Objectives. The purpose of this study was to investigate whether the femoral head–neck contour, characterised by the alpha angle, varies with the stage of physeal maturation using MRI evaluation of an asymptomatic paediatric population. . Methods. Paediatric volunteers with asymptomatic hips were recruited to undergo MRI of both hips. Femoral head physes were graded from 1 (completely open) to 6 (completely fused). The femoral head–neck contour was evaluated using the alpha angle, measured at the 3:00 (anterior) and 1:30 (anterosuperior) positions and correlated with physeal grade, with gender sub-analysis performed. Results. A total of 43 asymptomatic paediatric volunteers (26 male, 17 female) with mean age 13.0 years (eight to 18) were included with review of bilateral hip MRIs. Correlation between the physeal grade and alpha angle was moderate in males at both the 3:00 (r = 0.477, p < 0.001) and 1:30 (r = 0.509, p < 0.001) positions, whereas there was no significant correlation in females. A significant difference was found between the alpha angles of all the physeal grades (3:00, p = 0.030, 1:30, p = 0.005), but only in males, with the angle increasing with higher grades. For physeal grading, the inter-reader reliability was substantial (intraclass correlation coefficient (ICC) = 0.694), and the intra-reader reliability was also substantial (ICC = 0.788). . Conclusion . The femoral head–neck contour varies and correlates with the stage of physeal development, but only in males, with the alpha angle increasing with progressive physeal maturation. This suggests that gender differences exist in the natural physiological growth, development or remodelling of femoral head–neck junction. In males, pre-physeal fusion may be a critical period of vulnerability for development of morphologic abnormalities of the femoral head–neck junction. Cite this article: Bone Joint Res 2015;4:17–22

The October 2012 Spine Roundup. 360. looks at: a Japanese questionnaire at work in Iran; curve progression in degenerative lumbar scoliosis; the cause of foot drop; the issue of avoiding the spinal cord at scoliosis surgery; ballistic injuries to the cervical spine; minimally invasive oblique lumbar interbody fusion; readmission rates after spinal surgery; clinical complications and the severely injured cervical spine; and stabilising the thoracolumbar burst fracture

Aims

To benchmark the radiation dose to patients during the course of treatment for a spinal deformity.

The effect of early fusion on growth of the spine has been studied in rabbits. Free periosteal grafts from the tibia were transplanted either posteriorly between the spinous and articular processes or postero-laterally between the articular and transverse processes. Sound bony fusion was achieved in both the thoracic and the lumbar spine. Spinal fusion caused local narrowing and wedging of the intervertebral spaces, followed by retardation of growth and wedging of the vertebrae. A progressive structural scoliosis developed after unilateral postero-lateral fusion and a lordosis developed after posterior fusion

A retrospective study is reported of 36 children and adolescents who had undergone spinal exploration and fusion for Type I of Type II spondylolisthesis of more than 10 per cent. The patients were examined and their radiographs studied. No progression of slip after operation was found even in the presence of a pseudarthrosis. Where altered mobility was present at the level above the fusion, this tended to be associated with pain. Posterolateral fusion relieved symptoms in 75 per cent, produced a sound fusion in 83 per cent and prevented further slip in all patients

Aims

The use of 3D-printed titanium implant (DT) can effectively guide bone regeneration. DT triggers a continuous host immune reaction, including macrophage type 1 polarization, that resists osseointegration. Interleukin 4 (IL4) is a specific cytokine modulating osteogenic capability that switches macrophage polarization type 1 to type 2, and this switch favours bone regeneration.

The different methods described in the literature for the reduction of severe spondylolisthesis are reviewed. The case histories of two girls with neurological deficits in their legs due to Grade IV spondylolisthesis are described. Reduction and fusion by the posterior route in a one-stage operation were performed on these patients. For this purpose special instruments have been designed to exert a controlled force on the displaced vertebra in two perpendicular directions. Technical details of the procedure are reported. In both patients intervertebral and posterolateral fusion were carried out. Fusion was successful and redisplacement did not occur. There have been only few descriptions in the literature of a technique that reduces and stabilises spondylolisthesis in one stage. However, only patients with Grade III and IV spondylolisthesis require reduction and in less severe cases fusion without reduction is sufficient

We analysed the complications encountered in 102 consecutive patients who had posterolateral lumbosacral fusion performed with transpedicular screw and rod fixation for non-traumatic disorders after a minimum of two years. Of these, 40 had spondylolysis and spondylolisthesis, 42 a degenerative disorder, 14 instability after previous laminectomy and decompression, and six pain after nonunion of previous attempts at spinal fusion without internal fixation. There were 75 multilevel and 27 single-level fusions. There were 76 individual complications in 48 patients, and none in the other 54. The complications seen were screw misplacement, coupling failure of the device, wound infection, nonunion, permanent neural injury, and loosening, bending and breakage of screws. Screw breakage or loosening was more common in patients with multilevel fusions (p < 0.001). Screws of 5 mm diameter should not be used for sacral fixation. Forty-six patients had at least one further operation for one or several complications, including 20 fusion procedures for nonunion. The high incidence of complications is a disadvantage of this technically-demanding method

It will be seen that the proportion of successful fusions in this series of ninety-five patients treated by ischio-femoral arthrodesis of the hip was over 80 per cent. Similar percentages of successful fusion have been reported by Knight (1945), Freiberg (1946), Langston (1947), and Nisbet, who was resident surgical officer at the Robert Jones and Agnes Hunt Orthopaedic Hospital, and informed me in a personal communication that he had carried out twenty-six operations with an approximate fusion rate of 80 per cent. He stated: "It is the only operation which gives a reasonable chance of a successful arthrodesis in children. Up till now at Oswestry the chances of a fusion by the other methods in children have proved so disappointing that the operation had been abandoned. Dame Agnes Hunt, with her vast experience of the condition, was always very annoyed when she found a surgeon trying to fuse a child's hip. All this has been changed."

Aims

We report the long-term outcomes of the UK Heel Fracture Trial (HeFT), a pragmatic, multicentre, two-arm, assessor-blinded, randomized controlled trial.

Aims

Due to the opioid epidemic in the USA, our service progressively decreased the number of opioid tablets prescribed at discharge after primary hip (THA) and knee (TKA) arthroplasty. The goal of this study was to analyze the effect on total morphine milligram equivalents (MMEs) prescribed and post-discharge opioid repeat prescriptions.

The February 2014 Research Roundup. 360 . looks at: blood supply to the femoral head after dislocation; diabetes and hip replacement; bone remodelling over two decades following hip replacement; sham surgery as good as arthroscopic meniscectomy; distraction in knee osteoarthritis; whether joint replacement prevent cardiac events; tranexamic acid and knee replacement haemostasis; cartilage colonisation in bipolar ankle grafts; CTs and proof of fusion; atorvastatin for muscle re-innervation after sciatic nerve transection; microfracture and short-term pain in cuff repair; promising early results from L-PRF augmented cuff repairs; and fatty degeneration in a rodent model

Aims

This study, using a surgeon-maintained database, aimed to explore the risk factors for surgery-related complications in patients undergoing primary cervical spine surgery for degenerative diseases.

We made a retrospective study of 149 children and adolescents with moderate spondylolisthesis (slip less than or equal to 30%), 77 treated by fusion and 72 conservatively at an average follow-up of 13.3 years. Both groups were fully comparable with regard to age at diagnosis, sex distribution (46% girls), and mean slip. The patients who were treated operatively had more pain before treatment and showed more initial progression of the slip. They had better clinical results and less pain at latest review, but the total progression of the slip over the whole follow-up showed no statistical differences between the two groups. Patients with a pseudarthrosis after attempted fusion had had a longer period of postoperative pain, but at the latest review had no more pain than those with sound fusion. None of those treated conservatively came to fusion later and the long-term results in 18 patients who had refused the advised operation were no worse than those for other conservatively treated patients. Our results suggest that a moderate grade of spondylolisthesis in adolescents usually has a benign course. It seems that spontaneous segmental stabilisation occurs as a result of degeneration of the disc at the level of the slip

Aims

Alternative alignment concepts, including kinematic and restricted kinematic, have been introduced to help improve clinical outcomes following total knee arthroplasty (TKA). The purpose of this study was to evaluate the clinical results, along with patient satisfaction, following TKA using the concept of restricted kinematic alignment.

From 1975 to 1990 we performed subtalar or triple arthrodesis on 54 patients; 48 of them were reviewed after a mean follow-up of 10 years (6 to 15). There were 17 subtalar fusions in 14 patients and 37 triple arthrodeses in 28 patients. We assessed tibiotalar ankle function using the criteria of Mazur which gives a points score of a maximum of 100. Radiological evidence of degenerative change was graded on a scale of 0 to 4. The mean Mazur score was 85 for the subtalar fusions and 78 for the triple arthrodeses. The radiological score showed no degenerative changes in 36 feet (24 triple and 12 subtalar arthrodeses) and an increase of one grade in 14 feet (10 triple and 4 subtalar), of two grades in three feet (all triple arthrodeses) and of three grades in one foot after a subtalar arthrodesis. We found no statistically significant difference in the radiological score in unilateral fusions between feet with subtalar and triple arthrodeses and the contralateral foot. In all four feet which showed an increase in degenerative changes of two or more grades, there was an abnormality of the tibiotalar joint before the fusion operation. Of the 14 feet which showed an increase of one grade, there was a similar increase on the contralateral side in nine. Our findings show that subtalar or triple arthrodesis has little adverse influence on the function of the tibiotalar joint, even after many years

Evaluating musculoskeletal conditions of the lower limb and understanding the pathophysiology of complex bone kinematics is challenging. Static images do not take into account the dynamic component of relative bone motion and muscle activation. Fluoroscopy and dynamic MRI have important limitations. Dynamic CT (4D-CT) is an emerging alternative that combines high spatial and temporal resolution, with an increased availability in clinical practice. 4D-CT allows simultaneous visualization of bone morphology and joint kinematics. This unique combination makes it an ideal tool to evaluate functional disorders of the musculoskeletal system. In the lower limb, 4D-CT has been used to diagnose femoroacetabular impingement, patellofemoral, ankle and subtalar joint instability, or reduced range of motion. 4D-CT has also been used to demonstrate the effect of surgery, mainly on patellar instability. 4D-CT will need further research and validation before it can be widely used in clinical practice. We believe, however, it is here to stay, and will become a reference in the diagnosis of lower limb conditions and the evaluation of treatment options.

Cite this article: Bone Joint J 2021;103-B(5):822–827.