Osteonecrosis of the hip in the sickle-cell diseases. Treatment and complications.

The results of arthroplasty of the hip and other surgical procedures that were performed in nine patients who had sickle-cell disease or sickle-cell trait and osteonecrosis of the femoral head were not very satisfactory. After an average duration of follow-up of 6.5 years (range, two to 25.7 years), the complications were many and severe. Of eight arthroplasties that were done for replacement of a joint, five required early revision or excision: two, because of mechanical loosening; two, because of sepsis; and one, due to a fracture of the prosthetic stem. There was excessive perioperative blood loss, prolonged hospitalization, and medical or surgical complications in all patients, including the three who had sickle-cell trait and only slight manifestations of systemic disease. A survivorship analysis of this series indicated that a failure rate of 50 per cent could be expected by 5.4 years postoperatively.

Radiographic analysis of the axial alignment of the lower extremity.

The axial alignment of the lower extremities of twenty-five normal male volunteers whose mean age was thirty years was studied using a standardized radiograph of the entire lower extremity. The extremities were found to be in a mean of 1.5 degrees (right) and 1.1 degrees (left) of varus angulation at the knee between the tibial and femoral mechanical axes. The transverse axis of the knee lacked a mean of 3.0 degrees (right) and 2.6 degrees (left) of being perpendicular to the mechanical axis of the tibia. The anatomical axis of the femur did not pass through the center of the knee.

Radius fractures in the athlete.

With prompt and accurate diagnosis, a stable and anatomic distal radius fracture reduction, the detection and treatment of any associated intraarticular injuries with the use of wrist arthroscopy, and an early, comprehensive rehabilitation program, one usually can expect a favorable outcome. The treating physician never should compromise these basic principles solely for the sake of a speedy return to sports at the behest of the coach, the athlete, or his family. This could result in a less-than-favorable recovery, and a possible permanent loss of athletic skills.

Diagnostic and operative arthroscopy of the wrist.

The evaluation and diagnosis of wrist disorders has traditionally been difficult and problematic. Ligamentous wrist sprains and their associated carpal instabilities, triangular fibrocartilage complex disruptions, and cartilage injuries have been virtually impossible to fully assess because of the inadequacy of current diagnostic techniques. Arthroscopy of the wrist allows a thorough evaluation of the soft-tissue structures and cartilaginous surfaces within the radiocarpal and midcarpal joints. In selected cases, wrist arthroscopy can be employed to surgically modify the intraarticular lesions and to assist in the planning of reconstructive operations.

Chronic wrist pain: spin-echo and short tau inversion recovery MR imaging and conventional and MR arthrography.

The accuracy of T1-, proton-density-, and T2-weighted magnetic resonance (MR) imaging sequences and gadolinium-enhanced MR arthrography in evaluation of the triangular fibro-cartilage complex (TFCC) and the scapholunate (SL) and lunotriquetral (LT) ligaments was studied in 15 patients with chronic wrist pain. Arthrography and arthroscopy were used as standards of reference. Twelve patients also underwent imaging with short tau inversion recovery (STIR) sequences. MR imaging was more reliable in evaluation of the morphology of the TFCC and SL ligament than in that of the LT ligament. With arthrography as the standard, sensitivity was 0.721, specificity was 0.947, and accuracy was 0.887 for the TFCC; these values were 0.500, 0.864, and 0.765 for the SL ligament and 0.519, 0.455, and 0.490 for the LT ligament. No visualization of the SL ligament indicated a tear, but this sign was not helpful in evaluation of the LT ligament. Fluid in the distal radioulnar joint had a high association with TFCC tears. Accuracy with MR arthrography was higher than with the other sequences. STIR images were effective in evaluation of the TFCC. The combination of proton-density-and T2-weighted images appears to be useful because morphologic characteristics and the presence of fluid can be evaluated.