Osteonecrosis of the knee comprises two separate disorders, primary spontaneous osteonecrosis which is often a self-limiting condition and secondary osteonecrosis which is associated with risk factors and a poor prognosis. In a series of 61 knees (38 patients) we analysed secondary osteonecrosis of the knee treated by a new technique using multiple small percutaneous 3 mm drillings. Total knee replacement was avoided in 59 knees (97%) at a mean follow-up of 3 years (2 to 4). Of the 61 knees, 56 (92%) had a successful clinical outcome, defined as a Knee Society score greater than 80 points. The procedure was successful in all 24 knees with small lesions compared with 32 of 37 knees (86%) with large lesions. All the procedures were performed as day cases and there were no complications. This technique appears to have a low morbidity, relieves symptoms and delays more invasive surgery

Aims. Primary (or spontaneous) and secondary osteonecrosis of the knee can lead to severe joint degeneration, for which either total or unicompartmental arthroplasty may be considered. However, there are limited studies analyzing outcomes of unicompartmental knee arthroplasties (UKAs) for osteonecrosis involving an isolated compartment of the knee. The aims of this study were to analyze outcomes of UKAs for osteonecrosis with specific focus on 1) survivorship free of any revision or reoperation, 2) risk factors for failure, 3) clinical outcomes, and 4) complications. Patients and Methods. A total of 45 patients underwent 46 UKAs for knee osteonecrosis between 2002 and 2014 at our institution (The Mayo Clinic, Rochester, Minnesota). Twenty patients (44%) were female; the mean age of the patients was 66 years, and mean body mass index (BMI) was 31 kg/m. 2. Of the 46 UKAs, 44 (96%) were medial UKAs, and 35 (76%) were fixed-bearing design. Mean mechanical axis postoperatively was 1.5° varus (0° to 5° varus); 41 UKAs (89%) were performed for primary osteonecrosis. Mean follow-up was five years (2 to 12). Results. Survivorship free of any revision in the cohort was 89% (95% CI 77 to 99) and 76% (95% CI 53 to 99) at five and ten years, respectively. In patients undergoing UKA for primary osteonecrosis survivorship free of any revision was 93% (95% CI 83 to 100)at both five and ten years. Secondary osteonecrosis was a significant risk factor for poorer survivorship free of any revision or reoperation (hazard ratio 7.7, p = 0.03). Three medial UKAs (6.5%) were converted to total knee arthroplasties (TKAs): two for lateral compartment degeneration and one for development of lateral osteonecrosis. No implants were revised for loosening, fracture, or wear. Knee Society scores improved from a mean of 60 (44 to 72) preoperatively to a mean of 94 postoperatively (82 to 100) (p < 0.001). There were no surgical complications. Conclusion. When done for primary osteonecrosis of the knee, UKA resulted in reliable clinical improvement, minimal complications, and durable estimated implant survivorship free of revision at ten years. UKA done for secondary osteonecrosis was substantially less durable at mid-term follow-up. Progression of knee degeneration, rather than implant failure or loosening, was most common indication for conversion to TKA. Cite this article: Bone Joint J 2018;100-B:450–4

Aims. This retrospective cohort study compared the results of vascularised and non-vascularised anterior sliding tibial grafts for the treatment of osteoarthritis (OA)of the ankle secondary to osteonecrosis of the talus. . Patients and Methods. We reviewed the clinical and radiological outcomes of 27 patients who underwent arthrodesis with either vascularised or non-vascularised (conventional) grafts, comparing the outcomes (clinical scores, proportion with successful union and time to union) between the two groups. The clinical outcome was assessed using the Mazur and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores. The mean follow-up was 35 months (24 to 68). Results. The mean outcome scores increased significantly in both groups. In the vascularised graft group, the mean Mazur score improved from 36.9 to 74.6 and the mean AOFAS scale improved from 49.6 to 80.1. . In the conventional arthrodesis group, the mean Mazur score improved from 35.5 to 65 and the mean AOFAS scale from 49.2 to 67.6. . Complete fusion was achieved in 13 patients (76%) in the vascularised group, but only four (40%) in the conventional group. The clinical outcomes and proportion achieving union were significantly better in the vascularised group compared with the conventional arthrodesis group, although time to union was similar in the two groups. Take home message: Vascularised sliding tibial grafts may be used to achieve arthrodesis in patients with OA of the ankle secondary to osteonecrosis of the talus. Cite this article: Bone Joint J 2016;98-B:359–64

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 sickle cell disease. The pooled analysis showed an improvement of pre-operative knee score from 50.47 to 89.21 post-operatively. The pooled effect size for failure rate was 8.7% in joint preserving interventions and 9.2% in joint replacement group. Conclusion. Joint preserving techniques with bone marrow aspirate infiltration showed promising functional outcome and to a certain extent reversal of the pathological process. For advanced stages with subchondral collapse cemented arthroplasty showed satisfactory functional outcomes

Aims. Knee osteonecrosis in advanced stages may lead to joint degeneration. Total knee arthroplasty (TKA) for osteonecrosis has traditionally been associated with suboptimal results. We analyzed outcomes of contemporary TKAs for osteonecrosis, with particular emphasis on: survivorship free from aseptic loosening, any revision, and any reoperation plus the clinical outcomes, complications, and radiological results. Patients and Methods. In total, 156 patients undergoing 167 primary TKAs performed for osteonecrosis between 2004 and 2014 at a single institution were reviewed. The mean age at index TKA was 61 years (14 to 93) and the mean body mass index (BMI) was 30 kg/m. 2. (18 to 51) The mean follow-up was six years (2 to 12). A total of 110 TKAs (66%) were performed for primary osteonecrosis and 57 TKAs (34%) for secondary osteonecrosis. Overall, 15 TKAs (9%) had tibial stems, while 12 TKAs (7%) had femoral stems. Posterior-stabilized designs were used in 147 TKAs (88%) of TKAs. Bivariate Cox regression analysis was conducted to identify risk factors for revision and reoperation. Results. Survivorship free from aseptic loosening, any revision, and any reoperation at ten years was 97% (95% confidence interval (CI) 93 to 100), 93% (95% CI 85 to 100), and 82% (95% CI 69 to 93), respectively. No factors, including age, sex, BMI, primary versus secondary osteonecrosis, stem utilization, and constraint, were identified as risk factors for reoperation. Four TKAs (2%) underwent revision, most commonly for tibial aseptic loosening (n = 2). Excluding revisions and reoperations, there was a total of 11 complications (7%), with the most common being a manipulation under anaesthesia (six TKAs, 4%). Mean Knee Society Scores (Knee component) significantly improved from 57 (32 to 87) preoperatively to 91 (49 to 100) postoperatively (p < 0.001). No unrevised TKAs had complete radiolucent lines or radiological evidence of loosening. Conclusion. Contemporary cemented TKAs with selective stem utilization for osteonecrosis resulted in durable survivorship, a low complication rate, and reliable improvement in clinical outcomes. Cite this article: Bone Joint J 2019;101-B:1356–1361

Introduction. Osteonecrosis of the knee encompasses three conditions; spontaneous osteonecrosis of the knee, secondary osteonecrosis (ON) and post-arthroscopic ON. Early stage lesions can be managed by non-operative measures that include protected weight-bearing and analgesia. The aim of this study was to report the experience of the authors in managing early stages of knee ON by analysing the functional outcome and need for surgical intervention. Methods. All patients treated for osteonecrosis of the knee between 1st August 2001 and 1st April 2014 were prospectively collected. Treatment consisted of touch-down weight bearing for four to six weeks. The cases were retrospectively reviewed. MR imaging was evaluated for the stage of disease according to Koshino's Classification system, the condyles involved and the time taken for resolution. Tegner Activity Scale, VAS pain, Lysholm, WOMAC and IKDC scores were recorded at presentation and final follow up. Results. 51 cases were treated for knee ON at our centre; 40 cases of SONK, seven secondary ON and four post-arthroscopic ON. Of the seven cases of secondary osteonecrosis; 5 were secondary to self-reported high ethanol intake and two secondary to corticosteroid treatment. The mean age of the group was 56.9 years and 68.7% were male. The medial femoral condyle was the most commonly affected (54.9%). 86% reported resolution of clinical symptoms and a statistically significant improvement was reported in all functional outcome measures. Four patients required total knee arthroplasty; three in the post-arthroscopic group within 15 months and one following ON secondary to corticosteroids performed at 5 months. Conclusion. Early stage spontaneous osteonecrosis of the knee can be managed successfully without surgery if diagnosed early. Although secondary and post-arthroscopic ON seem to be more resistant. Larger studies are required to confirm or refute this. Level of Evidence. IV – a case series. Conflict of Interests. The authors confirm that they have no relevant financial disclosures or conflicts of interest. Ethical approval was not sought as this was a systematic review

Purpose: We hypothesized that thrombophilia-hypofibrinolysis are risk factors for femoral head osteonecrosis. Separately, we hypothesized that when Enoxaparin is started at Ficat stages I or II in patients with idiopathic osteonecrosis and thrombophilia-hypofibrinolysis, progression of osteonecrosis can be stopped. Method: We compared measures of thrombophilia and hypofibrinolysis in 71 adults with idiopathic osteonecrosis, in 62 with corticosteroid-associated secondary osteonecrosis, and in gender-race matched healthy controls. In a prospective Enoxaparin treatment study, 16 patients (25 hips)with one or more thrombophilic-hypofibrinolytic disorders and Ficat Stages I–II idiopathic ON of the hip(s). Enoxaparin (60 mg/day) was given for the first 12 weeks of the study. Yearly X-rays were taken for 5–7 years follow-up (average 6 years). Maintenance of Ficat Stages I-II versus progression to Stages III–IV or total hip replacement was the study outcome. Results: Patients with idiopathic osteonecrosis were more likely than controls to have high (> 150%) levels of heritable thrombophilic Factor VIII (19/71 [27%] vs 3/66 [5%], p =.0004), and to have inherited high levels of hypofibrinolytic lipoprotein(a) (25/69 [36%] vs 12/67 [18%], p =.016). Patients with secondary osteonecrosis were more likely than controls to have high (> 150%) levels of Factor VIII (16/62 [26%] vs 5/60 [8%], p =.011), to be heterozygous for the Factor V Leiden mutation (6/61 [10%] vs 0/61 [0%], p =.028), and to have heritable thrombophilic resistance to activated protein C (8/51[16%] vs 2/59[3%], p =.042). After 3 months on Enoxaparin, based on intent to treat, 17 of 25 hips (68%) have remained Ficat Stages I–II at 6-year follow-up versus approximately 20% 2-year hip survival in untreated historical controls. This suggests that the original 12 week Enoxaparin thromboprophylaxis produced lasting benefit. Conclusion: Inherited thrombophilia-hypofibrinolysis are risk factors for both idiopathic and secondary osteonecrosis of the head of the femur. The importance of the diagnosis of thrombophilia-hypofibrinolysis lies in the potential to stop the progression of osteonecrosis when Enoxaparin is started at Ficat stages I–II. Enoxaparin seemingly prevents progression of idiopathic hip ON, causing a decrease in the incidence of total hip replacement at 6 years follow-up

Background. Secondary osteonecrosis of the knee (SOK) generally occurs in relatively young patients in their working years; at advanced stages of SOK, the only viable surgical option is total knee arthroplasty (TKA). We conducted a retrospective study to investigate implant survivorship, clinical and radiographic outcomes, and complications of cemented TKA with/without patellar resurfacing for SOK. Methods. Thirty-eight cemented TKAs in 27 patients with non-traumatic SOK with a mean age 43 years (range 17–65) were retrospectively reviewed. Twenty-one patients (78%) were female. Mean body mass index was 31 kg/m. 2. (range 20–48); 11 patients (41%) received bilateral TKAs. Twenty patients (74%) had a history of corticosteroid use and 18% had a history of alcohol abuse. Patellar osteonecrosis was coincidentally found in six knees (16%), all of which had no anterior knee pain and had no patellofemoral joint collapse. The mean follow-up was 7 years (range 2–12). Knee Society Score (KSS) and radiographic outcomes were evaluated at 6 weeks, 1 year, then every 2–3 years thereafter. Results. Ninety-two percent had implant survivorship free from revision with significant improvement in KSS. Causes of revision included aseptic tibial loosening (one), deep infection (one), and instability with patellofemoral issues (one). Four of six cases also with patellar osteonecrosis received resurfacing, including one with a periprosthetic patellar fracture after minor trauma, with satisfactory clinical results after conservative treatment. None of the unrevised knees had progressive radiolucent lines or evidence of loosening. Non-resurfacing of the patella, use of a stem extension or a varus-valgus constrained prosthesis constituted 18%, 8% and 3% of knees, respectively. Conclusion. Cemented TKAs with selective stem extension in patients with SOK had satisfactory implant survivorship and reliable outcomes at a mean of 7 years. Patellar resurfacing is unnecessary in younger patients with no symptoms of anterior knee pain and no patellar collapse radiographically. For any figures or tables, please contact the authors directly

The purpose of our study was to identify possible risk factors of patients with GCT of the long bones after curettage and packing the bone cavity with bone cement or bone allografts. We retrospectively reviewed the records of 249 patients with GCT of the limbs treated at Musculoskeletal Oncology Department of our institution between 1990 and 2013, confirmed histologically and recorded in the Bone Tumor Registry. We reviewed 219 cases located in the lower limb and 30 of the upper limb. This series includes 135 females and 114 males, with mean age 32 years (ranging 5 to 80 yrs). According to Campanacci's grading system, 190 cases were stage 2, 48 cases stage 3, and 11 cases stage 1. Treatment was curettage (intralesional surgery). Local adjuvants, such as phenol and cement, were used in 185 cases; whereas in the remaining 64 cases the residual cavity was filled with allografts or autografts only. Oncological outcome shows 203 patients alive and continuously disease-free (CDF), 41 patients NED1 after treatment of local recurrence (LR), 2 patients NED1 after treatment of lung metastases, 2 AWD with lung metastases. One patient died of unrelated causes (DOD). LR rate was 15.3% (38 pts). Lung metastases rate was 1.6% (4 pts). In patients treated by curettage and cement (185 cases) LR was 12% (22 pts). Conversely, in patients treated curettage and bone allografts it was higher (16/64 cases), with an incidence of 25% of cases (p=0.004). Oncological complications seemed to be related with site, more frequently occurring in the proximal femur (p=0.037). LR occurred only in stage 2 or 3 tumors without statistical significance (p>0.05). The mean interval between the first surgical treatment and LR was 22 months (range: 3–89 mos). However, in the multivariate analysis no significant statistical effect on local recurrence rate could be identified for gender, patient's age, Campanacci's grading, or cement vs allografts. The only independent risk factor related to the local recurrence was the site, with a statistical significance higher risk for patients with GCT of the proximal femur (p= 0.008). Our observation on the correlation of tumor location and risk of local recurrence is new. Therefore, special attention must be given to GCTs in the proximal femur. In fact, primary benign bone tumors in the proximal femur are difficult to treat due to the risk of secondary osteonecrosis of the femoral head or pathologic fracture. Numerous methods of reconstructions have been reported. Among these, total hip arthroplasty (THA) or bipolar hip arthroplasty (BHA) should be avoided when possible as more cases are observed in young patients. Therefore, we do not suggest different approach for the proximal femur. GCT in the proximal femur is much more difficult to treat than in other sites, but if curettage is feasible, the best way is to save the joint with a higher risk of local recurrence, knowing that the sacrifice of the hip articulation in case of recurrence is always possible with THA or BHA

INTRODUCTION. The literature suggests a survivorship of unicompartmental knee arthroplasties (UKA) for spontaneous osteonecrosisof the knee range from 93% to 96.7% at 10 to 12 years. However, these data arise from series reporting 23 to 33 patients, jeopardizing meaningful conclusions. OBJECTIVES. Our purpose is to examine a long term survivorship of UKA's in a larger group of patients with SPONK, along with their subjective, symptomatic and functional outcome; to determine the percentage of failures and the reasons for the same in an attempt to identify relevant indications, contraindications, and technical parameters in treating SPONK with a modern implant design. METHODS. We retrospectively evaluated 84 patients with late-stage spontaneous osteonecrosis of the knee who had a medial UKA from 1998 to 2005. All patients had preoperative MRI to confirm the diagnosis, exclude metaphyseal involvemente, and confirm the absence of major degenerative changes in the lateral and patellofermoal compartment. Mean age at surgery was 66 years and mean body mass index was 28.9. A Kaplan-Meier survival analysis was conducted using revision for any reason as the end point. The minimum followup of 63 months (mean, 98 months; range, 63–145 months). RESULTS. The 10-year survivorship was 92%. Ten revisons were performed and the most common reasons for revision were subsidence of the tibial component (four) and aseptic loosening of the tibial component (three). No patient underwent revision for osteoarthritis progression in the lateral or patellofemoral compartment. There was a statistically significant difference between postoperative VAS, KSS, WOMAC, Oxford, Range of Motion and Tibial Slope (overcorrected by 3.7 degrees, p< 0.0023) between the survivors and the failures. CONCLUSION. SPONK may be an optimal indication for UKA provided secondary osteonecrosis of the knee is ruled out; pre-operative MRI is performed to document involvement of other compartments, status of the ligaments and depth of lesion; and there is no over-correction in any plane

Purpose: Spontaneous osteonecrosis of the knee is a potentially greatly debilitating condition. While success has been reported with non-operative treatment of this disorder in its earliest stages, knee arthroplasty is the only viable modality if allowed to progress to condylar collapse. The purpose of this report is to review the etiologic and pathophysiologic principles of spontaneous osteonecrosis of the knee, to present our experience with joint-preserving surgical treatment of this condition, and finally to introduce a treatment algorithm developed based on this knowledge. Method: Seventeen patients with a clinical and/or radiographic a diagnosis of spontaneous osteonecrosis of the knee, and exclusion of secondary osteonecrosis, who failed non-operative modalities were treated with joint-preserving surgery at a single center between January 2000 and December 2006. Treatment modalities included arthroscopy, and either percutaneous core decompression and/or osteochondral autograft transfer. Three knees were lost to follow-up, leaving 14 knees with a mean follow-up of 37 months (range, 11 to 84 months). Results: Twelve of 14 knees (86%) had knee joint survival with a mean Knee Society Score of 80 points (range, 45 to 100 points) at final follow-up. One patient was treated with serial core decompression followed by osteochondral transfer, and was included in both groups. Six of 7 patients (86%) treated with core decompression alone had a successful clinical outcome, as did 7 of 8 patients (87%) treated with osteochondral autograft transfers. Two patients (14%) progressed to condylar collapse, and were treated with total knee arthroplasty with successful results. Conclusion: Based on these results, we propose a treatment algorithm that begins with non-operative treatment, followed by joint-preserving surgery consisting of arthroscopy, core decompression, and/or osteochondral autograft transfer. Although our sample size is small, the results suggest that this proposed treatment algorithm can successfully postpone the need for knee arthroplasty in selected patients with pre-collapse spontaneous osteonecrosis of the knee

The mean age of patients with osteonecrosis reported in series in our literature is 38 to 53. Thus, performing a total hip replacement on a patient who would need a procedure to last 40–45 years is a concern. Patients with osteonecrosis of the hip require some type of surgical treatment. Without treatment, a large majority of femoral heads in patients even with Ficat stage I osteonecrosis will collapse or become symptomatic. A common scenario is a patient who first presents to the orthopaedic surgeon with severe arthritis secondary to osteonecrosis in one hip and a normal appearing radiograph on the asymptomatic contralateral side. Performing a total hip on the severe arthritic hip is usually not debated. A MRI will commonly show Ficat stage I osteonecrosis on the asymptomatic contralateral hip. Some method of core decompression is a reasonable choice if it is non-steroid induced, small more medially positioned lesion, but not for other Ficat stage 1 lesions or those with more advanced stages. The problem is convincing the patient to have anything done when they are asymptomatic. Because results with total hip replacement for patients with osteonecrosis of the hip have significantly improved, most patients with a symptomatic hip prefer arthroplasty as treatment. Arthroplasty has become the predominant surgical treatment for osteonecrosis of the hip in the United States. 88% of procedures performed on 6,400 patients with osteonecrosis in 2008 reported in the Nationwide Inpatient Sample Database of the hip were total hip replacements. From 16 years earlier, the number of procedures performed had almost doubled and the percentage use of arthroplasty as the performed treatment had increased by 13%. I expect both numbers will continue to increase

Aims

Treatment of chronic osteomyelitis (COM) for young patients remains a challenge. Large bone deficiencies secondary to COM can be treated using induced membrane technique (IMT). However, it is unclear which type of bone graft is optimal. The goal of the study was to determine the clinical effectiveness of bone marrow concentrator modified allograft (BMCA) versus bone marrow aspirate mixed allograft (BMAA) for children with COM of long bones.

The mean age of patients with osteonecrosis reported in series in our literature is 38 to 53. Thus, performing a total hip replacement on a patient who would need a procedure to last 40–45 years is a concern. Patients with osteonecrosis of the hip require some type of surgical treatment. Without treatment, a large majority of femoral heads in patients even with Ficat stage I osteonecrosis will collapse or become symptomatic. A common scenario is a patient who first presents to the orthopaedic surgeon with severe arthritis secondary to osteonecrosis in one hip and a normal appearing radiograph on the asymptomatic contralateral side. Performing a total hip on the severe arthritic hip is usually not debated. A MRI will commonly show Ficat stage I osteonecrosis on the asymptomatic contralateral hip. Some method of core decompression is a reasonable choice if it is non-steroid induced, small more medially positioned lesion, but not for other Ficat stage 1 lesions or those with more advanced stages. The problem is convincing the patient to have anything done when they are asymptomatic. Because results with total hip replacement for patients with osteonecrosis of the hip have significantly improved, most patients with a symptomatic hip prefer arthroplasty as treatment. Arthroplasty has become the predominant surgical treatment for osteonecrosis of the hip in the United States. Eighty-eight percent of procedures performed on 6,400 patients with osteonecrosis in 2008 reported in the Nationwide Inpatient Sample Database of the hip were total hip replacements. From 16 years earlier, the number of procedures performed had almost doubled and the percentage use of arthroplasty as the performed treatment had increased by 13%. I expect both numbers will continue to increase

In fifty-two knees with spontaneous osteonecrosis the diagnosis was based on a subchondral transradiancy in the weight-bearing surface of the medial femoral condyle. Strontium-85 scintimetry showed a unique pattern, indicating a lively repair reaction by localised high values. Thirteen of fifteen knees followed between two and twenty-three years developed osteoarthritis. The prognosis was based on the size of the transradiancy and the focality of the lesion as determined by scintimetry. It is suggested that scintimetry permits differentiation between primary osteoarthritis and arthritis secondary to osteonecrosis

Introduction:. A surgical hip dislocation provides circumferential access to the femoral head and is essential in the treatment pediatric and adult hip disease. Iatrogenic injury to the femoral head blood supply during a surgical may result in the osteonecrosis of the femoral head. In order to reduce vessel injury and incidence of AVN, the Greater Trochanteric Osteotomy (GTO) was developed and popularized by Ganz. The downside of this approach is the increased morbidity associated with the GTO including non-union in 8% and painful hardware requiring removal in 20% of patients. (reference) Recent studies performed at our institution have mapped the extra-osseous course of the medial femoral circumflex artery and provide surgical guidelines for a vessel preserving posterolateral approach. In this cadaveric model using Gadolinium enhanced MRI, we investigate whether standardized alterations in the postero-lateral surgical approach may reliably preserve femoral head vascularity during a posterior surgical hip dislocation. Methods:. In 8 cadaveric specimens the senior author (ES) performed a surgical hip dislocation through the posterolateral approach with surgical modifications designed to protect the superior and inferior retinacular arteries. In every specimen the same surgical alterations were made using a ruler: the Quadratus Femoris myotomy occurred 2.5 cm off its trochanteric insertion, the piriformis tenotomy occurred at its insertion and extended obliquely leaving a 2 cm cuff of conjoin tendon (inferior gemellus), and the Obturator Externus (OE) was myotomized 2 cm off its trochanteric insertion. (Figure 1) For the capsulotomy, the incision started on the posterior femoral neck directly beneath the cut obturator externus tendon and extending posteriorly to the acetabulum. Superior and inferior extensions of the capsulotomy ran parallel to the acetabular rim creating a T-shaped capsulotomy. After the surgical dislocation was complete, the medial femoral circumflex artery (MFCA) was cannulated and Gadolinium-enhanced MRI performed in order to assess intra-osseous femoral head perfusion and compared to the gadolinium femoral head perfusion of the contra-lateral hip as a non-operative control. Gross-dissection after polyurethane latex injection in the cannulated MFCA was performed to validate MRI findings and to assess for vessel integrity after the surgical dislocation. Results:. In 8 cadaveric specimens MRI quantification of femoral head perfusion was 94.3% and femoral head-neck junction perfusion was 93.5% compared to the non-operative control. (Figure 2) Gross dissection after latex injection into the MFCA demonstrated intact superior and inferior retinacular arteries in all 8 specimens. (Figure 3). Discussion and Conclusions:. In this study, perfusion to the femoral head and head-neck junction is preserved following posterior surgical dislocation through the postero-lateral approach. These preliminary findings suggest that specific surgical modifications can protect and reliably maintain vascularity to the femoral head after surgical hip dislocation. This approach may benefit hip resurfacing and potentially decease risk of femoral neck fracture secondary to osteonecrosis. In addition this may allow a vascular preserving surgical hip dislocation to be performed without the need for a GTO

Objectives

The primary objective of this study was to compare accuracy in restoring the native centre of hip rotation in patients undergoing conventional manual total hip arthroplasty (THA) versus robotic-arm assisted THA. Secondary objectives were to determine differences between these treatment techniques for THA in achieving the planned combined offset, component inclination, component version, and leg-length correction.

Aims

The aim of this study was to report the outcome of femoral condylar fresh osteochondral allografts (FOCA) with concomitant realignment osteotomy with a focus on graft survivorship, complications, reoperation, and function.

Partial knee arthroplasty (PKA), either medial or lateral unicompartmental knee artroplasty (UKA) or patellofemoral arthroplasty (PFA) are a good option in suitable patients and have the advantages of reduced operative trauma, preservation of both cruciate ligaments and bone stock, and restoration of normal kinematics within the knee joint. However, questions remain concerning long-term survival. The goal of this review article was to present the long-term results of medial and lateral UKA, PFA and combined compartmental arthroplasty for multicompartmental disease. Medium- and long-term studies suggest reasonable outcomes at ten years with survival greater than 95% in UKA performed for medial osteoarthritis or osteonecrosis, and similarly for lateral UKA, particularly when fixed-bearing implants are used. Disappointing long-term outcomes have been observed with the first generation of patellofemoral implants, as well as early Bi-Uni (ie, combined medial and lateral UKA) or Bicompartmental (combined UKA and PFA) implants due to design and fixation issues. Promising short- and med-term results with the newer generations of PFAs and bicompartmental arthroplasties will require long-term confirmation.

Cite this article: Bone Joint J 2015;97-B(10 Suppl A):9–15.