Hip dysplasia hiding in plain sight: A retrospective analysis of radiology reports.

INTRODUCTION: Timely recognition of dysplastic hip morphology is critical to facilitate appropriate management before significant joint damage has developed. It is likely that radiologist under reporting contributes to delays in diagnosis. This study aimed to assess how often adult hip dysplasia goes undetected in radiological reports and to identify clinical and radiological variables that impact the likelihood of detection of dysplasia by radiologists. METHODS: Referral details and radiology reports of patients who underwent periacetabular osteotomy by a single surgeon for symptomatic hip dysplasia between 1 January 2016 and 30 June 2020 were reviewed. Four assessors measured the lateral centre edge angle from the pelvic radiograph performed at time of referral. Film quality and other radiographic parameters were also assessed. RESULTS: Sixty-eight patients were included, 84% were female and the median age was 28.1 years. Dysplasia was not documented in the radiology report in 49% of cases. Dysplasia was more likely to be reported with no history of injury, an aspherical femoral head, lower lateral centre edge angle, higher acetabular index, increased femoral head shaft angle, higher femoro-epiphyseal acetabular roof index, or if there was disruption of Shenton's line, with the first three variables being independent predictors of radiologist detection. CONCLUSION: Hip dysplasia should be considered in all adolescents/young adults presenting with hip pain. Causes of radiologist under reporting are likely multifactorial. Clinical information can cause cognitive biases and result in selective looking. A systematic approach to pelvis radiographs should include assessment of acetabular coverage and active search for evidence of femoral head migration.

Outcomes of reverse shoulder arthroplasty in patients under 55 years old: Results from the New Zealand joint registry.

Background: The appropriate age at which to perform reverse shoulder arthroplasty is controversial. The aim of this study was to compare the outcomes of reverse shoulder arthroplasty between younger and older patients. Methods: Patients who underwent primary reverse shoulder arthroplasty between January 2000 and December 2019 were identified from New Zealand Joint Registry records. Patients were stratified into two cohorts according to age at the time of surgery: < 55 years and ≥ 55 years. These two groups were then compared with regard to baseline characteristics, indications for surgery, revision rates, and patient-reported outcomes using the Oxford Shoulder Score and American Shoulder and Elbow Score (ASES). Results: A total of 5518 primary reverse shoulder arthroplasty cases were identified, with 75 patients < 55 years at the time of surgery (range: 34-54 years). The mean duration of follow-up was 2.36 years (range: 0.11-13.37 years) in the younger cohort and 3.10 years (range: 0.01-16.22 years) in the older patient cohort. Indications for surgery differed significantly between the two groups, with younger patients having higher rates of inflammatory arthritis (p < 0.001), posttraumatic arthritis (p < 0.001), and avascular necrosis (p = 0.049). The younger cohort had an inferior 6-month postoperative Oxford Shoulder Score compared to the older cohort (mean: 28.5 [younger cohort] vs. 35.7 [older cohort]; p < 0.001). There was no significant difference in revision rate between the younger and older patient cohorts during the study period (1.56 [<55 years] vs. 0.74 [≥55 years] revisions per 100 component-years; p = 0.332). Conclusion: Our early results suggest that younger patients undergoing reverse shoulder arthroplasty demonstrate high implant retention rates, comparable to older patients. Longer-term patient-reported outcomes in younger patients are required to guide appropriate patient selection for reverse shoulder arthroplasty. Level of evidence: Level III, retrospective case-control study.

An Update on Pediatric Acute Hematogenous Osteomyelitis in New Zealand - A Decade on.

INTRODUCTION: New Zealand (NZ) has high rates of pediatric acute hematogenous osteomyelitis (AHO) with males and children of Pasifika and Maori ethnicity overrepresented. AIMS: To update the incidence of Pediatric AHO over 10 years, identifying trends in presentation, organisms, treatment, and outcomes. METHODS: A 10-year retrospective review of children aged 6 weeks to 15 years admitted with Pediatric AHO across two centers from 2008 to 2017. Demographic data, features of presentation, investigations, management, and complications were collected. Incidence was calculated from census data. Data were compared with our osteomyelitis database from the previous decade. (1). RESULTS: 796 cases were identified. The incidence was 18 per 100,000 per annum. The average age was 7.7 years. Pasifika and Maori children are overrepresented (57%). 370 children (51%) came from low socioeconomic areas. Methicillin-sensitive Staphylococcus aureus was the most common pathogen (87%). Methicillin-resistant Staphylococcus aureus (MRSA) rates are low (4.4%). Forty-four (5.5%) children were admitted to the Pediatric Intensive Care Unit (PICU) with 9% mortality. The mean duration of antibiotics was 40 days. 325 children (41%) had surgery. Chronic infection has increased from 1.7% to 5.7%. CONCLUSIONS: NZ has high rates of AHO, however, the incidence has decreased from the previous decade. Males, those in low socioeconomic areas, Pasifika and Maori have high disease burden. The use of MRI as a diagnostic modality has increased. Future studies should focus on improving treatment via prospective analysis and reporting long-term morbidity to improve outcomes for children with severe disease and reduce rates of chronic infection.

Intraoperative cell salvage use reduces the rate of perioperative allogenic blood transfusion in patients undergoing periacetabular osteotomy.

Blood loss during periacetabular osteotomy (PAO) is variable, with losses ranging from 100 to 3900 ml in published series. Perioperative allogenic blood transfusion is frequently utilized although is associated with significant risk of morbidity. Cell salvage (CS) is a common blood conservation tool; however, evidence supporting its use with PAO is lacking. Our aim was to assess whether CS affects perioperative allogenic blood transfusion rate in patients undergoing PAO. The clinical records of 58 consecutive PAOs in 54 patients (median age 24.7 years, interquartile range 17.8-29.4 years) performed by a single surgeon between 1 January 2016 and 30 April 2018 were reviewed. Autologous blood pre-donation and surgical drains were not used. Due to variable technician availability, CS was intermittently used during the study period. PAOs were allocated into a CS group or no cell salvage group (NCS group), according to whether an intraoperative CS system was used. There was no significant difference in patient age, gender, body mass index, dysplasia severity, regional anesthetic technique, tranexamic acid administration, surgical duration or estimated blood loss (all P > 0.05) between the two groups. The CS group had a lower preoperative hemoglobin compared to the NCS group (median, 13.4 g/dl versus 14.4 g/dl, P = 0.006). The incidence of allogenic blood transfusion was significantly lower in the CS group compared to the NCS group (2.5% versus 33.3% patients transfused, P = 0.003). Multivariate modeling showed CS use to be protective against allogenic blood transfusion (P = 0.003), with an associated 80-fold reduction in the odds of transfusion (odds ratio, 0.01; 95th% CI, 0-0.57). To our knowledge, this is the first study to assess the effect of CS use on allogenic transfusion rate in patients undergoing PAO. Our results demonstrate CS to be a mandatory component of blood conservation for all patients undergoing PAO.

Do young female dancers improve symptoms and return to dancing after periacetabular osteotomy for the treatment of symptomatic hip dysplasia?

Although preservation of high activity level has been reported in active young patients after periacetabular osteotomy (PAO) for the treatment of symptomatic hip dysplasia, there is limited evidence whether a dancer may be able to resume dancing after PAO. We asked whether female dancers experience improvement in pain and sports-related activities and return to dance following PAO. Between 1997 and 2014 we performed a total of 44 PAOs in 33 female dancers with symptomatic hip dysplasia. The mean age was 20.3 years (SD 5.6 years) and the median follow-up was 2.7 years (IQR 1.7-5.9 years). The Hip Disability and Osteoarthritis Outcome Score (HOOS), the modified Harris hip score (MHHS) and hip motion were collected preoperatively and at most recent follow-up. Return to dance was recorded from self-reported questionnaires and medical record review. Female dancers reported an improvement in HOOS total scores of nearly 20 points (P = 0.007) and MHHS improved over 17 points (P = 0.01) from preoperative to most-recent follow-up. Out of the 30 patients for whom information about return to dance was available, 19 (63%; 95% CI = 43.9-79.5%) had returned to dance at an average of 8.8 months (±3.6 months) after PAO. With the numbers available we did not identify any factors associated with returning to dance in this cohort. Improvement in hip pain, sports-related activities and hip function may be expected following PAO in young female dancers. Most female dancers can expect to return to dance during the first year after surgery.

Periacetabular osteotomy for developmental hip dysplasia with labral tears: is arthrotomy or arthroscopy required?

Patients with developmental dysplasia of the hip (DDH) who undergo periacetabular osteotomy (PAO) often have labral tears. The objective of this retrospective study was to compare PAO alone with PAO combined with arthrotomy or arthroscopy in DDH patients who had a full-thickness labral tear on magnetic resonance imaging. In total, 47 hips in the PAO group (PAO) were compared with 60 hips in the PAO with concomitant arthrotomy or arthroscopy (PAO-A) with respect to Hip Disability and Osteoarthritis Outcome Score (HOOS), modified Harris Hip Score (mHHS), Visual Analog Scale (VAS), clinical and radiographic outcomes at a median of 29 months. Reoperation rate and complications were compared between two groups of treatment. The PAO group was younger than the PAO-A group (25.2 ± 9.7 versus 31.3 ± 8.3). The PAO group was more likely to have worse dysplasia: lateral center edge angle (7.6°±9.63° versus 10.8°±6.85°) and anterior center edge angle (4°±12.92° versus 10.8°±9.92°). The PAO group had a higher preoperative mHHS (65.2 ± 15.3 versus 57.8 ± 14.8) and HOOS (66.3 ± 17.5 versus 55.8 ± 20.1). There were no significant differences in final functional outcome scores across treatment groups: mHHS (PAO; 86.8 ± 12.4 versus PAO-A, 83.3 ± 17.2), HOOS (86.5 ± 13.3 versus 82.5 ± 16.8) and VAS (2.5 ± 2.8 versus 2.5 ± 3.1). There was no difference in reoperation rate between two groups (6.4% versus 11.6%, P = 0.51). The overall complication rate was lower in the PAO group (26% versus 68%), but major complications were comparable. On the basis of our data, we were not able to conclusively demonstrate a clear benefit for the routine treatment of all labral tears; however, arthrotomy or arthroscopy may play a role in some conditions.

Reverse shoulder arthroplasty compared with hemiarthroplasty in the treatment of acute proximal humeral fractures.

BACKGROUND: Complex proximal humeral fractures may require prosthetic replacement of the humeral head. Surgical options include reverse shoulder arthroplasty (RSA) and shoulder hemiarthroplasty; however, the optimal technique remains controversial. The goal of this study was to compare functional outcomes and revision rates of RSA with hemiarthroplasty in patients with acute proximal humeral fractures. MATERIALS AND METHODS: Between January 1, 1999, and December 31, 2014, there were 218 patients who underwent RSA and 427 who underwent hemiarthroplasty for acute proximal humeral fractures identified through New Zealand Joint Registry records. Study groups were compared with regard to baseline characteristics, operative characteristics, and postoperative outcomes (Oxford Shoulder Score [OSS], revision rate, mortality rate) at 6 months and 5 years after surgery. RESULTS: RSA patients were significantly older (mean age, 78.2 vs. 71.6 years; P < .001), with a higher proportion of female patients (90% vs. 77%; P < .001) than in the hemiarthroplasty group. No statistically significant difference existed in revision rate per 100 component-years (0.58 [RSA] vs. 1.16 [hemiarthroplasty]; P = .137) or 1-year mortality (3.8% vs. 3.4%; P = .805) between both groups. There was no significant difference in 6-month OSS (29.6 vs. 28.4; P = .305). The RSA group demonstrated a superior mean 5-year OSS (37.6 vs. 32.7; P = .078); however, the difference did not achieve statistical significance. CONCLUSIONS: Although our results suggest that RSA patients may experience superior 5-year functional scores, we have identified no significant difference in functional outcomes and revision rates between RSA and hemiarthroplasty in the treatment of acute proximal humeral fractures.

The alpha angle as a predictor of contralateral slipped capital femoral epiphysis.

PURPOSE: Contralateral hip involvement in slipped capital femoral epiphysis (SCFE) is common. Femoral head-neck asphericity, as measured by an elevated alpha angle, has not previously been assessed with respect to SCFE risk. Our aim was to assess the utility of the alpha angle in predicting contralateral SCFE. METHODS: We retrospectively reviewed 168 patients (94 males) managed surgically for unilateral SCFE between 2001 and 2013 who had a minimum of 18 months follow-up. The alpha angle, the posterior sloping angle (PSA), and the modified Oxford score were recorded for every patient at the time of initial SCFE presentation. Follow-up clinical records and radiographs were assessed to determine the presence of absence of contralateral SCFE. RESULTS: Forty-five patients (27 %) developed a contralateral SCFE. Patients who developed a contralateral SCFE had a significantly higher alpha angle (51° vs 45°, p < 0.001) than patients who did not develop a contralateral SCFE. There was no significant difference in PSA or modified Oxford score (both p > 0.10) between patients who developed a contralateral SCFE and those who did not. Using a proposed alpha angle of 50.5° as a threshold for prophylactic fixation, 26 (58 %) of the 45 cases of contralateral SCFE in our study would have been prevented and 18 (15 %) of 123 patients would have undergone fixation unnecessarily. CONCLUSIONS: We found the alpha angle to positively correlate with contralateral SCFE risk. Patients with significantly elevated alpha angles may be at greater risk of contralateral SCFE and benefit from further investigation or prophylactic hip fixation.

Surgical Reconstruction of Metatarsal Type Preaxial Polydactyly Using an Amalgamating Osteotomy.

BACKGROUND: Polydactyly of the foot is a relatively common condition. Approximately 15% of cases are preaxial, with one third of these cases involving duplication of the metatarsal [metatarsal type preaxial polydactyly (MTPP)].Surgical reconstruction of polydactyly is indicated to improve shoe tolerance. Reconstruction of MTPP has traditionally involved resection of the hypoplastic lateral ray in addition to soft tissue reconstruction to correct hallux varus. Poor postoperative results have frequently been reported, primarily due to residual hallux varus. We present a novel surgical technique for the treatment of children with MTPP presenting with a cosmetic lateral hallux, involving an amalgamating osteotomy that permits retention of the stable medial metatarsotarsal joint while avoiding the complication of residual hallux varus. METHODS: This was a retrospective case series describing the surgical technique of an amalgamating osteotomy in the treatment of patients with MTPP and a cosmetic lateral hallux. The surgical technique involves corresponding metatarsal osteotomies of the medial and lateral halluces, with amalgamation of the metatarsals and ablation of the residual medial hallux, without the need for extensive soft tissue reconstruction. Clinical and radiologic outcomes were evaluated at a minimum of 2 years postoperatively in 2 patients who underwent this technique. RESULTS: Two children, 1 female and 1 male, underwent an amalgamating osteotomy at the age of 31 and 18 months, respectively. At latest follow-up, 7.3 and 2.8 years after osteotomy, respectively, both patients displayed an excellent functional result according to the Phelps and Grogan clinical outcome scale. Plain radiographs in both cases demonstrated a well-aligned first ray with no growth abnormality and no hallux varus. CONCLUSIONS: We have presented a novel surgical technique for the reconstruction of MTPP presenting with a cosmetic lateral hallux, involving an amalgamating osteotomy without extensive soft tissue reconstruction. This simple technique maintains the stable medial metatarsotarsal joint, permits ongoing longitudinal metatarsal growth, and avoids the complication of hallux varus. LEVEL OF EVIDENCE: Level IV-case series.

Does adjustable-loop femoral cortical suspension loosen after anterior cruciate ligament reconstruction? A retrospective comparative study.

BACKGROUND: Recent biomechanical research has suggested that adjustable-loop graft suspension constructs in anterior cruciate ligament (ACL) reconstruction may loosen after deployment. Our objective was to compare short-term knee stability and graft failure rate between adjustable-loop and fixed-loop femoral cortical suspension in patients undergoing primary ACL reconstruction. METHODS: A consecutive series of 188 patients who underwent primary ACL reconstruction using hamstrings autograft by a single surgeon were divided into two groups; 73 received adjustable-loop (TightRope RT (Arthrex Inc., Naples, FL)) and 115 received fixed-loop (RetroButton (Arthrex Inc., Naples, FL)) femoral cortical suspension. The two groups were compared at six months, one year, and two years postoperatively using KT-1000 arthrometer testing and graft failure rate (revision surgery, grade 2+ Lachman test, any pivot shift, >5mm side-to-side KT-1000 difference). RESULTS: There was no significant difference between the two groups in maximum side-to-side difference in KT-1000 testing at six months (mean 1.51mm (adjustable-loop group) vs. 1.79mm (fixed-loop group), p=0.23), one year (mean 1.44mm vs. 1.64mm, p=0.48), or two years (mean 1.14mm vs. 1.07mm, p=0.90) postoperatively. There was no significant difference between the two groups in rate of graft failure (10% vs. 11%, p=0.71) or timing of graft failure in affected patients (mean 11.4months vs. 13.8months, p=0.51). CONCLUSIONS: We found no significant difference in postoperative knee stability or graft failure rate between adjustable-loop and fixed-loop femoral cortical suspension in patients undergoing primary ACL reconstruction. Our results suggest that adjustable-loop suspension does not clinically loosen after ACL reconstruction. LEVEL OF EVIDENCE: III (retrospective cohort study).

Arthroscopic treatment of anterior ankle impingement: a prospective study of 46 patients with 5-year follow-up.

BACKGROUND: Midterm outcomes after arthroscopic debridement in patients with anterior ankle impingement without osteoarthritis are currently unclear. PURPOSE: To assess the functional and radiological outcomes after arthroscopic treatment of anterior ankle impingement with a minimum 5-year follow-up in patients without osteoarthritis. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: From September 1999 to March 2006, a consecutive series of eligible patients without ankle osteoarthritis and with anterior ankle impingement, who had persistent ankle pain and activity restrictions despite at least 6 months of nonoperative management, underwent standardized arthroscopic debridement and followed uniform postoperative management. Patients were assessed preoperatively and at 6 weeks, 6 months, and 12 months and then at 1-year intervals after surgery until a minimum of 5 years' follow-up had been achieved, with weightbearing ankle dorsiflexion, Foot Functional Index (FFI), and plain radiography including Scranton and McDermott classification (SMC) grade and tibial osteophyte size. RESULTS: A total of 46 patients (42 male, 4 female) were prospectively assessed, with a mean age at surgery of 29 years (range, 16-44 years) and a mean follow-up duration of 5.1 years (range, 5.0-7.5 years). Preoperative ankle radiographs demonstrated a median SMC grade of 2 and a mean tibial osteophyte size of 5.1 mm. At a minimum of 5 years postoperatively, patients demonstrated limited improvement in ankle dorsiflexion (mean, 24.7° [preoperatively] vs 27.0° [final follow-up]; P = .049); however, they demonstrated substantial improvement in the FFI (mean, 20.5 [preoperatively] vs 2.7 [final follow-up]; P < .001). Postoperatively, 84% of patients showed a recurrence of radiological osteophytes, with plain radiographs at final follow-up demonstrating no significant difference in the SMC grade (P = .107) or tibial osteophyte size (P = .212) compared with preoperative imaging. There was no significant effect of patient age, sex, body mass index, or SMC grade at the time of surgery on any of the postoperative outcome measures. CONCLUSION: In this prospective outcome study of 46 patients without osteoarthritis managed arthroscopically for anterior ankle impingement, the functional outcome scores had significantly improved at 5 years postoperatively despite a recurrence of radiographic osteophytes.

Reliability of two-dimensional computed tomography for measuring hip anatomy.

PURPOSE: To evaluate the reliability (inter- and intra-observer variability) of 4 hip anatomies using 2-dimensional pelvic computed tomography (CT). METHODS: Two-dimensional pelvic CT of 10 men and 10 women aged 33 to 89 (mean, 69) years presenting with non-orthopaedic conditions within one month were evaluated by 3 observers. The centre-edge angle of Wiberg, the Sharp angle, the acetabular depth ratio of Murray, and the acetabular anteversion angle of every hip were measured by each observer. After 6 weeks, these measurements were repeated. Reliability was evaluated using intraclass correlation coefficient (ICC), which represents the variation between patients as a percentage of the variation from all 3 sources (patients, inter-observers, and intra-observers). The ICC was classified as poor (<0.20), fair (0.21-0.40), moderate (0.41-0.60), substantial (0.61-0.80), and excellent (0.81-1.00). RESULTS: Reliability was substantial for the Sharp angle (ICC=0.74), the acetabular anteversion angle (ICC=0.69), and the acetabular depth ratio of Murray (ICC=0.62), and was fair for the centre-edge angle of Wiberg (ICC=0.40). CONCLUSION: The Sharp angle, the acetabular anteversion angle, and the acetabular depth ratio of Murray could be reliably measured using 2-dimensional CT. These measurements are appropriate for population-based studies of hip anatomy.

Functional outcomes of reverse shoulder arthroplasty compared with hemiarthroplasty for acute proximal humeral fractures.

BACKGROUND: Complex acute proximal humeral fractures may require prosthetic replacement of the proximal humerus. Reverse shoulder arthroplasty (RSA) has been suggested as an alternative to hemiarthroplasty in the management of such fractures. This study compared the functional outcomes of RSA with hemiarthroplasty in patients with acute proximal humeral fractures. MATERIALS AND METHODS: All patients who underwent RSA or shoulder hemiarthroplasty for acute proximal humeral fractures between January 1, 1999, and December 31, 2010 were identified from The New Zealand Joint Registry. Baseline information, operative characteristics, and postoperative outcomes (Oxford Shoulder Score [OSS] at 6 months and 5 years, revision rate, and mortality rate) were examined and compared between the study groups. RESULTS: During the study period, 55 patients underwent RSA and 313 underwent shoulder hemiarthroplasty for acute proximal humeral fractures. Compared with hemiarthroplasty patients, RSA patients were significantly older (mean age, 79.6 vs 71.9 years; P < .001) and more often women (93% vs 78%, P = .013). The 6-month OSS was 28.1 for RSA and 27.9 for hemiarthroplasty, which was not significantly different (P = .923); however, the RSA group had a significantly better 5-year OSS than the hemiarthroplasty group (41.5 vs 32.3; P = .022). There was no significant difference between the RSA and hemiarthroplasty groups in revision rate per 100 component-years (1.7 vs 1.1; P = .747) or in 1-year mortality (3.5% vs 3.6%; P > .99). CONCLUSIONS: Patients with acute proximal humeral fractures who undergo RSA appear to achieve superior 5-year functional outcomes compared with patients who undergo hemiarthroplasty.

Functional response to total hip arthroplasty in patients with hip dysplasia.

BACKGROUND: While recent studies have shown patients with developmental dysplasia of the hip (DDH) undergoing total hip arthroplasty (THA) to achieve comparable post-operative outcomes to patients with primary osteoarthritis (OA), it is unclear whether DDH patients display better or worse preoperative function than the general THA population. We aimed to compare the preoperative function and functional response to THA of DDH patients with OA patients. METHODS: Through a retrospective review of prospectively collected regional joint registry data, we compared the preoperative, 1-year post-operative and post-operative change in disease-specific (Oxford hip score (OHS), Western Ontario and MacMaster Universities Osteoarthritis Index (WOMAC)) and general health (short form 12 physical health (SF-12 PH), mental health (SF-12 MH) scores) functional scores of 33 DDH patients and 968 OA patients undergoing primary THA. RESULTS: The DDH group displayed substantially worse preoperative function than the OA group (mean OHS 11.2 versus 16.3 (P = 0.001), WOMAC 72.7 versus 60.6 (P < 0.001), SF-12 PH 27.8 versus 28.9 (P = 0.433), SF-12 MH 35.5 versus 44.7 (P < 0.001)). Functional response to THA at 1 year was significantly better in the DDH group than the OA group (mean score improvements: OHS 31.1 versus 24.6 (P < 0.001), WOMAC 61.4 versus 47.2 (P < 0.001), SF-12 PH 22.3 versus 16.5 (P = 0.003), SF-12 MH 18.4 versus 8.4 (P < 0.001)). CONCLUSION: Despite experiencing significantly worse preoperative function, DDH patients undergoing THA demonstrated superior early functional response to OA patients, with substantially greater improvements observed in all disease-specific and general health outcome measures.

Early results of total hip arthroplasty in patients with slipped upper femoral epiphysis compared with patients with osteoarthritis.

We have investigated the results of primary total hip arthroplasty (THA) performed in patients with slipped upper femoral epiphysis (SUFE). Through the New Zealand Joint Registry, we identified all patients with SUFE undergoing primary THA (n = 117) and all patients with primary osteoarthritis (OA) undergoing primary THA (n = 40 589) between January 1, 1999, and December 31, 2008. Baseline information, operative characteristics, and postoperative outcomes were analyzed and compared between the SUFE and the OA groups. There was no significant difference in postoperative Oxford Hip Score or revision rate between the 2 groups. Our results support THA as a successful surgical option in the management of degenerative arthritis in SUFE, with comparable functional outcomes and revision rates to THA performed for primary OA.

Early results of total hip arthroplasty in patients with developmental dysplasia of the hip compared with patients with osteoarthritis.

We have investigated the results of primary total hip arthroplasty (THA) performed in patients with developmental dysplasia of the hip (DDH). Through the New Zealand Joint Registry, we identified all patients with DDH undergoing primary THA (n = 1205) and all patients with primary osteoarthritis (OA) undergoing primary THA (n = 40 589) between January 1, 1999, and December 31, 2008. Postoperative outcomes, baseline information, and operative characteristics were analyzed and compared between the DDH and the OA groups. There was no significant difference in Oxford Hip Score or revision rate between the 2 groups. Our results support THA as a successful surgical option in the management of degenerative arthritis in DDH, with comparable functional outcomes and revision rates to THA performed for primary OA.

The paediatric Bohler's angle and crucial angle of Gissane: a case series.

BACKGROUND: Bohler's angle and the crucial angle of Gissane can be used to assess calcaneal fractures. While the normal adult values of these angles are widely known, the normal paediatric values have not yet been established. Our aim is to investigate Bohler's angle and the crucial angle of Gissane in a paediatric population and establish normal paediatric reference values. METHOD: We measured Bohler's angle and the crucial angle of Gissane using normal plain ankle radiographs of 763 patients from birth to 14 years of age completed over a five year period from July 2003 to June 2008. RESULTS: In our paediatric study group, the mean Bohler's angle was 35.2 degrees and the mean crucial angle of Gissane was 111.3 degrees. In an adult comparison group, the mean Bohler's angle was 39.2 degrees and the mean crucial angle of Gissane was 113.8 degrees. The differences in Bohler's angle and the crucial angle of Gissane between these two groups were statistically significant. CONCLUSION: We have presented the normal values of Bohler's angle and the crucial angle of Gissane in a paediatric population. These values may provide a useful comparison to assist with the management of the paediatric calcaneal fracture.

Hybrid management of an unusual presentation of acute ischaemic ventricular septal defect.

Acute ischaemic ventricular septal defect (VSD) is a severe complication of acute myocardial infarction. We present the unusual case of a 66-year-old man with a haemodynamically stable acute posterior basal ischemic VSD, who was managed successfully with hybrid primary coronary artery bypass grafting followed by delayed percutaneous VSD closure, with an excellent intermediate-term outcome. We feel this management strategy should be considered in selected patients with acute posterior VSDs and stable clinical status.

Large osteochondral fractures of the lateral femoral condyle in the adolescent: outcome of bioabsorbable pin fixation.

BACKGROUND: Large osteochondral fractures of the lateral femoral condyle of the knee in adolescent patients can be diagnostically and therapeutically challenging. Historically, management has involved removal of the fragment, leaving a large area of bone devoid of articular cartilage on the weight-bearing surface of the lateral femoral condyle. This study assessed open reduction and internal fixation of the osteochondral fragments with use of multiple polyglycolic acid rods. METHODS: Eight patients, between twelve and fifteen years old, with a large (>4 cm(2)) osteochondral fracture of the lateral femoral condyle were treated with open reduction and internal fixation with use of multiple polyglycolic acid rods. Each patient was evaluated at more than five years (a mean of nine years) after the index procedure with a clinical assessment, during which the knee was scored according to the International Knee Documentation Committee and Cincinnati knee rating systems, plain radiographs were made, and magnetic resonance imaging scans were acquired. RESULTS: The majority of patients scored well on both knee rating systems, with no poor results. Five of the eight patients had normal findings on knee radiographs, and three had radiographs that showed minor changes. Magnetic resonance imaging scans of all patients demonstrated intact articular cartilage in the lateral compartment with no area of full-thickness articular cartilage loss. No evidence of articular cartilage thinning was seen in two knees; a small area of <2 cm(2) of cartilage thinning, in four; a moderate area of 2.7 cm(2) of cartilage thinning, in one; and a large area of 11.2 cm(2) of abnormal cartilage signal, in one knee. CONCLUSIONS: Osteochondral fracture of the lateral femoral condyle is an injury to which adolescents with ligamentous laxity of the knee are prone. Our results show that internal fixation of these osteochondral fragments with bioabsorbable implants is possible and is a worthwhile option.