Search

AimsThe aim of this study was to report the long-term results of rotational acetabular osteotomy (RAO) for symptomatic hip dysplasia in patients aged younger than 21 years at the time of surgery.Patients and MethodsWe evaluated 31 patients (37 hips) aged younger than 21 years at the time of surgery retrospectively. There were 29 female and two male patients. Their mean age at the time of surgery was 17.4 years (12 to 21). The mean follow-up was 17.9 years (7 to 30). The RAO was combined with a varus or valgus femoral osteotomy or a greater trochanteric displacement in eight hips, as instability or congruence of the hip could not be corrected adequately using RAO alone.ResultsThe mean Merle d’Aubigné clinical score improved significantly from 15.4 to 17.2 (p < 0.0001). The mean centre-edge (CE) angle improved from -2.6° to 26°, the mean acetabular roof angle improved from 3.0° to 5.2°, and the mean head lateralization index improved from 0.68 to 0.62. Progression of radiological osteoarthritis (OA) was seen in seven hips, but no patient underwent total hip arthroplasty.ConclusionRAO is an effective form of correction for a severely dysplastic hip in adolescent and young adult patients.Cite this article: Bone Joint J2019;101-B:390–395.

AimsOur aim was to evaluate the radiographic characteristics of patients undergoing total hip arthroplasty (THA) for the potential of posterior bony impingement using CT simulations.Patients and MethodsVirtual CT data from 112 patients who underwent THA were analysed. There were 40 men and 72 women. Their mean age was 59.1 years (41 to 76). Associations between radiographic characteristics and posterior bony impingement and the range of external rotation of the hip were evaluated. In addition, we investigated the effects of pelvic tilt and the neck/shaft angle and femoral offset on posterior bony impingement.ResultsThe range of external rotation and the ischiofemoral length were significantly lower, while femoral anteversion, the ischial ratio, and ischial angle were significantly higher in patients with posterior bony impingement compared with those who had implant impingement (p <  0.05). The range of external rotation positively correlated with ischiofemoral length (r = 0.49, p < 0.05), and negatively correlated with ischial length (r = -0.49, p < 0.05), ischial ratio (r =- 0.49, p < 0.05) and ischial angle (r = -0.55, p < 0.05). The range of external rotation was lower in patients with posterior pelvic tilt (p < 0.05) and in those with a high offset femoral component (p < 0.05) due to posterior bony impingement.ConclusionPosterior bony impingement after THA is more likely in patients with a wider ischium and a narrow ischiofemoral space. A high femoral offset and posterior pelvic tilt are also risk factors for this type of impingement.Cite this article: Bone Joint J2017;99-B:1140–6.

In Japan, osteoarthritis (OA) of the hip secondary to acetabular dysplasia is very common, and there are few data concerning the pathogeneses and incidence of femoroacetabular impingement (FAI). We have attempted to clarify the radiological prevalence of painful FAI in a cohort of Japanese patients and to investigate the radiological findings. We identified 176 symptomatic patients (202 hips) with Tönnis grade 0 or 1 osteoarthritis, whom we prospectively studied between August 2011 and July 2012. There were 61 men (65 hips) and 115 women (137 hips) with a mean age of 51.8 years (11 to 83). Radiological analyses included the α-angle, centre–edge angle, cross-over sign, pistol grip deformity and femoral head neck ratio. Of the 202 hips, 79 (39.1%) had acetabular dysplasia, while 80 hips (39.6%) had no known aetiology. We found evidence of FAI in 60 hips (29.7%). Radiological FAI findings associated with cam deformity were the most common. There was a significant relationship between the pistol grip deformity and both the α-angle (p < 0.001) and femoral head–neck ratio (p = 0.024). Radiological evidence of symptomatic FAI was not uncommon in these Japanese patients.Cite this article: Bone Joint J2013;96-B:172–6.

We used interconnected porous calcium hydroxyapatite ceramic to bridge a rabbit ulnar defect. Two weeks after inducing the defect we percutaneously injected rabbit bone marrow-derived mesenchymal stromal cells labelled with ferumoxide. The contribution of an external magnetic targeting system to attract these cells into the ceramic and their effect on subsequent bone formation were evaluated.This technique significantly facilitated the infiltration of ferumoxide-labelled cells into ceramic and significantly contributed to the enhancement of bone formation even in the chronic phase. As such, it is potentially of clinical use to treat fractures, bone defects, delayed union and nonunion.

We have investigated the effectiveness of the transplantation of bone-marrow-derived mononuclear cells (BMMNCs) with interconnected porous calcium hydroxyapatite (IP-CHA) on early bone repair for osteonecrosis of the femoral head. We studied 22 patients (30 hips) who had osteonecrosis with a minimum follow-up of one year after implantation of BMMNCs. The mean age at surgery was 41 years (18 to 64) and the mean period of follow-up was 29 months (19 to 48). In a control group, cell-free IP-CHA was implanted into a further eight patients (9 hips) with osteonecrosis of the femoral head and the outcomes were compared.A reduction in the size of the osteonecrotic lesion was observed subsequent to hypertrophy of the bone in the transition zone in the BMMNC group. In three patients in the treatment group progression to extensive collapse was detected. In the control group subtle bone hypertrophy was observed, but severe collapse of the femoral head occurred in six of eight hips.In this limited study the implantation of BMMNCs and IP-CHA appears to confer benefit in the repair of osteonecrosis and in the prevention of collapse.

Acetabular dysplasia was produced in 24 immature white rabbits. A rotational acetabular osteotomy was then carried out and radiological and histological studies of the articular cartilage were made.In the hips which did not undergo osteotomy, radiographs at 26 weeks showed that residual subluxation remained and arthritic changes such as narrowing of the joint space or dislocation were still seen. However, in the operated group there was a remarkable increase in cover, but arthritic changes were not observed. After 24 weeks, the Mankin grading score in the operated group was significantly lower than that in the non-operated group. The latter hips showed an irregular surface of the cartilage, exfoliation and proliferation of synovial tissue. In those undergoing osteotomy, primary cloning of chondrocytes or hypercellularity was seen and at 24 weeks after operation and metaplasia of the cartilage in the fibrous tissue was observed in the boundary between the medial area of the acetabulum and the acetabular fossa.

Periacetabular osteotomies, such as rotational acetabular osteotomy (RAO) for osteoarthritis (OA) secondary to hip dysplasia, have produced satisfactory medium- and long-term results in early OA. However, as the degree of surgical invasion of these procedures is comparatively major and long-term postoperative rehabilitation is required, this procedure is generally not indicated for those in the fifth and sixth decades of life. Curved varus femoral osteotomy (CVO), which is a less invasive procedure, is considered a worthwhile option, although to the best of our knowledge no comparative study has been reported on these two procedures in older patients. We performed a comparative study on the outcomes of CVO for minimal dysplasia of the hip with a center-edge (CE) angle greater than 5° in 15 patients (15 joints) older than 45years of age at a mean period of 8years after surgery and on the outcomes of RAO in 16 patients (18 joints) performed during the same period. No significant difference was observed between the two groups regarding the Merle d’Aubigne score during follow-up. Progression of osteoarthritis was radiologically observed during follow-up in three hips in the CVO group and in one hip in the RAO group. Kaplan-Meier survivorship analysis, with radiological progression of osteoarthritis as the endpoint, predicted a survival rate of 75% at 10years in the CVO group. In the RAO group the predicted 10-year survival rate was 94%, demonstrating no significant difference between the two groups. CVO is a less invasive surgical technique than RAO, requires a comparatively shorter period of postoperative rehabilitation, and is useful as a joint-preserving procedure in older patients with minimal dysplasia of the hip with unilateral involvement. CVO should be selected for elderly patients with a CE angle greater than 5°.

Abstract Periacetabular osteotomies, such as rotational acetabular osteotomy (RAO) for osteoarthritis (OA) secondary to hip dysplasia, have produced satisfactory medium- and long-term results in early OA. However, as the degree of surgical invasion of these procedures is comparatively major and long-term postoperative rehabilitation is required, this procedure is generally not indicated for those in the fifth and sixth decades of life. Curved varus femoral osteotomy (CVO), which is a less invasive procedure, is considered a worthwhile option, although to the best of our knowledge no comparative study has been reported on these two procedures in older patients. We performed a comparative study on the outcomes of CVO for minimal dysplasia of the hip with a center-edge (CE) angle greater than 5° in 15 patients (15 joints) older than 45 years of age at a mean period of 8 years after surgery and on the outcomes of RAO in 16 patients (18 joints) performed during the same period. No significant difference was observed between the two groups regarding the Merle d’Aubigne score during follow-up. Progression of osteoarthritis was radiologically observed during follow-up in three hips in the CVO group and in one hip in the RAO group. Kaplan-Meier survivorship analysis, with radiological progression of osteoarthritis as the endpoint, predicted a survival rate of 75% at 10 years in the CVO group. In the RAO group the predicted 10-year survival rate was 94%, demonstrating no significant difference between the two groups. CVO is a less invasive surgical technique than RAO, requires a comparatively shorter period of postoperative rehabilitation, and is useful as a joint-preserving procedure in older patients with minimal dysplasia of the hip with unilateral involvement. CVO should be selected for elderly patients with a CE angle greater than 5°.

We have studied whether the state of the articular cartilage at the time of rotational acetabular osteotomy for dysplasia of the hip affects the outcome 2 to 5.5 years after surgery. Arthroscopy in 57 patients (59 joints) at the time of the operation showed grade-0 changes in seven, grade-1 in nine, grade-2 in 17, grade-3 in 14 and grade-4 in 12 joints, according to the classification of Outerbridge. There was radiological evidence of the progression of arthritis in four joints which were classified at arthroscopy as grade 4.Stepwise regression analysis showed that damage to acetabular or femoral articular cartilage significantly affected the progression of arthritis. We conclude that the short-term results of successful rotational acetabular osteotomy for dysplasia are affected by the state of the articular cartilage.

We studied nine patients who had had a transtrochanteric anterior rotational osteotomy, as developed by Sugioka, for osteonecrosis of the femoral head. At a mean of 2.5 years after the initial operation we carried out a histological study of the previously necrotic femoral head which had not shown collapse of the new primary weight-bearing site. In seven joints, there was proliferation of fibrous tissue in the dead trabeculae with vascular ingrowth. New bone covering dead trabeculae created the characteristic appearance of ‘creeping substitution’. However, these changes were limited and did not extend over the entire necrotic area. Dead bone remained in all the cases. In the other two heads we did not observe proliferation of fibrous tissue or vascular ingrowth, only dead trabeculae and dead bone marrow.

Abstract: Clinical and radiological studies were done on the results of rotational acetabular osteotomy for advanced osteoarthrosis secondary to dysplasia of 29 adult hips followed up for 6 to 11 years postoperatively (mean 8 years). Clinical evaluation by Merle d’Aubigne and Postel’s system showed improvement from a preoperative mean of 12.8 to a follow-up mean of 14.8, with aggravation being observed in 8 joints. Radiologically, this procedure produced adequated improvement regarding femoral head coverage, but improvement in joint congruency could not necessarily be obtained due to joint deformity and progression of arthrosis, with aggravation of joint congruency being observed in 6 joints. The most important factor influencing the postoperative results of this procedure was postoperative joint congruency. If the postoperative joint congruency is satisfactory, with the joint congruent index being more than 6.0, progression of arthrosis can be prevented in the long term by this procedure, even in advanced cases.

Background: We have previously shown that eradication of Helicobacter pylori increases acid secretion in H. pylori-associated enlarged fold gastritis.

We report the use of a new approach for elbow arthroplasty in 58 cases over a 20-year period. A wide exposure, obtained by elevating the triceps attachment and dividing the radial collateral ligament, allows the excision of diseased tissue, articular irregularities and osteophytes. Normal anatomy is restored and active mobilisation can be started 10 days after operation. Good or fair results, with over 70 degrees of joint movement, were achieved in 88% of cases.

Background: We have previously shown that eradication of Helicobacter pyloriincreases acid secretion in H. pylori‐associated enlarged fold gastritis.

Helicobacter pylori(H. pylori) induces hyperproliferation of the gastric mucosa. This study was designed to clarify whether H. pyloriinfection is involved in the gene expression of hepatocyte growth factor (HGF), a potent stimulator of cell proliferation in gastric mucosa. Levels of HGF mRNA were determined by a reverse transcription-polymerase chain reaction in endoscopic gastric biopsy specimens from 9 control subjects and 9 patients with H. pyloriinfection. In patients with H. pyloriinfection, levels of HGF mRNA in gastric mucosa were significantly higher than those in control subjects. HGF mRNA levels in patients with H. pyloriinfection were correlated with the severity of gastric mucosal inflammation. Our observations indicate that H. pyloriinfection increases the expression of HGF gene in gastric mucosa probably through the mucosal inflammation.

Lipopolysaccharide antigens were extracted from heated cell extracts of several serotypes of Pseudonomas aeruginosa. Indirect hemagglutination with the extracts indicated specific reactivity with sera from rabbits immunized with homologous serotypes of P. aeruginosa. Sera from healthy adults and patients infected with P. aeruginosa were studied subsequently and shown to possess antibodies against P. aeurginosa. In patients infected with P. aeruginosa type E, indirect hemagglutination antibody against type E was resistant to 2-mercaptoethanol (2-ME) and classified as immunoglobulin G. In patients infected with any other type of P. aeruginosa and in healthy adults, it was sensitive to 2-ME and classified as immunoglobulin M. The antibody in the seven patients infected with P. aeruginosa was titrated during the course of infection with lipopolysaccharide antigen prepared from the infecting strain. As a result, all patients either possessed 2-ME-resistant antibody or showed antibody rise to homotypic antigen during the infection. However, no patient showed 2-ME-resistant antibody against hetero-typic lipopolysaccharide antigens. In hospitalized patients, the incidence of anti body against type E, G, and I Pseudomonas strains was greater than that against type A. In particular, 2-ME-resistant antibody to all four serotypes was detected at a higher rate in hospitalized patients than in healthy adults.

We investigated the morphological changes in the articular cartilage after rotational acetabular osteotomy in 16 adolescent rabbits. Radiological and histological studies were conducted at 12 and 24 weeks postoperatively. The radiological evaluations at 12 and 24 weeks showed significantly increased femoral head coverage. No cases of osteonecrosis of the acetabulum or femoral head nor narrowing of the joint space was observed. The histology of the articular cartilage at 12 weeks postoperatively showed cloning and hypercellularity of the chondrocytes in the medial portion of the acetabular roof, indicating remodelling due to the increased weight-bearing stress caused by the osteotomy. The histology at 24 weeks postoperatively showed less cloning of the chondrocytes, indicating that the remodelling process in the articular cartilage induced by this procedure was almost complete at 24 weeks. Degeneration of the articular cartilage was not observed within 24 weeks of the operation.

The acetabular labrum tear has been considered the most common cause of groin pain and the most frequent hip pathology. We have performed arthroscopic treatments for the labrum tear without obvious hip dysplasia. The purpose of this study is to investigate clinical outcomes of arthroscopic treatments in patients with labrum tear and to clarify the character of failure cases of hip arthroscopy for the labrum tear.

The acetabular labrum tear has been considered the most common cause of groin pain and the most frequent hip pathology. We have performed arthroscopic treatments for the labrum tear without obvious hip dysplasia. The purpose of this study is to investigate clinical outcomes of arthroscopic treatments in patients with labrum tear and to clarify the character of failure cases of hip arthroscopy for the labrum tear.