Aims

We compared the accuracy, operating time and radiation exposure of the introduction of iliosacral screws using O-arm/Stealth Navigation and standard fluoroscopy.

We investigated a new intramedullary locking nail that allows the distal interlocking screws to be locked to the nail. We compared fixation using this new implant with fixation using either a conventional nail or a locking plate in a laboratory simulation of an osteoporotic fracture of the distal femur. A total of 15 human cadaver femora were used to simulate an AO 33-A3 fracture pattern. Paired specimens compared fixation using either a locking or non-locking retrograde nail, and using either a locking retrograde nail or a locking plate. The constructs underwent cyclical loading to simulate single-leg stance up to 125 000 cycles. Axial and torsional stiffness and displacement, cycles to failure and modes of failure were recorded for each specimen. When compared with locking plate constructs, locking nail constructs had significantly longer mean fatigue life (75 800 cycles (sd 33 900) vs 12 800 cycles (sd 6100); p = 0.007) and mean axial stiffness (220 N/mm (sd 80) vs 70 N/mm (sd 18); p = 0.005), but lower mean torsional stiffness (2.5 Nm/° (sd 0.9) vs 5.1 Nm/° (sd 1.5); p = 0.008). In addition, in the nail group the mode of failure was either cut-out of the distal screws or breakage of nails, and in the locking plate group breakage of the plate was always the mode of failure. Locking nail constructs had significantly longer mean fatigue life than non-locking nail constructs (78 900 cycles (sd 25 600) vs 52 400 cycles (sd 22 500); p = 0.04).

The new locking retrograde femoral nail showed better stiffness and fatigue life than locking plates, and superior fatigue life to non-locking nails, which may be advantageous in elderly patients.

Cite this article: Bone Joint J 2014;96-B:114–21.

The Salter innominate osteotomy has been used successfully for many years in the treatment of developmental dysplasia of the hip. One of its main drawbacks is the need for internal fixation with pins and their subsequent removal. We describe a modification of this osteotomy that does not require pin fixation and secondary removal. We retrospectively reviewed 114 hips in 94 patients who had been operated on by a single surgeon. An oblique rather than the original horizontal osteotomy was used without internal fixation. There were 80 female and 14 male patients. The mean age at operation was 25 months (18 to 84) and the mean follow-up was 30 months (12 to 88). Most patients required additional open reduction and capsuloplasty. The mean pre-operative acetabular index was 37.9° (24° to 54°), which decreased to 19.9° (7° to 29°) in the immediate post-operative period, and improved to 14.6° (5° to 25°) at the final follow-up (student’s t-test, p < 0.0001).

We believe that by changing the direction of the osteotomy line, it is possible to avoid pin fixation. The radiological outcomes are comparable to those of the original technique, but longer follow-up will be necessary.

Purpose: Total knee arthroplasty (TKA) is safe and effective in patients with advanced hemophilic arthropathy. This procedure is extremely successful in pain relief and improving functional status, however the limited restoration in motion due to preexisting soft tissue contractures, remains a concern. The purpose of this study is to report the results of TKA in patients with hemophilia using posterior cruciate ligament (PCL) sacrificing prostheses.

Materials and Methods: The records of 18 consequtive hemophilic arthropathy patients who underwent total knee arthroplasty at our institution between 1998 and 2003 were retrospectively reviewed. The patients were evaluated by International Knee Society (IKS) Scoring system with specific attention to range of motion parameters and functional status at preoperative and postoperative clinical evaluation. Postoperative radiologic evaluation was based on the knee Society roent-genographic evaluation and scoring system.

Results: The average age at operation was 34 years (range, 18–60) with an average follow-up of 51 months (range, 12–74). TKA resulted in an improvement in functional and knee scores, and range of motion parameters (p< 0,01). However, the functional status of the patients improved better than the knee status (p < 0,01). No signs of radiographic loosening were seen in any of the components at the final follow-up evaluation. There were two early hemarthrosis which required open lavage. Four patients had late complications. One patient had a periprosthetic fracture, which was treated with open reduction and internal fixation. Another patient had tibial tubercle avulsion and conservative treatment was choosen. One patient had revision secondary to progression of flexion contracture due to repetitive intraarticular hemorrhage, at the third year (26th month). One patient had deep infection.

Conclusions: Our results demonstrate the excellent results in terms of functional scores and to a lesser extent in knee scores. Evaluation of the subcategories of the knee score demonstrated the limited restoration of motion as the reason for lower success rate in knee scores. Although PCL sacrificing designs allow better motion restoration, futher techniques should be developed to release the extraarticular structures that contribute to the flexion contracture, such as hamstring release.

Purpose: Recurrent hemarthrosis is a common clinical entity in hemophiliacs. They not only interfere with daily life but also trigger hemophilic arthropathy. Synovial hypertrophy has a pivot role in hemarthrosis related joint damage and ablation of the synovium prevents further deterioration. Current treatment strategy is to ablate synovium in the early stages in order to prevent progression of the arthropathy. We report a series of hemophilia patients with advanced arthropathy who had been treated with radionuclide synoviorthesis.

Materials and Methods: The patients who had been treated with radionuclide synoviorthesis for either knee or elbow disease between 2002 and 2004 were included in this study. The inclusion criteria were having > 1 hemarthrosis episode per month in the index joint, chronic synovial hypertrophy, advanced degenerative changes of grade III and IV as defined by Arnold-Hilgartner Classification, F8 inhibitor level < 3. The frequency of hemarthrosis, range of motion of the affected joint, pain level that was evaluated by visual analog scale, was recorded during each follow-up. 90Y was used for the synoviorthesis of the knee, whereas 186Re was used for the elbow cases. Patients were screened for radionuclide leak by using a gamma camera following the injection.

Results: Twenty radionuclide synoviorthesis were performed in 14 knees. The average age was 20 (range, 10–31) with an average follow-up of 17 months (range, 3–29). There were 12 severe hemophilia A and 2 severe hemophilia B patients. The frequency of intaarticular bleeding episodes was significantly reduced at the final follow-up (p< 0,05). Although the range of motion and the pain scores were improved, the change was not statistically significant (p> 0,05). Six patients required repeated treatment because of inadequate response. No radioactive material leakage were detected at the draining lymph nodes.

Conclusions: Our results demonstrate that radionuclide synoviorthesis significantly reduces the number of the bleeding episodes even in the knees presenting with advanced arthritis, and increases the quality of life. Although most patients respond to single injection, some patients may require more than one injection, to achieve a satisfactory clinical outcome.