Aims.
Osteonecrosis of femoral head is well known and recognised complication in
Symptomatic and non-symptomatic hip osteonecrosis related to
Aim. Differentiation between bone infarction and bone infection in
Introduction: The treatment of end stage hip osteonecrosis in patients with
Salmonella osteomyelitis occurs infrequently in children without a
Introduction: Osteomyelitis remains a rare diagnosis and a difficult one to make. Acute osteomyelitis in the context of
18 Patients with SCD and 2ndry Osteoarthritis of their hips due to Avascular Necrosis underwent uncemented THA. There were 12 male and 6 female patients. Patient had their pre op WOMAC/SF-36/HOOS/and Oxford hip scores recorded preoperatively a well as 3 month, 6months and one year post op. The outcome scores at one year were significantly better than the pre operative scores However, when compared to a matched cohort of patients who underwent THA for reasons other than SCD/AVN, e.g. primary OA, rheumatoid arthritis, post traumatic OA, the WOMAC pain score improvement was less.
Hypoxic Inducible Factor and Hypoxic mimicking agents (HMA) trigger the initiation and promotion of angiogenic-osteogenic cascade events. However, there has been paucity of studies investigating how HIF could be over expressed under chronic hypoxic conditions akin to that seen in
Abstract. Introduction. Secondary osteonecrosis of the knee affects young population and causes bilateral extensive lesions. Arthroplasty is the last resort in younger population and joint preserving options questionable in pathological bone. Conservative measures have shown failure in multiple studies and hence no gold standard treatment advocated. We aimed at identifying and analysing various treatment options for secondary osteonecrosis with respect to the outcomes and studying features of symptomatic secondary osteonecrosis with regards to demographic pattern, radiological features and causative factors. Methods. A systematic review of literature was performed in accordance with the Cochrane handbook for systematic reviews and reported according to the PRISMA guidelines. Results. Six studies which included a total of 192 patients with data on 240 knee joints were included in the final review. Follow up period ranged from 1 year to 16 years. The mean age of the patients was 34.7. 3 studies were on arthroplasty and 3 on joint preserving interventions. Majority of patients were in Stage 2 or Stage 4 of osteonecrosis. Steroid induced osteonecrosis was the majority followed by SLE and
Purpose of the study: Infection is a leading cause of morbidity and mortality in
It is well documented that implant loosening rate in
We questioned about bearing surface and infection in two populations of patients who had bilateral THA with different bearings performed in the same hospital by the same surgical team from the year 1981 to the year 2010 (mean followup 15 years; 7 to 35). 1) first population (mean age 32 years): 325 patients (650 hips) with
Introduction: Osteonecrosis of the hip is a devastating disease that often results in the collapse of the femoral head and secondary osteoarthritis of the hip. Although total hip arthroplasty is considered the main therapeutic option in cases of advanced osteonecrosis (Ficat stage III or IV), historically high failure rates have been reported for this treatment. Variables such as, whether or not the prosthesis was cemented, year of implantation, age, various medical comorbidities, and risk factors such as alcohol abuse, corticosteroids usage, autoimmune disease, or
To investigate the underlying mechanism of osteocyte death in osteonecrosis of the femoral head (ONFH). Although there are a plethora of conditions that predispose to ONFH the underlying mechanism that results in the death of osteocytes is poorly understood. Consequently, treatment for early disease has a variable outcome. Recent investigation has focussed on the role of nitric oxide (NO) in the local control of bone turnover. NO is central to bone cell metabolism and has been implicated in the development of apoptosis. Bone samples were harvested from the femoral heads of 40 patients undergoing total hip arthroplasty – 20 for advanced ONFH and 20 for osteoarthritis (control group). Immunocytochemical techniques were used to demonstrate evidence of NO synthase (iNOS and eNOS) as a marker of NO production and for evidence of apoptosis. There was a marked increase in the expression of both eNOS and iNOS in the bone marrow and osteocytes from patients with ONFH secondary to steroids and alcohol with a correspondingly high proportion of apoptotic cells. Very little evidence of either eNOS or iNOS could be demonstrated in the control group and no significant apoptosis could be demonstrated. Samples from patients with ONFH secondary to
Successful nonarthroplasty solutions for the treatment of osteonecrosis of the femoral head continued to be sought. However, no definitive nonarthroplasty solutions have to date been found. Hence, even in the best of hands a large number of patients with osteonecrosis end up with debilitating end-stage osteoarthritis. In the inception of total hip arthroplasty (THA), the results of treatment of femoral head osteonecrosis by THA were inferior to total hip replacement performed for osteoarthritis. Reasons for this included the young age of many osteonecrosis patients, the high numbers of comorbidities in this population (SLE,
Osteomyelitis is usually related to trauma, surgery, immunocompromised patients, IV drug abuse, poor vascular supply, diabetes,
The management of fractures of the medial epicondyle is one of the greatest controversies in paediatric fracture care, with uncertainty concerning the need for surgery. The British Society of Children’s Orthopaedic Surgery prioritized this as their most important research question in paediatric trauma. This is the protocol for a randomized controlled, multicentre, prospective superiority trial of operative fixation versus nonoperative treatment for displaced medial epicondyle fractures: the Surgery or Cast of the EpicoNdyle in Children’s Elbows (SCIENCE) trial. Children aged seven to 15 years old inclusive, who have sustained a displaced fracture of the medial epicondyle, are eligible to take part. Baseline function using the Patient-Reported Outcomes Measurement Information System (PROMIS) upper limb score, pain measured using the Wong Baker FACES pain scale, and quality of life (QoL) assessed with the EuroQol five-dimension questionnaire for younger patients (EQ-5D-Y) will be collected. Each patient will be randomly allocated (1:1, stratified using a minimization algorithm by centre and initial elbow dislocation status (i.e. dislocated or not-dislocated at presentation to the emergency department)) to either a regimen of the operative fixation or non-surgical treatment.Aims
Methods
Currently, there are no generally accepted treatments for the prevention of osteonecrosis. To compound this further, despite considerable research efforts, the natural history of this disease remains poorly understood. The disease process appears to be initially asymptomatic, but after symptoms appear, the course becomes rapidly progressive. Clinical studies have shown that, if left untreated, collapse of the femoral head will occur in 80 per cent of the cases or greater within four years. As our knowledge of the etiology and pathogenesis of osteonecrosis improves, new treatments to halt, or at least impede, the progression of the disease may be possible. Achieving the best outcomes in the treatment of osteonecrosis depends on early, accurate diagnosis, and prompt treatment appropriate for the stage of the disease. In many cases, if treated early, long-term preservation of the native joint is possible. Magnetic resonance imaging allows accurate diagnosis in even the earliest asymptomatic stages of the disease. Non-surgical treatments such as pharmacological agents have shown promise in experimental studies, although further work remains before they are appropriate for widespread use. Various hip salvaging procedures such as core decompression, percutaneous drilling, non-vascularized and vascularized bone grafting, and various osteotomies have been successful in the majority of properly selected patients over follow-up times of a decade or more. Advances in arthroplasty technologies and techniques, including hip resurfacing and modern cementless total hip arthroplasty have allowed patients to return to pain-free, active lifestyles with excellent long-term prosthesis survival. Current treatments for osteonecrosis, while generally successful, focus on halting or delaying the progression of symptomatic disease. Recent discoveries concerning the relationship between genetic factors and the development of osteonecrosis, as well as the pathophysiologic effects of various indirect and direct risk factors such as corticosteroid use and
Intraosseous pressure measurements (IOP) are not new. Several authors have struggled to interpret static IOP and to understand arthritis and osteonecrosis pathology. This work uses a combination of simple experiments in vivo to reassess bone and joint physiology. Joint replacement needs to take into account the hydrodynamic conditions that are present in bone. Intraosseous pressure measurements were carried out with vascular occlusion, activity and saline injection in experimental conditions and then in man during walking. RESULTS. 1. Basal IOP has a pulse wave and an underlying respiratory wave (RW). 2. IOP closely reflects systemic vascular changes. 3. Proximal arterial occlusion causes loss of IOP (IOPa) and pulse volume (PV). 4. Proximal vein occlusion causes a rise in IOP (IOPv) with preservation of PV and RW. 5. Physical loading raises IOP with preservation of PV and RW. 6. Load with arterial occlusion caused minimal rise in IOP. Loading with venous occlusion caused an augmented rise in IOP with preservation of the PV. 7. Simultaneous recordings from the femoral head, condyle and upper tibia during vascular occlusion and loading show that the same effects occur at all sites. 8. Simultaneous recording from the femoral head, condyle and upper tibia during saline injection shows pressure is transmitted through bone but not across joints. 9. The Ficat bolus test destroys local circulation. Aspiration is better and preserves local perfusion. 10. Bone health at the needle tip is better assessed by IOPv – IOPa, the perfusion ‘bandwidth’. 11. Upper tibial pressure during standing, slow walking and fast walking shows large IOP changes in vivo. 12. There is probably a physiological subchondral bone blood pump. 13. Anatomical features are present which support this idea. CONCLUSIONS. IOP measurement in isolation is meaningless. With arterial and venous occlusion, perfusion at the needle tip can be studied. Compartment syndrome testing should be similar. Subchondral bone is a compressible perfused sponge with a ‘pumped’ microcirculation. Very high pressures arise in subchondral bone during activity. There are protective modifications of the microcirculation. Failure of subchondral circulation causes arthritis. Arthritis is mainly a ‘vasculo-mechanical’ disease. This work explains the spectrum of arthritis and osteonecrosis, and Perthes, caisson and