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Background: The role of the voiding cystourethrogram (VCUG) in the follow-up of children with posterior urethral valves (PUVs) post-ablation has been considered a standard practice. The urethral ratio and gradient of change have proven to be useful. Objectives: We aimed to review the role of the ‘ideal’ ratio on predicting residual PUV post-ablation. Methods: A systematic review of the PubMed, SCOPUS and Web of Science databases was performed (April 2019). The search terms included ‘Urethral Ratio and Posterior urethral valve ablation’. All cited reference lists were further evaluated for additional inclusive studies. Results: Eleven studies were identified, of which nine were relevant to the topic. Case reports, comments and adult and animal studies were excluded, leaving four studies for critical review. In total, 338 patients were assessed. The control group consisted of 167 age-matched, male children. Study regions included India and Australia. The ages ranged from 15 days to 3.4 years. Ablation methods included the use of a resectoscope with cutting diathermy, cold knife or Bugbee electrode. The mean urethral ratios in the control group ranged from 1.04 to 1.73. The suggested predictive urethral cut-off ratios recommended include 2.2 ( p = 0.001), 2.5–3 and 3.5. Conclusion: Although the precise cut-off ratio could not be clearly defined in this review, a urethral ratio less than a range of 2.2–3.5 has proven to be a beneficial predictor of ablation success and should thus be incorporated into standard VCUG reporting templates in the follow-up of PUVs in male children in resource-limited settings.

Introduction Morphology and mechanic properties of impacted cancellous bone are affected by carrier substances which provide high local concentrations of antibiotics. Methods Bone chips were taken from the femoral head of 6–7 months old piglets. One half was thermodisinfected and the other remained native. Ten specimens each were mixed with Herafill® antibiotic pellets and a control group of each 10 specimens respectively was examined. The cancellous bone was impacted according to Exeter technique and the implants were cemented. The distribution of the particles and the pores were defined with three dimensional computertomographic scan and shear force resistance was measured until failure. Results Shear force resistance was not measured significantly less for thermodisinfected (2.7 Nm) compared with native bone (3.5 Nm) and addition of antibiotic pellets reduced shear force resistance in both groups since this was significant for the native group. The average pore volume of the native bone specimens appeared significant smaller compared to the thermodisinfected group (p = 0.011) and the pore volume showed a negative correlation with shear force resistance (p = 0.044). Pore volume around the pellets was found significantly increased and it appeared smaller for native bone. The number of pellets located next to the implant showed a negative correlation with shear force resistance (p = 0.034) and the negative correlation increased for pellets below the tip of the shaft model (p = 0.024). Conclusion Adding antibiotic pellets to native and thermodisinfected impacted cancellous bone increased pore volume since the area around the pellets showed increased porosity which correlated with reduced shear force resistance. Computertomographic three dimensional measurement of porosity might predict shear force resistance of impacted cancellous bone and improve impaction of bone grafting intraoperatively.

Introduction Good osteointegration of implants requires sufficient primary stability. Aim of this study was to examine the influence of screw fixation on the primary stability of press-fit cups. Methods Two press-fit acetabular cups were tested with regard to the influence and number of screws and their primary stability. Results For the relatively thin-walled Allofit®-S cup, an influence of the number of screws on the different forms of movement could be demonstrated. Conclusions We see a clear influence of the cup wall thickness on the elastic deformability and accordingly on the primary stability of the examined cups.

Little is known about T-cell responses during acute coronavirus disease-2019 (COVID-19). We measured T-cell interferon gamma (IFN-{gamma}) responses to spike 1 (S1), spike 2 (S2), nucleocapsid (N) and membrane (M) SARS-CoV-2 antigens using the T-SPOT(R) Discovery SARS-CoV-2 assay, a proven EliSPOT technology, in 114 hospitalised adult COVID-19 patients and assessed their association with clinical disease phenotype. T-SPOT(R) Discovery SARS-CoV-2 responses were detectable within 2 days of a positive PCR and did not correlate with vaccination status or symptom duration. Higher responses to S1 protein associated with a higher symptom burden, and serum IL-6 levels. Despite treatment with dexamethasone this subgroup was also at greater risk of requiring continuous positive airway pressure (CPAP) in the days following sampling. Higher T-cell responses measured using T-SPOT(R) Discovery SARS-CoV-2 associate with progressive disease in acute COVID-19 disease and may have utility as a prognostic biomarker that should be evaluated in larger cohorts.

Little is known about T-cell responses during acute coronavirus disease-2019 (COVID-19). We measured T-cell interferon gamma (IFN-γ) responses to spike 1 (S1), spike 2 (S2), nucleocapsid (N) and membrane (M) SARS-CoV-2 antigens using the T-SPOT® Discovery SARS-CoV-2 assay, a proven EliSPOT technology, in 114 hospitalised adult COVID-19 patients and assessed their association with clinical disease phenotype. T-SPOT® Discovery SARS-CoV-2 responses were detectable within 2 days of a positive PCR and did not correlate with vaccination status or symptom duration. Higher responses to S1 protein associated with a higher symptom burden, and serum IL-6 levels. Despite treatment with dexamethasone this subgroup was also at greater risk of requiring continuous positive airway pressure (CPAP) in the days following sampling. Higher T-cell responses measured using T-SPOT® Discovery SARS-CoV-2 associate with progressive disease in acute COVID-19 disease and may have utility as a prognostic biomarker that should be evaluated in larger cohorts.

Following surgical Achilles tendon reconstruction surgery, there is a distinct trend towards an early and faster rehabilitation protocol to avoid muscle atrophy. However, this procedure involves the risk of a higher complication rate. In order to reduce the occurrence of re-ruptures and pathological tendon extensions, a tendon reconstruction with the highest possible primary stability is desirable. Therefore, the aim of this study was to determine if augmentation using synthetic polyester tapes (QuadsTape™) could provide greater primary stability in case of different tendon suture techniques. 90 tendons of the superficial toe flexor of pigs were divided into 9 groups. The reconstruction method was combined using the factors suture technique (Kessler and Bunnell), augmentation (non-augmented and augmented with QuadsTape™) and defect type (end-to-end and 10 mm gap). The biomechanical measurements were performed on a material testing machine and consisted of a creep test, a cyclic test and a tear-off test. This study compared creep strain, ultimate load failure, maximum stress and stiffness. Irrespective of the type of defect involved, augmentation of the tendon sutures led to a significant increase of the maximum force (not augmented: 82.30 ± 25.48 N, augmented: 135.73 ± 30.69 N, p 0.001) and the maximum stress (not augmented: 2.26 ± 0.83 MPa, augmented: 4.13 ± 1.79 MPa, p 0.001). Furthermore, there was a non-significant increase in stiffness and no significant differences were observed with respect to creep strain. Augmentation of Achilles tendon reconstruction using QuadsTape™ increases composite strength and stiffness in the in vitro model, thus potentially contributing to the feasibility of early rehabilitation programs. Biological factors still need to be investigated in order to formulate appropriate indications.

Introduction Demographic change and demand for high quality of life lead to increasing implantation numbers. Aim of this study was to compare the Plasmafit® cup to Allofit® and Plasmacup®. Methods The study included 174 patients who had received 33 Plasmacup®, 68 Allofit® and 73 Plasmafit® cup implants. These were reviewed postoperatively, after 6 months control and after 12 months. Results No significant progressive migration could be discovered in any of the cup systems. At each follow-up the cups showed nearly constant values. Conclusions All examined acetabular cups showed excellent migration behavior within the first 12 postoperative months.

The purpose of this study was to check the concept of the cementless Metha® short hip stem in order to find out whether proximal physiological load transfer can be achieved. Fourty-three patients were included. Epidemiological factors were established. The Harris Hip Score was determined and measurement of bone mass density as well as osteodensitometric and radiological measurements was carried out pre-operatively, post-operatively, and after six, 12, 24, and 36 months. Harris Hip Score improved from 55.9 ± 12.4 pre-operatively to 94.8 ± 8.2 after 36 months (p

Objectives The study aimed to assess the relationship between coffee intake, obstructive sleep apnea risk (OSA), and glycemic control among patients with diabetes mellitus. Results There were 110 patients with diabetes and 96 healthy control subjects (matched for age and sex) attending a diabetes center زinTabuk, Saudi Arabia during the period from June 2018–October 2019. Stop-Bang questionnaire was used to assess OSA risk, and Epworth Sleepiness Scale to investigate daytime sleepiness. OSA risk and daytime sleepiness were higher among patients with diabetes compared to controls (4.34 ± 1.61 vs. 2.86 ± 1.24, and 8.31 ± 4.40 vs. 6.39 ± 3.70 respectively, P 0.05). Women with diabetes were younger with short duration since the diagnosis of diabetes and consumed less coffee compared to men, P

Cementless straight stems show very good survival rates. However, the more distal force application of straight stems may lead to release-related proximal stress-shielding. Nevertheless, this technical brief had the objective of conducting a biomechanical in vitro analysis comparing short stems with established straight stems with respect to their primary torsional stability. Two cementless short hip stems and three cementless straight hip stems were implanted in n = 5 synthetic femora each. Torsional torques were applied into the hip stems at a continuous interval of ±7 Nm. Micromotions were measured by six inductive extensometers on four different measurement levels. At the proximal measuring point, significantly smaller relative micromotions of the CLS® prosthesis could be detected compared to all other stem models (p

Background The resultant hip force causes a varus torque which must be compensated by a shear force couple depending on the stem alignment of the prosthesis. Since the prosthesis is substantially less flexible than the bone, the interior of the femur is stiffened over the entire prosthesis length. The present study thus aims at analyzing short-stem prostheses for its elastic bending characteristics, considering inappropriate valgus alignment of the prosthetic stem. Methods Five short stem prostheses were implanted each in synthetic femora in a standardized manner – in neutral and valgus stem alignments. Bending movements were recorded applying a tilting torque MX of ±3.5 Nm in medio-lateral direction. Variance analyses and Friedman tests were used. A P-value Findings Bending movements b1-b6 showed significant differences (P Interpretation Regarding the elastic bending behavior we see a relevant influence of the stems´ design. We conclude that the short-stem principle does not necessarily require the shortest possible prosthesis but rather a long and thin extending stem tip to optimize the lever ratios, ensuring a more physiological bending behavior of the femur. In addition, without sufficient anchoring of the prosthesis, the valgus stem alignment could favor tilting of the implant and should therefore be avoided.

Mit der steigenden Anzahl von Endoprothesentragern wird die Revision von Huftendoprothesen weiter zunehmen. Die Rekonstruktion ossarer Defekte mit allogenen Knochen ermoglicht die Wiederherstellung eines knochernen Lagers und verbessert die langfristige Verankerung und die Resultate. Eine ausreichende Primarstabilitat des gewahlten Konstrukts ist Voraussetzung fur ein gutes klinisches Ergebnis und die langfristige ossare Integration, ebenso wie ein guter Kontakt des implantierten Knochens zum Knochenlager. Die Knochentransplantation kann zu einem „Down-Grading“ eines knochernen azetabularen Defekts beitragen und die Verwendung eines groseren Stutzimplantats vermeiden. Auch bei der Rekonstruktion femoraler Defekte kann die Knochentransplantation das Knochenlager verbessern und die Implantation eines kleineren Schafts ermoglichen, allerdings sind der Indikationsstellung bei sehr ausgepragten Defektzonen Grenzen gesetzt. Aufgrund der guten langfristigen Ergebnisse der modularen Revisionsschafte hat sich das „Impaction-Bone-Grafting“ im Bereich des Schaftes nicht generell etabliert.

Stress shielding may lead to aseptic loosening which is a common reason for implant failure. An established method to identify implants with risk of implant failure caused by aseptic loosening is to measure early migration of the stem with the “Ein Bild Roentgen Analyse” femoral component analysis (EBRA-FCA). Therefore, the aim of this study was to measure the migration of a cementless short stem prosthesis via EBRA-FCA to predict the future performance. A total collective of 71 patients were treated with a cementless short hip stem prosthesis. Indications for surgery were primary coxarthrosis, dysplasia coxarthrosis or femoral head necrosis. After surgery, the patients were followed-up immediately after 3, 6, 12, 24, 36, and 48 months and X-ray images for EBRA-FCA measurements were taken. Axial caudal migration as well as the varus/valgus tilting of the prosthesis was determined. Possible influencing factors like BMI, age, diagnosis, gender or Harris Hip Score (HHS) on the migration of the stem were assessed. HHS increased significantly direct postoperatively (p

For preclinical statements about the anchoring behavior of prostheses, the primary stability of the prosthesis is of special importance. It was the aim of this study to examine and compare the relevant relative micromotions of three different acetabulum prostheses by introducing three-dimensional torques.The cups were implanted under standard conditions into an anatomical artificial bone model. Three-dimensional torques were applied to the acetabular cups. Taking into account the resulting frictional moments of two different bearing couples, ceramic-on-ceramic and ceramic-on-polyethylene, the relative micromotions of the cups were recorded as maximum total micromotion, translational and rotational micromotion, and the primary stability values of the three cups were compared.Relative micromotion of all cup models was always significantly smaller with the CoC bearing couples than with the CoP bearing couples (p 0.001). The rotational micromotion was always lower (p 0.001) than the translational micromotion, and the rotational as well as the translational micromotions were each always lower than the maximum total micromotion (p 0.001, p 0.010). The thinnest-walled cup system always showed the largest relative micromotions.The results of our study can be interpreted as indicating that the low relative micromotions of all cups - irrespective of the use of CoC or CoP bearing couples - are within an acceptable range favoring secondary osseointegration of the implants. Furthermore, we were able to show that the cup wall thickness and the surface quality of the cup systems have an influence on the primary stability and the elastic deformability of the examined cup systems.

Revision surgery of joint replacements is increasing and raises the demand for allograft bone since restoration of bone stock is crucial for longevity of implants. Proceedings of bone grafts influence the biological and mechanic properties differently. This study examines the effect of thermodisinfection on mechanic properties of cancellous bone. Bone cylinders from both femoral heads with length 45 mm were taken from twenty-three 6–8 months-old piglets, thermodisinfected at 82.5 °C according to bone bank guidelines and control remained native. The specimens were stored at −20 °C immediately and were put into 21 °C Ringer’s solution for 3 h before testing. Shear and pressure modulus were tested since three point bending force was examined until destruction. Statistical analysis was done with non-parametric Wilcoxon, t test and SPSS since p

Introduction and Background: Multidrug-resistant tuberculosis (MDR-TB) has emerged as a significant global health concern. Patients who had failed previous TB treatment, relapsed after treatment, contacted known MDRTB patients or defaulted during previous treatment, and HIV patients are considered to be suspected and at high risk for developing drug resistant TB specially MDR-TB. However, there is little data available on the prevalence and trends of MDR tuberculosis in national level but luck of it in Mogadishu is our main concern. Methodology: This was a crosssectional, descriptive study involving all suspected MDR TB patients attended at the Mogadishu three Tb centers. Results: A total of 138 cases of suspected MDRTB patients were included in the study. Of these, 70 patients (51%) had rifampicin resistant-TB. Of the 138 study participants, 94 (68.62%) were between 21 - 40 years old that indicates the dominance of productive age group (21 - 40 years). Previous Tuberculosis treatment has been noted to be a major risk factor for development of multidrug resistance tuberculosis. MDR-TB prevalence is significantly higher in male than female patients. Conclusion and Interpretation: The prevalence of Rifampicin resistance among these high risk groups was significant. The high association of previous TB treatment to MDR-TB might be explained due to inappropriate anti-tubercular regimens, sub-optimal drugs, inadequate or irregular drug supply, unsatisfactory patient or clinician compliance, lack of supervision of treatment and absence of infection control measures in healthcare facilities. As the prevalence of MDRTB is high and yet the cases remain un-isolated in the community we recommend the MOH/NTP and funding agencies to facilitate establishment of MDRTB management centers earlier in Mogadishu in order to treat the MDRTB case otherwise it might Amplify of the incidence of this Emerging Disease.

The purpose of this study was to examine potential differences between patients under and over 60 years who underwent a total short hip stem arthroplasty in a 24-month follow-up in a clinical setting. Sixty seven patients were included in this prospective study and divided in two groups. In the younger cohort 39 patients ≤ 59 years and in the older cohort 28 patients ≥ 60 years were included. Clinical and radiological examinations of the patients took place preoperatively, postoperatively and after 3, 6, 12 and 24 months. The Harris Hip Score (HHS) was raised as clinical examination. Changes of bone mass density (BMD), stress shielding, reactive lines, spot welds and sclerosing were examined as radiological analysis. The HHS improved from 53.6 ± 8.2 preoperative to 93.2 ± 9.6 in the younger cohort and for the older cohort from 57.6 ± 14.8 to 94.1 ± 7.6 after 24 months. BMD growth was detectable in regions of interest (ROI) 3 and 6 for both groups. Different results between the cohorts could only be detected in ROIs 4 and 5. The older cohort showed a loss of BMD of 5.95% in ROI 4 and 3.17% in ROI 5 after 24 months, whereas the younger cohort showed no loss of BMD in both ROIs. No significant differences or any influences of osseointegration and clinical outcome of the short hip stem for both groups were detectable. Lower losses (ROIs 1 and 2) and higher growths (ROIs 3, 4, 5) were discovered in younger patients and the HHS improved in both groups. Reasons for this result could be age, sex or the level of activity of the patients, but in both groups the short hip stem shows comparable results in clinical as well as in radiological examination. We conclude that the short hip stem seems to be an adequate treatment also for older patients.

Background A norovirus maintains its viability, infectivity and virulence by its ability to replicate. However, the biological mechanisms of the process remain to be explored. In this work, the NanoLuc™ Luciferase gene was used to develop a reporter-tagged replicon system to study norovirus replication. Methods The NanoLuc™ Luciferase reporter protein was engineered to be expressed as a fusion protein for MNV-1 minor capsid protein, VP2. The foot-and-mouth disease virus 2A (FMDV2A) sequence was inserted between the 3'end of the reporter gene and the VP2 start sequence to allow co-translational 'cleavage' of fusion proteins during intracellular transcript expression. Amplification of the fusion gene was performed using a series of standard and overlapping polymerase chain reactions. The resulting amplicon was then cloned into three readily available backbones of MNV-1 cDNA clones. Results Restriction enzyme analysis indicated that the NanoLucTM Luciferase gene was successfully inserted into the parental MNV-1 cDNA clone. The insertion was further confirmed by using DNA sequencing. Conclusion NanoLuc™ Luciferase-tagged MNV-1 cDNA clones were successfully engineered. Such clones can be exploited to develop robust experimental assays for in vitro assessments of viral RNA replication.

The chemical nature of most of the mycotoxins makes them highly liposoluble compounds that can be absorbed from the site of exposure such as from the gastrointestinal and respiratory tract to the blood stream where it can be dissimilated throughout the body and reach different organs such as the liver and kidneys. Mycotoxins have a strong tendency and ability to penetrate the human and animal cells and reach the cellular genome where it causes a major mutagenic change in the nucleotide sequence which leads to strong and permanent defects in the genome. This defect will eventually be transcribed, translated and lead to the development of cancer. In this review, the chemical and physical nature of mycotoxins, the action of mycotoxins on the cellular genome and its effect on humans, mycotoxins and their carcinogenicity and mycotoxins research gaps are discussed, and new research areas are suggested. The research review posed various questions. What are the different mycotoxins that can cause cancer, what is the role of mycotoxins in causing cancer and what types of cancers can be caused by mycotoxins? These questions have been selected due to the significant increase in the mycotoxin contamination and the cancer incidence rate in the contemporary world. By revealing and understanding the role of mycotoxins in developing cancer, measures to reduce the risks and incidents of cancer could be taken.

Aquilaria crassna (agarwood) has been used in traditional Asian medicine to treat vomiting, rheumatism, asthma, cough and inflammation. Despite the wide range of ethno-pharmacological use of agarwood, its anti-angiogenic effect has not previously been evaluated through systematic studies. Therefore, the aim of this study was to prepare essential oils extracts from the stem bark of A. crassna native to Malaysia, and determine their anti-proliferative and anti-angiogenic activities. Stem bark samples were extracted with 80% ethanol and hydrodistillation methods. The resulting essential oils from both extraction approaches were subjected for cytotoxic activity using four cancer cell lines and one normal cell line. Hydrodistilled essential oils displayed significant cytotoxic effect against HCT 116 cells with the lowest IC50 value calculated (28.0 ± 1.5 μg/mL). Furthermore, we have investigated the effect of hydrodistilled essential oils (active extract) on angiogenesis in vitro and ex vivo, and found that essential oils directly inhibited tube formation after plating endothelial cells on matrigel. In addition, essential oils caused significant inhibition of microvessels outgrowth of rat aortic ring assay in a dose-dependent manner (P

Acute transverse myelitis is the leading cause of non-compressive myelopathy, linking the clinical presentation with Magnetic Resonance Imaging (MRI) may aid in proper stratification of patients improving management, we aimed to study the correlation between the clinical presentation of acute transverse myelitis with MRI findings. This cohort, hospital-based study conducted at Alshaab Teaching Hospital, Sudan among patients with acute transverse myelitis, Participants signed a written informed consent then the clinical presentation was recorded and followed including symmetry and extent of the lesion, site of lesion, sensory involvement. Correlation between various clinical presentations and MRI findings was done. The ethical committee of Alshaab Teaching Hospital approved the research, and the Statistical Package for Social Sciences was used for data analysis. Out of 100 patients infections was observed in 25%, and autoimmunity in 8%, involvement of more than three segments of the spinal cord was commoner among patients with symmetrical and complete presentation, no significant difference was evident between patients with symmetrical and complete presentation, compared to partial asymmetrical presentation regarding the site of spinal cord involvement on MRI. Complete and symmetrical presentation are commonly associated with more than three segments involvement of the spinal cord, no significant difference was found between complete symmetrical presentation and partial asymmetrical presentation regarding the site of involvement on MRI.

Background: Gender differences among patients with the acute coronary syndrome is still being debated, no research has been done on gender inequality among coronary syndrome patients in Sudan. Objectives: To study gender differences in presentation, management, and outcomes of acute coronary syndrome in Sudan. Subjects and Methods: This cross-sectional descriptive longitudinal study was conducted in Omdurman Teaching Hospital between July 2014 and August 2015. Patients were invited to sign a written informed consent form, were interviewed and examined by a physician, and then followed during their hospital stay. Information collected includes coronary risk factors, vital signs, echocardiography findings, arrhythmias, heart failure, cardiogenic shock, and death. The Ethical Committee of Omdurman Teaching Hospital approved the research. Results: A total of 197 consecutive acute coronary syndrome patients were included, 43.1% were females. A significant statistical difference was evident between males and females regarding the type of acute coronary syndrome, its presentation, and time of presentation to the hospital, smoking, and receipt of thrombolysis (P < 0.05). No differences were found with regard to age, hypertension, diabetes, family history of myocardial infarction, percutaneous coronary intervention, and in-hospital acute coronary complications (P > 0.05). Conclusion: Women were less likely to receive thrombolytic therapy, present with chest pain, and diagnosed with ST-segment elevation myocardial infarction. No gender differences were found in acute coronary syndrome risk factors apart from smoking, which was more common in males, and there were no differences between males and females as regards in-hospital complications.

Background Closing-wedge high tibial osteotomy (HTO) is successful for the treatment of medial osteoarthritis with varus malalignment. Preoperative risk factors for HTO failure are still controversial. The aim of this study was to elucidate the outcome and assess the influence of risk factors on long term HTO survival. Methods 199 patients were retrospectively studied with a mean follow-up period of 9.6 years after HTO. HTO failure was defined as the need for conversion to TKA. Survival was analyzed with the Kaplan-Meier method. Knee function was evaluated by the Hospital for Special Surgery (HSS) score. HTO-associated complications were also assessed. Univariate, multivariate, and logistic regression analysis were performed to evaluate the influence of age, gender, BMI, preoperative Kellgren-Lawrence osteoarthritis grade, and varus angle on HTO failure. Results 39 complications were recorded. Thus far, 36 HTOs were converted to TKA. The survival of HTO was 84% after 9.6 years. Knee function was considered excellent or good in 64% of patients. A significant preoperative risk factor for HTO failure was osteoarthritis, Kellgren-Lawrence grade >2. Conclusion HTO provides good clinical results in long-term follow-up. Preoperative osteoarthritis Kellgren-Lawrence grade >2 is a significant predictive risk factor for HTO failure. Results of HTO may be improved by careful patient selection. Complications associated with HTO should not be underestimated.

Introduction Silicone injection is a common procedure in cosmetic surgery. Granuloma formation and migration are the most commonly observed complications. Case presentation We report an unusual case of avascular necrosis of the hip in a 41-year-old woman from Thailand presenting with hip pain. Subcutaneous nodules were observed in the clinical examination. A pelvic X-ray revealed necrosis of the right femoral head and histological analysis of the punctuated nodules showed a reaction of foreign body granulomas. During surgical treatment with a hip replacement solitary silicone cysts were removed. Conclusions This case report emphasizes that orthopedic surgeons treating patients with necrosis of the hip joint in combination with palpable granulomas in the gluteal region have to be aware of silicone augmentation and its potential complications before planning a hip replacement.