Removal of well-fixed, cementless, acetabular components during revision arthroplasty remains a challenging problem. Further damage to host bone may limit options for reconstruction and compromise the long-term result of the revision operation. We report the results of 31 hips with well-fixed, cementless sockets which were removed using a new cup extraction system. In all hips the socket was removed without difficulty and with minimal further bone loss.
We made a prospective study of 58 patients with suspected internal derangement of the knee. They were examined by magnetic resonance imaging using 3-D gradient echo intermediate-weighted studies before having an arthroscopy. The preoperative clinical assessment was found to have a diagnostic sensitivity of 77% and a specificity of 43%, compared with 100% and 63% respectively for magnetic resonance imaging. Comparison of magnetic resonance imaging and arthroscopy confirmed the accuracy of magnetic resonance imaging in the diagnosis of internal derangement but the results for articular cartilage lesions were much less good, with a sensitivity of only 18% but a specificity of 100%. Acceptance of the magnetic resonance imaging findings could have resulted in a 29% reduction in the number of arthroscopies without missing any significant meniscal lesion.
We cultured human osteoblasts from trabecular bone explants and confirmed their phenotype by alkaline phosphatase assay, increased cyclic adenosine monophosphate production in response to prostaglandin E2 and radiographic micro-analysis of nodules of calcification. The osteoblasts were seeded on to demineralised human bone fragments and examined at ten-day intervals over a 50-day period by scanning electron microscopy. During this time the bank bone became progressively repopulated by the cultured osteoblasts. This system may offer a means of graft enhancement in elective orthopaedic and maxillofacial surgery by delivery of cultured autologous human osteoblasts to bone defects.
One-hundred newborn children at high risk of hip instability were prospectively assessed clinically and by ultrasound. The decision to treat was based only on the clinical examination. At the age of three months all the children were evaluated clinically and with an anteroposterior radiograph of the pelvis. None of the standard ultrasound measurements of acetabular depth and femoral head cover correlated with the outcome at three months. Dynamic assessment of stability was the only ultrasound technique that had a significant relation with outcome.
An area of fibrous dysplasia of bone may undergo rapid enlargement which may be due to either cystic degeneration or malignant transformation. These complications may be clinically and radiologically indistinguishable and, unless both are borne in mind, incorrect management may follow. Magnetic resonance imaging was used in one of our cases and was the only imaging modality to demonstrate the true nature of the condition.
Ultrasound examination has been recommended for the evaluation of acute haemorrhages into soft tissues or joints in haemophilic patients. We have reviewed the notes of all such patients admitted during one calendar year and find that in 47 separate admissions the ultrasound examination assisted management decisions on 27 occasions. The technique is described with an analysis of the ways in which ultrasound observations may influence the clinician.
