup?

Background: In recent years, surgical treatment of symptomatic femoroacetabular impingement (FAI) has been increasingly performed using arthroscopy. Bony pathomorphologies and damage to the labrum as well as cartilage defects can be addressed with comparable results to open surgery with overall less surgery-related complications. Despite the increasing importance of hip arthroscopy, however, reports on midterm clinical and radiographic outcomes and comparison to open surgical hip dislocation are scarce.

How Does the dGEMRIC Index Change After Surgical Treatment for FAI? A Prospective Controlled Study: Preliminary Results.

Background: Delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) allows an objective, noninvasive, and longitudinal quantification of biochemical cartilage properties. Although dGEMRIC has been used to monitor the course of cartilage degeneration after periacetabular osteotomy (PAO) for correction of hip dysplasia, such longitudinal data are currently lacking for femoroacetabular impingement (FAI).

Questions/purposes: (1) How does the mean acetabular and femoral dGEMRIC index change after surgery for FAI at 1-year followup compared with a similar group of patients with FAI treated without surgery? (2) Does the regional distribution of the acetabular and femoral dGEMRIC index change for the two groups over time? (3) Is there a correlation between the baseline dGEMRIC index and the change of patient-reported outcome measures (PROMs) at 1-year followup? (4) Among those treated surgically, can dGEMRIC indices distinguish between intact and degenerated cartilage?

Methods: We performed a prospective, comparative, nonrandomized, longitudinal study.

An increased iliocapsularis-to-rectus-femoris ratio is suggestive for instability in borderline hips.

Background: The iliocapsularis muscle is an anterior hip structure that appears to function as a stabilizer in normal hips. Previous studies have shown that the iliocapsularis is hypertrophied in developmental dysplasia of the hip (DDH). An easy MR-based measurement of the ratio of the size of the iliocapsularis to that of adjacent anatomical structures such as the rectus femoris muscle might be helpful in everyday clinical use.

Twelve percent of hips with a primary cam deformity exhibit a slip-like morphology resembling sequelae of slipped capital femoral epiphysis.

Background: In some hips with cam-type femoroacetabular impingement (FAI), we observed a morphology resembling a more subtle form of slipped capital femoral epiphysis (SCFE). Theoretically, the morphology in these hips should differ from hips with a primary cam-type deformity.

Questions/purposes: We asked if (1) head-neck offset; (2) epiphyseal angle; and (3) tilt angle differ among hips with a slip-like morphology, idiopathic cam, hips after in situ pinning of SCFE, and normal hips; and (4) what is the prevalence of a slip-like morphology among cam-type hips?

Methods: We retrospectively compared the three-dimensional anatomy of hips with a slip-like morphology (29 hips), in situ pinning for SCFE (eight hips), idiopathic cam deformity (171 hips), and 30 normal hips using radial MRI arthrography.

Diagnosis and management of developmental dysplasia of the hip from triradiate closure through young adulthood.

The current treatment of painful hip dysplasia in the mature skeleton is based on acetabular reorientation. Reorientation procedures attempt to optimize the anatomic position of the hyaline cartilage of the femoral head and acetabulum in regard to mechanical loading. Because the Bernese periacetabular osteotomy is a versatile technique for acetabular reorientation, it is helpful to understand the approach and be familiar with the criteria for an optimal surgical correction.

Valgus hip with high antetorsion causes pain through posterior extraarticular FAI.

Background: Valgus hips with increased antetorsion present with lack of external rotation and posterior hip pain that is aggravated with hip extension and external rotation. This may be the result of posterior femoroacetabular impingement (FAI).

Questions/purposes: We asked whether (1) the range of motion (ROM); (2) the location of anterior and posterior bony collision zones; and (3) the prevalence of extraarticular impingement differ between valgus hips with increased antetorsion compared with normal hips and hips with idiopathic FAI.

Using micropower impulse radar technology to screen for pneumothorax: an international bi-institutional study.

Background: Pneumothoraces (PTXs) are a common entity in thoracic trauma. Micropower impulse radar (MIR) has been able to detect PTXs in surgical patients. However, this technology has not been tested previously on trauma patients.