Methylene blue inhibits angiogenesis in chick chorioallontoic membrane through a nitric oxide-independent mechanism.

Angiogenesis is the process of generating new blood vessels from preexisting vessels and is considered essential in many pathological conditions. The purpose of the present study was to evaluate the effect of methylene blue in chick chorioallantoic membrane angiogenesis model in vivo. In this well characterized model, methylene blue inhibited angiogenesis in a concentration-dependent manner. In addition, when methylene blue was combined with sodium nitroprusside, a spontaneous generator of nitric oxide, an inhibition of angiogenesis was evident which was comparable with that observed by the application of methylene blue alone. Sodium nitroprusside, alone, caused a significant inhibition in basal angiogenesis. These results provide evidence that methylene blue inhibits angiogenesis independently of nitric oxide pathway and suggest that methylene blue may be useful for treating angiogenesis-dependent human diseases.

Long-term behaviour of the Charnley offset-bore acetabular cup.

We report the long-term radiological results of 58 total hip arthroplasties (THA) using the Charnley offset-bore acetabular socket. Wear was measured at four sites and radiolucent lines and possible migration were recorded. Four cups were retrieved at revision and were examined using light microscopy, SEM and X-ray microanalysis. At a mean follow-up of seven years the mean wear in the DeLee and Charnley zone I was 0.4 mm and in zone II 0.26 mm. The wear rate was 0.06 and 0.04 mm/year, respectively. Progression of radiolucent lines was seen in five cases (8.6%). Three sockets (5.2%) were revised because of aseptic migration at a mean follow-up of 9.8 years and one socket for infection at two years. The offset-bore acetabular cup had excellent wear behaviour and a low migration and revision rate. We recommend that it should be considered in THA since the use of small cups is increasing, particularly in revision cases.

Charnley low friction arthroplasty in young patients with osteoarthritis. A 12- to 24-year clinical and radiographic followup study of 84 cases.

The long term outcome of 84 Charnley low friction arthroplasties performed between January 1973 and December 1984 on 69 patients (84 hips) with osteoarthritis was assessed. The patients were 55 years old or younger (mean, 46 years) at the time of surgery. The probability of survival was 89.8% (range, 85.9%-93.7%) after 10 years with 69 hips at risk and 73.3% (range, 65.5%-81.1%) after 18 years with 33.5 hips at risk. Of the 84 hips in the study, 24 (28.6%) failed. Of the hips that survived, clinical results were good and excellent with Charnley scores of four or more for pain and function in all hips. Of the hips that survived, 93.3% achieved good or excellent results for movement.

Congenital hip disease in adults. Classification of acetabular deficiencies and operative treatment with acetabuloplasty combined with total hip arthroplasty.

We describe three distinct types of congenital hip disease in adults. The first type is dysplasia, in which the femoral head is contained within the original true acetabulum. The second type is low dislocation, in which the femoral head articulates with a false acetabulum, the inferior lip of which contacts or overlaps the superior lip of the true acetabulum, giving the appearance of two overlapping acetabula. The third type is high dislocation, in which the femoral head has migrated superoposteriorly and there is no contact between the true and the false acetabulum. We describe and classify the acetabular abnormalities and deficiencies found with these three types. If the anterior, posterior, and superior aspects of the acetabular component cannot be covered during a total hip arthroplasty because of a deficient acetabulum in an adult who has congenital hip disease, we advocate and acetabuloplasty technique (which we have named a cotyloplasty) that involves medial advancement of the acetabular floor by the creation of a controlled comminuted fracture of its medial wall, autogenous bone-grafting, and the implantation of a small acetabular component with cement. This procedure was performed in sixty-six patients (eighty-six hips). Forty-nine of the hips had a high dislocation, thirty-one had a low dislocation, and six were dysplastic. Two to fifteen years (mean, seven years) after the operation, the clinical and radiographic results were satisfactory. Only two acetabular components needed to be revised for aseptic loosening, at 5.3 and 7.5 years postoperatively. Moreover, the cumulative success rate for the acetabular components was 100 percent at five years and 93.2 percent at ten years.

A 12- to 18-year radiographic follow-up study of Charnley low-friction arthroplasty. The role of the center of rotation.

In a 12- to 18-year radiographic follow-up study of 95 Charnley low-friction total hip arthroplasties (THA), there was a statistically significant correlation between location of the center of rotation of the total hip prosthesis (notably the element horizontal distance cup to tear-drop) and long-term, unfavorable, radiographic signs, such as acetabular and stem demarcation, cup wear, cup migration, subsidence of the stem, and calcar resorption. Small differences, as little as 2 mm, in the placement of the cup in relation to anatomic landmarks were responsible for these findings. A logistical regression analysis showed that the horizontal distance cup to teardrop was the most significant parameter influencing long-term unfavorable radiographic signs of a THA in comparison with the parameters of age, gender, diagnosis, and body-weight.