1. In rabbit knees the effects of daily injections of saline, Varidase, blood, blood and Varidase simultaneously, and blood alternating with Varidase every third day have been compared. 2. Saline alone produces changes in joint cartilage comparable with a slight damage to the gel structure of the intercellular matrix. 3. The other four experiments resulted in changes in the articular cartilage comparable with the effects of a partial chemical degradation of the polysaccharide of the intercellular matrix. 4. Blood also induced hypertrophy of the synovial tissues. After the end of the injections healing of the cartilage was slower than with saline or with Varidase. 5. When blood and Varidase were given together the immediate effects were additive, but there was a considerable delay in healing

1. The hypothesis is advanced that the fundamental lesion of epiphysiolysis is a slow posterior growth migration of the head on the neck. 2. It is suggested that this is unrelated to the erect posture or to any abnormality of the growth cartilage. 3. Sitting stresses are measured and are postulated as the likely cause of the growth deviation. 4. The result of the deviation is an increase in the shear stress component; in the erect posture clinical epiphysiolysis is regarded as a simple fracture occurring in a proportion of deviated cases when the increased shear component exceeds the critical level appropriate to the individual. 5. It is suggested that this hypothesis explains the age and sex incidence, the left predominance, the reduced epiphysial angle found on the uninvolved hip and the clinical and radiological evolution of the disorder

1. Frostbite in a child may be severe enough to destroy the cartilage cells of the epiphysial plate of a digit, and produce clinical deformity. 2. Both the direct effect of the freezing itself and the vascular changes secondary to such frostbite appear to cause necrosis of the growing epiphysis with destruction of the epiphysis and disappearance of the epiphysial line or plate. The disappearance of the epiphysial plate is obvious, but whether the epiphysis itself is actually destroyed and disappears or simply fuses with the metaphysis is a question now being studied. 3. It is suggested that the deformities may be helped by interphalangeal fusion of severely involved joints in the position of function, and phalanges that become angled into varus or valgus may be improved by open wedge osteotomy or epiphysiodesis of the side of the epiphysis still functioning

We obtained medial and lateral subchondral cancellous bone specimens from ten human postmortem proximal tibiae with early osteoarthritis (OA) and ten normal age- and gender-matched proximal tibiae. The specimens were scanned by micro-CT and the three-dimensional microstructural properties were quantified. Medial OA cancellous bone was significantly thicker and markedly plate-like, but lower in mechanical properties than normal bone. Similar microstructural changes were also observed for the lateral specimens from OA bone, although there had been no sign of cartilage damage. The increased trabecular thickness and density, but relatively decreased connectivity suggest a mechanism of bone remodelling in early OA as a process of filling trabecular cavities. This process leads to a progressive change of trabeculae from rod-like to plate-like, the opposite to that of normal ageing. The decreased mechanical properties of subchondral cancellous bone in OA, which are due to deterioration in architecture and density, indicate poor bone quality

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.

In order to study the effect of pure torsional forces upon the rotational development of the growing tibia, 35 immature rabbits underwent torsional loading of one tibia in vivo with a spring-loaded cylinder while the other tibia was a control. The radiographic results showed rotation occurring only at the epiphysial plate. Histologically this was assocaited with angulation of the hypertrophic cartilage columns occurring as little as 24 hours after loading which with longer periods of loading produced angled primary and secondary trabeculae. Radiographic and histological analyses of the diaphysis using tetracycline labelling and Spalteholtz injection techniques failed to show any evidence of cortical remodelling or reorientation of the cortical vessels of a rotational nature, suggesting that rotational modelling occurs solely at the epiphysial plate

Aims

The modified Dunn procedure has the potential to restore the anatomy in hips with severe slipped capital femoral epiphyses (SCFE). However, there is a risk of developing avascular necrosis of the femoral head (AVN). In this paper, we report on clinical outcome, radiological outcome, AVN rate and complications, and the cumulative survivorship at long-term follow-up in patients undergoing the modified Dunn procedure for severe SCFE.

In two cases of partial closure of an epiphysial plate causing angular deformity, one of a finger and one of the lower end of a femur, the deformities were corrected by growth after resection of a small peripheral bone bridge and its replacement with a free transplant of fat. This procedure has a firm basis on experimental work. Thus, when part of a growth plate in the rabbit is destroyed but the formation of a bone bridge uniting epiphysis and metaphysis is prevented, the destroyed part is replaced by regeneration of cartilage from the adjacent parts of the plate. Moreover, it has been proved in rabbits that when a bone bridge is induced and later resected and replaced with fat, recurrence of the bridge can be prevented and subsequent growth may correct the deformity

1. Degenerative arthritis has been produced consistently in adult rabbits by the injection of the proteolytic plant enzyme papain into the hip joint. Arthritic changes were recognisable radiographically after six weeks. 2. A progression of changes occurred, from loss of acid mucopolysaccharide staining in the matrix, fibrillation, fissuring and erosion of articular cartilage with death of chondrocytes in the weight-bearing areas, to secondary bony changes of subchondral sclerosis, occasional cysts and osteophyte formation. 3. Synovial inflammation occurred with accumulation of cartilage and bone debris in the inferior capsule and later capsular thickening. 4. It is suggested that this arthritis is sufficiently similar to human osteoarthritis to be useful as a model for further studies of the pathogenesis of the disease and the effects of different methods of treatment

1. The epiphyses of the metatarsal heads of 250-gramme rabbits were separated at the zone of cell columns, stripped of perichondrium, labelled with tritiated thymidine and transplanted into the back muscles of the same animals. 2. Endochondral ossification started in the grafts at four days, was well established by seven days and progressed until fourteen days, the end of the study. 3. Progressive passage of the label down the zone of cell columns and into the hypertrophic zone was observed. 4. The tritiated-. 3. H thymidine label had disappeared from the cartilage cells by ten days. No labelling was observed in the bone cells at any stage. 5. It was not possible to demonstrate from the experiment that growth plate chondrocytes are precursors of osteoblasts in the process of endochondral ossification in rabbits

1. The routes by which adult human articular cartilage can receive its nutrition is still a subject of controversy. 2. Microscopic examination of normal adult human femoral heads has revealed vascular channels which penetrate the subchondral plate and calcified cartilage. These channels bring the medullary soft tissue into contact with the articular cartilage. 3. A fluorescent dye migration technique was used to show that the observed vascular channels are pathways for dye from the medullary cavity to the articular cartilage. It is suggested that these pathways could also be routes by which articular cartilage receives part of its nutrition. 4. The nutritional mechanism in the mature rabbit and adult human femoral heads cannot be compared because histological studies revealed differences in their subchondral structures

In this work the role of the blood vessels surrounding the epiphysial growth plate has been studied. The nutritional dependence of the proliferative cells on the epiphysial vessels has been established whereas the metaphysial vessels were seen to take part in calcification and ossification at the metaphysis. As it does not seem likely that the blood circulating in the two systems of vessels had a different constitution, particularly in hormones and vitamins, it seems permissible to assume that it is the characteristics, particularly in shape and number, of such vessels that make growth the orderly process it is, with the repeated birth of a cell at the top of a column and burial at the bottom end. But, despite this undeniable role of the vessels, growth depends on the ability of the cartilage cell to form a matrix which, in due course, will be avid for apatite crystals

1. Severe osteolathyrism has been induced in chicks of different ages by a diet containing 50 per cent seeds of Lathyrus odoratus. 2. In these chicks, most of which became paraplegic after seven days, a meningeal tumour, articular and bony deformities, spontaneous fractures and osteoporosis have been observed. 3. In cartilage the lesion involves depletion of both neutral and acidic polysaccharides. 4. The primary effect on bone consists of changes in the osteoblasts and in the osteocytes involving cytoplasmic granulation and vacuolation, "mineralisation" and eventual disintegration of the cells. 5. These events are followed by osteoporosis. abnormal mineral deposits in the marrow spaces and reactive callus-like activation of the periosteum. 6. The role of the osteoblast and of the osteocyte in mineral transit and deposition is reconsidered

1. The influence of various methods of preserving bone on the calcifying mechanism of the tibial epiphysial cartilage of rachitic rats was studied. An in vitro calcification technique was employed. 2. Preservation by deep freezing, aqueous merthiolate, boiling, or acetone inactivated the calcifying mechanism. 3. The inactivation was reversed with calcium ions, most readily in the deep-frozen bones, less readily in the merthiolate treated bones, still less readily in the acetone stored bones, and least in boiled bones. 4. Exposure to calcium ions before preservation in the deep-freeze chest prevented inactivation. 5. The inactivation, reactivation and survival of the calcifying mechanism were confirmed by metachromasia studies. 6. The theory of the mode of action of calcium chloride on reactivation and survival of the calcifying mechanism is presented

Rat patellae were preincubated with culture medium M199 for one hour and then with either fresh culture medium or Ringer's solution, Ringer lactate, Ringer glucose, normal saline or Betadine for another hour. The rate of proteoglycan synthesis in the articular cartilage was then measured by uptake of 35SO4 for the next 16 hours. Cartilage metabolism was inhibited by all of the solutions even after a recovery time of 16 hours. The inhibition was by 5% for Ringer's solution, 10% for Ringer glucose (p < 0.01), 20% for saline and Ringer lactate (p < 0.001) and 55% for Betadine (p < 0.001). Ringer's solution is therefore the best choice for joint irrigation during arthroscopy or other procedures

We describe the histology of a specimen taken from an amputated leg seven months after a 15 cm bone gap in the tibia had been closed by bone transport. Lengthening appeared to have occurred by repeated minor trauma to the bone, with the fractured trabeculae in sufficiently close contact for the repair process to proceed. Osteogenesis did not occur through a cartilage phase, but the fracture gaps were bridged by collagen fibres, around which new bone formed. Microfractures had repaired by primary healing with woven bone and with no microcallus. Small regions of bone were necrotic. Resorption of the necrotic bone and remodelling of the immature bundle and woven bone were still at an early stage, suggesting that complete remodelling in man may take years rather than months

During the 11-year-period from 1970 to 1980, 799 total hip arthroplasties with metal-on-plastic prostheses were performed for primary osteoarthritis. In all cases high viscosity cement was used, but not under pressure; acetabular cartilage was removed, but the femoral canal was not plugged. The rate of revision and risk factors were evaluated by survivorship analysis. The overall cumulative revision rates were 11%, 14% and 19% after 8, 10, and 14 years respectively. When prophylactic antibiotics were not used, there was a significant risk of revision for infection. The risk of revision for mechanical loosening of both the acetabular and femoral components was significantly increased for men, younger patients, and if a snap-fit prosthesis with a 35 mm head and short wedged stem was used. The survivorship findings were validated by multivariate statistical analysis

From an anatomical study and clinical review of fractures of the lateral humeral condyle in children, the following conclusions are drawn. The mechanism of injury is a violent varus force with the elbow in extension, the condyle being avulsed. by the lateral ligament and the extensor muscles. If the fracture is incomplete, with an intact hinge of pre-osseous cartilage medially, the fragment will not be displaced. If the fracture is complete the fragment may be displaced, and open reduction with internal fixation is mandatory. The results of open reduction more than three weeks after the fracture are no better than those of no treatment at all, and may kill the lateral condylar fragment by damaging its blood supply. The major problem of a neglected fracture is tardy ulnar nerve palsy; to avoid this, immediate anterior transposition of the nerve is recommended, operation for the fracture itself being of no benefit