Objective

Modic changes (MC), a form of intervertebral disc degeneration visible as subchondral and vertebral bone marrow changes on spine magnetic resonance (MR), are known to be associated with low back pain. This study aimed to identify genes contributing to the development of MC using genome-wide association study.

The purpose was to investigate back pain and disability and their relationship to vertebral changes in patients with untreated Scheuermann's.

Overall, 136 patients who had attended the outpatient clinics between 1950 and 1990 for Scheuermann's were contacted, 49 of them (12 females, 37 males) responded. There was no difference in the baseline data between responders and non-responders. From radiographs, th-kyphosis, l-lordosis, and scoliosis were measured. The number of affected vertebrae and the degree of wedging were registered. Anthropometric data, occurrence of back pain, disability scores, and employment status were compared to a representative sample (n=3835) of the normal population.

After mean follow-up of 37 (6.5;25.9-53.7) y, their average age was 58.8 (8.2;44.4.-79.3) y. Male patients were significantly taller than the control subjects. Female patients were on average 6 kg heavier (P=0.016) and their mean BMI was higher (23.9 kg/m² vs 20.8 kg/m²,P=0.001) at age 20 than in the controls.

Females had a greater mean kyphosis than males (51.7 vs. 43.2°, p=0.11). There was no correlation between the degree of thoracic kyphosis and disability. Scheuermann's patients had an increased risk for constant back pain (P=0.003), a 2.6-fold risk for disability because of back pain during the past 5 years (P=0.002), a 3.7-fold risk for back pain during the past 30 days (P<0.001), and a 2.3-fold risk for sciatic pain (P=0.005). They reported a poorer quality of life (p<0.001) and general health (p<0.001). There was no difference in working ability and employment status between patients and controls.

Preliminary results using Trabecular Metal (TM) acetabular component (made of tantalum) in primary and in revision total hip arthroplasty are encouraging in few published papers in the literature.

Patients and Methods: The outcome and survivorship of a TM revision uncemented acetabular cup were assessed in 85 consecutive patients (Male 48, Female 37, mean age 70,9 years, range 54–92) undergoing revision THA in the time period from 13.5.2004 to 8.6.2006. Years from previous operation to revision arthroplasty was in average of 10,0 years (range 1–23). Acetabular bone defects were assessed using Paprosky grading system. Monoblock TM cup was used in 26 operations(Paprosky grade I=13; grade IIa=1; Grade IIb=6 and Grade IIc=6). Modular revision TM cup was used in 59 operations (Paprosky grade I=7; Grade IIa=5; Grade Ibis=15;Grade IIc=24; Grade IIIa=5 and Grade IIIb=3). 55 allografts (femoral heads) were used to fill bone defects in 39 acetabulums. TM augment was needed in 4 operations. In 17 operations also the femoral component was revised. Seven of these operations were re-revision operations. Full weight-bearing was allowed after 44 operations, partial weight-bearing after 37 operations and no weight-bearing after 4 operations. In four operations, where TM cup was initially tried to use, the fixation was found to be insufficient. Consequently, the method of revision was changed either to plating and TM-cup (Paprosky grade IIIB, n=2) or protection cup-system (Paprosky grade IIc, n=2).

Results: Subjectively, the patients were satisfied with this operation at the follow-up (mean 14 months, range 3–26). 58 (68%) patients were painless and 72 (85%) patients walked without any support. X-ray studies showed good TM-cup fixation into acetabular host bone and bone defect filling in 84 out of 85 cases in this short follow-up.

Complications: 7 dislocations, 1 deep infection and 1 sciatic nerve injury. These complications were concentrated to alcoholic and patients with many other health problems.

Conclusion: TM implant has very good primary fixation properties in host bone. The cup shows reliable ingrowths and defect filling with host bone. Our good short-term results with TM-cup are similar to the few previously published papers. Further clinical investigation is needed to show the durability and functionality of this new prosthetic material.

Purpose: The multitude of symptoms after a whiplash injury have caused a lot of discussion because of the lack of objective radiologic findings. However, in such a trauma the ligaments that stabilize the cervical spine and the skull to the spine can be injured. These injuries can seldom be seen on static radiographs but pathological motion patterns caused by the injury of these ligaments can be detected on functional kine MRI.

Methods and results: Thirty consecutive patients who had had a whiplash trauma and were clinically supposed to have a problem at the level of C0–C2 were included in the study. The control group consisted of age and sex matched healthy persons. Images of four patients were missing.

The imaging was performed with Philips Gyroscan Intera 1.5 T magnet. A manual therapist performed the bending and rotation of the upper cervical spine to the patients and controls to ensure that the movements were limited to the C0–C2 levels.

The analysis was made blinded and was done by one radiologist. The movement of the dens and the signal of the alaria ligaments were analysed.

Of the 26 patients, 11presented with a normal movement of the dens, whereas 15 presented with a pathological movement. Among controls we could see a normal movement in 24 individuals and pathological in 6 individuals.

Only one patient presented with a normal signal and a normal movement, whereas 20 controls presented with a normal signal as well as normal movement.

Conclusion: Functional kine MRI is a reliable method to find ligament injuries and movement disturbances between C0 and C2.

Aims: The role of unicompartmental knee arthroplasty (UKA) in the treatment of medial knee osteoarthritis (OA) is controversial. The purpose of the study was to analyse our mid-term results of our UKAs operated in 1991–94. Method: Patient þles, the special knee arthroplasty form and radiographs were used to retrospectively analyse the results of 155 UKAs in 142 patients operated for medial knee OA. Results: The mean age of the patients was 66,4 years (39–86), and 65,5% of the patients were women. Good pain relief was reached in all cases with an average ROM of 0–121 degrees at 3 months postoperatively. The operations were complicated by superþcial wound infection in three patients (2,1%), deep vein thrombosis in one patient (0,7%), and limited ROM in one patient (0,7%). The survival rate of UKA was 91,6% at 9,4 years. A total of 13 knees were revised with a total knee prosthesis. Polyethylene wear (n=9), disease progression (n=2), aseptic loosening (n=1) and fracture (n=1) were the indications for the revision. The postoperative period was uneventful in all patients, and mean ROM was 0–108 degrees at 3 months. Conclusion: In our experience, UKA is a procedure with rapid recovery, good knee motion and patient satisfaction for the carefully selected patients in the treatment of medial knee OA. Once failed, UKA is safely revised with a routine TKA

Aims: The aims of this prospective study was to elucidate, how the high tibial opening wedge osteotomy (OW-HTO) corrected the varus angle of the lower extremity to the desired valgus angle in arthrotic knee joint, and what are the typical complications concerning this operation method. Methods: Twenty-one patients were operated on by using the operation technique (Puddu 1998) from September 1999 to August 2000. Results: The mean preoperative femoro-tibial varus-angle of the þrst 21 patients was 1.4. degrees, immediate postoperative valgus-angle was 7.1 degrees and at the latest follow-up, the valgus angle was 5.6 degrees, respectively.

In 16 of these 21 patients the healing was uneventful. Five patients sustained complications. Three patients had fracture of the opposite tibial lateral cortex peroperatively. Two of these fractures healed without complication. One of these patients needed total knee arthroplasty later on because of pseudoarthrosis and loss of OW-HTO correction angle at the osteotomy site. Two patients sustained peroperative þssural fracture up to the lateral tibial joint articulation surface. These fractures healed uneventfully. Conclusion: A group of young, active heavy patients sustaining varus gonarthro-sis are candidates for HTO. After promising results of these 21 OW-HTO operations, we have operated 34 more patients. Complication rate has dropped because of better operative experience. However, OW-HTO is a sensitive operation with itñs possible complications. In experienced hands it is reliable and good operation. Also we have to remember, that this operation allow patients to keep their own knee joint with itñs normal kinesiology.