1/17. Femoral bone regeneration subsequent to impaction grafting during hip revision: histologic analysis of a human biopsy specimen.Cemented revision with impaction grafting shows encouraging early clinical results; postoperative biopsy specimens taken from the proximal femur in humans have demonstrated viable trabecular and cortical bone. Human radiographic studies also illustrate density changes within the proximal femur, consistent with remodeling of bone-graft. In an animal experiment, bone incorporation was shown in the proximal femur, but graft lysis was reported around the distal portion of the implant. We report on a patient who sustained a traumatic femoral fracture at the level of the tip of the femoral component 27 months after revision with impaction grafting and a collarless polished taper stem. At the time of open reduction and internal fixation of the fracture, we obtained circumferential biopsy specimens from the fracture site. Three distinct zones could be identified histologically: i) an inner zone consisting of bone-cement, fibrous tissue, and partially necrotic trabeculae with evidence of bone remodeling; ii) a middle zone consisting of viable trabecular bone and probable neocortex formation with fewer particles of bone-cement; and iii) an outer zone with viable cortex. Fibrous tissue was present around some of the incorporating bone-graft fragments, but no continuous fibrous membrane was present. Cement particles were identified, but no polyethylene debris was found by light microscopy. biopsy specimens from the distal aspect of the prosthesis may not reflect changes seen proximally, but based on the available tissue, this case illustrated histological evidence of bone-graft remodeling after impaction grafting. These results are consistent with our expectations based on radiographic findings and clinical results.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
2/17. Failure after customized curved femoral stems in total hip arthroplasty for Paget's disease.We describe 2 patients with Paget's disease who underwent total hip arthroplasty for osteoarthrosis. In view of the femoral deformity in each case, a custom-made, long, curved femoral stem was used. Both patients have subsequently sustained periprosthetic fractures at the level of the tip of the prosthesis.- - - - - - - - - - ranking = 0.33333333333333keywords = fracture (Clic here for more details about this article) |
3/17. Valgus-lateralization osteotomy: notes on surgery.There are specific forms of nonunion secondary to per-inter-subtrochanteric fractures that make surgical planning a critical phase. In cases such as these, it may be useful to transform the center of the nonunion into an osteotomy plane. Because of the anatomotopographical features, course and progression of the lesion, cases such as these constitute a pathology that is difficult to define in terms of a therapeutic protocol. The authors report the surgical technique used in 4 cases of nonunion of the proximal metaphysis of the femur.- - - - - - - - - - ranking = 0.33333333333333keywords = fracture (Clic here for more details about this article) |
4/17. Early MRI findings of rapidly destructive coxarthrosis.Rapidly destructive coxarthrosis (RDC) is known to affect elderly women, but its etiology is unknown. This is the first report to our knowledge, based on a search of the English literature, that reveals the entire process of hip destruction from the onset to the terminal stage of RDC, in an 80-year-old woman. Radiographic evaluation showed subchondral insufficiency fracture of the femoral head at an early stage of this disease. An MRI examination within a month of the onset of hip pain showed the entire femoral head with low intensity on T1-weighted images and high intensity on T2-weighted images, and a small low-intensity band at the subchondral area of the lateral weight-bearing portion of the head. These findings are consistent with subchondral insufficiency fracture and associated bone marrow edema. The lesion developed into a deep and large erosion at the superolateral portion of the femoral head, the process being observed on both roentgenograms and MRI. These findings were confirmed during total hip arthroplasty. This case suggests that subchondral insufficiency fracture of the femoral head may be a preceding sign of destruction of the femoral head.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
5/17. Can ischemic hip disease cause rapidly destructive hip osteoarthritis? A case report.Avascular osteonecrosis of the femoral head (AONFH) usually goes through the four stages described by Arlet and Ficat: normal radiographs, heterogeneity and sclerosis of the femoral head, subchondral fracture with an individualized sequestrum, and secondary osteoarthritis. Arlet and Ficat individualized a specific pattern of AONFH which they called ischemic hip disease, in which cartilage damage seen as concentric joint space loss precedes the bony alterations. Although radiological and pathological studies of ischemic hip disease have been published, no clinical data are available. We report the case of a 65-year-old man admitted for a 1-month history of severe hip symptoms with concentric joint space loss but no osteophytes. Laboratory tests and examination of fluid aspirated from the hip ruled out septic arthritis and inflammatory hip disease. Two magnetic resonance imaging (MRI) studies done 1 month apart showed diffuse edema involving not only the femoral head but also the neck and trochanter, as well as major synovial hypertrophy. This atypical MRI appearance prompted synovial membrane and pertrochanteric core biopsies, which showed reactive synovitis and stage IV osteonecrosis, respectively. The pain, disability, and joint space loss worsened. Total hip arthroplasty was performed 1 month after the biopsy. Histological examination of the femoral head showed diffuse necrosis; no evidence of another condition was found on histological sections of the entire synovial membrane. This case corroborates the hypotheses put forward by Lequesne that some cases of rapidly destructive hip osteoarthritis may be ascribable to ischemia.- - - - - - - - - - ranking = 0.33333333333333keywords = fracture (Clic here for more details about this article) |
6/17. Non-operative management of a peri-prosthetic subcapital fracture after metal-on-metal Birmingham hip resurfacing.We describe a patient who sustained a peri-prosthetic fracture of the femoral neck two weeks after undergoing a resurfacing procedure for osteoarthritis of the hip. The fracture was minimally displaced and a satisfactory outcome was obtained following conservative treatment.- - - - - - - - - - ranking = 2keywords = fracture (Clic here for more details about this article) |
7/17. Rotational acetabular osteotomy for acetabular dysplasia of the hip with a giant acetabular bone cyst: a case report.In acetabular dysplasia of the hip joint accompanied by a giant acetabular bone cyst, rotational acetabular osteotomy may cause serious complications, such as bone necrosis after surgery or fracture of the fragile acetabulum during the operation. In a patient with this condition, we performed a two-stage operation: first, autogenous bone grafting supplemented with hydroxyapatite filling, then rotational acetabular osteotomy (after new bone formation had been assured). Radiographs and CT scans showed favorable fusion of the grafted bone. Some 18 months after the second operation, arthrograms showed no inflow of contrast medium from the articular cavity into the bone cyst region, although this had been observed before treatment. Thus, an effective remodeling of bony congruency was indicated in the mobile acetabulum 5 years after the second operation. This two-stage operation appears to be useful for correcting acetabular dysplasia accompanied by a giant bone cyst and to carry a reduced risk of serious complications, such as deterioration of the articular surface of the acetabulum or necrosis of the translocated acetabulum.- - - - - - - - - - ranking = 0.33333333333333keywords = fracture (Clic here for more details about this article) |
8/17. Fracture of a Y-TZP ceramic femoral head. Analysis of a fault.We studied factors contributing to the initiation of fracture and failure of a zirconia ceramic femoral head. The materials retrieved during a revision total hip replacement were submitted to either visual, stereomicroscopic and scanning electron microscopy (SEM) or SEM and energy-dispersive X-ray analysis. x-ray diffraction was performed in order to investigate the extent of tetragonal to monoclinic phase transition. Histological examination was performed on the periprosthetic tissues. The results showed that failure was due to the propagation during clinical use of defects which may have been introduced into the material during the processing of the ceramic, rather than those intrinsic to zirconia. The literature relating to previous failures of zirconia components is reviewed.- - - - - - - - - - ranking = 0.33333333333333keywords = fracture (Clic here for more details about this article) |
9/17. Resurfacing arthroplasty of the hip in osteopetrosis.A 34-year-old woman with a benign form of osteopetrosis developed osteoarthritis of the hip. In order to avoid the difficulties associated with inserting the femoral component of a conventional total hip arthroplasty, a hybrid metal-on-metal resurfacing was performed. There were several technical challenges associated with the procedure, including the sizing of the component, press-fit fixation of the acetabular component and femoral head preparation, as well as trying to avoid a fracture. No surgical complication occurred. After more than a year following surgery, the patient showed excellent clinical function and remained satisfied with the outcome. We conclude that the hybrid metal-on-metal resurfacing arthroplasty represents a valuable option for the treatment of patients with osteopetrosis and secondary hip osteoarthritis.- - - - - - - - - - ranking = 0.33333333333333keywords = fracture (Clic here for more details about this article) |
10/17. Bipolar hip arthroplasty without acetabular bone-grafting for dysplastic osteoarthritis. Results after 6-9 years.The authors report the clinical and radiographic results of 36 bipolar hip arthroplasties after performing excavation of the steep and shallow acetabulum without acetabular bone-grafting for dysplastic osteoarthritis. The procedures were carried out between 1981 and 1985. Survivorship analysis showed that 84.6 of the bipolar hip arthroplasties were retained for 8 years. Twenty-nine patients, which were followed for 6-9 years after surgery, were reviewed. Severity of acetabular dysplasia was classified according to the method of Crowe. Class 1 included 17 hips and class 2 included 12 hips. The average preoperative clinical score was 49 points. The average postoperative clinical hip score improved to 87 points after 6 years. Twenty-seven of the 29 hips assessed were classified as either excellent or good by Charnley's function score. Stress fracture, due to excessive acetabular excavation at the time of surgery, and femoral component loosening were major symptomatic complications. The cessation of radiographic evidence of migration of the bipolar socket was recognized in 25 of 29 procedures at 6 years after surgery (86.2%). Cineradiographic study demonstrated that the abduction motion under standing position for 20 of 24 hip joints functioned dominantly at the inner-bearing and metallic-stem interface.- - - - - - - - - - ranking = 0.33333333333333keywords = fracture (Clic here for more details about this article) |
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