Bilateral knee lipoma arborescens: a case report.

A 45-year-old Chinese man presented with recurrent bilateral knee swelling and pain. He was initially diagnosed with gouty arthritis, but later found to have lipoma arborescens. Magnetic resonance imaging demonstrated frond-like proliferations of fatty synovium. Arthroscopic synovectomy was performed. Histological examination of the specimen revealed villiform fatty tissue covered by slightly thickened synovium characteristic of lipoma arborescens. Magnetic resonance imaging is useful in differentiating lipoma arborescens from other intra-articular lesions in patients with recurrent knee pain and swelling.

The management of superior dislocation of the patella with interlocking osteophytes--an update on a rare problem.

The superior dislocation of the patella with interlocking osteophytes is a rare condition. A review of the English literature revealed only 12 reported cases. The purpose of reviewing these case reports is to highlight the unusual presentation and the injury mechanism in 2 of our patients, and to present our treatment algorithm. Closed reduction with manipulation of the patella, with or without anaesthesia, was performed without difficulty. We recommend an intermediate step of trying a regional nerve block before proceeding to general anaesthesia. Our patients had full range-of-motion after reduction and they were symptom-free after 3 years of follow-up. There were no recurrent dislocations in our patients.

Local recurrence of parosteal osteosarcoma adjacent to a prosthesis after 20 years: a case report.

We describe the treatment of an uncommonly late presentation of a recurrent parosteal osteosarcoma of the distal femur. The osteosarcoma had originally been detected 20 years earlier, and had been treated with wide excision and mega-prosthesis to reconstruct the femur. The tumour recurred in close proximity to the femur prosthesis and encased half the femoral stem. Because there was a large piece of metal at the site of recurrence, which might have interfered with computed tomography and magnetic resonance imaging, ultrasonography was used to locate the lesion. The tumour was successfully treated with wide local re-excision. This case emphasises the importance of the long-term follow-up of patients with parosteal osteosarcoma.

Group G streptococcus--a rare cause of osteomyelitis simulating bone tumour: a case report.

We report a case of osteomyelitis of the proximal femur caused by Lancefield group G streptococcus in a 71-year-old otherwise healthy man. The organism has rarely been identified as the cause of osteomyelitis. The subacute nature of the symptoms and the radiological appearance of the femur in this patient mimic bone tumour. The patient was successfully treated with conservative methods, including a prolonged period of oral antibiotics. We stress the importance of histological and bacteriological evidence in avoiding misdiagnosing patients with equivocal clinical and radiological presentation.

Use of bisphosphonate to manage avulsion fracture of tibial tuberosity with underlying angiomatosis: a case report.

An unusual case of avulsion fracture of the tibial tuberosity with underlying angiomatosis in a middle-aged man is described, with particular emphasis on the successful use of bisphosphonate in its treatment and the value of serial dual energy X-ray absorptiometry in its subsequent disease monitoring. This case illustrates the importance of careful correlation of the clinical, radiological, and histological findings in the management of skeletal tumour and tumour-like lesions. The differential diagnosis of osteolysis with vascular ectasia is discussed.

Arthroscopic treatment of patellar symptoms in posterior stabilized total knee replacement.

Twenty-one patients with patellar symptoms had arthroscopic treatment. Symptoms included frank patellar clunk and painful patellofemoral crepitus. All patients had posterior stabilized total knee replacement (TKR). The average onset of symptoms following TKR was 17 (range 3-75) months. All patients were referred to physiotherapy treatment before arthroscopic treatment. The average duration of symptoms prior to arthroscopic treatment was 23 (range 4-92) months. All patients were satisfied with resolution of symptoms at average follow-up of 32 (range 12-52) months. No complications were encountered; however, one patient had recurrence of a painful patellar crepitus 8 months after arthroscopy.