Amorphous calcium deposits of the hip joint: current observations and state of the scientific discussion.

INTRODUCTION: As a result of increasing hip arthroscopies, rare pathologies as intra-articular amorphous calcium deposits in the capsule-labral (perilabral) recess can be recognized. There is a lack of publications on this pathology. The largest case series included 18 patients. An association between femoroacetabular impingement syndrome (FAIS) and female sex was observed. Furthermore, a correlation between the size of the calcific deposit and the preoperative hip function score was reported. Our hypothesis was that the data of our patient collective with intraoperative amorphous calcium deposits of the hip joint are comparable to the existing data to confirm previous observations. MATERIALS AND METHODS: From 01/2018 to 08/2020, a total of 714 hip arthroscopies were performed. 12 (1.7%) patients who presented intra-articular amorphous calcium deposits during arthroscopy were included. On radiographs, signs of impingement and osteoarthritis were determined. Characteristics and size of the calcific deposits were examined. Preoperative and at the time of follow-up (23 months), patient-reported outcome scores (PROS) were evaluated. Duration of symptoms, pain medication, comorbidities, and return-to-work were evaluated too. RESULTS: The PROS of the four female and eight male patients improved significantly. The average size of the calcific deposit was 6.9 mm in the anteroposterior radiographs. Separation of the calcific deposit from the acetabular rim was seen in nine cases. No correlation between deposit sizes and PROS was found. Cam morphology was treated in ten cases. All patients returned to work after a median of 7 weeks (2.5-13 weeks). CONCLUSION: Amorphous calcium deposits were found in approximately 1% of all hip joints with indication for hip arthroscopy. They are not consistently associated with gender, intra-articular hip pathologies or comorbidities. The clustered occurrence in cam FAI can be justified solely by the fact that impingement is by far the most common indication for hip arthroscopy.

[Hip arthroscopy technique]. / Technik der Hüftarthroskopie.

OBJECTIVE: Arthroscopy of the central and peripheral compartment is an obligatory part of hip arthroscopy to evaluate, confirm or find pathologies and their treatment. INDICATIONS: Loose bodies, lesions of the labrum and ligamentum capitis femoris, cartilage damage, femoroacetabular impingement, synovial diseases, initial osteoarthritis, femoral head necrosis (ARCO stage 1-2) and adhesions. CONTRAINDICATIONS: Local infections, bone tumors near the joint, extensive peri-articular ossification, severe arthrofibrosis with peri-articular involvement, advanced osteoarthritis, protrusio acetabuli, advanced femoral head necrosis (from ARCO stage 3-4 extended), recent fracture of the acetabulum and extensive joint capsule tears. SURGICAL TECHNIQUE: Precise positioning of the patient on a fracture table is essential to avoid complications. Central and peripheral compartment arthroscopy requires at least 2, in some cases more than 3 portals. Arthroscopy of the central compartment is carried out under traction by an anterolateral (AL) and anterior portal (A). A posterolateral (PL) portal and distal ventrolateral portal (DVL) may also be required. For peripheral compartment arthroscopy, an anterolateral (AL) and anterior (A), alternatively/additively a proximal ventrolateral portal (PVL) and/or and distal ventrolateral (DVL) portal are established in 45° flexion and no traction of the hip joint. POSTOPERATIVE MANAGEMENT: Mobilization with full weight bearing from the day of the operation, crutches are optional. After stimulating cartilage surgery or autologous chondrocyte transplantation, partial weight bearing of 10 kg on crutches is indicated until the end of postoperative week 6. Physiotherapy with full range of motion allowed, except for labrum refixation, should take place from postoperative day 1. RESULTS: From 01/2010-12/2019, 2815 hip arthroscopies were performed; average patient age 43 (12-81) years. All procedures include a diagnostic arthroscopy of the hip. Two to 5 portals were used. Average operation time was 70 (18-48) min. In 26 cases (0.9%), arthroscopy of the central compartment at a high CE angle was not possible or not performed, even after previous arthroscopy of the peripheral compartment with capsule release. Intraoperative or directly postoperative problems and complications were rare, e.g., damage to the skin/genitals due to contact pressure (0.7%), instrument breakage (0.5%), transient lesions of the pudendus nerve (<1.5%).

Comparison of different thoracic trauma scoring systems in regards to prediction of post-traumatic complications and outcome in blunt chest trauma.

BACKGROUND: As accurate assessment of thoracic injury severity in the early phase after trauma is difficult, we compared different thoracic trauma scores regarding their predictive ability for the development of post-traumatic complications and mortality. MATERIALS AND METHODS: Two hundred seventy-eight multiple trauma patients (ISS ≥ 16) age > 16 y with severe blunt chest trauma (AIS(chest) ≥ 3) admitted between 2000 and 2009 to Level I Trauma center were included. Exclusion criteria were severe traumatic brain injury (AIS(head) ≥ 3) and penetrating thoracic trauma. The association between AIS(chest), Pulmonary Contusion score (PCS), Wagner-score and Thoracic Trauma Severity score (TTS), and duration of ventilation, length of ICU stay, development of post-traumatic complications, and mortality was investigated. Statistical analysis was performed with χ(2)-test, ANOVA, logistic regression, and receiver operating characteristic (ROC) curve. RESULTS: Patients' mean age was 42.7 ± 17.0 y, the mean injury severity score was 28.7 ± 9.3 points. Overall, 60 patients (21.6%) developed ARDS, 143 patients (51.4%) SIRS, 110 patients (39.6%) sepsis, and 36 patients (13.0%) MODS. Twenty-two patients (7.9%) died. Among the examined thoracic trauma scores only the TTS was an independent predictor of mortality. With the TTS showing the best prediction power, the TTS, PCS, and Wagner-score were independent predictors of ventilation time, length of ICU stay, and the development of post-traumatic ARDS and MODS. CONCLUSIONS: Thoracic trauma scores combining anatomical and physiologic parameters like the TTS seem to be most suitable for severity assessment and prediction of outcome in multiple trauma patients with concomitant blunt chest trauma.