A longitudinal study of MARS MRI scanning of soft-tissue lesions around metal-on-metal total hip arthroplasties and disease progression.

We investigated the changes seen on serial metal artefact reduction magnetic resonance imaging scans (MARS-MRI) of metal-on-metal total hip arthroplasties (MoM THAs). In total 155 THAs, in 35 male and 100 female patients (mean age 70.4 years, 42 to 91), underwent at least two MRI scans at a mean interval of 14.6 months (2.6 to 57.1), at a mean of 48.2 months (3.5 to 93.3) after primary hip surgery. Scans were graded using a modification of the Oxford classification. Progression of disease was defined as an increase in grade or a minimum 10% increase in fluid lesion volume at second scan. A total of 16 hips (30%) initially classified as 'normal' developed an abnormality on the second scan. Of those with 'isolated trochanteric fluid' 9 (47%) underwent disease progression, as did 7 (58%) of 'effusions'. A total of 54 (77%) of hips initially classified as showing adverse reactions to metal debris (ARMD) progressed, with higher rates of progression in higher grades. Disease progression was associated with high blood cobalt levels or an irregular pseudocapsule lining at the initial scan. There was no association with changes in functional scores. Adverse reactions to metal debris in MoM THAs may not be as benign as previous reports have suggested. Close radiological follow-up is recommended, particularly in high-risk groups.

A simple guide to determine the magnification of radiographs and to improve the accuracy of preoperative templating.

Templates are used in the preoperative planning of many orthopaedic procedures. The magnification of the bones on preoperative radiographs can vary despite using standardised radiological techniques. Templates will give misleading measurements unless this magnification is quantified. A coin may be used to calculate the magnification, with significant improvement in the accuracy of templating (p = 0.05). A group of patients undergoing uncemented arthroplasty of the hip was at high risk for intraoperative fracture of the femur because the magnification of the radiograph was larger than that of the template.

[Labrum lesions from the viewpoint of arthroscopic hip surgery]. / Die Labrumläsion aus der Sicht eines arthroskopischen Hüftchirurgen.

The torn acetabular labrum is a classical indication for hip arthroscopy. Clinical and imaging diagnosis are not so reliable compared to hip arthroscopy, which also allows therapeutic intervention. Advances in the technique of arthroscopic examination of the hip joint enable an accurate diagnosis of a torn acetabular labrum as well as arthroscopic resection of such pathology. During 267 consecutive hip arthroscopies, 37 labral lesions (13.9%) could be identified and were resected successfully. The morphological classification of labral tears, and their frequency was allocated to radial flap tears (57%), fibrillated radial tears (22%), longitudinal peripheral tears (16%) and unstable labra (5%). One year after surgery, 78% of the patients were improved, whereas 5 were not improved and 3 had worsened. Larger series with longer follow-up should be reported enabling scientific assessment of the procedure. At this early stage, however, we would recommend that all patients with a suspected labral tear should undergo hip arthroscopy.

A simple laser guide to reduce the screening time during the insertion of dynamic hip screws.

A simple laser pointer can be used to guide the radiographer to position the image intensifier during the insertion of a dynamic hip screw in the treatment of fractures of the trochanteric area of the proximal femur. This significantly reduces the screening time and, by implication, the amount of radiation for the theatre staff and patient.

The torn acetabular labrum - a hip arthroscopist's view.

The torn acetabular labrum is a classical indication for hip arthroscopy. Clinical and imaging diagnosis are not so reliable compared to hip arthroscopy, which also allows therapeutic intervention. Advances in the technique of arthroscopic examination of the hip joint enable an accurate diagnosis of a torn acetabular labrum as well as arthroscopic resection of such pathology. During 267 consecutive hip arthroscopies, 37 labral lesions (13,9 %) could be identified and were resected successfully. The morphological classification of labral tears, and their frequency was allocated to radial flap tears (57 %), fibrillated radial tears (22 %), longitudinal peripheral tears (16 %) and unstable labra (5 %). One year after surgery, 78 % of the patients were improved, whereas 5 were not improved and 3 had worsened. Larger series with longer follow-up should be reported enabling scientific assessment of the procedure. At this early stage, however, we would recommend that all patients with a suspected labral tear should undergo hip arthroscopy.

Extrusion of Teflon aortic pledgets from a sternal wound six years after cardiac surgery.

We present a case of a cardiac surgery patient with a persistent low-grade discharge from his sternal wound for over six years. It finally healed when some suture material and Teflon felt pledgets were extruded. These had been used intraoperatively to close the aortic cannulation site. The extrusion of prosthetic material from this site after this length of time has never been described.

Staphylococcus aureus meningitis--a rare complication of iliacus muscle abscess.

Staphylococcus aureus meningitis is a rare but well recognized condition which had a high mortality and incidence of neurological sequelae. It is usually associated with chronic underlying conditions. A case is reported of S. aureus meningitis in a previously healthy young man. The epidemiology, microbiological findings and treatment of this condition are discussed.