Comparison of the 5-Year Outcomes Between Standard and Short Fit-and-Fill Stems in Japanese Populations.

Background: Fit-and-fill stems are known to have excellent outcomes; however, severe stress shielding has been reported in Japanese populations. Short fit-and-fill stems were modified for Asians; however, there have been no previous reports of its outcome. In this study, we compared the 5-year (mean 68-month) outcomes of 2 fit-and-fill stems with different lengths (standard or short). Material and methods: We reviewed 100 total hip arthroplasties in each standard- or short-stem group. Radiographs were evaluated for femoral morphology, stress shielding, bone remodeling, and fixation. Clinical evaluation was performed using the Japanese Orthopaedic Association (JOA) scores. Results: There was no difference in the degree of stress shielding between the 2 groups. Significant differences were observed in radiolucent lines in zone 4 (P = .005) and cortical hypertrophy in zone 3 (P < .0001) and 5 (P = .048) between the 2 groups. The canal flare index (P < .0003), cortical index (P < .0003), height (P < .0345), and stem size (P < .0081) individually affected stress shielding in the standard-stem group. In contrast, the cortical index (P < .0107) was the only relative factor in the short-stem group. All stems were judged to have bone ingrowth. The JOA score improved significantly (P < .0001); however, there were no significant differences between the 2 groups. Conclusion: The outcomes of both standard and short fit-and-fill stems were favorable. There were no significant differences in the stress shielding or JOA scores. Although there were a few differences in bone remodeling and factors affecting stress shielding, stem length reduction has been achieved without adverse effects with the Japanese femur.

Delayed sciatic nerve injury by posterior flange of reinforcement ring after acetabular revision surgery.

Delayed onset of sciatic neuropathy after total hip arthroplasty is uncommon, and late hardware-induced sciatic nerve complications are rarely reported. Here, we report a patient in whom the posterior flange of the reinforcement ring caused severe late sciatic nerve injury. Sciatic nerve radiography was useful for diagnosing flange-related sciatic nerve injury.

Closed irreducible dislocation of the interphalangeal joint of the thumb: report of two cases.

Two cases of closed dislocation of the interphalangeal joint of the thumb are presented. It was impossible to achieve manual reduction in either patient. This rare injury required open reduction with anatomical repositioning of the volar plate in both patients. We fixed the IP joint with a steel wire after reduction in both cases because of slight joint instability. At the latest follow-up, both patients do not have any problems with in daily life.

Rotational acetabular osteotomy for secondary osteoarthritis after surgery for developmental dysplasia of the hip.

The treatment of residual deformity following surgery for developmental dysplasia of the hip remains controversial. The rationale for the use of the rotational acetabular osteotomy (RAO) is that it increases the weight-bearing area by shifting the osteotomized acetabulum to cover the femoral head. This can improve joint function as well as achieve relief of pain. However, it is unclear if this osteotomy can improve a compromised hip when performed for the treatment of residual deformity and acetabular dysplasia after surgery for developmental dysplasia of the hip. We aimed to report the clinical outcome as assessed by need for total hip arthroplasty (THA) and by the Merle d'Aubigné and Postel scores. In addition, we tried to assess the radiographic outcomes as assessed by Tönnis's classification. Only two hips required THA, which was performed in two patients at 11 and 12 years after RAO, respectively. The mean Merle d'Aubigné clinical score improved from 14.1 +/- 2.3 points (range, 10 to 17) preoperatively to 15.8 +/- 2.9 points (8 to 18) at final follow-up (p < 0.02). Radiological assessment at final follow-up showed the obvious progression of osteoarthritis in five hips. One patient in grade 1 preoperatively progressed into grade 3 at final follow-up; four patients in grade 2 preoperatively progressed into grade 3. In our study, this osteotomy prolonged the functional life of the hip, and only two hips needed THA after a mean follow-up of 11 years. We found that advanced arthritis pre-osteotomy is associated with progression of radiologic changes.

Rotational acetabular osteotomy for advanced osteoarthritis of the hip joint with acetabular dysplasia.

Between August 1986 and July 1997, we performed rotational acetabular osteotomy (RAO) according to the methods of Ninomiya and Tagawa in 161 patients (179 hips). Among them, 63 patients (68 hips) had advanced osteoarthritis. We assessed the outcome at a mean of 12 years after rotational acetabular osteotomy was performed for the treatment of advanced osteoarthritis in a series of patients with acetabular dysplasia. Eleven patients did not return for final follow-up and were excluded from the study, leaving 52 patients (57 hips) for analysis. The mean Merle d'Aubigné clinical score improved from 12.6 points (range 9-16) preoperatively to 14.3 points (range 7-18) postoperatively (p < 0.002), mainly because of increased scores for pain. At final follow-up, 50 of the 57 hips were still functioning. The results of rotational acetabular osteotomy for correction of advanced osteoarthritis in adults with acetabular dysplasia were satisfactory after a mean of 12.2 years.

Severe subluxation of the femoral head after rotational acetabular osteotomy: a case report.

We encountered a rare case of severe subluxation of the femoral head after the performance of rotational acetabular osteotomy to treat osteoarthritis of the hip, secondary to acetabular dysplasia. The subluxation was corrected by performing varus and flexion osteotomy.

Subcapital femoral neck fracture after fixation of an intertrochanteric fracture with a proximal femoral nail: a report of two cases.

Subcapital femoral neck fractures are a rare complication after fixation of an intertrochanteric fracture with a proximal femoral nail. We report 2 such cases where the patients had severe osteoporosis, based on Singh's index and pathological findings. In one case there was a technical error leading to a tip-apex distance of more than 20 mm, but osteoporosis appeared to be a more significant cause than any technical problems.

Bizarre accessory metatarsal located between the left fourth and fifth metatarsals: a case report.

We report a case of bizarre accessory metatarsal located between the left fourth and fifth metatarsals without a supernumerary digit in a 6-year-old girl. The accessory metatarsal was resected to alleviate foot pain on walking. This metatarsal dysplasia might have arisen from sequential failures of digital formation at an early stage of development.

Rotational acetabular osteotomy for osteonecrosis of the femoral head after intracapsular fracture of the neck of the femur.

The treatment of osteonecrosis of the femoral head in younger patients varies among orthopaedic surgeons. In particular, the optimal treatment of extensive osteonecrosis associated with femoral head collapse remains controversial. Since 1995, we have performed rotational acetabular osteotomy on 70 hips, including those of 3 patients with extensive osteonecrosis of the femoral head after intracapsular fracture of the neck of the femur. In all 3 patients, adequate coverage of the femoral head by the osteotomized acetabulum was obtained, and their symptoms (especially pain) showed marked improvement at latest follow-up.

Rapid resolution of femoral head osteonecrosis after rotational acetabular osteotomy.

The natural history of osteonecrosis of the femoral head is generally thought to be one of progressive deterioration if no intervention is undertaken. However, it is unknown whether surgical intervention is beneficial for patients with a small region of osteonecrosis. We observed rapid improvement of MRI findings after rotational acetabular osteotomy (RAO) was performed in a young patient with osteonecrosis of the femoral head. The band-like low signal area on T2-weighted images almost resolved by six months after surgery. He returned to work as an electrician by six months after surgery. Early surgical intervention such as RAO that alters the mechanical force acting on the necrotic region of the femoral head may accelerate the recovery of osteonecrosis and the improvement of symptoms.