Bipolar hemiarthroplasty versus total hip arthroplasty in allograft-prosthesis composite reconstruction of the proximal femur following primary bone tumour resection.

AIMS: The consensus is that bipolar hemiarthroplasty (BHA) in allograft-prosthesis composite (APC) reconstruction of the proximal femur following primary tumour resection provides more stability than total hip arthroplasty (THA). However, no comparative study has been performed. In this study, we have compared the outcome and complication rates of these two methods. METHODS: In a retrospective study, 57 patients who underwent APC reconstruction of proximal femur following the primary tumour resection, either using BHA (29) or THA (28), were included. Functional outcome was assessed using the Musculoskeletal Tumour Society (MSTS) scoring system and Harris Hip Score (HHS). Postoperative complications of the two techniques were also compared. RESULTS: The mean follow-up of the patients was 8.3 years (standard deviation (SD) 5.5) in the BHA and 6.9 years (SD 4.7) in the THA group. The mean HHS was 65 (SD 16.6) in the BHA group and 88 (SD 11.9) in the THA group (p = 0.036). The mean MSTS score of the patients was 73.3% (SD 16.1%) in the BHA and 86.7% (SD 12.2%) in the THA group (p = 0.041). Limping was recorded in 19 patients (65.5%) of the BHA group and five patients (17.8%) of the THA group (p < 0.001). Dislocation occurred in three patients (10.3%) of the BHA group and two patients (7.1%) of the THA group. CONCLUSION: While the dislocation rate was not higher in THA than with BHA, the functional outcome was significantly superior. Based on our results, we recommend THA in APC reconstruction of the proximal femur. Cite this article: Bone Joint J 2020;102-B(4):524-529.

Benign bone tumours of tibial tuberosity clinically mimicking Osgood-Schlatter disease: a case series.

INTRODUCTION: Osgood-Schlatter disease (OSD) is a traction apophysitis of the tibial tubercle and a common cause of anterior knee pain in growing adolescents. A variety of benign neoplasms can also cause bony prominence over the tibial tubercle in adolescents that might clinically imitate OSD. Therefore, the differential diagnosis of tumours mimicking OSD is critical and considered the primary goal of this study. METHODS: Eleven patients who were referred to our orthopaedic oncology department with clinical suspicions of OSD and obscure radiographic presentation were identified. The final diagnosis was OSD in three cases. The demographic, clinical, and radiologic characteristics of the remaining eight patients in whom a tumour mimicked OSD were evaluated. The diagnosis was confirmed by pathologic examination. RESULTS: The final diagnosis was periosteal chondroma in four cases, osteochondroma in three cases, and dysplasia epiphysealis hemimelica (DEH) in one case. The average age of the patients was 10.5 ± 3.1 years. In the majority of patients (62.5%), the lesion was painless. The mean size of the bump was 6.5 ± 1.2 cm2. In patients with a painful knee, the pain was constant and activity-independent. At history taking, the pain and bump size were progressive. CONCLUSION: Lack of pain, progressive pain and bump, activity-independent pain, a bump size larger than 5 cm2 at presentation, and age fewer than ten years could be considered in favour of tumours and against OSD.

Short to Mid-term Outcomes of Single-stage Reconstruction of Multiligament Knee Injury.

BACKGROUND: Multiligament knee injury (MLKI) is a complex orthopedic injury leading to the tear of at least two of the major knee ligaments. However, there is no consensus on the optimal management of this debilitating condition. Regarding this, the present study was performed to evaluate the outcomes of single-stage multiligament reconstruction surgery in patients with MLKI. METHODS: This retrospective study was conducted on 41 consecutive MLKI patients who underwent surgical reconstruction. Objective evaluation of the outcome included active extension and flexion. Furthermore, the subjective evaluation of the outcome was accomplished using the Lysholm scoring scale and International Knee Documentation Committee (IKDC) form in Persian. Postoperative complications were also recorded for all patients. RESULTS: The mean age of the participants was 31.95±7.82 years. In addition, the mean follow-up period and the mean time interval between the injury and surgery were recorded as 36.9±17.8 and 11.5±8.9 months, respectively. The mean Lysholm and IKDC scores were obtained as 86.9±11.5 and 70±18.7, respectively. The mean Lysholm and IKDC scores were not statistically different between the patients who underwent surgery less than 6 months after the injury and those subjected to reconstruction 6 months postinjury (P=0.07 and P=0.3, respectively). Seven patients showed postoperative restricted range of motion, which was resolved with physiotherapy. The only surgical complication was popliteal artery injury. CONCLUSION: As the findings indicated, the single-stage reconstruction of MLKI provided an acceptable outcome. However, several aspects of this reconstruction, such as the timing of the surgery, still remain to be resolved in future investigations.

Denosumab in Patients with Giant Cell Tumor and Its Recurrence: A Systematic Review.

Recent studies suggest that Denosumab reduces tumor size, therefore, makes the surgery easier with lower morbidity. However, some studies have reported several complications for this drug. So, this systematic review was performed to determine the effectiveness and safety of Denosumab in reducing bone destructions activity of giant cell tumor and skeletal-related events (SRE) in affected patients with giant cell tumor of bone (GCTB) and its recurrence. We explored studies in PubMed, and Cochrane Library. For this purpose, articles of various levels were retrieved until October 22, 2016. Two reviewers assessed the articles independently based on predefined criteria to extract the relevant data. Primary outcomes associated with skeletal-related event, overall survival, and secondary outcomes such as pain, quality of life and adverse events were evaluated and analyzed. The total population of this meta-analysis consisted of 686 patients. Of this population, 55% had primary GCTB and 45% had giant cell tumor recurrence, with 2% experiencing secondary recurrence. The results showed the effectiveness of Denosumab in reducing the tumor size due to inhibiting the Osteoclastogenesis. Denosumab didnot show any effect on reducing tumor recurrence, but, in cases where complete tumor surgery is not possible and tumor residuals may remain, Denosumab can be helpful. Also, the clinicians should consider the risk benefit of Denosumab.

Locking plate and fibular strut-graft augmentation in the reconstruction of unicameral bone cyst of proximal femur in the paediatric population.

PURPOSE: Several therapeutic strategies have been used for managing unicameral bone cyst (UBC) of the proximal femur. However, there is insufficient evidence to support one treatment over another, and the optimal treatment is controversial. This study aims at describing our experience with surgical reconstruction of paediatric UBCs of the proximal femur using a proximal locking plate and fibular strut allograft. METHODS: In total, 14 consecutive paediatric patients with Dormans types IB (four cases) and IIB (10 cases) UBC were assessed. Mean patient age was 8.6 ± 2.3 years, and mean follow-up period was 41.7 ± 29.8 months. Six patients (42.8%) were referred with a pathologic fracture. Clinical/radiological outcome and complication rates were evaluated at the final follow-up session. RESULTS: No cysts were Capanna's class III (recurrence) or IV (no response). Complete healing (Capanna's class I) was seen in ten cysts, while four other cysts healed with residual radiolucent areas (Capanna's class II). Mean healing period was 14.1 ± 5.1 (9-24 months). One patient had superficial infection, one heterotopic ossification, and one mild coxa vara, and mean Musculoskeletal Tumor Society (MSTS) score was 99.5%. CONCLUSION: According to our results, locking plate and fibular strut graft in Dormans classification types IB and IIB results in a favorable outcome in managing UBC of the proximal femur in the paediatric population.

Surgical Outcome of Reduction and Instrumented Fusion in Lumbar Degenerative Spondylolisthesis.

BACKGROUND: Lumbar degenerative spondylolisthesis (LDS) is a degenerative slippage of the lumbar vertebrae. We aimed to evaluate the surgical outcome of degenerative spondylolisthesis with neural decompression, pedicular screw fixation, reduction, and posterolateral fusion. METHODS: This before-after study was carried out on 45 patients (37 female and 8 male) with LDS operated from August 2008 to January 2011. The patients' pain and disability were assessed by visual analogue scale (VAS) and Oswestry disability index (ODI) questionnaire. In surgery, we applied distraction force to facilitate slip reduction. All the intra- and postoperative complications were recorded. The paired t-test and Pearson correlation coefficient were used for statistical analysis. RESULTS: The mean age of patients and mean follow-up period were 58.3±3.5 years and 31.2±4.8 months, respectively. The mean slip correction rate was 52.2% with a mean correction loss of 4.8%. Preoperative VAS and ODI improved from 8.8 and 71.6 to postoperative 2.1 and 28.7, respectively. Clinical improvement was more prominent in more reduced patients, but Pearson coefficient could not find a significant correlation. CONCLUSION: Although spinal decompression with fusion and posterior instrumentation in surgical treatment of the patients with LDS result in satisfactory outcome, vertebral reduction cannot significantly enhance the clinical improvement.

Posterior hip fracture -dislocation associated with ipsilateral intertrochantric fracture; a rare case report.

Hip dislocation occurs when the femur does not break and the force is transmitted towards the hip joint leading to a posterior dislocation of the femoral head with or without posterior acetabular fracture. We present the case of a 26 year old patient involved in motor vehicle accident. Clinical and imaging (radiography, CT) examination revealed an intertrochanteric fracture associated with ipsilateral posterior hip dislocation and posterior acetabular wall fracture simultaneously with epsilateraal tibial and fibular fractures. Such associations is very rare and can be explained by an extremely powerful force generated the three lesions simultaneously. This case is important not only because of its extreme rarity but also because of treatment method.

A modified triple pelvic osteotomy for the treatment of hip hypoplasia.

BACKGROUND: The prevalence of hip dysplasia is 1 in 1000. Several pelvic osteotomy methods have been developed to prevent early osteoarthritis, such as triple osteotomy. In this study we are going to introduce our new technique that was done on 4 patients with favorable short-term results. METHODS: Four patients underwent triple osteotomy and fixation using a reconstruction plate and early weight bearing was started. RESULTS: The Harris Hip Score, limb length, center-edge angle, and acetabular inclination showed improvement. CONCLUSION: This modified technique is suggested for corrective surgery on adult dysplastic hips.

Trans-scaphoid perilunate fracture-dislocation and isolated perilunate dislocations; surgical versus non surgical treatment.

BACKGROUND: Trans-scaphoid perilunate fracture-dislocation and perilunate dislocations are among uncommon injuries, most commonly seen in young patients due to high energy trauma. The treatment can be achieved either surgically by open reduction and internal fixation or closed reduction and casting. METHODS: To compare surgical versus non-operative results of treatment after trans-scaphoid perilunate fracture-dislocation and isolated perilunate dislocation, we collected the data of 34 patients who were treated at least 5 years before our study, twenty of whom were treated surgically and fourteen were treated non-surgically. We compared clinical and radiological findings in two groups. Functional outcome was assessed by Mayo wrist score for each patient. RESULTS: The surgically treated patients had much higher Mayo wrist scores, 85 and 87.78 for perilunate dislocation and trans-scaphoid perilunate fracture-dislocation respectively, while 71 and 71.11 in non-surgically treated group respectively. Wrist range of motion was also more favorable in operative group (55 degrees flexion - 54 degrees extension for trans-scaphoid perilunate fracture-dislocation and 50 degrees flexion, 51 degrees extension for perilunate dislocations)than non-operative group(49 degrees flexion, 48 extension for trans-scaphoid fracture-dislocations and 48 degrees flexion, 50 degrees extension for perilunate dislocation). The radiographic changes showed arthritic changes but those changes did not significantly interfered with functional outcome and wrist scores. CONCLUSION: Regarding our better clinical results after early open reduction and internal fixation for these injuries, we can suggest the operative treatment of these complicated hand injuries.

The relationship between morphology of lumbar disc herniation and MRI changes in adjacent vertebral bodies.

BACKGROUND: Intervertebral disc herniation has two common types, extrusion and protrusion, which may affect the adjacent vertebrae.In addition, it is associated with significant signal changes in T1 MRI (short TR/TE) and T2 MRI (long TR/TE). METHODS: The present study is a cross-sectional analytic one, in which sampling was performed retrospectively. Cases were randomly selected from the patients undergoing discectomy in our department in a one-year period. Before surgery, MRI images, T1-weighted and T2-weighted sagittal cuts were interpreted by an expert radiologist. Signal intensity of the upper and the lower adjacent vertebra and the operated herniated disc were compared with the normal discs, both in T1-weighted and T2-weighted. Changes in signal intensity were recorded in qualitative variables. Statistical analysis was then performed between two groups. RESULTS: In the present study, we have evaluated 170 patients undergoing lumbar disc herniation surgery, which included 97 protruded and 86 extruded discs. The patients' age ranged from 21 to 78 years old, with an average of 43.03 ±11.4 years. Evaluating the type of discopathy with the presence of signal changes (hypo or hyper signal changes) demonstrated more signal changes in upper adjacent vertebrae in T2-weighted MRI (45.3%). However, patients with protruded discs showed less changes (30.9%). It showed that the difference was statistically significant (P<0.05). CONCLUSION: Extruded discs are associated with increased signal in T1-weighted MRI (short TR/TE) in the upper adjacent vertebrae. Signal changes in T2-weighted MRI (long TR/TE) in upper adjacent vertebrae are significantly more common in extruded discs, in comparison with protruded discs.