Denosumab prevents acetabular bone loss around an uncemented cup: analysis of secondary outcomes in a randomized controlled trial.

Background And Purpose: Uncemented total hip arthroplasty (THA) is associated with periprosthetic bone loss. In a secondary outcome analysis from a randomized controlled trial, we studied whether denosumab can prevent loss of acetabular periprosthetic bone mineral density (pBMD) in patients who received a trabecular metal cup during uncemented THA.

Patients And Methods: 64 patients (aged 35-65 years) with unilateral osteoarthritis of the hip were randomized to 2 subcutaneous injections with denosumab or placebo, given 1-3 days post-surgery and 6 months post-surgery.

Denosumab Prevents Early Periprosthetic Bone Loss After Uncemented Total Hip Arthroplasty: Results from a Randomized Placebo-Controlled Clinical Trial.

Implant loosening is the most common indication for revision surgery after total hip arthroplasty (THA). Although bone resorption around the implants plays a pivotal role in the pathophysiology of loosening, it is unknown whether potent early inhibition of osteoclasts could mitigate this process and thus reduce the need for revision surgery. We performed a randomized, double-blind, placebo-controlled phase 2 trial in 64 patients aged 35 to 65 years with unilateral osteoarthritis of the hip.

An open, randomized, controlled study of transdermal hormone replacement therapy on the rate of bone loss in primary biliary cirrhosis.

Objectives: The prevalence of osteoporosis amongst patients with primary biliary cirrhosis (PBC) is high and may be a serious clinical problem. Hormone replacement therapy (HRT) is effective in preventing bone loss but has not been evaluated in randomized trials in PBC. The primary aim was to study the effect of transdermal HRT in combination with daily vitamin D and calcium supplementation on bone loss compared with vitamin D and calcium supplementation only in postmenopausal women with PBC.

The significance of radiolucent zones surrounding pedicle screws. Definition of screw loosening in spinal instrumentation.

We examined the radiographs from a prospective clinical study of fixation by pedicle screws and those from an experimental study in a sheep model. In the clinical study, instruments were removed from 21 patients after implantation for 11 to 16 months and the extraction torques of the screws were recorded. A structured protocol was used for the radiological examinations.

The cone hip stem: a prospective study of 13 patients followed for 5 years with RSA.

We operated on 13 patients (14 hips) with dysplastic hips, mean age 42 (28-58) years, with a cementless Cone stem and followed them for 5 years, using the Merle d'Aubigné clinical score, conventional radiography and repeated radiostereometry analyses. The clinical scores improved markedly at 4 months and still more throughout the study. None of the patients complained of thigh pain.

Two years of treatment with recombinant human growth hormone increases bone mineral density in men with idiopathic osteoporosis.

We have investigated the effects of GH treatment on bone turnover, bone size, bone mineral density (BMD), and bone mineral content (BMC) in 29 men, 27-62 yr old, with idiopathic osteoporosis. The patients were randomly assigned to treatment with GH, either as continuous treatment with daily injections of 0.4 mg GH/d (group A, n = 14) or as intermittent treatment with 0.

Hydroxyapatite coating improves fixation of pedicle screws. A clinical study.

We investigated the effects of hydroxyapatite (HA) coating on the purchase of pedicle screws. A total of 23 consecutive patients undergoing lumbar fusion was randomly assigned to one of three treatment groups. The first received uncoated stainless-steel screws, the second screws which were partly coated with HA, and the third screws which were fully coated.

Dual X-ray absorptiometry of hip, heel ultrasound, and densitometry of fingers can discriminate male patients with hip fracture from control subjects: a comparison of four different methods.

Few studies have examined different bone densitometry techniques to determine male hip fracture risk. We conducted a case-control study of 31 noninstitutionalized men, mean age 77 yr, with a first hip fracture and compared the results with 68 randomly selected age-matched control subjects. The methods used were dual X-ray absorptiometry (DXA) of the proximal femur, quantitative ultrasound (QUS) of the heel and fingers, and radiographic absorptiometry of the fingers.

Cervical spine degeneration in fighter pilots and controls: a 5-yr follow-up study.

At 5 yr after MRI of the cervical spine, for evaluation concerning degenerative lesions, follow-up MRI was performed on asymptomatic experienced military high performance aircraft pilots (mean age 47 yr; mean accumulated flying time 3,100 h) and on age-matched controls without military flying experience. Young military high performance aircraft pilots (mean age 28 yr, mean accumulated flying time 915 h) were also re-examined. Compared with baseline MRI 5 yr earlier, there was significant increase in disk protrusions in all groups, in osteophytes in controls, and in foraminal stenoses in experienced pilots, and a significant reduction in disk signal intensity in young pilots.

DXA of the hip and heel ultrasound but not densitometry of the fingers can discriminate female hip fracture patients from controls: a comparison between four different methods.

Dual-energy X-ray absorptiometry (DXA) of the proximal femur and in more recent years quantitative ultrasound (QUS) of the heel are the most established methods for assessing hip fracture risk. Measurement of the fingers offers a new approach. We performed DXA of the proximal femur, QUS of the heel and fingers, and radiographic absorptiometry (RA) of the fingers in 87 non-institutionalized women, 65-85 years of age, with a first hip fracture and compared them with 195 randomly selected age-matched controls.

Cauda equina syndrome as a postoperative complication in five patients operated for lumbar disc herniation.

Study Design: A retrospective analysis of records and radiographs in five patients who developed acute cauda equina syndrome after surgery for lumbar disc herniation.

Objectives: To postulate as a possible pathophysiologic mechanism the venous congestion caused by preexisting spinal stenosis and to present a management plan: extended decompression within 48 hours.

Summary Of Background Data: Cauda equina syndrome is reported as a sequela in 0.

Serum bone markers after intramedullary fixed tibial fractures.

Serum levels of bone markers were measured prospectively for 1 year in 30 adult patients with an intramedullary fixed tibial fracture. In a double blinded design, half of the patients received low intensity ultrasound. All fractures healed, although in seven of 30 the healing was delayed more than 6 months.

MRI cervical spine findings in asymptomatic fighter pilots.

MRI of the cervical spine for evaluation concerning degenerative lesions was performed on asymptomatic experienced military high performance aircraft pilots (mean age 42 yr with mean accumulated flying time of 2600 h), and for comparison on age-matched controls without military flying experience. Young military high performance aircraft pilots (mean age 23 yr with 220 h of flying per person) were also examined. There were significantly more osteophytes, disk protrusions, compressions of the spinal cord and foraminal stenoses in the experienced pilots than in the age-matched controls.

No effect of low-intensity ultrasound on healing time of intramedullary fixed tibial fractures.

Objective: To determine whether stimulation with low-intensity ultrasound will reduce the radiologic healing time of fresh tibial shaft fractures fixed with a reamed and statically locked intramedullary rod.

Design: Prospective, randomized, double blinded, and placebo controlled.

Patients And Methods: Thirty-two adult patients were included, fifteen in the active ultrasound group and seventeen in the placebo group.

Oral isotretinoin therapy in severe acne induces transient suppression of biochemical markers of bone turnover and calcium homeostasis.

Although dietary vitamin A is required for normal growth and development, long-term or high-dose administration of vitamin A derivatives (retinoids) may produce a variety of skeletal side-effects in man. In this study we investigated the early effects of oral isotretinoin therapy on bone turnover and calcium homeostasis in eleven consecutive patients with nodulocystic acne. The effects on bone metabolism were correlated to radiological and bone mineral density measurements following drug therapy for six months.

Skeletal metastases from breast cancer: uptake of 18F-fluoride measured with positron emission tomography in correlation with CT.

Objective: To characterise the uptake of 18F in skeletal metastases from breast cancer using positron emission tomography (PET) and to relate these findings to the appearance on CT.

Patients And Design: PET with 18F and CT were performed in five patients with multiple skeletal metastases from breast cancer. The CT characteristics were analysed in areas with high uptake on the PET study.

Pathoanatomical and radiographic findings in spinal breast cancer metastases.

Spine specimens infested with breast cancer metastases, ranging from localized seed of small tumor deposits to massive invasion and vertebral collapse, were frozen in situ, removed, examined with both conventional radiography and high resolution computed tomography (CT), and then studied in great detail by serial cryoplaning. The majority of metastases in the total of 53.5 vertebrae were lytic, and most were in close contact with the vertebral wall or the endplates.

Clinical and experimental imaging of breast cancer metastases in the spine.

An investigation was undertaken to determine the characteristics of spinal breast cancer metastases with respect to MR signal intensity (SI), patho-anatomy and uptake of the bone-seeking radionuclide 18F measured with positron emission tomography (PET). Patients with spinal metastases from breast cancer, or spinal specimens, were examined with MRI and the results were correlated to histopathological findings, or they were examined with conventional radiography and CT in correlation with cryomicrotomical images, with CT and dynamic 18F-PET; or with MRI, CT, skeletal scintigraphy and conventional radiography, compared with one another. Metastases were detected in all anatomical parts of the vertebrae.

Detection of breast cancer metastases in the cervical spine.

Thirty women with breast cancer and indications of possible cervical spine metastases underwent skeletal scintigraphy, conventional radiography, MR imaging and CT. By combining all examinations a diagnosis was settled in each patient and the different imaging techniques were compared. For all of the 26 patients with metastases in the cervical spine the correct diagnosis was found with MR imaging and CT.

MR imaging with histopathological correlation in vertebral metastases of breast cancer.

In 5 patients with advanced breast cancer and spinal metastases MR imaging of the spine was performed before and/or after death. T1-, proton density-, and T2-weighted and "phase contrast" images were obtained in the sagittal plane. Autopsies included histopathologic examination of whole sagittal sections of the vertebral body.

Locking screw-plate fixation of cervical spine fractures with and without ancillary posterior plating.

Forty consecutive patients with 19 fractures and 21 fracture-dislocations in the lower cervical spine were treated prospectively with open reduction and interbody fusion, using the AO titanium locking screw-plate system. There were 30 men and 10 women with a mean age of 36 years (range 16-90 years). Eight were admitted tetraplegic, 12 tetraparetic, and 6 had nerve root injuries.

Diagnostic methods in planning palliation of spinal metastases.

In a prospective study of 30 patients with newly diagnosed spinal metastases the benefit of different imaging techniques in planning palliation was studied. Magnetic resonance imaging (MRI) was compared to scintigraphy, conventional radiography and computerized tomography (CT), prior to radiotherapy or surgery. In the first comparison, a total of 159 pathologic lesions could be evaluated.