Arthrography of the prosthesetized painful hip: the importance of imaging and functional testing.

Thirty-four patients with painful prosthesetized hips were submitted to arthrography in order to evaluate the correlation between pain and the anatomical situation between the implants and the host bone. By injecting a local anaesthetic together with the contrast medium it was possible to perform functional tests comprising passive movements of the hip and full weightbearing for at least 5 minutes in order to ascertain whether or not the pain persisted. This yielded different results varying from total relief to persistence, depending on the type of mobilisation demonstrated by arthrography. In particular, pain was reduced in cases of mobilisation of the acetabular component, and persisted when mobilisation was in the femoral component. A correlation between functional testing, arthrography and bacteriological examination for possible low grade infection allowed for a closer study of the origin of pain, and more accurate planning of surgery when re-prosthesetization was being considered.

Arthrography in the study of extrameniscal pathology of the knee.

We re-examined 800 arthrographies performed between 1984 and 1986 according to the Lindblom-Ficat-Philippe method. 280 had pure meniscal lesions. In the remaining 520 cases, arthrography revealed extrameniscal pathology, sometimes associated with meniscal lesions, as well as other pathologies which were either negative or equivocal. The purpose of this study was to emphasize the advantages of a simple method of diagnosis applicable to out patients in the study of extrameniscal pathologies which are often concealed by the associated meniscopathy. In fact, it is possible to observe chondral, synovial, capsular and ligamentous pathologies which may be very useful as a prelude to diagnostic arthroscopy, which we consider to be a second level test.

Contrast arthrography in symptomatic varus knees.

The authors carried out a study of contrast arthrography in 48 cases of primary genu varum, i.e. not secondary to trauma or to pathological conditions of the hip or foot. The patients all had symptoms and were classified according to the commonly used Trillat-Dejour method into four groups or stages depending on the degree of varus and the radiographic and arthrographic findings. Associated lesions secondary to the basic pathology were observed in all cases. These ranged from hypertrophic synovitis to torn medial or lateral menisci up to total compromise of the joint typical of stage 4 arthritic varus knee. In these patients, contrast arthrography is useful in planning surgery, particularly high tibial osteotomy. It also enables the surgeon to decide whether complementary intra-articular measures are indicated without having to resort to arthroscopy. This is always a more invasive method, necessitating general anaesthesia, as these knees are quite painful and the arthroscopic access is difficult.

The surgical treatment of metastatic tumours of the lumbar spine.

Thirty-three patients affected by metastases in the lumbar spine were treated surgically with the objective of stabilising the affected area while at the same time alleviating involvement of the neurological structures. The surgical technique was adapted to the type and site of the lesion. The lumbar spine differs from the dorsal and cervical spine in that there are two quite different levels of neurological risk above and below L2. Above L2 it is severe, of rapid onset, and usually irreversible. Below L2 it is more easily reversible, even if surgical intervention is not carried out immediately. In cases with neurological involvement, the results were always very much better in the cases operated on early. This led us to carry out the operation prophylactically with rewarding results because none of these patients subsequently developed neurological damage.

Retrosternal dislocation of the clavicle. Observations on three cases.

The writers report three cases of retrosternal dislocation of the clavicle which exemplify the three fundamental anatomical variants and the consequent different therapeutic approach. A review of the literature indicates that this condition is extremely rare, although it may sometimes be related to severe and even fatal complications.

Fractures of the limbs complicated by ischaemia due to lesions of the major vessels.

The authors present their case material of 68 patients who had substained fractures of the limbs complicated by arterial lesions. Orthopaedic and vascular surgery should be performed within the shortest possible period of time, preferably within 12 hours of injury, and in certain severe arterial injuries within 4 hours. Osteosynthesis was performed in all cases prior to the arterial repair; in the authors' opinion this brief prolongation of the period of ischaemia has no effect on the general outcome of treatment. In the light of the results obtained, they believe that osteosynthesis should be performed with intramedullary nails in preference to plates. They found that the least satisfactory results were obtained in fractures of the lower two thirds of the tibia and fibula with lesions of the tibial arteries which at this level show characteristics typical of terminal arteries.