We investigated the effect of calcitonin in the prevention of acute
The treatment of substantial proximal femoral
bone loss in young patients with developmental dysplasia of the
hip (DDH) is challenging. We retrospectively analysed the outcome
of 28 patients (30 hips) with DDH who underwent revision total hip
replacement (THR) in the presence of a deficient proximal femur,
which was reconstructed with an allograft prosthetic composite.
The mean follow-up was 15 years (8.5 to 25.5). The mean number of
previous THRs was three (1 to 8). The mean age at primary THR and
at the index reconstruction was 41 years (18 to 61) and 58.1 years
(32 to 72), respectively. The indication for revision included mechanical
loosening in 24 hips, infection in three and peri-prosthetic fracture
in three. Six patients required removal and replacement of the allograft
prosthetic composite, five for mechanical loosening and one for
infection. The survivorship at ten, 15 and 20 years was 93% (95%
confidence interval (CI) 91 to 100), 75.5% (95% CI 60 to 95) and
75.5% (95% CI 60 to 95), respectively, with 25, eight, and four
patients at risk, respectively. Additionally, two junctional nonunions
between the allograft and host femur required bone grafting and
plating. An allograft prosthetic composite affords a good long-term outcome
in the management of proximal femoral
We reviewed 13 patients with infected nonunion of the distal femur and
We present a retrospective study of 27 patients treated by callus distraction using a unilateral external fixator of our own design for nonunion with
We performed a retrospective analysis of the clinical and radiological outcomes of total hip replacement using an uncemented femoral component proximally coated with hydroxyapatite. Of 136 patients, 118 who had undergone 124 primary total hip replacements were available for study. Their mean age was 66.5 years (19 to 90) and the mean follow-up was 5.6 years (4.25 to 7.25). At the final follow-up the mean Harris hip score was 92 (47.7 to 100). Periprosthetic femoral fractures, which occurred in seven patients (5.6%), were treated by osteosynthesis in six and conservatively in one. We had to revise five femoral components, one because of aseptic loosening, one because of septic loosening and three because of periprosthetic fracture. At the final follow-up there were definite signs of aseptic loosening in two patients. Radiologically, proximal femoral
We evaluated changes in bone mineral density (BMD) after tibial fractures, both at the site of fracture and at adjacent sites, using dual-energy X-ray absorptiometry. Five patients were studied prospectively for six months after fractures of the midshaft treated by intramedullary nailing or the application of an external fixator. We also reviewed 21 adult and 10 children who had sustained fractures of the tibia at least five years previously, comparing BMD in the injured limb with that in the non-injured limb and in a control group of 10 normal subjects. We found a significant fall in BMD distal to a tibial fracture; this was evident at one month, fell to approximately 50% of normal at three months and persisted at six months. We found no significant improvement with weight-bearing. Review at 5 to 11 years after adult midshaft fractures showed persistent
Cancer-induced bone diseases are often associated with increased bone resorption and pathological fractures. In recent years, osteoprotective agents such as bisphosphonates have been studied extensively and have been shown to inhibit cancer-related bone resorption in experimental and clinical studies. The third-generation bisphosphonate, ibandronate (BM 21.0955), is a potent compound for controlling tumour osteolysis and hypercalcaemia in rats bearing Walker 256 carcinosarcoma. We have studied the effect of ibandronate given as an interventional treatment on bone strength and
To define the natural history of
Pelvic discontinuity with associated
We report the results in the first 16 patients treated in Sheffield using bifocal techniques for diaphyseal
Ununited fractures of the scaphoid with extensive bone resorption are usually treated by bone grafting and internal fixation, using either an open or a minimally invasive technique. We studied the feasibility of percutaneous fixation without bone grafting in a consecutive series of 27 patients with established nonunion of an undisplaced fracture of the scaphoid and extensive local resorption of bone. They were treated by a single surgeon with rigid fixation alone, using a headless cannulated screw inserted through a volar percutaneous technique. Clinical examination, standard radiographs and CT confirmed that the fracture had united in all patients at a mean of 11.6 weeks (8 to 16), and that their functional scores had improved. We concluded that extensive resorption at the fracture site is not an absolute indication for bone grafting, and that percutaneous fixation alone will eventually produce healing of ununited undisplaced fractures of the scaphoid regardless of the size of the gap.
Glenoid bone loss can be a challenging problem when revising
a shoulder arthroplasty. Precise pre-operative planning based on
plain radiographs or CT scans is essential. We have investigated
a new radiological classification system to describe the degree
of medialisation of the bony glenoid and that will indicate the
amount of bone potentially available for supporting a glenoid component.
It depends on the relationship between the most medial part of the
articular surface of the glenoid with the base of the coracoid process
and the spinoglenoid notch: it classifies the degree of bone loss
into three types. It also attempts to predict the type of glenoid reconstruction
that may be possible (impaction bone grafting, structural grafting
or simple non-augmented arthroplasty) and gives guidance about whether
a pre-operative CT scan is indicated. Inter-method reliability between plain radiographs and CT scans
was assessed retrospectively by three independent observers using
data from 39 randomly selected patients. Inter-observer reliability and test-retest reliability was tested
on the same cohort using Cohen's kappa statistics. Correlation of
the type of glenoid with the Constant score and its pain component
was analysed using the Kruskal-Wallis method on data from 128 patients.
Anatomical studies of the scapula were reviewed to explain the findings.Aims
Patients and Methods
We report our experience of the use of the Ilizarov technique to treat nine patients with severe compound tibial fractures. The mean defect in bone was 6.3 cm, and four cases were infected. All nine patients had satisfactory union and function without the use of bone grafts or antibiotics. The Ilizarov technique was very satisfactory; there were no major complications.
Femoral revision after cemented total hip replacement
(THR) might include technical difficulties, following essential cement
removal, which might lead to further loss of bone and consequently
inadequate fixation of the subsequent revision stem. Femoral impaction allografting has been widely used in revision
surgery for the acetabulum, and subsequently for the femur. In combination
with a primary cemented stem, impaction grafting allows for femoral
bone restoration through incorporation and remodelling of the impacted
morsellized bone graft by the host skeleton. Cavitary bone defects
affecting meta-physis and diaphysis leading to a wide femoral shaft,
are ideal indications for this technique. Cancellous allograft bone
chips of 1 mm to 2 mm size are used, and tapered into the canal
with rods of increasing diameters. To impact the bone chips into
the femoral canal a prosthesis dummy of the same dimensions of the definitive
cemented stem is driven into the femur to ensure that the chips
are very firmly impacted. Finally, a standard stem is cemented into
the neo-medullary canal using bone cement. To date several studies have shown favourable results with this
technique, with some excellent long-term results reported in independent
clinical centres worldwide. Cite this article:
Aims. It has been well documented in the arthroplasty literature that lumbar degenerative disc disease (DDD) contributes to abnormal spinopelvic motion. However, the relationship between the severity or pattern of hip osteoarthritis (OA) as measured on an anteroposterior (AP) pelvic view and spinopelvic biomechanics has not been well investigated. Therefore, the aim of the study is to examine the association between the severity and pattern of hip OA and spinopelvic motion. Methods. A retrospective chart review was conducted to identify patients undergoing primary total hip arthroplasty (THA). Plain AP pelvic radiographs were reviewed to document the morphological characteristic of osteoarthritic hips. Lateral spine-pelvis-hip sitting and standing plain radiographs were used to measure sacral slope (SS) and pelvic femoral angle (PFA) in each position. Lumbar disc spaces were measured to determine the presence of DDD. The difference between sitting and standing SS and PFA were calculated to quantify spinopelvic motion (ΔSS) and hip motion (ΔPFA), respectively. Univariate analysis and Pearson correlation were used to identify morphological hip characteristics associated with changes in spinopelvic motion. Results. In total, 139 patients were included. Increased spinopelvic motion was observed in patients with loss of femoral head contour, cam deformity, and acetabular
Aims. Osteoporosis can determine surgical strategy for total hip arthroplasty (THA), and perioperative fracture risk. The aims of this study were to use hip CT to measure femoral bone mineral density (BMD) using CT X-ray absorptiometry (CTXA), determine if systematic evaluation of preoperative femoral BMD with CTXA would improve identification of
Aims. The aim of this study was to examine the implant accuracy of custom-made partial pelvis replacements (PPRs) in revision total hip arthroplasty (rTHA). Custom-made implants offer an option to achieve a reconstruction in cases with severe acetabular