Aims.
Osteonecrosis of femoral head is well known and recognised complication in
Salmonella osteomyelitis occurs infrequently in children without a
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.
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,
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
INTRODUCTION. Total hip arthroplasty (THA) is not commonly performed in young patients. However, markedly advanced hip disease can cause disabling end-stage arthritis, and THA may be the only available option for pain relief and restoration of function. We report our experience with modern alternative bearing THA in patients younger than 21 years. METHODS. Twenty-one consecutive primary THAs were performed in 18 patients. Pre- and post-operative Harris Hip Scores (HHS) and any postoperative complications were recorded. Radiographs were reviewed for evidence of premature component loosening. Mean patient age at operation was 18 years (range, 13-20). There were 14 females (78%) and 4 males (22%). Nine patients (50%) were Caucasian, 8 (44%) were African-American, and 1 (6%) was Asian. Average follow-up was 45 months (range, 16-85). All patients failed conservative treatment; 15 patients had prior core decompression and bone grafting. Underlying etiology was chemotherapy induced osteonecrosis (7, 33%), steroid induced osteonecrosis (6, 29%),
As the peak of the COVID-19 pandemic passes, the challenge shifts to safe resumption of routine medical services, including elective orthopaedic surgery. Protocols including pre-operative self-isolation, COVID-19 testing, and surgery at a non-COVID-19 site have been developed to minimize risk of transmission. Despite this, it is likely that many patients will want to delay surgery for fear of contracting COVID-19. The aim of this study is to identify the number of patients who still want to proceed with planned elective orthopaedic surgery in this current environment. This is a prospective, single surgeon study of 102 patients who were on the waiting list for an elective hip or knee procedure during the COVID-19 pandemic. Baseline characteristics including age, ASA grade, COVID-19 risk, procedure type, surgical priority, and admission type were recorded. The primary outcome was patient consent to continue with planned surgical care after resumption of elective orthopaedic services. Subgroup analysis was also performed to determine if any specific patient factors influenced the decision to proceed with surgery.Aims
Methods
The Precice intramedullary limb-lengthening system has demonstrated significant benefits over external fixation lengthening methods, leading to a paradigm shift in limb lengthening. This study compares outcomes following antegrade and retrograde femoral lengthening in both adolescent and adult patients. A retrospective review of prospectively collected data was undertaken of a consecutive series of 107 femoral lengthening operations in 92 patients. In total, 73 antegrade nails and 34 retrograde nails were inserted. Outcome was assessed by the regenerate healing index (HI), hip and knee range of movement (ROM), and the presence of any complications.Aims
Patients and Methods