Usefulness of MR Arthrography of the Hip with and without leg Traction in Detection of Intra-articular Bodies.

RATIONALE AND OBJECTIVE: Although intra-articular bodies are a classic indication for MR arthrography and surgical removal, diagnostic studies are currently sparse. To assess the diagnostic performance of MR arthrography with and without leg traction in detection of intra-articular bodies in the hip joint. MATERIAL AND METHODS: The institutional hip arthroscopy data base (2009-2016: 631 hips) was retrospectively reviewed. Inclusion criteria were hips with and without intra-articular bodies and direct MR arthrography performed with and without leg traction. Twenty-one hips with intra-articular bodies constituted the "disease-positive" group. Seventy-nine randomly selected hips without intra-articular bodies constituted the "disease-negative" group. Images were reviewed independently for presence of intra-articular bodies by two blinded readers. Overall diagnosis and location of intra-articular bodies was recorded (peripheral or central). Arthroscopy served as goldstandard for diagnosis and location of intra-articular bodies. Diagnostic performance and kappa statistics of traction MR arthrography with and without traction were calculated. RESULTS: For both readers sensitivity/specificity of traction MR arthrography was 86%-95% respectively 90%-91% for overall diagnosis of intra-articular bodies and was 81%-86% respectively 90%-92%for MR arthrogrpahy without traction. For central intra-articular bodies sensitivity was higher for both readers with traction (79%-89%) than without traction (74% each). CONCLUSION: MR arthrography with and without traction of the hip is highly accurate in identifying central and peripheral intra-articular bodies. Application of traction was further useful for visualization of centrally located intra-articular bodies.

[Experience with hybrid hip prosthesis walter-motorlet/poldi.]. / Zkusenosti s hybridní endoprotézou kycelního kloubu Walter-Motorlet/Poldi.

In 1987-1992 at the Orthopaedic Clinic IPVZ 108 hybrid endoprostheses of the hip joint, type Walter-Motorlet/Poldi were implanted (non-cemented socket Walter-Motorlet, cemented shank Poldi). The authors submit evaluations of 75 endoprotheses made 2-7 years after surgery (mean follow-up period 3 and a half years). The mean age of the patients was 49 years (range 39-62 years), the most frequent preoperative diagnosis was secondary postdysplastic coxarthrosis (52%), other diagnoses were primary coxarthrosis (24%), idiopathic necrosis of the head of the femur (20%) and posttraumatic coxarthrosis (4%). Genneral evaluation according to Harris revealed excellent results in 6% of the patients and unsatisfactory results in 1% of the patients. Subjective evaluation of the painfulness revealed a painless hip joint in 56%, mild occasional pain was reported by 30% of the patients and mild pain which can be mitigated by aspirin was recorded in 14% of the patients. The prosthesis became loosened in one patient bilaterally - it was a case of poor indication of a total endoprosthesis of the hip joint in a patient with a metabolic disorder and osteopathy. The general incidence of paraarticular ossifications was 17%. Comparison of the results with a similar group of patients with non-cemented total endoprostheses Walter-Motorlet, the results obtained with hybrid total endoprostheses are better from the subjective and objective aspect. Key words: hybrid total endoprosthesis of the hip joint, aseptic loosening.