Long-term follow-up of DDH patients who underwent open reduction without a postoperative cast.

We present the results - assessed after bony maturation - of an early anterior approach open reduction performed using our modified technique on 49 hips at 6-24 months of age. We start postoperative functional treatment using a Pavlik harness and an abduction splint, abandoning plaster cast. Secondary surgeries were performed in 11 hips (22.4%) at 3-7 years of age. Our results were 'satisfactory' (Severin Grade I, II) in 96% of the cases. According to the joints' Severin Grade, the total hip replacement probability at an early age is 8.16% in our series. Our principles and practice, introduced in 1980 in terms of secondary surgeries, are in total harmony with the recent literature.

Assessment of thrombotic risk factors predisposing to thromboembolic complications in prosthetic orthopedic surgery.

BACKGROUND: Congenital thrombophilia is responsible for thromboembolic complications despite prolonged low-molecular-weight heparin (LMWH) prophylaxis following hip and knee endoprosthesis surgery. METHODS: A series of 86 patients with hip or knee endoprosthesis surgery were assessed 1 year after operation. Antithrombin III, protein C, and protein S were determined, and the activated protein C sensitivity ratio was measured. We screened for the presence of lupus anticoagulant, factor V Leiden mutation, and polymorphism of prothrombin G20210A. The lower limb venous circulation was monitored by color Doppler ultrasonography. Pulmonary embolism (PE) was diagnosed using ventilation and perfusion scintigraphy. RESULTS: In all, 33 patients had thromboembolic complications, 18 with thrombophilia (7 with combined form). Of the 53 patients without complications 12 had thrombophilia (2 with combined form). The differences were statistically significant. The risk score, the prevalence of FV Leiden and prothrombin G20210A mutations, and lupus anticoagulant were also significantly higher in the symptomatic group. Deep vein thrombosis (DVT) developed preoperatively in 15 patients; DVT and PE in 4 patients; thrombophilia was diagnosed in 53% and 75% of these cases. In all, 17 patients had postoperative thromboembolic complications: DVT developed in nine and PE in one patient (all with thrombophilia); DVT + PE developed in seven patients (all but one had thrombophilia). CONCLUSIONS: Significant differences were found in the incidence (P < or = 0.01) of thrombophilia and the risk score (P < or = 0.02) between symptomatic and asymptomatic patients. We recommend preoperative thrombophilia screening for patients with a history or familial prevalence of thromboembolism and/or with a high risk score (> or =15). In cases of thrombophilia, the form and duration of anticoagulant treatment must be decided individually.

Histological changes in the symptomatic mediopatellar plica.

One of the causes of anterior knee pain may be symptomatic mediopatellar plica. The pain is usually attributed to the mechanical damage caused by the plica inside the joint, or, more precisely, to the synovitis induced as a result. Recent observations seem to suggest, however, that the pain is, in addition, likely to be engendered by an increased number of nerve-elements present in the substance of the plica. The present study used up-to-date histochemical methods to reveal in the symptomatic mediopatellar plicae nerve-elements that may be made responsible for the pain. Semi-quantitative methods were used to establish the number of nerve-elements in the tissue samples obtained from 21 symptomatic mediopatellar plicae (Group 'A'), exposing them to view with the aid of synaptophysin and neurofilament serum, coupled with routine light microscope as well as polarising microscope examinations following H&E and van Gieson staining. Tissue samples taken from the asymptomatic mediopatellar plica of 11 patients served as control (Group 'B'). A significantly larger number of nerve-elements were found in the substance of the plicae of Group 'A' 6.9 (S.D.+/-2.9) than in Group 'B' 3 (S.D.+/-1.2). Within Group 'A', more nerve-elements were revealed in trauma-related case histories than in those with no recollections of trauma (an average of 9.6 vs. 5.2, respectively). Similarly, the reduction of pain achieved by surgery was greater in the trauma-related group than in the non-traumatic one (3.0 vs. 1.8, respectively). Relying on our observations, we claim that the painfulness of the knee joint plicae is in all probability also attributable to the fact that their tissue substance contains an increased number of nerve-elements. A major trauma in a particular case history contributes, in all likelihood, to an increase in the number of nerve-elements, but further examinations are required to clarify the pathomechanism involved.

Capsular neuronal elements and their relation to pain reduction and functional improvement following total hip replacement.

We studied changes of pain intensity and functional impairment in 22 patients with osteoarthrosis undergoing total hip replacement. Using a visual analogue scale, the mean scores for pain and disability before surgery were 71.7 and 70.9 respectively. Both scores showed gradual improvement during a 1-year follow-up period, with more than 90% of the total improvement occurring within the first 3 months. After 1 year, the scores for pain and disability were 11.9 and 4.1 respectively. The hip joint capsule was studied using immunohistochemistry to detect neurofilaments. Neurofilament immunoreactivity was observed in 16/22 cases and was correlated with pain and disability scores. However, there were no correlations between pre- and postoperative pain scores, the score changes, and the quantity of capsular neurofilaments. Thus, other factors than capsular neurofilaments influence the scores of pain and disability in osteoarthritis.

Technique of synovial biopsy of metacarpophalangeal joints using the needle arthroscope.

We demonstrate the technique, advantages, and disadvantages of metacarpophalangeal joint examination with needle arthroscope. We evaluated our experience from biopsies of 10 metacarpophalangeal joints of eight rheumatoid women aged 41-45 years. The procedures were performed using a 1-mm needle arthroscope. The synovium biopsy was taken with a microforceps. The procedure was performed under local anesthesia. The tight tension of the joint and traction of the finger is necessary for good visualization, but despite this visibility can be difficult. Needle biopsy is a useful method for the early diagnosis of rheumatoid arthritis.