Periprosthetic fractures of the distal femur following total knee arthroplasty: even very distal fractures can be successfully treated using internal fixation.

PURPOSE: We treat periprosthetic fracture of the distal femur above total knee arthroplasty using single or double plating and the minimally invasive plate osteosynthesis (MIPO) technique. Here, we report the results of using this operative treatment and our analysis of whether very distally extended fractures can also be successfully treated using internal fixation. METHODS: We retrospectively reviewed 32 periprosthetic distal femoral fractures. Mean patient age was 73 years and mean follow-up period 25 months. There were 11 (34.4 %) Su type I/II and 21 (65.6 %) type III fractures. All Su type I/II fractures were treated by single plating, whereas 14 of 21 (66.7 %) type III fractures were treated using double plating and the MIPO technique. We defined bony union as the primary endpoint of this study based on callus formation across the fracture site at two or more cortices (1 medial and 1 other) on 3D computed tomography (CT). RESULTS: Bony union was confirmed in 30 cases (93.8 %) after a mean time to union of 3.7 (range, 3-7) months. Two patients showed nonunion (6.2 %), and one demonstrated delayed union (3.1 %), none of whom complied with our rehabilitation protocol. There was one instance of nonunion among both Su types I/II and III fractures; however, this difference was not significant (p = 0.577). CONCLUSIONS: Periprosthetic fractures of the distal femur can be successfully healed using internal fixation, either the single- or double-plate MIPO technique, even for very distally extended fractures.

Why do subchondral cysts occur at the medial aspect of the femoral head in hip dysplasia?

INTRODUCTION: Osteoarthritis in dysplastic hips should develop from the lateral side of the acetabulum and the femoral head just below. However, the existence of subchondral cysts located more on the medial side contradicts the weight-loading theory. The aim of this study was to confirm the presence of medial cysts at the femoral head and to investigate the relationship between medial cysts and injuries of the ligamentum teres in hip dysplasia. METHODS: A retrospective analysis was conducted on 257 cases of hip dysplasia. All patients had x-rays and 3-dimensional computed tomographies (3D CT) preoperatively and 123 patients had magnetic resonance arthrographies. A comparison was performed between cases with and without medial cysts according to the severity of damage to the ligamentum teres, the presence of bony spurs around the fovea capitis, and the Tönnis grade. RESULTS: Medial subchondral cysts around the fovea capitis were found in 100 cases. Mild osteoarthritis (Tönnis grade 0 or 1) was present in 89% of cases in the medial cyst group. A significant difference between the groups was observed in the incidence of bony spurs around the fovea capitis (p < 0.05) and injuries of the ligamentum teres (p < 0.05). CONCLUSIONS: The formation of subchondral cysts at the medial femoral head in hip dysplasia may be related to damage in the ligamentum teres. Considering that subchondral cysts develop in early osteoarthritis, the progression of arthritis in hip dysplasia appears to correlate with damage to the ligamentum teres, as well as compressive pressure on the joint.

Reliability of the acetabular reconstruction technique using autogenous bone graft from resected femoral head in hip dysplasia: Influence of the change of hip joint center on clinical outcome.

INTRODUCTION: The previous studies have not reached on consensus as to the outcome of acetabular reconstruction with autogenous bone graft for dysplastic hips, especially in severe cases such as Crowe type IV. The current study aimed to determine the survivorship of the arthroplasty and the grafts as well as the change of hip joint center averagely 9.8 years (range, 5-19) after cementless total hip arthroplasty. MATERIALS AND METHODS: We reviewed 52 cases including 19 cases of complete hip dislocation of which acetabular defects were augmented with autogenous bone grafts taken from the resected femoral heads. For radiographic evaluation, in addition to checking failures of THA, acetabular coverages of the grafts as well as lateral center-edge angles were measured and compared between two time points, immediately postoperative and the final evaluations. Those outcomes were also analyzed according to the degree of hip dysplasia, grouping the subjects by Crowe classification. Translations of the reconstructed hip joint center after THA were measured and checked if they affected clinical outcomes or caused any complications. To assess clinically, Harris hip score and visualized analogue pain scale were reviewed. RESULTS: Mean coverage ratio of the sockets with the grafts was 28.4% immediately after the surgery (range, 11.1%-65.0%) and 27.2% at the final follow-up (range, 11.1%-63.6%). When comparing high grade dysplasia (Crowe type III, IV) to low grade dysplasia (Crowe type I, II), there was no significant difference of the above outcomes (p = 0.476). As to the location of hip joint center, 14 outliers were located distally within the normal horizontal range especially in cases with Crowe type IV. Those outliers showed no difference on clinical outcome. The mean HHS was 52.2 (range, 19-87) and VAS was 7.2 (range, 5-9) preoperatively, each of which was improved to 92.9 (range, 63-100) and 1.4 (range, 0-4) postoperatively. No failures were experienced during the study period. CONCLUSIONS: Acetabular augmentation using autogenous bone graft from the resected femoral head is found to be a successful method for dysplastic hip, even in severe cases such as Crowe type IV, showing favorable results in more than 8 years. When inevitable, a degree of compromise on hip joint center can be needed in dealing with severe hip dysplasia.

Aspergillus Septic Arthritis of the Hip in an Immunocompetent Middle-aged Female with Undiagnosed Recurrent Pulmonary Aspergillosis.

We present a case of Aspergillus septic hip arthritis in an immunocompetent patient with undiagnosed recurrent pulmonary aspergillosis who underwent arthroscopic surgery. Biopsy specimens of synovium revealed fungal hyphae, confirming Aspergillus infection. Aspergillus septic hip arthritis can occur in immunocompetent patients, and arthroscopy can be a noninvasive surgical option in these cases.

The effects of lignan-riched extract of Shisandra chinensis on amyloid-ß-induced cognitive impairment and neurotoxicity in the cortex and hippocampus of mouse.

ETHNOPHARMACOLOGICAL RELEVANCE: The fruits of Schisandra chinensis (Trucz.) Baill. (Schisandraceae) which have been used as a tonic especially for kidney yin deficiency in Chinese traditional medicine are recently receiving attention for its preventive activity on age-related neurodegenerative diseases. A variety of studies demonstrated the cognitive-enhancing effects of Schisandra chinensis through animal tests and also in clinical trials. AIM OF STUDY: In this study, we attempted to investigate the effects of the lignan-riched extract of Schisandra chinensis fruits (ESP-806) on neurotoxicity and memory impairment induced by Aß1-42 injection in mice. MATERIALS AND METHODS: The fruits of Schisandra chinensis were extracted with the mixture of n-hexane:ethanol (9:1), which is riched with bioactive dibenzocyclooctadiene lignans, schizandrin, gomisin N, wuweigisu C. After oral treatment of ESP-806 (100 mg/kg body weight) followed by injection of Aß1-42 (2 µg/mouse, i.c.v.), novel object recognition and passive avoidance tests were evaluated. To verify the cognition enhancing effects of ESP-806, we examined the effects of ESP-806 on the activities of ß-secretase and acetylcholinesterase, and the contents of Aß and the reduced glutathione within the cortex and hippocampus of Aß-injected mice. RESULTS: Oral treatment of ESP-806 (100 mg/kg body weight) significantly attenuated Aß1-42-induced memory impairment evaluated by behavioral tests. Furthermore, the treatment of ESP-806 attenuated the elevation of ß-secretase activity accompanying the reduced level of Aß1-42 in the cortex and hippocampus of the brain. ESP-806 also significantly inhibited the acetylcholinesterase activity in the hippocampus and increased the content of the reduced glutathione in the cortex and hippocampus of mouse brain. CONCLUSIONS: These data suggested that the extract of Schisandra chinensis fruits riched with dibenzocyclooctadiene lignans may be useful in the prevention and treatment of Alzheimer's disease.