bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficiency of Pupillary Stretching in Cataract Surgery
Authors: Bacskulin A. , Kundt G. , Guthoff R.
Published: March 2018

Purpose

To assess the efficiency of pupillary stretching with iris hooks in poorly dilatable pupils during phacoemulsification.

Methods

Forty eyes with maximal preoperative mydriasis less than 4.5 mm (mean 3.9 mm S.D. 1.0) received bimanual pupillary stretching according to the technique of Miller and Keener (1994).

Results

Small pupils were mainly caused by long-term pilocarpine therapy (n=21), posterior synechia (n=11) or diabetic iridopathy (n=7). With multidirectional stretching, the pupil could be enlarged to mean 6.6 mm (S.D. 0.66), lasting throughout phacoemulsification. The effect of stretching was significantly greater in eyes with synechias, but no significant differences in post-operative pupil motility was observed between the three subgroups. Six eyes with pronounced postoperative inflammation responded well to antiinflammatory treatment.

Conclusions

Done with routine surgical instruments, bimanual pupillary stretching seems to be an easy, safe and effective procedure for enlarging small pupils by an average of 2.7 mm during phacoemulsification, especially in eyes with posterior synechias.
Color Doppler Imaging of the Retrobulbar Circulation in Age-Related Macular Degeneration
Authors: Hosal B.M. , Karakoç G. , GÜrsel E. , Çamur M.
Published: March 2018

Purpose

The aim of this study was to assess hemodynamic changes in the retrobulbar circulation in patients with age-related macular degeneration (ARMD).

Methods

Color Doppler imaging was used to calculate blood flow velocities and vascular resistance of the central retinal artery, short posterior ciliary artery and ophthalmic artery in patients with ARMD and in control patients.

Results

The average peak systolic velocity was significantly lower in the central retinal artery (p < 0.001), posterior ciliary artery (p < 0.001) and ophthalmic artery (p < 0.01) of the patients with ARMD than in control. End-diastolic blood flow velocities in the retrobulbar arteries of ARMD patients were also significantly lower (p < 0.001) than controls. Gosling's pulsatility index was significantly higher in the ophthalmic artery (p<0.01) and posterior ciliary artery (p < 0.001) of eyes with ARMD. In addition, the resistivity index was significantly higher in all retrobulbar arteries (p < 0.001) of these patients.

Conclusions

The hemodynamic abnormalities in the retrobulbar circulation suggest that vascular impairment may play a role in the pathogenesis of ARMD.
The Effect of Pulsed Electromagnetic Field on Patients with Endocrine Ophthalmopathy
Authors: Jankauskienė J. , Paunksnis A. , Blužienė A , Saulgozis J.
Published: March 2018

Purpose

To evaluate eye signs, proptosis and ocular movements in patients with endocrine ophthalmopathy under the influence of pulsed electromagnetic field therapy.

Methods

We examined 14 patients (9 women, 5 men) with endocrine ophthalmopathy and evaluated eye signs, proptosis and ocular movements before and after the course of pulsed electromagnetic field therapy, and 12 controls. Their age ranged from 29 to 57 years. Visual sensitivity was investigated with a static automatic perimeter (Allergan Humphrey Field Analyzer). The score was calculated by rating the severity of involvement of soft tissue, proptosis, extraocular movements, corneal state and optic nerve function on a scale from 0 to 3. The pulsed electromagnetic field procedures were carried out with the help of electromagnetic spectacles.

Results

Pulsed electromagnetic field therapy reduced the score for soft tissue and proptosis in patients who suffered from endocrine ophthalmopathy. There was fall in the mean score for ocular movements, corneal and optic nerve function but it did not reach significance after treatment. Electromagnetic field therapy has no useful effect on visual signs and eye movements in two patients who had had the illness more than two years.

Conclusions

Localised pulsed electromagnetic field procedures can be recommended, together with other methods of conservative treatment of endocrine ophthalmopathy.
Orbital Dirofilariasis
Authors: Strianese D. , Martini A. , Molfino G. , Falabella L. , Tranfa F.
Published: March 2018

Purpose

To warn the ophthalmologist to consider orbital dirofilariasis in the differential diagnosis of inflammatory masses of the orbit.

Patients

Two cases with non-specific swelling and pain of the orbit who had a initial diagnosis of “inflammatory pseudotumor of the orbit”.

Results

These are two new cases of orbital dirofilariasis.

Conclusion

In the ophthalmic literature, the highest incidence of ocular dirofilariasis is reported in Italy. Since both these patients had no history of travel in endemic areas of Dirofilaria, this parasitic infection is presumably not rare in Italy and is probably underdiagnosed.
Retinal Vein Occlusion in a Woman with Heterozygous Fabry's Disease
Authors: Oto S. , Kart H. , Kadayifçilar S. , Özdemir N. , Aydin P.
Published: March 2018

Fabry's disease is associated with high incidence of thrombosis in hemizygous males and heterozygous females. We describe a woman with Fabry's disease who developed hemi-central retinal vein occlusion during the follow-up. The vein occlusion showed a fulminant course ending with a painful blind eye within a short period. Fabry's disease should be considered in the differential diagnosis of the vascular occlusive disorders especially in young patients.
Changes in Bone Turnover and Bone Density after Total Hip Arthroplasty
Authors: Harris N.J. , Lowman A. , Wolsey L. , Hannon R. , Smith T.W.D. , Eastell R.
Published: March 2018

The purpose of this study was to relate changes in bone mineral density post-operatively around a cemented femoral prosthesis with changes in bone turnover. This might allow appropriate timing of antiresorptive therapies in the prevention of aseptic loosening. We recruited ten patients and evaluated both bone turnover, by measurement of urinary N-telopeptide of collagen type I, bone specific alkaline phosphatase and osteocalcin, and bone mineral density following total hip arthroplasty. Bone formation markers decreased significantly postoperatively (p<0.001). Bone resorption markers increased postoperatively and were maximal at 6 weeks (p<0.05). There was a 5–15% decrease in bone mineral density at the proximal femur by 6 months (p<0.01). The changes in bone mineral density confirm the pattern of reduced stress in the proximal femur. The early decrease in bone formation markers was unexpected and could relate to enoxaparin therapy. The optimal time to administer antiresorptive therapy might be 6–12 weeks post-operatively.
The Long Term Results of Charnley Low-Friction Arthroplasty in Patients with Juvenile Chronic Rheumatoid Arthritis
Authors: Sochart D. H. , Porter M. L.
Published: March 2018

Eighty Charnley low-friction arthroplasties, performed on 49 patients with juvenile chronic rheumatoid arthritis, between 1966 and 1986, were followed-up for an average duration of 217 months (18.1 years; 26 to 366 months). There were 10 male patients (17 arthroplasties) and 39 females (63 arthroplasties) whose average age at time of operation was 28.5 years (18 to 35 years). A total of 14 patients (24 arthroplasties) had died, at an average of 208 months (17.3 years, 26 to 339 months) following operation.

All patients had marked improvement in levels of pain, function and range of movement of the joint, with 88% (43 patients, 70 arthroplasties) being completely free of pain and all but one of the remainder experiencing only minimal discomfort. Fourteen acetabular components (18%) were revised at an average of 148 months (12.3 years: 26 to 252 months) from the time of operation. Three were revised for deep sepsis, four for excessive wear, and seven for aseptic loosening (9%). Three acetabular components are currently loose and the total aseptic loosening rate was therefore 13% (10 hips). The average acetabular wear rate was 0.11 millimeters per year for the entire series. Twelve femoral components were revised at an average of 153.8 months (12.8 years; 26 to 231 months), three for deep sepsis, five for aseptic loosening (6%) and three following fracture of the implant. One component was revised, although not actually loose, during an operation to replace a loose acetabular component. One of the surviving implants is currently loose and the total rate of mechanical failure of the femoral implant was therefore 11% (9 hips). Acetabular component survivorship was 94% (95% C.I.: 88 - 99%) at 10 years and 79% (69 - 89%) at 25 years, with the survivorship of the femoral implant being 95% (90 - 100%) and 81% (70 - 91%) respectively.
Acetabular Revision with Morsellized Allograft and the Harris Galante Porous Cup. Two to Ten Year Results
Authors: Hubble M.J. , Eldridge J.D. , Lee M.B. , Whitehouse S.L. , Smith E.J. , Learmonth I.D.
Published: March 2018

Sixty eight cementless acetabular revisions were performed using impacted morsellized bone graft and the Harris Galante 1 porous coated component (HGP 1). Acetabular defects were graded according to the American Association of Orthopaedic Surgeons classification. Twenty nine (43%) were contained (Type 2 cavitatory) and thirty nine (57%) uncontained (Types 1 or 3 - segmental or combined) defects. The patients were followed prospectively for a mean of five years (range two to ten years). Radiological evidence of graft remodelling was seen in twenty two hips. Progressive radiolucent lines were present in eight cases (12%). Two screws broke. There were two cases of deep infection. Radiological failure, with a change in cup angle of greater than 5 degrees or migration of greater than 5 mm, was seen in six cases (9%). All six had uncontained defects (segmental or combined). Gratifying medium term results have been obtained after reconstruction of contained acetabular defects using impacted morsellized bone graft and the cementless HGP 1 cup. Inadequate graft support in uncontained defects resulted in six cases of failure.
The Use of Plla Screws for the Fixation of Bone Graft in Total Hip Arthroplasty
Authors: Ando K. , Yamaji T. , Ukai T. , Nakagawa K.
Published: March 2018

We used Poly-L-lactic Acid (PLLA) screws for fixation of bone graft during THA operation in 22 patients (22 hips) with terminal stage coxarthrosis accompanied by marked acetabular dysplasia. Fixation with PLLA screws alone was performed in 6 of the first 7 cases. A metal washer was also used for better stability in one hip in which the bone graft was soft. In order to achieve adequate fixation between graft bone and acetabulum, a PLLA washer was produced and used at the time of PLLA screw fixation in the other 15 cases. Good bone union and good remodelling of the graft bone were observed in all hips. Since the follow-up period was short, the long term state of the grafted bone in the absorption process of the PLLA screws is still unclear. However, at present, PLLA screws appear to be a promising material that can replace metal or ceramic screws which may have some problems.
Aseptic Loosening of Boneloc Cemented Exeter Total Hip Replacement. A 5 Year Follow-Up of the First 100 Hips
Authors: Thomsen P.B. , Bøvling S. , Jacoby B. , Hansen T.B.
Published: March 2018

To evaluate the midterm performance of Boneloc cemented primary Exeter hip arthroplasty we examined the first 100 hips in 93 patients, who were alive at a median 56.6 (50–62) months after the operation. During the follow-up period 2 femoral stems and 2 acetabular cups were revised because of aseptic loosening from 3–5 years after the operation. A third acetabular cup was revised at the same time as a loose femoral stem, but was not found loose. The 5-year survival of both the stem and the cup was 98 per cent and for the surviving 98 hips the average Harris Hip Score was 87.6 (43–100) and the average pain score was 42.2 (10–44). Eighty nine per cent of patients were very satisfied or satisfied with their hip prosthesis and the patients’ own evaluations correlated well with the Harris Hip Scores. Follow-up radiographs revealed definite loosening of 3 stems and 2 cups, probably loosening of one stem and 2 cups, and possibly loosening of 2 stems and one cup. The Exeter stem subsided significantly within the cement mantle by median 3.3 (0–19) mm. In a subgroup of patients subsidence diminished significantly from the first 28 months compared to the last 31 months. Subsidence at the cement bone interface was only seen in 4 hips, where cement fractures had developed. Poor quality cementation, and valgus position of the femoral stem, significantly increased the risk of aseptic loosening, as did osteolysis and cement fracture. Poor cementing technique and continuous radiolucent lines at follow-up radiographs were positively correlated with acetabular cup loosening. The rather good midterm results with the Exeter femoral stem can probably be ascribed to the collarless, polished, double tapered stem design.
Confirmation of the Reduction and Containment of the Femoral Head with CT or MRI Scans in DDH: The Need for Repeated Scans
Authors: Case R.D. , Gargan M.F. , Grier D. , Portinaro N.M.A.
Published: March 2018

The accuracy of reduction of the femoral head in the acetabulum after the application of plaster casts in open and closed reduction was retrospectively assessed by means of CT or MRI scan in 59 patients and 67 hips. Scanning after the first plaster application showed that the position was not maintained in the hip spica in 1 out of 37 patients (3%), who had undergone open reduction, and 8 out of 30 (27%), who had undergone closed reduction. All hips shown to be reduced and contained at the time of the first scan, and held in a spica remained reduced on subsequent scans.

This study shows that the hip is vulnerable to redisplacement, especially after closed reduction, but stabilises after the first 6 to 8 weeks in plaster. This suggests therefore that repeating the scan after each plaster change was not necessary, and that resources could be conserved.

This study has also shown that all the 113 CT scans clearly defined the anatomy but 6 out of the 33 MRI scans were blurred and needed repeating.
Fragmentation of the Polyethylene Cement Restrictor in Total Hip Arthroplasty
Authors: Gabbar O.A. , Williams R.W. , Spencer R.F.
Published: March 2018

The presence of polyethylene wear particles at the bone-cement interface after joint replacement is considered a major cause of prosthetic loosening. Nevertheless, many surgeons continue to use winged Hardinge polyethylene restrictor of which fragments are frequently seen to detach during insertion into the femoral canal, and to emerge during medullary lavage. The extent to which such fragments may be retained in the femoral cement mantle is not clear, and there is obvious concern that such fragments may result in polyethylene granuloma formation. We reviewed 89 post-operative X-rays after hip replacement employing the Hardinge restrictor. The following issues were examined:

1. Dimensions and number of distal radiolucencies in the cement and their correspondence with the wing size of the restrictor,

2. method of suction used during pressurised lavage,

3. Proximal and distal canal diameter and amount of taper,

4. Gruen zone location of radiolucencies.

Linear lucencies corresponding exactly to the wings of the restrictor were found on 14 X-rays (15.7%), 7 were seen out of 54 cases in which distal suction was used during lavage, and 7 were seen in 35 cases in which proximal suction only was employed. There was no statistical difference between these two methods of suction in limiting the number of retained fragments of restrictor (P= 0.156). There was no correlation between the likelihood of fragment detachment and canal taper or distal diameter. A total of (17) detached fragments were identified, distributed in the following Gruen zones; 3 (35.3%), 4 (38.2%), 5 (26.5%). We suggest that the above observations should alert surgeons who wish to use this type of restrictor to the importance of meticulous femoral preparation, preferably under direct vision, to ensure that no fragments of restrictor become detached
A Simple Method of Planning and Performing a Proximal Femoral Varus-Shortening-Derotation Osteotomy for Hip Dislocation in Cerebral Palsy Using a Blade-Plate
Authors: Brooks R.A. , Kirby K. , Theologis T.N.
Published: March 2018

Femoral varus, derotation and shortening osteotomy is part of the surgical treatment of hip subluxation and dislocation in children with cerebral palsy. In such cases, a post-operative neck-shaft angle of 110–120° is desirable as well as 0–15° anteversion. Standard techniques of planning a femoral osteotomy require accurate knowledge of proximal femoral deformity, but in cerebral palsy this may be difficult to measure owing to excessive anteversion and difficulties with positioning for radiographs.

We have developed and used a method that does not rely on preoperative radiographic measurements or the use of the femoral diaphysis for reference. Our method is focused on achieving the desired postoperative neck-shaft and anteversion angles mentioned above. The centre of the femoral neck is used as a reference and the chisel for a blade plate is applied 20–30° varus to this neutral axis. Osteotomy cuts are then made parallel to the chisel and perpendicular to the femoral shaft. The chisel is replaced with a 90° blade plate and the osteotomy is reduced, derotated and fixed to the femoral shaft. The final neck-shaft angle is therefore 90° plus 20–30°, ie the desirable 110–120°. This position is achieved without knowledge of the angle of the wedge of bone removed by the osteotomy.

This technique has been performed in 16 hips in 10 patients with cerebral palsy during one year. The final neck shaft angle fell within the desired range in 12 hips (75%). We have found this technique to be a simple and reliable means of achieving correction in patients in whom accurate preoperative estimate of the femoral neck shaft angle is not possible.
Selective Arterial Embolization for Postoperative Bleeding after Total Hip Arthroplasty
Authors: Court C.H. , Boisrenoult P.H. , Chick G. , Nordin J.Y.
Published: March 2018

The Authors report a case of postoperative bleeding after total hip replacement revision, successfully stopped by the use of selective arterial embolization. Physiopathology and treatment of postoperative bleeding after total hip arthroplasty are discussed.
Intraprosthetic Disassembly of the Charnley-Hastings Prosthesis
Authors: Lund J.M. , Vince A.S. , Donell S.T.
Published: March 2018

The Charnley-Hastings hip prosthesis is a hybrid bipolar hemiarthroplasty derived from a Hastings acetabular component and a Charnley stem. This report documents a presentation in which the acetabular component rotated in a medial fashion, resulting in an intra-acetabular dislocation of the Charnley femoral component.
Drainage versus Non-Drainage in Total Hip Arthroplasty. A Prospective Randomised Study
Authors: Ravikumar K.J. , Alwan T. , Fordyce M.J.F. , Tuson K.W.R.
Published: March 2018

We present a prospective review of 23 patients having 25 primary total hip arthroplasties (THAs) over a two-month period. Patients were randomly allocated into two groups, one with wound drainage and the other without.

There were 12 hips in the Drain group and 13 hips in the No-drain group. Demographic characteristics and risk factors were similar in the two groups. The average wound score (ASEPSIS) was found to be higher for the No-drain group and this was statistically significant. In the No-drain group, 7 out of 13 hips developed infection (5 superficial and 2 deep). In the Drain group, 1 out of 12 hips developed deep infection. The difference in the average drop in the haemoglobin between the two groups was not statistically significant. In the Drain group, the average drainage volume was 463ml. The type of anaesthetic, duration of the operation, experience of the surgeon and the surgical approach used were not found to have a statistically significant correlation with postoperative wound infection.

Our small series supports the view that the use of closed suction drainage after THA results in lower incidences of drainage from the wound site and also of wound infection.
Total Hip Arthroplasty in Greece
Authors: Dretakis EMM. K. , Dretakis K. EMM. , Papakitsou E.F. , Steriopoulos K.A.
Published: March 2018

In this paper data are presented regarding total hip replacement during the year of 1998 in Greece. These are derived from Orthopaedic Departments of all Hellenic State Hospitals and from major private hospitals. A questionnaire together with a relevant letter was sent to the Consultants of the Orthopaedic Departments explaining the purpose of the study. The reply rate was 100 per cent. The answers to the questions were prompt and the results were received in a short time. Analysis of the data revealed that 4477 total hip replacements were performed in Greece during the year 1998. This number includes 411 (9.2 per cent) patients with revision arthroplasty. The operations were performed on 3247 women and 1230 men with a mean age of 66 years. Degenerative osteoarthrosis of the hip was the most common diagnosis (74 per cent). Intracapsular fractures of the hip (7 per cent), neglected congenital dislocation of the hip in the adult (5 per cent), osteonecrosis of the femoral head (5 per cent), rheumatoid arthritis and ankylosing spondylitis (4 per cent) and miscellaneous conditions (5 per cent) accounted for the remainders. The mean time of hospitalization was 13 days. The postoperative mortality rate during hospitalization was 0.29 per cent, deep infections 0.7 per cent and dislocations 1 per cent.
Augmentation of Acetabular Cement Fixation in Revision Hip Arthroplasty with Titanium Screws
Authors: Busch C.A. , Tucker J.K. , Wooster A.
Published: March 2018

A method is described in which acetabular cement fixation is augmented by the use of specially designed titanium bone screws. In this analysis 22 elderly patients (24 hips) with severe acetabular bone loss at the time of revision have been prospectively studied both clinically and radiologically at a mean follow-up of 4.8 years. (Range 3 - 10.5 years). Three patients showed progression of peri-acetabular bone-cement lucent lines. In two patients a cement fracture occurred next to the bone screw. Two patients showed migration of the screw-cement unit of greater than 4mm at maximum follow-up. The post-operative Harris hip score was 81 (Range 68–96) There were no significant technical complications associated with the technique of screw insertion.
Unrecognised Post-Operative Hyponatraemia in the Elderly with Hip Fractures
Authors: Shewale S.B. , Pandit H.G. , Rana P.S.
Published: March 2018

Inappropriate fluid therapy and surgical stress further decrease renal ability to excrete water. This results in hyponatraemia in the elderly, who tend to have a precarious homeostatic equilibrium. There is a high incidence of post-operative hyponatraemia in elderly patients undergoing surgery. We scrutinised biochemistry records, notes and fluid charts in 227 patients who had undergone treatment for hip fractures. Patients with a possible medical cause for hyponatraemia (25) were excluded. The group of 202 patients had an average age of 77.8 years. We noted an incidence of 17.8% of mild hyponatraemia and 4.4% of severe hyponatraemia.

A high index of clinical suspicion and sound knowledge of fluid balance can prevent this potentially serious complication.
Atypical Infection of a Total Hip Endoprosthesis Due to Mycobacterium Fortuitum Case Report of An Infection of a Total Hip Endoprosthesis with Mycobacterium Fortuitum
Authors: Bachfischer K. , Waizenhoefer A. , Gerdesmeyer L. , Gradinger R.
Published: March 2018

Only a few cases of infection of an endoprosthesis with mycobacterium fortuitum have been reported, each resulting in functionally unsatisfactory outcomes. We performed a stem revision cementless total hip endoprosthesis six months after primary implantation after the appearance of the typical radiological and clinical signs of aseptic loosening.

Histological and molecular-biological analysis of the intra-operative specimens confirmed an infection with Mycobacterium fortuitum.

Following antimicrobial therapy, the patient is painfree and fully weight-bearing seven months after replacement.

If aseptic loosening of an endoprosthesis is suspected, an infection with Mycobacterium fortuitum should be considered.
Clinical Experiences with An Endoscopically Controlled New Device for Extraction of the Cement Plug in Hip Revision Arthroplasty
Authors: Porsch M. , Schmidt J.
Published: March 2018

Removal of the distal cement plug in revision total hip arthroplasty may be difficult, even if the plug is located distally in the famur. We have developed a new extraction device, which consists of a K-wire and a cannulated drill and extractor, which could be placed centrally under visual control. Our clinical experience demonstrates that the use of this device reduces the risk of a femoral perforation and facilitates removal of the plug.
Long-Term Outcomes in Developmental Dysplasia of the Hip
Authors: Petra M. , Benson M. K. D.
Published: March 2018

Developmental dysplasia of the hip (DDH) encompasses conditions ranging from irreducible neonatal dislocation to asymptomatic acetabular dysplasia in the adult. The age at diagnosis and the severity of displacement influence the procedures selected by the treating surgeon. Treatment modalities include abduction splintage, closed or open reduction with casting, pelvic osteotomies, femoral osteotomies, complex reconstruction and salvage procedures. The consequences of management of children with DDH affect our patients for a life time. Sadly, there are few long-term outcome studies of DDH management published. A literature review reveals only nine well documented and clinically relevant studies, which follow patients beyond the age of 30 years. Several classification systems have been used to assess functional and radiological outcomes which makes comparison of the results unreliable.

Most studies report 70% of good or excellent radiographic and functional results where the study period is less than 20 years. When the average follow-up is 30 years, however, the percentage of good or excellent radiographic results decreases to 45%.

Natural history studies have shown that untreated congenital hip dislocation is not invariably associated with a poor functional result. Children we treat for DDH must have an outcome better than if we had not treated them.
Lateral Direction of Penetration into Acetabular Sockets Using a 32 mm Diameter Femoral Head
Authors: Elfick A.P.D. , Hall R.M. , Unsworth A. , Pinder I.M.
Published: March 2018

A cohort of 35 explanted acetabular sockets was examined to ascertain the direction of penetration. The penetration relative to the open face of the socket was measured using the shadowgraph method and the corresponding anatomical direction was then deduced using anterior-posterior radiographs. A median anatomical penetration direction of 17.5° lateral to the sagittal plane was found (range 27° medial to 44° lateral). These observations confound explanation through analysis of the motion and loading of the hip joint.
Safer Preparation of Femoral Head Bone Grafts during Revision Arthroplasty
Authors: Roberts P.J. , Gregson P.A. , Mcgeoch C.
Published: March 2018

Femoral head bone-grafts are useful in the treatment of both acetabular and femoral bone stock reconstruction. We describe a novel adaptation of equipment that allows safe and rapid fragmentation of whole femoral heads.
Proximal Femoral Reconstruction for Revision Hip Arthroplasty with Severe Bone Loss: A New Technique Using Autologous Bone Graft and a Proximally Loading Femoral Component
Authors: Adrian J. Alfaro , Emerton M. , Murray D.W. , Mclardy-Smith P.
Published: March 2018

We report the results of a new method of reconstructing the femur in 22 patients with severe bone loss having revision hip arthroplasty. The calcar and metaphysis were reconstructed with cortico-cancellous autograft around a new modular hip replacement. The metaphyseal portion of the implant is free to slide on the stem and therefore loads the graft and, we believe, encourages bone graft incorporation. The stem gains cementless fixation distal to the area of bone loss, thus preventing fractures and allowing the areas of bone loss to heal.

At the time of review at a mean of 3 years follow-up there had been no revisions (since then there has been one re-revision due to recurrence of infection). The modified D'Aubigné and Postel hip score improved from 7.3 to 15. In 17 patients the graft has incorporated, in 5 it has partially resorbed but the prosthesis remains secure.

We conclude that this is a relatively simple and successful technique for overcoming the problem of major femoral bone loss.
Hydroxyapatite-Coated Threaded Acetabular Prostheses. A Five-Year Follow-Up Radiographic Study
Authors: Loupasis G. , Birtwistle S.J. , Hyde I.D.
Published: March 2018

We have reviewed 83 consecutive cementless Furlong hydroxyapatite (HA)-coated threaded acetabular components which were inserted in 75 patients. The mean age of the patients at the operation was 54 years (range 31 to 67 years) and the mean follow-up period was 61 months (range 40 to 82 months). Large size gaps at the implant -bone interface (attributed to failure to achieve bone-prosthesis contact), were present in 89% of the cases on the initial radiographs. At the last follow-up, the gaps were either no longer visible or had decreased in 95% of the cases. Radiolucencies were absent in well-fixed components. Three acetabular components were considered to be loose and are awaiting revision, giving a 3.6% aseptic loosening rate. The remainder of the cups were radiographically stable with positive evidence of bone ingrowth and no signs of impending loosening.
Radiological Assessment of Bone Graft in Revision Acetabular Arthroplasty
Authors: Abols I. , Olivier H.
Published: March 2018

The purpose of this study was to describe the radiological appearance of moulded cancellous bone graft used for acetabular reconstruction in revision arthroplasty of the hip.

We reviewed retrospectively 48 cases with a mean follow-up of 3.5 years. The radiological study was based on: the density of the graft, the delineation line between the graft and the host bone or the presence of trabecular continuity between the graft and the acetabular bone, and the position of the cup. Increasing density of the graft was observed in 35 cases.

Trabecular continuity between the graft and the host bone appeared in 9 cases, in Zone I, with a mean delay of 2.6 years. This finding was associated with the disappearance of the dense line separating the graft from the acetabular bone in 8 hips (16.6%). At a mean follow-up of 2.5 years, 4 patients showed migration of the cup; this was secondary to graft resorption in 3 cases. Only one of these patients had been reoperated on.

From these observations we have made an attempt to describe the evolving appearance of the bone graft and the radiological signs that may be used to assess graft incorporation.
A New Procedure for Revision for Fracture of the Stem in Total Hip Replacement
Authors: Houshian S. , Hvass I. , Riegels-Nielsen P.
Published: March 2018

A new system for antegrade removal of fractured femoral stems, the Anspach Extractor III®, is described. A conical hole is made in the fracture surface of the stem with a high speed drill. An extractor rod is then fixed into the hole with a malleable sleeve. We have used the system in eight cases of a broken Charnley stem and removed the distal hip in 6 cases without problems. 2 cases were unsuccessful and needed femoral fenestration for retrograde removal.

This system is easy to use and we have found it to shorten operation time in case of broken stem revision.
Intrapelvic Dislocation of the Femoral Head after Central Acetabular and Femoral Neck Fracture
Authors: Mesa A. Ceballos , Manent R. Balmaseda , Rodriguez R. Puente , Canto M. Pedroso
Published: March 2018

Central fracture-dislocation of the hip associated with fracture of the femoral neck and intrapelvic intrusion of the femoral head is a very rare condition. The treatment of choice consists of open reduction of the dislocation and internal fixation of both fractures, but this is often not possible in delayed cases. In our patient, a young female, operated on six months after the trauma by partial resection of the femoral head and a cementless total hip arthroplasty, a good clinical result was achieved.
Orthopaedic Consequences of Slipped Capital Femoral Epiphysis in Adults
Authors: Lazovic D. , Peters G.
Published: March 2018

Slipping of the femoral head usually occurs at the beginning of puberty. With sexual hormone deficiency the growth plates remain open with the danger of a Slipped Capital Femoral Epiphysis (SCFE) beyond the normal age of growth. In several endocrine disorders such as hypothyroidism or growth hormone deficiency, and especially during supplemental therapy with hormones, SCFE can occur. SCFE can occur even if the hormonal replacement therapy has stopped. Since 1984 we have seen and treated 7 adult patients (6 male, 1 female) with SCFE. They were between 17 and 36 years old. Due to the lack of sexual hormones three patients had severe osteoporosis which caused difficulties in surgical treatment. From the orthopaedic point of view regular clinical and radiological check-ups are necessary in patients with open physes beyond the normal growth age - especially in patients with endocrine dysfunction and hormonal supplement therapy. These reviews have to be continued until the growth plates are closed be-cause SCFE occur even after hormonal replacement has been stopped for years. Prophylactic screwing of the opposite hip is also recommended in high risk patients.
Patterns of Osteolysis in Two Different Cementless Total Hip Arthroplasties
Authors: Hubble M.J. , Eldridge J.D. , Smith E.J. , Learmonth I.D. , Harris W.H.
Published: March 2018

The incidence and pattern of distribution of osteolysis around two different cementless total hip arthroplasties, the Harris Galante Porous (HGP) and the Porous Coated Anatomic (PCA), were compared. The HGP femoral component has a straight, collared, titanium alloy stem with non circumferential titanium mesh pads. The PCA has a collarless cobalt chrome stem with an anatomical bow and a circumferential proximal porous coating. Ninety-four HGPs and 104 PCAs were followed for an average of four and a half years. Both groups were well matched for age, sex and primary diagnosis. Each group was operated on at seperate, single, institutions by a single surgeon at each centre.

The incidence of osteolysis around the acetabular components (1%) was the same. The incidence of femoral osteolysis was 31% with the HGP and 23% with the PCA. The pattern of femoral osteolysis was very different, being predominantly around the mid and distal stem with the HGP, and restricted to the proximal with the PCA. The presence of osteolysis was clinically silent unless the femoral component was also loose. Prosthetic design, in particular the presence or absence of a circumferential ingrowth mesh or porous coating, will influence the effective joint space and the distribution of wear debris particles. This may explain the prosthesis specific pattern of osteolysis seen.
Reinforcement Rings for Deficient Acetabular Bone in Revision Surgery: Long-Term Results
Authors: Garcia-Cimbrelo E. , Alonso-Biarge J. , Cordero-Ampuero J.
Published: March 2018

This study analyzes the long-term results of 23 metal ring supports used in revision surgery since 1979. Only a metallic ring and a cemented cup were used in this series. Bone grafts and cementless cups were excluded from this study. One deep infection was excluded from the follow-up study. In the 22 cases analyzed, the mean follow-up period was 10 years for all cases and 12.2 years for unrevised cases. Bone defects according to the AAOS classification were: Grade 1, 1 case, Grade 2, 1 case, Grade 3, 10 cases, and Grade 4, 10 cases. A Müller ring was indicated in an anterior or medial wall defect (12 cases) and a Burch-Schneider ring was indicated in an anterior or posterior column defect or in pelvic discontinuity (10 cases). The clinical results were good in 8 cases, fair in 8 cases, and poor in 6 cases. Six cases were rerevised or removed, resulting in a total cumulative probability of rerevison or removal of 23.8% after 10 years according to the Kaplan-Meier analysis. Postoperatively, 18 cases had neutral rings, 2 cases had horizontal rings, and 2 cases had vertical rings. Radiological cup migration was found in 12 cases, resulting in a total cumulative probability of migration of 56.8% after 13 years according to the Kaplan-Meier analysis. Changes in the acetabular angle were present in 2 cases, vertical migration in 12 cases, and medial migration in 10 cases. Our data suggest that the metal ring and cemented cup alone could be used for salvage surgery in elderly patients and in low-demand patients. Possibly, adding bone graft could improve these results.
Fat Embolism in Hip Arthroplasty
Authors: Hofmann S. , Salzer M.
Published: March 2018

Since 1970 cardiorespiratory deterioration has been a well recognised complication during cemented Total Hip Arthroplasty (THA). Originally this effect was attributed to chemical and thermal effects of bone cement. There is evidence from several animal and clinical studies that these cardiorespiratory changes are caused by fat embolism to the lung, and high intramedullary pressure (IMP) is the main causative factor for this fatty marrow release into the circulation. Fat embolism syndrome (FES) as a rare but severe perioperative complication represents the clinical manifestation of severe fat embolism. It is of clinical importance that surgeons have a better understanding on this syndrome. In this review a new pathophysiological model for FES is presented. As there is no causal therapy for FES, several modified surgical techniques are discussed in relation to their efficiency in preventing fat embolism during endoprosthetic surgery of the hip. The anaesthetic contribution to prophylaxis is also described and a therapeutic concept for the symptomatic treatment of FES is proposed.
Prognosis of the Müller Straight Stem
Authors: Oosterbos C.J.M. , Tonino A.J.
Published: March 2018

214 primary total hip arthroplasties in 208 patients with the Müller straight stem using the second generation cementing technique were performed between 1979 and 1983. 149 hips were assessed clinically and 134 hips radiographically after a minimum of 10 years of follow-up. 55 patients had died and 10 hips had been revised, 4 for infection and 6 for aseptic loosening. In the remaining 139 patients the clinical results were very satisfactory (Merle d'Aubigné score). According to Harris’ radiographic and subsidence criteria there were 13.2% stem loosenings at 10 years. Stress shielding induced bone resorption of the proximal part of the femur was noted in 61.2% of the hips. Survival analysis of the stem showed a success rate at 10 years of 89.2% while the cumulative survival rate was 91.22% which compares well with the “gold standard” (Charnley's THA). It is suggested that there is a correlation between “physiological” subsidence and stress shielding induced bone resorption, which may lead to an elevated level of stem loosening after 10 years.
Femoral Perforation during Cement Removal in Revision Hip Arthroplasty
Authors: Williams P.R. , Maheson M.V.S.
Published: March 2018

Eighty two cemented femoral revision hip arthroplasties were reviewed to assess the incidence of intraoperative perforation of the femur and subsequent periprosthetic fracture using a high speed pneumatic burr for the removal of acrylic bone cement with an extensile exposure. There was one case of intraoperative femoral perforation; this patient did not go onto fracture postoperatively. There were no cases of intraoperative femoral fracture. There were 3 cases of periprosthetic femoral fracture all of which occurred more than 12 months after their impaction grafted femoral revision arthroplasty using a standard length cemented stem.

The pneumatic high speed burr was extremely effective in the removal of acrylic bone cement in femoral revision arthroplasty. The incidence of subsequent femoral fracture in the impaction grafted revised population was low and did not appear to be related to intraoperative femoral perforation.
Standardised Audit of Hip Fracture in Europe (SAHFE)
Authors: Parker M.J. , Currie C.T. , Mountain J.A. , Thorngren K.-G.
Published: March 2018

The Standardization Audit of Hip Fracture in Europe (SAHFE) project aims to encourage centres in Europe to participate in hip fracture audit. It defines a data set consisting of a core of 34 questions which includes outcome measures at 120 days from injury. In addition there is a larger number of optional questions. It is envisaged that each participating centre will collect and analyse its own data, with national centres to provide comparative data. Because the data is standardised, international comparisons can be made, thereby assisting in defining the optimal method of treatment and rehabilitation for this common condition.
Proximal Cementing for Revision Hip Arthroplasty
Authors: Alfaro-Adrian J. , Crawford R.W. , Wulke A. , Murray D.W. , Mclardy-Smith P.
Published: March 2018

We report the results of a new technique of proximal cement fixation in 41 patients having revision hip arthroplasty using the Oxford modular femoral component. This consists of two parts, a metaphised wedge and a stem. The metaphyseal wedge is cemented and applies the load proximally to encourage bone healing. The wedge is free to slide on an uncemented stem that gains fixation distal to areas of bone loss, with the intention of reducing the risk of fracture. The clinical and radiographic follow-up ranged from a minimum of 3 years to 7 years. There have been no re-revisions. Ninety percent of the patients had pain or slight pain. Despite a relatively high rate of early subsidence, we feel that our results are encouraging, and justify the continued use of this component in hip revision surgery.
Histomorphology-Correlated Imaging of Osteonecrosis
Authors: Hofmann S. , Urban M. , Kramer J. , Plenk H.
Published: March 2018

Early diagnosis and proper staging is of crucial clinical importance for osteonecrosis (ON). To better understand the different imaging patterns, the underlying pathophysiological sequence has to be known. The initial stage 0 is less understood and all routine imaging modalities are negative. In stage I, the bone marrow changes can be visualised by bone scintigraphy and MRI only, but a sufficiently effective repair mechanism can make the lesion reversible. In stage II an insufficient repair process demarcates the necrotic lesion from the viable bone. At this “point of no return” the lesion becomes irreversible and on MRI the demarcation border appears as a “reactive interface” with a “double-line sign”. In this early stage II plain radiographs and computed tomography (CT) are normal or show only non-specific changes. In the late stage II the insufficient repair process leads to typical patchy subchondral radiolucencies mixed with sclerotic changes in the necrotic area surrounded by a sclerotic rim on radiographs and CT. In stage III the repair mechanism and the loading stress produce the subchondral fracture which can be best visualised as a “crescent sign” by radiographs or CT. In stage IV mechanical instability leads to flattening of the femoral head followed by late secondary joint destruction. Nevertheless in ON plain radiographs remain the first diagnostic step and allow exclusion of most of the differential diagnoses for hip joint pain. However, CT is very helpful for early detection of a possible subchondral fracture. Although bone scintigraphy is very sensitive in the early onset of the disease, it remains non-specific in most of the cases. MRI is the modality of choice for a proper diagnosis and staging in early ON.
Early Pathophysiology of Osteonecrosis
Authors: Jones J.P.
Published: March 2018

Current concepts regarding the early pathophysiology of osteonecrosis (ON) are reviewed. Traumatic ON appears to result from arterial severance, an acute ischaemic event. Intravascular coagulation of the intraosseous microcirculation (capillaries and venous sinusoids) progressing to generalized venous thrombosis, and less commonly retrograde arterial occlusion, now appears to be the genesis of nontraumatic ON. However, a coagulopathy is only an intermediary event, which is always activated by some underlying aetiological risk factor(s). Conditions capable of triggering intravascular coagulation include familial thrombophilia (resistance to activated protein C, decreased protein C, protein S, or antithrombin III), hyperlipaemia and embolic lipid (alcoholism and hypercortisonism), hypersensitivy reactions (allograft organ rejection, immune complexes, and antiphospholipid antibodies), bacterial endotoxic (Shwartzman) reactions and various viral infections, proteolytic enzymes (pancreatitis), tissue factor release (inflammatory bowel disease, malignancies, neurotrauma, and pregnancy), and other prethrombotic and hypofibrinolytic conditions. In order to exceed the ischaemic threshold and produce ON, significant residual fibrin-platelet microthrombi must remain within the intraosseous vasculature for a minimum of two to six hours, and not be immediately removed by endogenous fibrinolysis. Hypofibrinolysis with increased plasminogen activator inhibitor has been found in patients with ON. The thrombotic threshold may be decreased in those hypercoagulable patients with hereditary thrombophilia, antiphospholipid antibodies, or hyperlipaemia. Subsequent exposure to an additional factor should facilitate intraosseous thrombosis and ON. It is also conceivable that fractional subchondral ON can cause both degenerative disc disease and “primary” osteoarthritis of aging and obesity.
Cement within Cement Revision Hip Arthroplasty a Minimum 5 Year Follow-Up Study
Authors: Holland J.P. , Weber F.A.
Published: March 2018

Complete removal of femoral shaft cement during revision hip surgery is a difficult task prone to complications. If the cement bone interface is intact however, is there a place for its preservation and re-use with a new cemented stem? The results are reported of 51 cement within cement femoral stem revisions carried out between 1984 and 1991 with a minimum of 5 years’ follow-up, and a mean of 7.8 years. Excluding patients lost or deceased, 39 hips in 38 patients were reviewed clinically and radiologically. Eighty-two percent of these were still functioning in situ, 72% were excellent or good using the HSS scoring system and 97% had no radiological evidence of loosening. Femoral stem failure due to aseptic loosening occurred in 4 cases (10%) between 4 and 12 years after revision. Comparing this series to a previous revision hip series by the senior author, there appears to be no deterioration in long term results using this technique, and a better long term radiological outcome.
Treatment of Femoral Fractures Associated with Stem Loosening following Total Hip Arthroplasty
Authors: Erdemli B. , Gurkan I. , Guzel B. , Cetin I.
Published: March 2018

We report the results of Kent hip revision arthroplasties performed in 5 patients with fractures of the femur associated with femoral loosening following total hip arthroplasty. The fractures occurred at an average of 40.4 months following the primary hip arthroplasty. The system of Merle D'Aubigné and Postel, as modified by Charnley, was used for the clinical evaluation. One to four years (mean, 2.6 years) after the revision operation, the clinical and radiographic results were satisfactory. With the help of the transfixion screws the Kent Hip prosthesis provides stable fixation and facilitates early mobilization, with its attendant advantages.