Age and sex-related distribution of alpha angles and the prevalence of the cam morphology of the hip in Asians do not differ from those of other ethnicities.

PURPOSE: This study was performed to evaluate the effects of age on the alpha angle and the incidence of asymptomatic cam morphology. METHODS: The radiographs of asymptomatic individuals between ages 8 and 22 were retrospectively collected. A total of 1417 individuals were included and grouped according to age: 8-12 (Group A), 13-18 (Group B), and 19-22 (Group C) years. Radiographic measurements of the alpha angles of the right hip were obtained from anteroposterior (AP) and frog-leg lateral (FL) radiographs. The correlations among alpha angles, the presence of cam morphology, and age were determined. RESULTS: The mean alpha angles of the three groups were statistically different (p < 0.001, each). The alpha angles on both radiographs were positively correlated with age. Intra-group analysis revealed that this correlation was only evident on the FL images of males in Group B. The presence of a radiographic cam morphology also positively correlated with age (p < 0.001 in both AP and FL images). The cam morphology on AP radiographs was 0 in Group A, 17(3.0%) in Group B, and 21(4.8%) in Group C; that on FL radiographs was 2(0.3%) in Group A, 45(7.9%) in Group B, and 103(23.6%) in Group C. Intra-group analysis revealed that the correlation was only significant in males in Group B. CONCLUSIONS: Higher alpha angles and the presence of cam morphology were positively correlated with age, particularly in males at or before the time of skeletal maturation. The prevalence of cam morphology did not differ from those in other ethnicities. LEVEL OF EVIDENCE: IV.

Acetabular Insufficiency Fracture Following Prolonged Alendronate Use and the Failure of Total Hip Arthroplasty in "Frozen" Bone: Two Cases Report.

Atypical insufficiency fracture of the femur following prolonged bisphosphonate use is well described. Regardless of the cause, insufficiency fracture of the acetabulum is extremely rare, and no reports have described insufficiency fractures of the acetabulum that are associated with prolonged bisphosphonate use. This report demonstrates the possibility of insufficiency fracture at the acetabulum following long-term alendronate use and the necessity of particular care in managing insufficiency fractures in "frozen" bone. We describe two cases of insufficiency fracture of the acetabulum following 6 years of alendronate use. Given the patients' medical histories and bone biopsy findings, these insufficiency fractures were thought to be attributable to alendronate use. One case involved the left hip and the presence of pelvic fractures on the opposite side. The patient was treated using cementless total hip arthroplasty (THA), which failed 1 year after surgery. The hip was revised with a massive bone graft and a supportive wire mesh. The other case was managed via THA with a Ganz reinforcement ring due to concerns regarding the use of a cementless implant.

Amyloid Arthropathy of the Hip Joint Associated with Multiple Myeloma: A Case Report.

Amyloidosis is a disease characterized by the deposition of non-soluble fibrous protein in multiple tissues with a number of possible causes. This protein deposition can occur in any tissue, yet is most commonly seen in kidneys, heart, and gastrointestinal tracts. However, invasion to bone tissues is not often reported. The deposition of amyloid proteins in bone tissues may result in joint pain and pathological fractures; it is important to elucidate the causes and detect early to determine prognosis and treat optimally. In the present case report, with relevant literature review, the authors report a case of total hip arthroplasty in an amyloidosis patient.

Asymmetric epiphyseal closure of the femoral head as a potential cause of the primary cam lesion: a case report.

Cam-type femoroacetabular impingement is a pathologic condition caused by repetitive impact of the abnormal femur on a normal acetabular rim, resulting in damage to the articular cartilage. Excluding cases with known underlying diseases, the development of primary cam deformity is not well understood. Here, we describe a patient with cam-type femoroacetabular impingement exhibiting delayed epiphyseal closure at the site of the cam lesion. The authors believe that this may represent a cause of primary cam deformity, and hereby report the case with review of the literature.

Does the Time of Postoperative Bisphosphonate Administration Affect the Bone Union in Osteoporotic Intertrochanteric Fracture of Femur?

PURPOSE: This study was designed to investigate the effect of bisphosphonate administration starting time on bone healing and to identify the best administration time following surgical treatment of osteoporotic intertrochanteric fractures. MATERIALS AND METHODS: Two hundreds and eighty four patients (284 hips; 52 males, 232 females) who underwent surgery following osteoporotic intertrochanteric fracture from December 2002 to December 2012 were retrospectively analyzed. The average follow-up period was 68.4 months. The patients were divided into three groups according to the time of bisphosphonate administration after operation: 1 week (group A; n=102), 1 month (group B; n=89), and 3 months (group C; n=93). Koval scores and change of Koval scores 1 year after operation were used for clinical evaluation. For radiologic evaluation, the time of callus appearance across the fracture line on sagittal and coronal radiographs and the time to absence of pain during hip motion was judged as the time of bone union. RESULTS: Koval scores one year after surgery for groups A, B, and C were 2.44, 2.36, and 2.43 (P=0.895), respectively. The mean time of union was 12.4, 11.9, and 12.3 weeks after operation in the three groups (P=0.883), respectively. There were zero cases of nonunion. There were 3, 5, and 7 cases of fixative displacement in the three groups, respectively, but the distribution showed no significant difference (P>0.472). CONCLUSION: The initiating time of bisphosphonate administration following surgery does not affect the clinical outcomes in patients with osteoporotic intertrochanteric fracture.

Meniscus allograft transplantation for discoid lateral meniscus: clinical comparison between discoid lateral meniscus and nondiscoid lateral meniscus.

PURPOSE: This study was performed to compare the clinical results of meniscus allograft transplantation (MAT) after total meniscectomy in torn discoid lateral meniscus (DLM) and nondiscoid lateral meniscus (NLM). METHODS: We conducted a retrospective study of 36 patients who underwent MAT. The discoid and nondiscoid groups consisted of 16 and 20 patients, respectively. The mean follow-up period was 32 months. We checked range of motion (ROM), visual analog scale (VAS) score, International Knee Documentation Committee (IKDC) subjective score, Lysholm score, Tegner activity score for clinical evaluation; magnetic resonance imaging (MRI) was checked for objective evaluation. RESULTS: The mean last follow-up VAS score, IKDC subjective score, Lysholm score, Tegner activity score, and subjective satisfaction of the patient were not significantly different between the discoid group and the nondiscoid group. The ROM of the discoid group was significantly decreased compared with that of the nondiscoid group (P < .05). Follow-up MRI was performed in 17 patients (9 from the discoid group and 8 from the nondiscoid group). Mean extrusion of the graft was 2.0 mm in the discoid group and 2.4 mm in the nondiscoid group (P = .344). Relative percentage of extrusion (RPE) was 22.8% in the discoid group and 22.7% in the nondiscoid group (P = .519). CONCLUSIONS: According to the minimal 2-year follow-up observations, MAT in patients with a torn discoid meniscus is an effective method for reducing the pain caused by meniscal deficiency and improving the function of the knee joint. LEVEL OF EVIDENCE: Level IV, therapeutic case series.