Cam-type hip morphology in asymptomatic patients.

BACKGROUND: The alpha angle has been widely used in the assessment of cam-type of impingement, but recent studies have shown that this angle may also be high in asymptomatic patients. The aim of this study is to report the prevalence of cam-type morphology in asymptomatic volunteers and explore its correlation with hip clinical and radiological parameters. METHODS: This single-centre prospective study included 48 asymptomatic male volunteers (96 hips). All candidates fulfilled the inclusion and exclusion criteria. Physical examination and 1.5 -T MRI imaging were done for bilateral hips on the same day. Alpha angle measurements were obtained from 4 different positions and cam-type morphology was considered positive using 2 different cut points >55° and >60°. Descriptive statistics were analysed and correlations were performed where appropriate and p-value < 0.05 was considered to be significant. RESULTS: The prevalence of cam-type morphology using alpha angle >55° was 68.8%, 87.5%, 50% and 34.4% in the 12, 1, 2 and 3 o'clock positions respectively. While it was 38.5%, 69.8%, 26% and 12.5% in the 12, 1, 2 and 3 o'clock positions of the studied hips respectively using alpha angle >60°. The maximum alpha angle was more frequently prevalent at the 1 o'clock position in 71 (74%). Labral tear was detected in 26 (27.1%) hips and impingement test was positive in 12 (12.5%) hips. There was no correlation between the presence of cam-type morphology and range of motion of the hip, presence of positive impingement test nor labral tears. CONCLUSIONS: Cam-type morphology prevalence is high among asymptomatic males, and mostly pronounced at the 1 o'clock position. A correlation between high alpha angle and positive impingement test or labral tear was not found in our cohort. Future studies are required to determine the natural history of asymptomatic cam-type morphology and risk of hip derangement.

Vancomycin flushing syndrome in orthopaedic practice: A case report.

BACKGROUND: Vancomycin flushing syndrome (VFS), also known as red man syndrome, is an allergic reaction to vancomycin. It typically presents as a rash on the face, neck, and upper torso after intravenous administration of vancomycin. VFS is blamed on rapid intravenous infusion of vancomycin during management and rarely happens after local use. A review of the literature showed that in the last 23 years, 4 such cases have been reported. Here, we add another case of VFS developed after slow local absorption of vancomycin in cement beads. CASE SUMMARY: A 44-year-old male with a known case of hypertension, no history of allergies to medications, and a history of chronic osteomyelitis of the right tibia with discharging sinus over the anterolateral aspect of the leg. The pus culture grew Staphylococcus aureus, which was sensitive to clindamycin and vancomycin. The patient underwent irrigation and debridement with the placement of vancomycin cement beads made from 4 g of vancomycin powder and 40 g of polymethyl methacrylate. Three hours postoperatively, the patient developed a pruritic, erythematous, macular rash predominantly on his face, neck, chest, and lower extremities and to a lesser extent his upper extremities. A diagnosis of VFS was made and was successfully treated with cetirizine (10 mg, oral) and methylprednisolone sodium succinate (125 mg, intravenous). The patient continued to have itching with a facial rash for 12 h with gradual improvement. A decision was made to not remove the beads as the patient continued to improve. Gradually, the rash disappeared after 96 h with no further sequela. CONCLUSION: VFS can occur not only after rapid intravenous injection of vancomycin but also with local release, as in our case. As orthopaedic surgeons routinely use vancomycin with polymethyl methacrylate in chronic osteomyelitis and revision arthroplasty, they should be aware of such a complication occurring.

Review of Soft Tissue Masses of the Foot and Ankle: Magnetic Resonance Imaging Features.

A large number of soft tissue masses affect the foot and ankle, with the majority being benign. Benign and malignant soft tissue lesions usually present as lumps, and it is important to differentiate between them to allow for optimal management. Imaging, in particular magnetic resonance imaging (MRI), can contribute to narrow the differential diagnosis of soft tissue masses of the foot and ankle by describing its exact location, internal signal characteristics, presence of enhancement, and its relation to adjacent structures. In this review, we review the literature to describe the most common soft tissue masses around the foot and ankle, focusing on the MRI features of the lesions.

Autologous Bone Marrow-Derived Chondrocytes for Patients with Knee Osteoarthritis: A Randomized Controlled Trial.

RESULTS: There were a total of 60 patients who were followed up. Three patients in Group II were removed from the analysis as they underwent total knee arthroplasty (TKA). A notably significant improvement was noticed in the ABMDC group on all scores of VAS and MKSSSF with P < 0.0001. The control group continued to be dissatisfied with the treatment they were taking. CONCLUSIONS: This study reveals that a single injection of 5 million of ABMDC was efficient in reducing the symptoms, improving the functional score and betterment of QOL.

Time out: should vitamin D dosing be based on patient's body mass index (BMI): a prospective controlled study.

The recommended daily dose of vitamin D is 2000 IU was found to be insufficient in many patients. The objective of the present study is to find whether the daily dose of vitamin D should be based on BMI. Two hundred and thirty patients with an established vitamin D deficiency (serum level of 25 Hydroxy vitamin D3 (25OHD3) of ≤20 ng/ml) and patients with BMI ≥30 kg/m2 were included in the study. Demographic data, comorbidities and BMI were recorded. Pre-treatment and post-treatment serum 25OHD3, calcium, phosphorus and parathyroid hormone (PTH) were tested at 0-, 3- and 6-month periods. Patients were treated with a standard dose of 50 000 IU of vitamin D weekly and 600/1200 mg of calcium a day. Once their level of 25OHD3 reached ≥30 ng/ml, patients were randomised into two groups. Group A received a standard recommended maintenance dose of 2000 IU daily and Group B patients received 125 IU/kg/m2 of vitamin D3. The data were entered in the database and analysed. The mean age of Group A was 50⋅74 ± 7⋅64 years compared to 52⋅32 ± 7⋅21 years in Group B. In both groups, pre-treatment vitamin D level was ≤15 ng/ml and increased to 34⋅6 ± 2⋅6 and 33⋅7 ± 2⋅4 ng/ml at the end of 3 months treatment with a dose 50 000 IU of vitamin D3 and calcium 600/1200 mg once a day for group A and group B, respectively. At 6 months, patients in Group A 25OHD3 level was 22⋅8 ± 3⋅80 and in Group B was 34⋅0 ± 1⋅85 ng/ml (P < 0⋅001). This preliminary study suggests that obese patients need higher dosage of vitamin D than the recommended dose. It is prudent that the dosage should be based on the BMI to maintain normal levels for a healthy musculoskeletal system.

Stem-cell therapy for ovariectomy-induced osteoporosis in rats: a comparison of three treatment modalities.

Background: Recent studies have shown that ovariectomy-induced osteoporosis in rats can be reversed by infusion of osteoblasts cultured from mesenchymal stem cells (MSCs). This study compares the influence of MSCs, osteoblasts, and exosomes derived from osteoblasts for the treatment of osteoporosis. Methods: Osteoporosis was induced in 40 female Sprague Dawley rats by performing ovariectomy. After 12 weeks, bone marrow was harvested and MSCs separated from bone-marrow aspirate as described by Piao et al. After 15 days, autologous osteogenically differentiated cells from the MSCs were available. Exosomes were isolated from osteoblasts by modification of the technique described by Ge et al. MSCs and osteoblasts (106 cells in 0.5 mL normal saline) and exosomes (100 µg protein) were injected into the tail veins of the animals. Animals were euthanized after 12 weeks and femurs and lumbar spines dissected and analyzed using high-resolution peripheral quantitative computed tomography. Results: When compared to the control group, osteoblast-treated animals showed significant differences in all parameters compared, with P-values ranging between <0.002 and <0.0001. Comparison among osteoblasts, MSCs, and exosomes, showed that osteoblasts had positive and statistically significant new-bone formation. The comparison for the spine was similar to the distal femur for osteoblasts. Conclusion: This study showed robust positive bone-forming changes after osteoblast injection in the distal femur and the spine when compared to controls, MSCs, and exosomes.

The natural history of inflammatory pseudotumors in asymptomatic patients after metal-on-metal hip arthroplasty.

BACKGROUND: Although pseudotumors have been reported in 32% of asymptomatic metal-on-metal hips, the natural history of asymptomatic pseudotumors is unknown. QUESTIONS/PURPOSES: The purpose of this study was to assess changes over time in asymptomatic pseudotumors and the effect of revision on pseudotumor mass. METHODS: Followup ultrasound was performed a mean of 25.8 months (range, 21-31 months) after the detection of 15 pseudotumors and five isolated fluid collections in a cohort of 20 asymptomatic patients (13 metal-on-metal, three metal-on-polyethylene, and four hip resurfacings) [42]. Changes in pseudotumors and fluid collections size and nature, and serum ion levels were determined. RESULTS: Among the 15 nonrevised patients, pseudotumors increased in size in six (four solid and two cystic) of 10 patients, three of which had clinically important increases (13-148 cm(3); 28-74 cm(3); 47-104 cm(3)). Three pseudotumors (one solid and two cystic) disappeared completely (the largest measured 31 cm(3)). One solid pseudotumor decreased in size (24 to 18 cm(3)). In five revised patients, pseudotumors completely disappeared in four patients. The fifth patient had two masses that decreased from 437 cm(3) to 262 cm(3) and 43 cm(3) to 25 cm(3). All revision patients had a reduction of chromium (40.42 µ/L to 2.69 µ/L) and cobalt ions (54.19 µ/L to 0.64 µ/L). Of five isolated fluid collections, four completely disappeared (two metal-on-metal and two metal-on-polyethylene) and one (metal-on-metal) increased from 26 cm(3) to 136 cm(3). CONCLUSIONS: Our observations suggest pseudotumors frequently increase in size in asymptomatic patients with occasional remission of small masses. Revision resulted in remission of pseudotumors.