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We report our results obtained using Ludloff’s anteromedial approach in 17 patients affected by disorders other than congenital dislocation of the hip. These disorders were all localized on the anteromedial aspect of the hip joint and the proximal part of the femur (6 heterotopic ossifications, 3 osteoid osteomas, 2 osteochondromas, 1 aspecific coxofemoral synovitis, 1 chronic epiphysiolysis of the hip, 3 fractures of the femoral head, and 1 malignant fibrous histiocytoma). The treated group comprised 10 males and 7 females with a mean age of 33 years (range, 11–72 years). The anteromedial approach allowed for complete or almost complete removal of the pathological masses, withdrawal of synovial tissue for biopsy purposes, the reduction and fixation of femoral head fractures and even a corrective femoral neck osteotomy. The suitability of this treatment for skeletal disorders has been confirmed by clinical and radiographic controls carried out after a mean period of 7 years (range, 2–10 years).

The tolerability and safety of hyaluronan-based three-dimensional scaffolds as a culture vehicle for mesenchymal progenitor cells was investigated in this pilot study. The proliferation patterns and extracellular matrix production of rabbit and human mesenchymal, bone-marrow-derived progenitors first were characterized in vitro. Subsequently rabbit autologous cells were cultured in this hyaluronan-based scaffold and implanted in a full-thickness osteochondral lesion. In vitro histologic findings showed that mesenchymal progenitor cells adhered and proliferated onto the hyaluronan-derived scaffold. Human stem cells were shown to produce the main extracellular matrix molecules, accompanied by an occasional synthesis of mature type II collagen. In vivo data demonstrated that the biomaterial, with or without mesenchymal progenitors, did not elicit any inflammatory response and was completely degraded within 4 months after implantation. With regard to the efficacy of this cell therapy, even among the small number of animals tested there was histologic evidence that lesions filled with the biomaterial, either seeded or unseeded with cells, achieved a faster and better healing compared to empty controls. The present data suggest that the hyaluronan-based scaffolds are well tolerated and safe and may be a valuable delivery vehicle for tissue engineering in the repair of articular cartilage defects.

Transient algodystrophy of the hip in pregnancy is a relatively rare condition, still unknown to many and easily overlooked. Diagnosis is important because of the related difficulties in natural delivery and the risk of fracture. Four unilateral cases are presented (two right and two left), characterised by pain, limping, limitation of the hip motion and demineralisation of the head and neck of the femur. Treatment was by rest and protected weight-bearing. Three were delivered by caesarean section. In one patient a fracture of the neck of the femur occurred a few weeks before delivery, requiring surgery. In all four cases the outcome was benign. Like algodystrophy occurring in adults of either sex the aetiology is unknown. In pregnant women the association with the right occiput anterior position of the fetus (documented in one patient where the affected hip was the right) suggests the possible involvement of one of the autonomic pelvic plexuses (right or left) in the unilateral cases.

Starting from about the 40th year of life the lumbar spinous processes of man undergo morphological changes, which mainly affect their posterior edges. These changes consist of asymptomatic osseous appositions or spurs radiologically visible in the lateral view, with a major incidence in the elderly. Spondyloarthritis is a constant accompanying finding. Histologically the condition corresponds' to a process of substitution by Haversian bone of a layer of calcified fibrocartilage, which constantly occupies the ligamentous and tendinous attachments for a variable distance. While in the young adult fibrocartilaginous metaplasia is limited to the bony attachments of the spinous ligaments, in the elderly it spreads to the greater part or to all of their thickness. The author believes that such a phenomenon is due to a reduced flexibility of the vertebral column as a whole and to exaggerated lumbar lordosis with ageing. The elongation of the lumbar spinous processes secondary to osseous appositions increases the posterior arm of the lever and favours the "extensores spinae" m.

Background. Joint hypermobility (JH) is frequently seen in rheumatology; in some cases, such as rheumatoid arthritis (RA), it may represent a worsening of disease evolution. The aim of our study was to evaluate the influence of joint hypermobility on RA synovial fluid (SF) inflammation. Patients and methods. One hundred consecutive adult patients with RA and joint effusion of the knee were examined for the presence of JH. In the SF we evaluated volume, the number of white blood cells (WBC) and the levels of interleukin (IL)-1β, IL-6 and IL-8 and prostaglandin E 2 (PGE 2 ). Results. JH was associated with RA (JH-RA) in 18 patients, all of whom were female. Compared with non-JH RA, all the SF indices found in JH-RA were higher, although significant differences were observed only for volume, IL-8 and PGE 2 . Conclusion. In JH-RA, increased joint mobility seems to be associated with a more severe local inflammatory response, which may contribute to the more erosive evolution observed in our patients.

Le diagnostic de kyste du menisque externe est faible a faire mais ne peut etre considere comme certain jusqu'a confirmation chirurgicale. Dans 2 cas l'intervention a revele un kyste de la gaine du tendon poplite