We also had a second population of twelve patients presenting persistent limping at one year with no objective cause. The same parameters were measured for this population.
The aim of this study was determine if the detection of pathology in children with a limp can be optimised by screening with blood tests for raised inflammatory markers. The entry criteria for the study were children (0–15 years) presenting to our hospital Emergency Department from 2012–2015 with a non-traumatic limp or pseudoparalysis of a limb, and no sign of fracture or malignancy on plain radiographs. ESR and CRP blood tests were performed along with other standard investigations. Children with ESR or CRP over 10 underwent MRI scan of their area of pain or tendernesss, with those under 7 years old having general anaesthetic. MRI provided the diagnosis in cases of osteomyelitis, pyomyositis, fasciitis, cellulitis, discitis, as well as non-infective conditions such as malignancy and fracture not visible on plain radiographs. Where a joint effusion was present, the diagnosis of septic arthritis was made from organisms cultured following surgical drainage, or high white cell count in joint fluid if no organisms were cultured. The study was completed once data from 100 consecutive children was available. 64% of children had an infective cause for their symptoms (osteomyelitis, septic arthritis, pyomyositis, fasciitis, cellulitis or discitis). A further 11% had positive findings on MRI from non-infective causes (juvenile idiopathic arthritis, cancer, or occult fracture). The remaining 25% had either a normal scan, or transient synovitis. ESR was a more sensitive marker than CRP, since ESR was raised in 97% of those with abnormal scans, but CRP in only 70%. There were no complications from any of the GA MRI scans. Conclusion: This shows that MRI imaging of all children with a limp and either raised ESR or CRP is a sensitive method to minimise the chance of missing important pathology in this group, and is not wasteful of MRI resources.
Introduction and Purposes. Custom made acetabular prosthesis are a valid option for the reconstruction after the resection of pelvic tumors. They should guarantee a stable and reliable reconstruction for the expected survival of the patient. Nevertheless in many cases periacetabular metastatic lesions have been compared to high grade (IIIA-B) Paprosky defects, but treated with low or intermediate longevity implants. Some complex post-traumatic scenarios or total hip arthroplasty (THA) multiple failures need a reconstruction according to oncologic criteria to fill in the huge defect and to obtain an acceptable function. The aim of the study is to compare 3D custom-made implants for tumors and for THA failures. Materials and Methods. Three custom-made implants after tumor resection (group A: 1 chondroblastic osteosarcoma, 1 bifasic synovialsarcoma, 1 high grade chondrosarcoma) were evaluated and compared to 3 acetabular complex reconstructions after non-oncologic bone defect (group B: 3 cases of aseptic loosening after at least 2 revisions). All the implants were case-based designed, 3D printed, and realized with porous or trabecular surfaces on a Titanium base prosthesis. Age range 16–70 ys in oncologic patients and 60–75 ys in non-oncologic patients. The bone defect to be reconstructed after tumor resection was classified according to Enneking zones (1 type 1-2-3 resection, 1 type 2 resection, 1 partial type 2 resection). Non-oncologic cases were comparable in term of remaining bone stock and classified according to Paprosky classification for acetabular defects as 1 type IIIA an 2 type IIIB. Complications, MSTS functional score, necessity of walking-aids were evaluated at minimum follow up of 1 year. Results. In both groups, good functional results were obtained (MSTS score 25/30 in both groups). No cases of aseptic loosening and no infection occured. After 3 months of partial or no weight-bearing on the operated limb, 3 patients were able to walk unaided and 3 walked with one cane or crutch. No limb length discrepancy (major than 2 cm) were observed.
To map the Oxford Knee Score (OKS) and High Activity Arthroplasty Score (HAAS) items to a common scale, and to investigate the psychometric properties of this new scale for the measurement of knee health. Patient-reported outcome measure (PROM) data measuring knee health were obtained from the NHS PROMs dataset and Total or Partial Knee Arthroplasty Trial (TOPKAT). Assumptions for common scale modelling were tested. A graded response model (fitted to OKS item responses in the NHS PROMs dataset) was used as an anchor to calibrate paired HAAS items from the TOPKAT dataset. Information curves for the combined OKS-HAAS model were plotted. Bland-Altman analysis was used to compare common scale scores derived from OKS and HAAS items. A conversion table was developed to map between HAAS, OKS, and the common scale.Aims
Methods
Introduction. Direct lateral approaches to the hip require detachment and repair of the anterior part of the gluteus medius and minimus tendon attachments.
Introduction: This study evaluated the clinical and radiological outcomes of Chiari osteotomy for severe coxa irregularis and subluxation of the femoral head. Materials and Methods: The study group included patients with late Legg-Calvé-Perthes disease (6 patients), posttraumatic avascular necrosis (1 patient), and multiple epiphyseal dysplasia (1 patient). The mean age at surgery was 11.4 years (range, 6.8 to 14.7). The clinical parameters evaluated included changes in pain, limp, and range of motion of the hip. Radiographic measurements were made to determine the width of the medial and superior joint spaces, acetabular coverage, lateral epiphyseal extrusion, and the Stulberg classification. Results: At a mean follow-up of 5 years (range, 1.1 to 11.0 years), pain disappeared completely in 5 patients or markedly decreased, enough to complete normal daily physical activities, in the remaining 3 patients.
Purpose: Despite renewed interest in limb lengthening in western countries, the method is not widely used in Africa where congenital or acquired malformations produce a significant number of indications. We reviewed the first cases of limb lengthening procedures performed over the last five years. Material and methods: The series included ten patients, five male five female, mean age 16.3 years (5–28). Indications for lengthening procedures were limb length discrepancy which was painful, bothersome, or disabling (n=8) or loss of bone substance (n=3). Indications were established after history taking, physical and radiographic examinations (telemetry of the lower limbs to determine leg length discrepancy or identify gap, or to identify associated anomalies). The classical technique was used: external fixator, osteotomy, progressive lengthening, 1 mm/d after a latency period. Results: Initially mean length discrepancy was 7.8 cm (range 3 – 16). Mean duration of external fixation was 207.9 days (60–294). The de Bastiani consolidation index was 24 d/cm. Nine complications were recorded and there was one therapeutic failure requiring amputation. Discussion:
The purpose of the study was to analyse the clinical and radiological results of cementless HAP-coated Mallory- Head hip replacement in dysplastic hips. The collective included 20 males and 30 females (64 hips), with a mean age of 52.6 (range 20–68) years at operation. We also included two patients (4 hips) with spondyloepiphy-seal dysplasia (dwarfism). All patients were operated by one surgeon (EvL) during the period 1991–1997. A majority had “champaign flute” type femur. A minority had a normal or “stove pipe” type femur (Dörr). Most patients had acetabular dysplasia classified as A or B (Eftekar); some were classified as C and one as D (after Schanz osteotomy). Previous operations included: derotating varous osteotomy (11), acetabular shelf plasty (9), Salter or Chiari pelvic osteotomy (4) and tenotomy of the hip adductors (2). After a mean follow-up of 57 (range 32 to 97) months, a clinical and radiological analysis was performed by an independent investigator (TG). Postoperatively no or only mild pain was reported by 89% of all patients. The VAS for pain (0–10) was excellent: 1.70 (0–7).
Hip fractures are frequent due to osteoporosis and old age. The incidence of the second hip fracture had been reported as 5–9%. Subcapital displaced fractures in the elderly are treated sometimes with hip hemiarthroplasty. Our aims was to evaluate patients with bilateral no simultaneous hip fracture treated with hemiarthroplasty at our institution. Material and methods.- Twenty-two patients, 19 women and 3 men, were evaluated with a mean age of 79 at the initial fracture and 82 at the subsequent fracture. In 13 the first fracture was on the left and 9 on the right. All were of Garden grade IV. One of the fractures occurred from 1994 to 2003. The mean hospital stay was 18 days for the first fracture and 14 for the second. The second fracture happened a mean of 4 years after the first one (1 month to 9 years). This report is based on 14 of these patients, with more than one-year follow-up. The others 8, 6 had died and 2 were missing. Results.- Walking capacity: previous to the first fracture 11 walked more than 1000 meters, 3 between 100 and 500 meters. Outdoors: after the first fracture 6 walked without help, 3 used one cane and 3 used a walker or two canes, and 2 were unable. After the second fracture 1 walked without help, 2 used one cane, 5 used two canes or walker and 6 were unable. Indoors: after the first fracture 12 walked without help, 2 were able with the help of one cane, 2 with two canes. After the second fracture 2 walked without help, 3 used one cane, 7 used two canes or walker and 2 were unable to walk. Dressing: all were independent before; after the first 12 and after the second 7. Bathing: 13 were independent before, after the first 9 and after the second 5. Feeding: all were independent before, after the first 11 and after the second 6. Toilet: 13 were independent before, after the first 9 and after the second 4. Shopping: 11 were independent before, after the first 5 and after the second 0. Housekeeping: 11 independent before, 1 with help and 2 unable, after the first 4 were independent, 5 need help and 5 unable, and after the second 1 was able, 3 with help and 11 unable after the second. Public transport: 3 were able and 11 unable before the fracture, after the first fracture 3 were able and 11 unable, after the second fracture none was able, 2 with help and 12 unable. Finances: 2 were able and 12 unable before the fracture, after the first fracture 2 were able and 12 unable, and after the second 2 with help and 12 unable. Eight were limping and 6 had groin pain. Conclusion.- Previous to the first fracture walking capacity was good in this age group. Following the first hemiarthroplasty patients deteriorate in their walking capacity and others activities of daily life and much so after the second one.
DDH with or without previous treatment is the most frequent source of early hip OA in adolescents. Others are hip joint deformation following Legg-Calve-Perthes disease, slipped capital epiphysis or trauma. Secondary OA after rheumatoid arthritis, bacterial infection or as result of an hemophilic hip joint are relatively infrequent. The choice of treatment depends on the type of the deformity and the severity of osteoarthritic changes. Osteotomies are favorably performed in adolescents. Arthrodesis is rarely accepted in this age group. In selected individuals THR is the matter of choice. Pain, limping gait, restricted joint motion and sometimes clicking phemomena are the usual complains. Pain is usually aggravated by running and other sports activities. Residual dysplasia of the hip with a spherical femoral head is best treated by a triple periacetabular osteotomy. The Bernese ostetomy of Ganz (. 3. ) and the triple osteotomy of Tönnis (. 9. ) are popular procedures. They mobilise an acetabular fragment, then reorient and stabilise the fragment in an optimal position. Internal fixation with screws provides stability and allows early mobilisation with partial weight bearing. Chiari’s osteotomy is a supracetabular rotatory displacement osteotomy. Femoral head and joint capsule are medialised and covered by the osteomised iliac bone. The joint capsule in the weight bearing zone is transformed into fibrous cartilage by time. Congruent remodelling of the acetabular roof and fibrous tissue transformation into cartilage are biased by inproper height and orientation of the osteotomy (. 5. ). There is still an indication in severe DDH with subluxation of the femoral head and those with a severely deformed femoral head. In pathomorphologies with aspherical femoral heads femoral osteotomies, usually valgus osteotomies, are required additionally in order to optimize the joint congruency. A dysplastic hip in a high dislocation and moderate to severe OA are contraindications. Radiographic work up includes pelvic ap view and faux profil view. Assessment of the anterior and posterior acetabular rim indicate orientation of the acetabulum in terms of anteversion / retroversion. Orientation of the subchondral sclerosis over the femoral head is an indicator of femoral head coverage as CE-angle and AC-angle. 20°–30° abduction view in neutral rotation mimikes the postoperative acetabulum / femoral head relation. From CT-scans acetabular orientation ( ante-version / retroversion ), degenerative bone cysts, posteroinferior joint space and femoral head deformities and femoral neck osteophytes are depicted. Labrum pathology is dedectable by MRT and MRT-arthrography. After treatment of DDH deformation of the femoral head and neck due to ischaemic necrosis develop in an incidence up to 20 %, depending on the method. Premature closure of the epiphyseal plate can also follow trauma, septic arthritis and Legg-Calve-Perthes disease. Most often an combination of acetabular dysplasia and coxa magna with short femoral neck and a high-standing greater trochanter are typical deformities. Specchiulli’s classification (. 8. ) is very helpful for deformations after avascular necrosis in DDH.
The Oxford hip score (OHS) is a 12-item questionnaire designed
and developed to assess function and pain from the perspective of
patients who are undergoing total hip replacement (THR). The OHS
has been shown to be consistent, reliable, valid and sensitive to
clinical change following THR. It has been translated into different
languages, but no adequately translated, adapted and validated Danish
language version exists. The OHS was translated and cross-culturally adapted into Danish
from the original English version, using methods based on best-practice
guidelines. The translation was tested for psychometric quality
in patients drawn from a cohort from the Danish Hip Arthroplasty
Register (DHR).Objectives
Methods