Aims

The aim of this study was to evaluate the diagnostic accuracy of the synovial alpha-defensin enzyme-linked immunosorbent assay (ELISA) for the diagnosis of prosthetic joint infection (PJI) in the work-up prior to revision of total hip (THA) and knee arthroplasty (TKA).

A case of pencil-gore granuloma occurring 45 years after the initial injury is described. The clinical and radiological presentation was suggestive of a soft-tissue sarcoma. The diagnosis was confirmed by biopsy, which also revealed foreign body fragments which, on spectometric analysis, had high concentrations of carbon and aluminium

A 35-year-old man was seen with pain in the back of the knee. MRI showed a mass in the anterior cruciate ligament. Biopsy indicated mucoid degeneration. Arthroscopic resection of the ligament was carried out, with relief of symptoms

Aims

Femoroacetabular impingement (FAI) is a potential cause of hip osteoarthritis (OA). The purpose of this study was to investigate the expression profile of matrix metalloproteinases (MMPs) in the labral tissue with FAI pathology.

A case of benign chondroblastoma in the upper end of the humerus is described. A plea is made that radiotherapy should be avoided in the treatment of this tumour. It is suggested that biopsy should be performed in every case

A case of salmonella osteomyelitis of the spine complicated by meningitis after needle biopsy is described. The importance of obtaining definitive bacteriological diagnosis in bone infection is emphasised and the changing pattern of salmonella infection discussed

Schistosomiasis is a common parasitic infestation in Egypt. We describe the case of a 24-year-old Egyptian man who presented with the signs of acute septic arthritis of the hip and in whom biopsy subsequently revealed schistosome ova in the synovium

1. Five cases of calcified enchondroma are described. In all except one the condition was symptomless and was discovered accidentally. 2. The radiographic features are described and the differential diagnosis is discussed. 3. It is emphasised that when the diagnosis is in doubt biopsy should be undertaken

The problems of diagnosis and treatment of osteoclastoma are considered. The importance of full investigation, and the advantages of drill biopsy in confirming the diagnosis, are discussed. Treatment by radiation is believed to be better than treatment by surgical measures. Curettage and excision are unnecessary. Amputation for benign osteoclastoma is unjustifiable

In a series of over 1000 elderly patients with femoral neck fracture, who were routinely screened by iliac crest bone biopsy, a 2% prevalence of osteomalacia was found. This low figure suggests that osteomalacia is not a significant predisposing factor in the development of these fractures and that routine screening is not cost-effective

Two patients presented with pain in the arm and a radiographic lesion of the upper humerus which warranted surgical exploration and excision biopsy. In both cases the pathology was inflammatory and involved the insertion of pectoralis major. Tendinitis of the pectoralis major with an associated lesion of the humerus has not previously been described

1. A case of polyarteritis nodosa is reported, the presenting manifestation of which was subperiosteal new bone formation in both legs. 2. The effect of cortisone on the symptoms is recorded. 3. The histology is reported after biopsy of bone and adjacent tissue. 4. Skeletal involvement in polyarteritis nodosa is believed to be hitherto unrecorded

A 65-year-old man presented with a painful hip five years after a cemented replacement. Histological examination of a biopsy taken from tissue surrounding the femoral implant showed infiltration of a squamous-cell carcinoma. Further investigation revealed a primary growth in the left lung. This rare example of a metastasis in relation to a joint replacement illustrates the necessity for histological examination of the tissue adjacent to a loose prosthesis

A patient with polyostotic fibrous dysplasia had several fractures of the right lower limb. An above-knee amputation was eventually performed, followed by arthrodesis of the hip. Five years later the stump became painful and swelled with dramatic rapidity. Biopsy showed that this was not due to malignant change, but that an aneurysmal bone cyst had developed in association with the fibrous dysplasia

Chondromas may arise from the ribs but seldom grow to giant size. In a series of twenty-one cases, four giant tumours were encountered. Three were treated by excision without leaving a significant defect of the chest wall or impairment of respiration; the fourth was examined by biopsy. No evidence of malignant change was discovered in these four large tumours

1. Recently described histological and radiographic methods of diagnosing osteoporosis have been applied to patients with transcervical and intertrochanteric fractures of the femur. 2. Both methods indicate a higher incidence of osteoporosis in such patients than in a control series, especially in older women with intertrochanteric fractures. 3. A discrepancy between the results of biopsy and radiographic examination was encountered, the explanation of which is not yet clear

1. Twenty-five cases of benign giant-cell tumour of bone, treated at Westminster Hospital, London, are reported. 2. The diagnosis can often be made on clinical and radiographic grounds alone but biopsy is sometimes necessary and seldom, if ever, contra-indicated. 3. Some cases may best be treated by excision, but in general irradiation is the treatment of choice. 4. Details of treatment by irradiation are given

We present a case of Mycobacterium avium-intracellulare (MAI) infection of the ankle joint in a patient with HIV infection. The patient presented with a painful, destructive arthropathy of the ankle. Initial microbiological studies were negative but infection with MAI was later identified from biopsies taken during hindfoot fusion. Antibiotic triple therapy was given and the patient remains pain-free without evidence of active infection. To our knowledge, this is the first case of MAI infection of the ankle reported in the literature. A high index of suspicion of (atypical) Mycobacterial infection should be maintained in patients with HIV infection presenting with an indolent but destructive arthropathy of the ankle joint

1. Three cases of cystic angiomatosis of bone are presented and the literature is reviewed. 2. The typical radiological appearances are described and illustrated. 3. The diagnosis must be confirmed by biopsy, and it is essential that the bone removed should be from an involved rib. 4. The prognosis is dependent upon extraskeletal visceral involvement and is not influenced by radiotherapy or chemotherapy. Splenectomy may improve the chance of survival when the spleen is the only viscus involved