Sealing the skin barrier around transcutaneous implants: in vitro study of keratinocyte proliferation and adhesion in response to surface modifications of titanium alloy.

Conventional amputation prostheses rely on the attachment of the socket to the stump, which may lead to soft-tissue complications. Intraosseous transcutaneous amputation prostheses (ITAPs) allow direct loading of the skeleton, but their success is limited by infection resulting from breaching of the skin at the interface with the implant. Keratinocytes provide the skin's primary barrier function, while hemidesmosomes mediate their attachment to natural ITAP analogues.

Use of an 'internal proximal femoral replacement' with distal fixation in revision arthroplasty of the hip.

We have managed 27 patients (16 women and 11 men) with a mean age of 68.4 years (50 to 84), with failed total hip replacement and severe proximal femoral bone loss by revision using a distal fix/proximal wrap prosthesis. The mean follow-up was for 55.

Prevention of strain-related osteopenia in aseptic loosening of hip prostheses using perioperative bisphosphonate.

The hypothesis tested in this study was that perioperative administration of the bisphosphonate zoledronate will reduce strain protection-related calcar osteopenia and maintain functional integration of the femoral component in an ovine hemiarthroplasty model. Twelve sheep received a unilateral cemented hemiarthroplasty where six animals were given nine intravenous infusions of zoledronate (10 microg/kg) pre-, peri-, and postsurgery over 8 months. Control animals received physiological saline only.

Oestrogen status in relation to the early training responses in human thumb adductor muscles.

Aims: The aims of this study were to identify the mechanisms for the early response to training in women of different oestrogen status and to determine whether any oestrogen and exercise effects on these would be additive.

Methods: We monitored training (ten 5-s contractions per day for 12 weeks)-induced changes in the size, strength, voluntary activation capacity and index of crossbridge force state (i.e.

Do autologous mesenchymal stem cells augment bone growth and contact to massive bone tumor implants?

This study investigated the hypothesis that spraying autologous mesenchymal stem cells (MSCs) onto grooved hydroxyapatite (HA) coated collars of segmental bone tumor implants would increase bone growth and contact to the implant surface in an ovine model. Autologous MSCs were isolated from bone marrow, grown in culture and during surgery implants in group 1 were sprayed with MSCs, suspended within fibrin glue. Implants in group 2 received no MSC therapy and acted as control.

Osteofibrous dysplasia of the tibia. Is there a need for a radical surgical approach?

Osteofibrous dysplasia is an unusual developmental condition of childhood, which almost exclusively affects the tibia. It is thought to follow a slowly progressive course and to stabilise after skeletal maturity. The possible link with adamantinoma is controversial and some authors believe that they are part of one histological process.

Development of a soft tissue seal around bone-anchored transcutaneous amputation prostheses.

Conventional amputation prosthetics are problematic because they rely on the stump-socket interface for attachment. Intraosseous transcutaneous amputation prostheses (ITAP) could solve these problems; however they rely on the integrity of the soft tissue-implant interface as a barrier to exogenous agents, and in the prevention of downgrowth and marsupilisation. We have used an in vivo animal model to study the soft tissue interfaces around bone-anchored transcutaneous implants.

Enzyme histochemical localisation of alkaline phosphatase activity in osteogenesis imperfecta bone and growth plate: a preliminary study.

At the ultrastructural level alkaline phosphatase has been studied in calcifying cartilage but not in bone. The aim of this study was to assess if there is an osteoblast dysfunction in Osteogenesis Imperfecta (OI) with respect to alkaline phosphatase activity. Specimens from three OI type II foetal femoral bones, two OI type II growth plates, one normal foetal femoral bone and growth plate, one OI type III femoral bone specimen and one normal juvenile bone specimens were examined using modified lead nitrate method to identify alkaline phosphatase reactivity.

Unexpected ultrastructral changes in bone osteiod collagens in osteogenesis imperfecta.

Osteogenesis Imperfecta (OI) is a heterogeneous, inherited bone disorder usually resulting from a defect in collagen synthesis or function. The Sillence classification recognises four OI subtypes of which type III is the severe, progressively deforming form. Here, we report distinctive ultrastructural abnormalities of bone osteoid collagen fibrils from three patients with OI type III and compared with normal controls.

Growth as a corrective force in the early treatment of progressive infantile scoliosis.

This prospective study of 136 children with progressive infantile scoliosis treated under the age of four years, and followed up for nine years, shows that the scoliosis can be reversed by harnessing the vigorous growth of the infant to early treatment by serial corrective plaster jackets. In 94 children (group 1), who were referred and treated in the early stages of progression, at a mean age of one year seven months (6 to 48 months) and with a mean Cobb angle of 32 degrees (11 degrees to 65 degrees), the scoliosis resolved by a mean age of three years and six months. They needed no further treatment and went on to lead a normal life.

Role of hydroxyapatite coating in resisting wear particle migration and osteolysis around acetabular components.

The main problem facing the longevity of total joint replacements is wear particle-induced osteolysis, particularly around the acetabular component. Ovine Total Hip Replacement surgery was performed with roughened femoral heads in order to enhance wear debris generation in vivo. The resistance to aseptic loosening of acetabular components with different surface coatings was investigated.

Chondroid lipoma: correlation of imaging findings and histopathology of an unusual benign lesion.

The imaging findings of soft tissue tumours are often non-specific and generally require biopsy to differentiate between benign and malignant lesions. The finding of curvilinear, annular or amorphous mineralisation in an enlarging mass has sinister connotations. In this case report, we present the imaging findings with histological correlation of a chondroid lipoma, an unusual benign soft tissue tumour, which presented with radiographic evidence of calcification, an imaging finding not previously described.

Effects of voluntary activation level on force exerted by human adductor pollicis muscle during rapid stretches.

We have observed the force resulting from sudden stretches (3-10 mm in 10-20 ms) of human adductor pollicis muscle during voluntary contractions maintaining different proportions of the maximum voluntary force from 20% to 100%. The ratio of the peak force during stretch (S) to the voluntary force (I) just before the start of the stretch was calculated. The S/ I ratio was dependent both on the level of activation and the speed of the stretch.

Whole spine MRI in the assessment of acute vertebral body trauma.

Objective: To determine the incidence and types of multilevel vertebral body injury in association with acute spinal trauma as assessed by whole spine MRI.

Design And Patients: All acute admissions to a regional spinal injury unit had whole spine MRI carried out, to detect occult vertebral body injury. Two radiologists assessed 127 cases prospectively, over a period of 3 years.

Clinical management. Where medicine meets management. Whose bright idea?

Managers can fall to act on creative thinking from the ground, often through preoccupation with the short term. Royal National Orthopaedic trust has pioneered voice-activated endosuites, CD-ROM training and cartilage transplants. Without an innovator, shaper and implementer, new projects are almost certain to fall.

Imaging of intra-articular osteoid osteoma.

Intra-articular osteoid osteoma accounts for approximately 13% of all osteoid osteomas and presents as a monoarthropathy. Radiographs commonly do not identify the nidus, and in this event, MRI is likely to be the next imaging investigation. MRI may show a variety of appearances depending upon the age of the lesion.

Activity in three parts of the quadriceps recorded isometrically at two different knee angles and during a functional exercise.

The purpose of this study was to evaluate individual differences in three parts of the quadriceps activated isometrically at 60 degrees and 90 degrees of knee flexion, and during a functional activity involving both concentric and eccentric muscle work. Surface EMG amplitudes were therefore recorded from oblique parts of vastus medialis (VMO) and vastus lateralis (VLO) and from rectus femoris (RF). VMO and VLO showed less activation at 60 degrees than at 90 degrees, but in RF there was no difference between the two angles.

Magnetic resonance imaging of the cervical ligaments in the absence of trauma.

Study Design: Prospective study of cervical spine magnetic resonance imaging.

Objectives: To determine the frequency of nonvisualization of the cervical spinal ligaments in patients who have not suffered acute spinal trauma.

Summary Of Background Data: The cervical ligaments appear on magnetic resonance studies as a thin hypointense line, the "black stripe.

Return to work after lower limb amputation.

This study investigated the proportion of patients who returned to work following amputation and the factors that influenced a positive or negative outcome. One hundred patients of working age who had sustained unilateral lower limb amputation at least 1 year previously and who were established prosthesis users participated in the study. A specially designed questionnaire similar to a guided interview was administered by the rehabilitation physician at the patients' routine follow-ups.

Water activity limbs.

With advances in technology there is an increasing availability of Water Activity Limbs (WALs) and subsequently a greater number of requests for their provision. This study aims to establish a national consensus for indications, recommended best practice and procedures. The study was conducted with 2 rounds of questionnaires sent to 40 doctors, prosthetists and therapists each.

Postoperative use of a cough-assist device in avoiding prolonged intubation.

Postoperative management following major surgery in patients with neuromuscular disorders associated with scoliosis is frequently complicated by sputum retention and ventilatory failure. This report demonstrates the successful perioperative management of an 11-yr-old boy with type II spinal muscular atrophy undergoing a single-stage posterior spinal fusion procedure. Use of an MI-E device was able to successfully treat sputum retention and avoid a tracheostomy.

Does Chiari osteotomy compromise subsequent total hip arthroplasty?

We compared 28 total hip arthroplasties done in dysplastic hips after previous Chiari osteotomy (group I) with a well-matched control group of 50 primary procedures (group II) done during the same period at an average follow-up of 5 years (range, 25-199 months). Group I required significantly less acetabular augmentation, had significantly shorter operative times, had less intraoperative blood loss, and had fewer complications than group II. There was no significant difference between the 2 groups in terms of clinical or radiographic outcome.

Ultrastructural localization of proteoglycans in bone in osteogenesis imperfecta as demonstrated by Cuprolinic Blue staining.

The role of proteoglycans in bone in osteogenesis imperfecta (OI) has been examined. Using Cuprolinic Blue staining of whole fetal bone tissue and examining the tissue in the transmission electron microscope, the presence of proteoglycans was observed. Quantitative comparative image-analysis of the proteoglycans from electron micrographs was performed, with measurement of sizes and number of proteoglycan particles.

An ergonomic comparison of rowing machine designs: possible implications for safety.

Objectives: Ergometer training is a common cause of injuries in rowers. A randomised crossover study comparing two power head designs was carried out to examine ergonomic risk factors.

Methods: Six elite male rowers undertook 20 minute fatiguing rowing pieces with both fixed and floating power heads.

Ultrasound diagnosis of shoulder congruity in chronic obstetric brachial plexus palsy.

Ultrasound (US) was used to determine the congruity of the shoulder in 22 children with a deformity of the shoulder secondary to chronic obstetric brachial plexus palsy. There were 11 boys and 11 girls with a mean age of 4.75 years (0.