Aim of the study: To evaluate the results of metal-on-metal resurfacing hip arthropalsty in young patients

Materials and Methods: Between February 2000 and December 2004, this operation was performed in 181 patients (205 hips) using the posterior approach. The main indications were osteoarthritis, osteonecrosis, hip dysplasia, post-traumatic arthritis, perthe’s disease and slipped capital femoral epiphysis. There were 142 males and 39 females aged 26 to 68 years (average 47.4 years). 136 patients had a minimum 3 year follow-up (range 1–5 years). Clinical and radiological evaluation was performed at 3 months, 1 year, 2 years and 5 years from time of surgery. All patients were scored using the Charnley’s modification of Merle d’Aubigne score preoperatively and at last follow-up. Radiological evaluation included grading acetabular and femoral zones for loosening, determining stem-shaft angle, hip ratio. The endpoint for outcome evaluation was revision which was two in this series. Survivourship analysis was performed by Kaplan-Meier analysis. The results in our patients were encouraging with most returning to sporting activities at an average of 12 months. 1 patient with bilateral hip resurfacing had evidence of osteolysis after surgery and had occasional hip pain until last follow-up. Complications like neck fracture, heterotrophic ossification were not seen in our series.

Conclusion: Early results of metal-on-metal resufacing arthroplasty in our series are encouraging. Continued follow-up and evaluation remains important to determine the long term results of this operation.

Purpose : Mucoid degeneration of the Anterior cruciate ligament(ACL) is not a well-known entity. Only 1 case of mucoid degeneration of the ACL has been reported in the English literature. This article describes 5 cases of mucoid degeneration of the ACL with clinical features, MRI findings and a method of arthroscopic management of these cases.

Methods : Over a period of 18 months from 1999-2001, 5 patients were diagnosed to be suffering from mucoid degeneration of the ACL using MRI, histopathological and arthroscopic criteria. All patients presented with progressive knee pain and restriction of flexion without history of a significant trauma or instability preceding the symptoms. MRI showed an increased signal in the substance of the ACL both in the T1 and T2 weighted images with a mass like configuration that were reported as a partial or complete tear of the ACL by most radiologists. At arthroscopy the ACL was homogenous, bulbous, hypertrophied and taut occupying the entire intercon-dylar notch. The ligamentum mucosum was absent in all patients. A debulking of the ACL was performed by a judicious excision of the degenerate mucoid tissue taking care to leave behind as much of the intact ACL as possible. Releasing it and performing a notchplasty treated impingement of the ACL to the roof and lateral wall. The ACL was not fully excised in any of the patients.

Results : All patients were pain free and had recovered full flexion except one who had painful flexion beyond 120°. None of the patients had symptoms of instability.

Conclusion : Mucoid degeneration of the ACL is a clinical condition afflicting active middle aged people without a single significant traumatic episode with a specific MRI picture. They respond well to a judicious arthroscopic release of the ACL with notchplasty.

Aim: There were no reports of epiphyseal separation in cerebral palsy/spastic conditions, though cases of displaced metaphyseal & diaphyseal fractures have been reported.

Materials and Methods: There were 9 cases of epiphyseal separation involving the distal femur and proximal humerus in 4 severely handicapped children with spastic cerebral palsy. In these 9 cases there was significant epiphyseal slip with periosteal stripping with extensive subperiosteal ossification obvious on the X-rays. The X-rays also showed the following radiological signs: Frankel’s line and a scurvy line. Clinically the area was swollen and painful.

Results: The X-ray appearances confirmed the cause to be that of scurvy. Treatment was with Vitamin C, Vitamin D, nutritional support and splintage which resulted in rapid healing with excellent re-modelling. Lack of Vitamin C results in suppression of osteoblasts and interferes with collagen synthesis.

Conclusion: Scurvy should be considered as a potential cause of an epiphyseal slip in a child suffering from severe cerebral palsy. Routine Vitamin C dietary supplementation in this group of potentially mal-nourished, non-ambulant children should be considered. The cause of the slip is thought to be lack of Vitamin C in combination with weakness of the bone, spastic muscle acting on long, fragile bones and in some cases, anti-convulsant treatment.