How is quality of life after total hip replacement related to the reconstructed anatomy? A study with low-dose stereoradiography.

PURPOSE: The purpose of this study was to evaluate the relationships between the three-dimensional anatomy of operated hip in standing position using low-dose stereo-radiography imaging system and postoperative hip disability and osteoarthritis outcome score (HOOS) after total hip arthroplasty (THA). MATERIAL AND METHODS: A total of 123 patients who underwent THA during a one-year period were included. There were 50 men and 73 women with a mean age of 67.3±13.6 (SD) years (range: 19-89 years). All patients underwent pre- and postoperative low-dose stereo-radiography examination and completed a HOOS form (score from 0 to 100, 100 for full satisfaction). We recorded 16 anatomical parameters before THA, and 15 after THA. After binary transformation of HOOS score using 70 as threshold value, outcome was assessed using logistic or generalised linear models. RESULTS: A total of 103 patients (103/123; 83.7%) had a HOOS score≥70 and were considered as the satisfied group. A significant difference in pelvic incidence (the angle between a line perpendicular to the sacral plate at its midpoint and a line connecting the same point to the centre of the bicoxofemoral axis) was found between the satisfied 56.4±10.4 (SD)° (range: 31-85°) and the unsatisfied group 48.7±8.9 (SD)° (range: 40-65) (P=0.006). The relative variation of offset (distance from the centre of rotation of the femoral head to a line bisecting the long axis of the femur) compared to the contralateral hip was -7% in the satisfied group and 7.2% in the unsatisfied group (P=0.01). CONCLUSION: Pelvic incidence, a parameter independent of the reconstructed anatomy, probably influences the quality of life of patients with THA, via pelvic compensatory capabilities. A loss of femoral offset negatively influences the satisfaction of patients.

[Lumbar epidural and foraminal injections: update]. / Infiltrations épidurales et foraminales lombaires: mise au point.

A fluoroscopy-guided lumbar spine injection procedure may be complicated by immediate paralysis. Twelve cases (five recent and seven published) that occurred between 2002 and 2008 were reviewed (history of lumbar surgery, route of injection, image-guidance, injection of contrast, type of steroid, level of paraplegia, MR imaging features). MRI showed cord ischemia from arterial origin. The high number of patients with prior lumbar spine surgery suggests that the presence of scar tissue could increase the risk of paraplegia. A transforaminal approach was used in all patients without history of lumbar surgery while transforaminal, interlaminar and juxta-zygapophyseal approaches were used in patients with prior lumbar surgery. The high number of cases in France could be explained by the exclusive use of prednisolone acetate which has a higher rate of macro-aggregate formation that could lead to embolization in medullary arteries.

Dactylitis: A pictorial review of key symptoms.

Dactylitis refers to a global swelling of a finger or a toe giving it a clinical sausage-shape presentation. It is an extremely suggestive symptom as it guides the rheumatologist towards a shortlist of diagnoses. However, radiologists are less familiar with dactylitis. The aim of this review is to detail and illustrate the main causes of dactylitis using standard X-ray imaging, ultrasound, computed tomography and magnetic resonance imaging in order to make radiologists more familiar with this symptom by illustrating the various conditions that are associated with dactylitis including infection, peripheral spondyloarthritis, sarcoidosis, microcrystalline deposition, osteoid osteoma, and sickle cell disease.

[Plain radiographs of the spine: static and relationships between spine and pelvis]. / Clichés simples du rachis: statique et relations entre rachis et bassin.

Man, with his erect posture, evolves in a world subject to the laws of gravity. His spine reflects these constraints. The morphology and static of human spine and biomechanical relationships between spine and pelvis are in direct relation with bipedia. Owing to this position the pelvis widened and straightened, characteristic sagittal spinal curves appeared and the perispinal muscles were deeply reorganized. Each pelvis is characterized by an important anatomical landmark: the pelvic incidence that reflects the sagittal morphology of the pelvis. Based on this anatomical characteristic, a chain of reactions determines the more efficient equilibrium of the whole body in the sagittal plane in term of energy consumption. Incidence affects the sacral slope, which determines lumbar lordosis, which itself influences pelvic tilt, thoracic kyphosis, and even hip and knee position. All these landmarks can easily be studied on a sagittal radiograph. Knowledge of these functional relationships is essential to understand the origin of low back pain, sagittal imbalance and above all before surgical treatment of spine disorders especially when arthrodesis is considered.

[Plain X-rays of the spine: dynamics and elements of semiology]. / Clichés simples du rachis: dynamique et points de sémiologie.

Man is standing up and he moves himself in a world subject to the gravity's laws. His spine reflects these constraints. Each bivertebral unit that composes the long supple stem of the spine has an anatomic cohesion with some mobility. The mobility of the spine is the sum of the motilities of its elementary units. Despite the criticisms, all deserved, the dynamic radiographies in flexion (seating position) and in extension (standing position, lower limbs straight and buttocks wedged) give major informations with important clinical consequences. Some semiologic points of the radiographic study of the vertebra are perfectly explained by its specific architecture: a radiolucent lesion is difficult to see whereas a sclerotic one is much more easy to individualize; the sclerotic line of the vertebral endplate must be continuous and any interruption is pathologic; the corners of the vertebra must be sharp; the foramen's shape reflects the size of the spinal canal.

[Muculoskeletal radiology: ankle and foot in adults]. / Radiologie osseuse: cheville et pied de l'adulte.

The main views and indications in adult foot and ankle radiography are detailed. Among foot and ankle diseases, mechanical ones are most frequent, including usual podologic changes (commonly followed by peculiar involvement of certain bones, ligaments, joints, tendons and other soft tissues), synostoses, occult and stress fractures, sprains, and tendon changes. Although they are less frequently encountered in common clinical practice, the radiographic appearance of inflammatory, infectious, and tumoral diseases of foot and ankle are disclosed as well. The correlation existing between some subtle radiographic changes and their counterpart on US, CT, or MR examinations are also emphasized.

[Soft tissue tumors and pseudotumors of the foot and ankle]. / Tumeurs et pseudo-tumeurs des tissus mous de la région pied-cheville.

Soft tissue masses around the foot and ankle are frequent. While benign lesions are two times more frequent than malignant lesions, the latter still represent one third of all lesions. The main purpose of this article is to propose a systematic approach to the differential diagnosis of soft tissue tumors of the foot and ankle based on a combination of 5 elements: clinical history and physical examination, top 10 most frequent diagnoses, patient age, lesion location, and MRI features of the mass. Selected soft tissue tumors will be described and illustrated with emphasis on these 5 elements.

[Normal and abnormal imaging of the foot's extensor system]. / Imagerie normale et pathologique du système suro-achilléo-plantaire propulseur du pied.

The extensor system of the foot is mainly composed by a powerful engine, the triceps surae muscle, equiped with a very sophisticated driving belt, the unit Achilles tendon-posterior part of calcaneus bone-plantar aponeurosis, in continuity with the fibrous skeleton of the triceps surae. The exact knowledge of the anatomy of this fibrous skeleton allows us to understand the occurence of the main anatomical lesions of the extensor system and its imaging. On these solid bases, it's possible to divide the lesions of the foot's extensor system in different subtypes with, for each one, a typical clinical feature, a characteristic imaging and an codified treatment. The pair radiography-ultrasonography is enough for diagnosis and follow-up of the majority of lesions. The others need MRI.

[The "de Sèze" magnetic imaging]. / Le "de Sèze" magnétique.

The authors propose that a coronal STIR sequence with large FOV, similar to the de Sèze projection, including lumbar spine, sacrum, pelvis and hips should be obtained in all patients as part of the lumbar spine MRI protocol. For an additional few minutes of scanning time, this additional sequence could demonstrate the presence of lesions (hips, pelvis, sacrum, SI joints, retroperitoneum...) that would otherwise go undetected on standard sagittal and axial MRI images of the lumbar spine.

Imaging of lumbar degenerative changes involving structures other than disk space.

Degenerative changes in the lumbar spine involve intervertebral disks and intervertebral posterior elements at different extents. Much less attention has been directed toward degenerative changes of the posterior vertebral elements, however, when compared with intervertebral disk degeneration. These changes may involve the apophyseal joints, the bony elements of the neural arch, the intervening soft tissues, and the spinal longitudinal ligament. Roentgenographic, CT, and MR findings in these changes are depicted.

Radiologic assessment of lumbar intervertebral instability and degenerative spondylolisthesis.

Despite many efforts, there is no clear and widely accepted definition of lumbar instability because there are no unquestionable and currently applicable clinical or radiologic criteria available for this entity. This article reviews the current concepts of lumbar instability and the different imaging modalities used to make the diagnosis as evident as possible.

Percutaneous treatments of painful shoulder.

Percutaneous treatments are useful in two, frequent, painful conditions involving the shoulder. In frozen shoulder syndrome, distention arthrography with intra-articular injection of steroid is used to provide pain relief and to improve joint motion. In rotator cuff tendon calcifications, needle aspiration of calcific deposits is used to treat pain. Surgery should be restricted to failures of needle aspiration. The techniques of these procedures are described and their results are reported.

Lumbar disc herniation. Computed tomography scan changes after conservative treatment of nerve root compression.

In 21 patients with computed tomography-diagnosed lumbar herniated nucleus pulposus, nerve root pain resolved after conservative treatment. A subsequent computed tomography scan was performed 6 months or more after presentation. This follow-up computed tomography scan was compared with the initial one. A definite decrease in size of the herniated nucleus pulposus was observed in 14 patients: disappearance in 5, obvious decrease in 5, and moderate decrease in 4. No definite change was observed in seven patients. Major computed tomography scan changes occurred significantly more frequently in large herniated nucleus pulposus than in small ones (p. less than 0.05). This study suggests that large lumbar herniated nucleus pulposus can decrease and even disappear in some patients treated successfully with conservative care.

Computerized tomographical study of dorsal neck muscles for insertion of EMG wire electrodes.

A computerized tomographical (CT) study of the main dorsal neck muscles was performed on 60 subjects (30 males and 30 females) in order to quantify individual anatomical variations and to describe valid means of accurately inserting intramuscular wire electrodes in these deep and superimposed muscle layers. Depth and thickness of transverso-spinalis (TS), semispinalis capitis (SSC) and splenius capitis (SPL) muscles were measured on a cross-sectional image of the neck at the level of the fith cervical vertebrae. Thickness and depth were significantly greater in males than in females. SSC and SPL thicknesses were less than 10 mm in most subjects and their depths were highly variable depending on the subject's morphology. TS was thicker but its depth was also variable. This CT study clearly demonstrated that the interindividual variations of dorsal neck muscles are important and CT may provide a valid way to position wire electrodes accurately in most cervical muscles.

[Osteo-articular ultrasonography of the hip and the knee]. / Echographie ostéo articulaire du genou et de la hanche.

Experience in the field of musculoskeletal diseases and advanced technology of medical sonographers allow increasing accuracy in US investigations of most lesions of both hip and knee superficial tendons. In this field, US is more and more widely replacing other imaging modalities, including MR imaging. Ultrasonography may now be used also for articular diseases purpose, including joint effusion, synovitis, intraarticular loose bodies, ligamentous injuries, articular cysts, as well as for certain osseous lesions like stress or insufficiency fractures of superficial bones. However, ultrasonography has still to be evaluated for these latter indications.

[Ultrasonography of tendons and ligaments of foot and ankle]. / Echographie des tendons et des ligaments du pied et de la cheville.

UNLABELLED: The main ligaments and tendons of the ankle and the hind-foot can now be studied by US. This simple and safe technic constitutes a more and more reliable alternative to MRI and CT scan. AIMS: Know the normal US appearance of the tendons and ligaments of the ankle and the hind-foot, and how to study them with US. Know their main usual pathological appearance.

[Posterior lumbar vertebral arthrography. Pathologic aspects]. / Arthrographie articulaire vertébrale postérieure lombaire. Aspects pathologiques.

Findings on arthrography of posterior lumbar spine joints in 55 patients were compared with those reported in the literature. Two major degenerative lesions of these joints, diverticula and cysts, can provoke back pain and symptomatic nerve compression. Whereas diagnosis of a cyst is dependent mainly on computed tomography imaging, that of a diverticulum is ensured by arthrography, an investigation which also has a therapeutic aim since it allows infiltrations to be performed.

[Posterior lumbar vertebral arthrography. Normal anatomic study]. / Arthrographie vertébrale lombaire postérieure. Etude anatomique normale.

Historical aspects and anatomophysiologic features of posterior lumbar vertebral joints are summarized and results of arthrography of 55 joints presented, together with a simple, original method for performing this examination. Normal anatomic appearances condition understanding of principal lesions encountered, particularly with respect to compression of adjacent nerve structures.

[Spontaneous fracture of the sternum]. / Fracture spontanée du sternum.

Spontaneous fractures of the sternum are unusual. They can simulate cardio-thoracic emergencies. A case of stress fracture of the sternum and of the femoral neck in a patient with corticosteroid induced osteoporosis is reported and the peculiar value of CT assessing the absence of tumoral mass is emphasized.

[Unilateral isthmic lysis in x-ray computed tomography]. / Lyse isthmique unilatérale en tomodensitométrie.

Condensing pediculolaminar hypertrophy of mechanical origin is known as "Dahu's sign". Dahu's sign corresponds to hypertrophy of the vertebral hemi-arch found by CT scan and leads to suspicion of controlateral lysis of the isthmus. It is the CT scan equivalent of vertebral "anisocorism" by conventional radiology.