Lymphatic filling in arthrography following total hip replacement.

The significance of lymphatic filling at hip arthrography on prosthetic hips is uncertain. Clearly if lymphatic opacification has a direct relationship to loosening, this could lead to increased surgical exploration. Ninety-one patients were studied to determine whether opacification of lymphatics during hip arthrography correlated with loosening of the prosthetic hip. Plain radiographs were evaluated and a total of 92 hip arthrograms were assessed retrospectively. Radiological evidence of prosthetic loosening at hip arthrography was present in 61 patients. Fifty-three patients subsequently had surgical exploration and 50 were confirmed to have loose and/or infected components. In only 18 of these patients had lymphatic filling been demonstrated at arthrography. No evidence of loosening was seen in 23 patients; however, lymphatic opacification occurred in 10 of these arthrograms. This study does not demonstrate any correlation between prosthetic loosening, either with or without infection, and filling of the nearby lymphatic vessels. This finding contradicts an earlier report in the literature.

Benign osteopetrosis: a review of 42 cases showing two different patterns.

Radiographs of 42 patients with benign osteopetrosis were reviewed. Clinical notes were available for approximately half of these. According to the classification of Bollerslev and Andersen in 1987, 29 patients had type II disease of whom 18 sustained fractures. Thirteen patients had type I disease; only one of these patients sustained fractures. Transverse banding of the metaphyses was a common feature in type II disease; it was not seen in any of the type I cases. This review confirms that type II patients are at high risk of fracture, while type I patients are not. The presence of sclerotic metaphyseal bands distinguishes between the two types, its presence being enough to confirm type II. However, its absence is not an indication of type I disease, since it is not seen in all cases of type II. Banding does not correlate with liability to fracture. Typing patients with the benign form of osteopetrosis is important in order to anticipate the fracture pattern.

Titanium lines: a manifestation of metallosis and tissue response to titanium alloy megaprostheses at the knee.

Titanium alloy, in its Ti-318 (Ti-A16-V4) format, is a widely used material for orthopaedic implants. However, it has frequently been reported as causing black staining of the periprosthetic tissues as a result of debris from metallic wear. This process of metallosis has been implicated in implant failure. We report three cases in which titanium alloy prostheses for primary bone tumours at the knee have caused the formation of fluid-filled cysts containing metallic debris. The cysts result in radiological appearances which may mimic soft tissue tumour recurrence and also contribute to post-operative failure of the extensor mechanism of the knee.

Spiking of the tubercles of the intercondylar eminence of the tibial plateau in osteoarthritis.

"Spiking", "sharpening" or "peaking" of the tubercles of the intercondylar eminence of the tibial plateau has been described as an early sign of osteoarthritis of the knee joint, but there are no reports confirming this association. The radiographs of 55 patients with established osteoarthritis of the knee joint and 36 controls were reviewed. Measurements were made of the angulation of the tips of the medial and lateral tubercles, and the ratio of the tubercle height to the width of the tibial plateau was calculated. There was a significant difference in both these parameters between the two groups, confirming that lengthening and sharpening of the angles of the tubercles are features of osteoarthritis of the knee joint.

Needle biopsy of musculoskeletal lesions. A review of 208 procedures.

Needle biopsies, performed on 208 consecutive patients and interpreted at the London Bone Tumour Service over a two-year period, were reviewed. A correct diagnosis was reached in 97% (133 out of 137) using this technique alone. Needle biopsy is safe and accurate when undertaken in consultation within a bone tumour service; it offers considerable advantages to both patient and surgeon over conventional open biopsy.

Clinical oncology: case presentations from oncology centres. 1. Ewing's sarcoma. The London Bone Tumour Service.

The management of a case of Ewing's sarcoma of the left proximal humerus in a 15-year-old girl is presented, and the radiological and pathological findings are described. The chemotherapeutic, radiotherapeutic and surgical management of Ewing's sarcoma are discussed with reference to the case.

Parosteal osteosarcoma. Treatment by wide resection and prosthetic replacement.

We have reviewed 20 cases of parosteal osteosarcoma treated by wide local resection and prosthetic replacement and followed up for six to 17 years. Limb function was excellent in 85%. One patient with grade III histological disease developed pulmonary metastases. Four patients had local recurrences, which were related to repeated preliminary biopsies, inappropriate siting of biopsy and vascular encroachment by the tumour. After this mode of treatment, the outcome was not related to medullary invasion by the tumour.

Malignant fibrous histiocytoma complicating chronic osteomyelitis.

Sarcomas occurring in relation to draining sinuses and foci of chronic osteomyelitis are rare. We report a case of malignant fibrous histiocytoma (MFH) as a complication of chronic osteomyelitis. This highly malignant sarcoma has not previously been reported in this condition.

A comparative study to evaluate the role of intra-articular adrenaline in double-contrast knee arthrography.

The addition of adrenaline to meglumine iothalamate (Conray 280) in double-contrast knee arthrography significantly improves meniscal coating, in both immediate and delayed films, when compared with iothalamate alone. The quality of coating is comparable to that with sodium meglumine ioxaglate (Hexabrix 320) without adrenaline. The addition of adrenaline to ioxaglate produces no significant improvement in arthrographic quality in either immediate or delayed films. The use of iothalamate with adrenaline is less expensive than ioxaglate alone, but this financial advantage has to be balanced against the significantly greater pain associated with the use of intra-articular adrenaline.

Fibrous dysplasia of the spine.

Fibrous dysplasia affecting the spine is unusual. A further 11 cases are reported and the radiological features are described. The complications and difficulties with the diagnosis of this condition are discussed.