Short to long term outcomes of 154 cemented total hip arthroplasties in ankylosing spondylitis.

BACKGROUND: Long-term outcome of Total Hip arthroplasty (THA) in Ankylosing Spondylitis (AS) remains unreported. Literature suggests a higher overall failure rate in ankylosing spondylitis as compared to osteoarthritis. Concern has been expressed regarding joint survival, given that recipients are generally young. The results of cemented THA in patients with ankylosing spondylitis were studied to determine the utility of THA for these patients. METHODS: Consecutive series of 96 patients (77 males (80%) and 19 females (20%)) with ankylosing spondylitis who underwent 154 cemented THAs at a tertiary referral orthopaedic centre between January 1990-September 2015 were retrospectively analyzed for clinical and radiological outcomes; 58 patients (60.4%) underwent bilateral surgery. RESULTS: Mean age at surgery was 48 years. Average follow up was 12.8 (2.1-24.8) years. 95% of the patients had a good or excellent post-operative outcome.Out of the total 154 hips operated on, 11% (17 hips) developed post-operative complications. Overall, 15 hips (9.7%) required a revision of the procedure, with the most common indication being aseptic loosening of the acetabulum. Average time to revision was 8.5 years (2-15). Survivorship analysis revealed probability of survival of both components at the end of 10 years, with revision due to any reason as the end point to be 92% (with 95% confidence intervals).21 hips (14%) developed heterotopic ossification post-operatively, of which 4 patients (2%) had clinically significant ossification (Brooker III or IV). CONCLUSION: This is one of the largest series of patients with ankylosing spondylitis with long term follow up available. Cemented THA in patients with ankylosing spondylitis provided consistently good and predictable long term results, with low rate of complications and revisions.

Assessment of MRI as a Modality for Evaluation of Soft Tissue Injuries of the Spine as Compared to Intraoperative Assessment.

INTRODUCTION: Traumatic injuries of the spine and spinal cord are potentially devastating as they may lead to significant neurological damage as the clinical and prognostic spectrum of the effects of spinal injuries is vast. Timely imaging studies can help mitigate these possibly life threatening complications. There is a dearth of studies that directly compare MR imaging findings to surgical findings. AIM: Hence, this study was undertaken to assess the sensitivity of MRI in identifying injuries to the soft tissue structures of the spine. MATERIALS AND METHODS: MRI scans were performed on 31 cases of acute spinal injuries that presented within 72 hours of the trauma and underwent surgical fixation by either an anterior or posterior approach. The non-osseous structures namely; Anterior Longitudinal Ligament (ALL), Posterior Longitudinal Ligament (PLL), Intervertebral Disc, Ligamentum Flavum, Interspinous Ligament (ISP) and the Spinal Cord were evaluated. They were classified as 'True Positive' if an injury was found to correlate with intraoperative findings and as 'False Negative' when diagnosed falsely as normal. The statistical sensitivity of MRI in diagnosing injuries to the non-osseous structures of the spine were thus calculated. RESULTS: Of the 31 patients, in 51.6% of patients the site of injury was to the cervical spine (n=16), thoracic spine was the next highest in occurrence of 39% (n=12) and lumbar spine accounted for the least. In correlating the imaging findings to the intraoperative findings, MRI was highly sensitive in detecting injuries to the Posterior Longitudinal Ligament (94.4%) and the Spinal cord (93%) and fairly high in detecting injuries to the Intervertebral disc. However coming to the ligamentum flavum and interspinous ligaments, the sensitivity of the MRI dropped to 62.5% and 63.6% respectively. CONCLUSION: MRI was found to be highly sensitive in detecting injuries to the spinal cord and the posterior longitudinal ligament and moderately sensitive for detection of disc injuries. Though concerning the Anterior Longitudinal Ligament, Ligamentum Flavum and the Interspinous Ligaments MRI performed ineffectively with higher number of false negative interpretations.

Bizarre Parosteal Osteochondromatous Proliferation causing angular deformities: A Case Report.

INTRODUCTION: There have been fewer than 150 cases of Bizarre Parosteal Osteochondromatous proliferation (Nora Lesions) reported in the literature to date and no significant reports on angular deformities caused by this lesion. Nora's lesion can easily be misdiagnosed as osteochondroma or chondrosarcoma and therefore inappropriately managed. Although this condition classically appears in the second or third decade, we present to you a three year old boy who presented with multiple bony swellings over the hand and feet that caused an angular deformity of the involved digits. In the case report we have detailed the angular deformities and its treatment outcome. CASE REPORT: A three year old boy presented with valgus deformity of middle finger of right upper limb with an associated ulnar bony swelling at the level of middle phalanx which was noticed two years before and was progressing rapidly since last three months. On physical examination the swellings were found to be bony hard, midly tender and found to have been causing an angulare deformity of the digits. The initial suspicion was of osteochondromatous lesion however the excision biopsy showed the lesion to be of the rare entity of bizarre parosteal osteochondromatous proliferation. 1 year follow up showed no progression of angular deformity of the operated digits. CONCLUSION: Bizarre osteochondromatous proliferation is an entity that can rarely present in children which needs to be identified and tackled early to prevent the onset of deformities. Almost all cases warrant surgical intervention and the type of excision varies with the type of lesion.