Degenerative changes in the ligamentum teres of the hip: cadaveric study with magnetic resonance arthrography, anatomical inspection, and histologic examination.

OBJECTIVE: Review and classify the pathologic abnormalities of the ligamentum teres in degenerative hip joints. MATERIAL AND METHODS: Eleven cadaveric hip joints were examined with magnetic resonance arthrography and were then sectioned. The appearance of the ligamentum teres and its attachment seen by inspection of the anatomical sections was correlated with findings seen at magnetic resonance imaging. Histologic evaluation was done. RESULTS: Magnetic resonance arthrographic and histologic findings showed a spectrum of ligamentum teres degeneration. The thickest ligamentum teres revealed mucoid and fibromatous degeneration with microscopic tear. Ligamentum teres with intermediate thickness revealed fatty replacement with and without fibromatous degeneration, fibromatous degeneration with and without mucoid degeneration, and eosinophilic change. The thinnest ligamentum teres was near-complete disruption of the ligament. CONCLUSIONS: The ligamentum teres revealed degenerative changes that were similar histologically to degenerative changes in tendons. Magnetic resonance arthrography provided a sensitive technique for demonstration of the ligamentum teres and various patterns of degeneration.

Changes in the acetabular fossa of the hip: MR arthrographic findings correlated with anatomic and histologic analysis using cadaveric specimens.

OBJECTIVE: The objective of our study was to determine the morphologic and histologic pattern of tissue changes in the acetabular fossa and evaluate its association with osteoarthritis of the hip joint. MATERIALS AND METHODS: Eleven cadaveric hip joints derived from elderly persons were examined using MR arthrography. All 11 joints were then sectioned. The pattern of acetabular fossa changes determined during inspection of the anatomic and histologic sections in all cadaveric specimens was correlated with MR arthrographic findings. We classified acetabular fossa changes into three stages. Imaging findings of osteoarthritis were reviewed to assess for an association between acetabular cartilage changes and acetabular fossa changes. RESULTS: MR arthrographic findings of changes in the acetabular fossae included low signal intensity related to multiple thin or thick fibrous strands in the acetabular fat and a decrease in the amount of peripheral fatty tissue. Histologic findings revealed fat necrosis, fibrous strands, a decrease in the amount of fat, fibrocartilaginous metaplasia of fat, and chondroid metaplasia at the bony surface of the acetabular fossa. There was a statistically significant correlation between the advanced stage (stage IV) of acetabular cartilage degeneration and the advanced stage (stage 3) of acetabular fossa change (p < 0.001). CONCLUSION: In a small number of specimens, MR arthrographic findings and histologic analyses showed fibrofatty tissue changes and chondroid metaplasia in the acetabular fossae of cadavers derived from an elderly population. The advanced stage of acetabular fossa change was correlated statistically with the advanced stage of acetabular cartilage degeneration.

Lower extremities' postthrombotic syndrome after total knee arthroplasty.

BACKGROUND: Deep venous thrombosis (DVT) is a disease associated with high morbidity in 40-60% patients who underwent Total Knee Arthroplasty (TKA). Postthrombotic syndrome (PTS) is a common long-term complication that may develop within 6 months or more than 2 years after episode of DVT. OBJECTIVE: To examine the prevalence of PTS in patients who had history of previous DVT and non-previous DVT at least 2-year follow-up period after TKA. MATERIAL AND METHOD: Retrospective chart review was done. All patients who underwent TKA during October 2002-2005 were included. They were postoperatively assessed for PTS with Villalta score and duplex ultrasonography at > or =2 years. The confirmed diagnosis of DVT was done by contrast venography. RESULTS: 22 of 76 patients (56 previous DVT 20 non-previous DVT) had PTS based on the clinical assessment. The previous-DVT group had significantly higher risk to PTS (OR = 1.59; 95% CI: 1.294-1.949; p-value = 0.001). When diagnosed with duplex ultrasonography, 36 in 56 patients of previous-DVT group and 8 in 20 of non-previous-DVT group were found positive venous reflux. Most of venous reflux occurred at popliteal vein (77%) and posterior tibial vein (59%). CONCLUSION: After TKA, the patients who developed DVT had higher risk to PTS (OR = 1.588). Treatment of DVT may not decrease this risk. Prevention of DVT becomes an important approach to prevent PTS.