1. The venographic findings in clinical primary osteoarthritis are described. 2. Experimental venous engorgement, of the knee joint and of healing fibular fractures, results in accelerated bone formation and disturbed cartilage formation. 3. Changes in pH, ppCO. 2. , and PPO. 2. are indicated as the chemical means by which chondrogenesis and osteogenesis can be altered. 4. It is suggested that chronic venous stress in joints is a causal factor in primary osteoarthritis

This systematic review examines the current literature regarding surgical techniques for restoring articular cartilage in the hip, from the older microfracture techniques involving perforation to the subchondral bone, to adaptations of this technique using nanofractures and scaffolds. This review discusses the autologous and allograft transfer systems and the autologous matrix-induced chondrogenesis (AMIC) technique, as well as a summary of the previously discussed techniques, which could become common practice for restoring articular cartilage, thus reducing the need for total hip arthroplasty. Using the British Medical Journal Grading of Recommendations, Assessment, Development and Evaluation (BMJ GRADE) system and Grade system. Comparison of the studies discussed shows that microfracture has the greatest quantity and quality of research, whereas the newer AMIC technique requires more research, but shows promise.

Cite this article: W. E. Hotham, A. Malviya. A systematic review of surgical methods to restore articular cartilage in the hip. Bone Joint Res 2018;7:336–342. DOI: 10.1302/2046-3758.75.BJR-2017-0331.

The management of radial head fractures complicated by ligamentous disruption remains a matter of controversy. The use of a silicone radial head implant to provide temporary stability is thought to help to protect the ligaments during healing. The reported complications of long-term implantation of a silicone replacement include fracture, dislocation, synovitis, lymphadenitis and subchondral resorption. We now report one case in which an inflammatory process resulted in generalised cartilage degeneration. This has not previously been noted

1. Osteotomy for osteoarthritis of the hip induces a fibrin layer over the exposed bone which forms the basis of a fibrocellular protective mantle that can differentiate towards cartilage. 2. The process is accompanied by bone remodelling, which reduces sclerosis, resolves osteolytic foci and, in company with bone formation in the fibrous mantle, restores the subchondral plate. 3. Many important aspects of the pathogenesis of osteoarthritis and of its partial repair by osteotomy remain to be elucidated

Objectives

The aim of this study was to review the current evidence and future application for the role of diagnostic and therapeutic ultrasound in fracture management.

1. Five elderly patients who suffered acute synovitis of one or both knee joints are reported. 2. All showed radiological evidence in several joints of cartilage calcification. 3. It is suggested that the synovitis in each case was due to calcium irritation of the synovial membrane. 4. In three of the patients it is shown that the synovial fluid calcium content was raised during the acute attack. 5. In all patients acute symptoms were relieved by aspiration of the effusion

1. Sixteen patients with articular cartilage erosions after slight injury have been described, as have the results of their treatment. 2. The clinical features of this rarely diagnosed condition are discussed. Attention is drawn to "articular crepitus" and "synovial crepitus" as useful physical signs in establishing the diagnosis. 3. A radiographic sign of localised subarticular osteoporosis is reported and discussed. 4. The surgical treatment used was either shaving of the affected area of cartilage or a combination of shaving with drilling of the subchondral bone plate

1. Epiphysial tilt commonly precedes slipping. 2. This tilt is due to a diminished or arrested growth from compression of the back of the epiphysial plate. 3. The stresses on the upper end of the femur are such that the upper femoral epiphysial plate is peculiarly liable to compression. 4. A primary abnormality of the cartilage of the epiphysial plate renders it susceptible to the effect of compression. 5. Because this abnormality is diffuse, deformities due to a similar pathology may be found elsewhere, notably in the spine

We describe six knees in five patients, referred to us after accidental irrigation with chlorhexidine 1% in aqueous solution during arthroscopy. All six knees developed persisting pain, swelling and crepitus with loss of range of movement. Radiographs showed loss of joint space in all three compartments due to extensive chondrolysis, with many loose bodies and synovitis. Histological examination showed partial necrosis of the cartilage, with slight non-specific inflammation and fibrosis of synovial specimens. Care is needed in checking irrigation fluids, and these should have a distinctive colour

CT scans of 18 hips with typical congenital dislocation have been studied in 16 children. These show that the common position of dislocation is lateral, superior and slightly anterior, and that a "false acetabulum" can be distinguished even in young children. A defect in the posterior ischium causing distortion of the acetabulum was also present in most cases. The cartilage and the acetabular contents were well shown. Positions of reduction and the anteversion of the acetabulum and the femoral neck were studied. Hypotheses are presented on the mode of dislocation and on the cause of the pathological changes

We applied joint distraction using an Ilizarov apparatus in 11 patients with post-traumatic osteoarthritis of the ankle to try to delay the need for an arthrodesis. Distraction for three months resulted in clinical improvement in pain and mobility for a mean of two years, with an increase in the joint space. We considered that these effects may be produced by the absence of mechanical stress on the cartilage combined with the intra-articular hydrostatic pressures during distraction. We measured these pressures during walking with distraction, and found levels very similar to those reported to improve osteoarthritic cartilage when applied in vitro

Specimens of tissue from haemophilic synovium and articular cartilage were collected from 39 patients during reconstructive surgery. They were studied by histochemistry, electron microscopy and microprobe analysis. The detailed findings are presented and discussed. It is suggested that haemophilic arthropathy is the result of a number of mechanisms affecting the synovial lining which becomes progressively fibrotic and the hyaline cartilage which disintegrates and is eventually lost. Mechanical and chemical processes cause degeneration of cells but enzymatic processes appear to be primarily responsible for the degradation of the matrix of the articular cartilage

1. The importance of recognising osteochondral fractures of the femoral condyle in the adolescent knee joint is emphasised. 2. The mechanism of the formation of the fractures is discussed. Essentially, a powerful rotary and compressive force shears off cartilage and subchondral bone. The absence of lateral condylar lesions in the experimental group lends support to the theory that the patella may cause the fracture by impingement. 3. On the basis of the mechanism a clinical classification of osteochondral fractures of the femoral condyles is presented. 4. Early surgery is recommended. The arguments for removal or replacement of the fragment are discussed

1. All articulating cartilages are fibrocartilages. 2. The articular cartilages of the synovial joints are largely composed of collagen fibres. 3. These fibres form a dense network, the fibres of which run obliquely between the articular surface and the bone. 4. This network is operative when the parts are at rest and in contact under pressure. It takes the tensile component of the resultant shear stress, and is a postural mechanism of the joint. 5. The articular cartilage is most heavily chondrified at its centre, between the juxta-synovial and juxta-osseous parts. 6. The technique for demonstrating the fibrous structure is described

We studied the most superficial layer of macroscopically normal articular cartilage obtained from human femoral heads, using polarising microscopy and SEM. The most superficial layer, 4 to 8 microns thick, was acellular consisting of collagen fibrils. This layer could be peeled away as a thin film, with no broken collagen fibrils on its inferior surface or on the surface of subjacent cartilage layers. The orientation and diameter of collagen fibrils were different on these two surfaces. Our findings suggest that the most superficial layer is an independent one which is only loosely connected to the fibrous structure in the layer deep to it

1. Clinical studies in humans have indicated that a delay of one to three weeks in the open reduction of a fracture decreases the incidence of delayed union and non-union. 2. Studies in cats indicate that a delay of two weeks before open reduction causes a different repair mechanism from that following immediate operation. 3. Repair after delayed operation is characterised by increased periosteal new bone formation and more rapid endochondral bone formation. After immediate operation periosteal new bone is slow to develop; much more fibrous tissue and cartilage develop, followed by slow endochondral bone formation

1. Periosteal bone is supplied by periosteal vessels and endochondral bone by the nutrient artery. 2. In the earliest stages of development the metaphysis is supplied by vessels derived only from the nutrient artery. Later, metaphysial arteries derived from the periosteum take over the supply of its peripheral part, the extent of their area of supply progressively increasing. 3. In injected specimens the blood vessels approaching the epiphysial cartilaginous plate end in saccular dilations. Histological sections show these dilations to be blood-filled cartilage lacunae, with no endothelial lining and into which open the blood vessels approaching the epiphysial plate

1. The bone changes in four autopsied cases of Cushing's syndrome are described. The changes take the form of osteoporosis, which is most marked in the spine and the ribs. 2. The osteoporosis results from impaired osteoblastic bone formation in the presence of a normal degree of osteoclastic bone resorption. 3. Histological abnormalities of fracture callus in Cushing's syndrome indicate interference with the proliferation of osteoblasts and cartilage cells and with the formation of new tissue by these cells. 4. The bone changes in Cushing's syndrome are comparable with those produced in experimental animals by the administration of A.C.T.H. or cortisone