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Background: The vascular supply to the acetabular labrum is important in the treatment of labral lesions. However, in vivo blood flow measurements in the acetabular labrum have not been described in the literature. The purpose of this study was to examine this blood flow in vivo using laser Doppler flowmetry (LDF) in patients with acetabular dysplasia. Methods: Periacetabular osteotomy combined with arthroscopy was performed in 47 consecutive patients (three males, 44 females; mean age at surgery, 35.6 years; range, 15-60 years). In all patients, blood flow in the acetabular labrum was measured with LDF during arthroscopy. The acetabular labral lesions were categorized according to the modified Beck classification: detachment and full-thickness labral tears were assigned to the T group and normal labrum to the N group. Blood flow rates in the acetabular labrum were compared between the T and N groups. The associations between labral blood flow and the lateral center-edge angle (CEa) and patient age were also evaluated. Results: The T and N groups comprised 31 and 16 patients, respectively. The mean blood flow rate was 1.94 ±0.41 ml/ min/100 g in the T group and 1.94 ± 0.34 ml/min/100 g in the N group, with no significant difference between the groups (P = 0.884). No association was noted between blood flow and either the CEa or patient age (β = -0.018, P= 0.077 and β= -0.001, P = 0.770, respectively). Conclusions: On LDF, blood flow in the acetabular labrum was present in all patients, regardless of the severity of acetabular labral tears, CEa, or age. [ABSTRACT FROM AUTHOR]

Objectives: Total hip arthroplasty (THA) is often performed in the lateral decubitus (lateral) position. In this position, the pelvis may have various degrees of tilt leading to implant malposition. We sought to quantify the pelvic tilt in lateral position and further pelvic movement during surgery. Methods: In 95 cases with primary THA, three-dimensional pelvic tilts were quantified by superimposing images reconstructed from CT data onto antero-posterior radiographs taken in lateral position at set-up and after cup placement. Pelvises were fixed with a device compressing anterior superior iliac spines and sacrum. Results: Various degrees of pelvic tilt occurred compared to the supine position; sagittal:-3.1° (-25.5° to 10.2°), axial: 3.9° (-8.4° to 17°), coronal: 0.9° (-11.9° to 13.2°). Absolute changes more than 5° were observed 43%, 47%, and 12% in the sagittal, axial, and coronal planes, respectively. The more preoperative posterior pelvic tilt resulted in the more change in the sagittal plane. Further pelvic movement of about 3° in three planes were observed ranging from -11° to 20° after cup placement. Conclusion: This study showed various pelvic tilt and movement during THA. As pelvic tilt directly alters the cup orientation, its changes should be well understood. Improved tools for positioning and holding the pelvis are required. [ABSTRACT FROM AUTHOR]

Introduction Preventing post-traumatic osteoarthritis is a challenging problem following acetabular fracture. Progressive osteoarthritis is considered to be caused by an irregular articular surface of the acetabular roof or cartilage injury, but little is known about the pathogenesis of collapse of the femoral head after acetabular fracture. We report a case of post-traumatic osteoarthritis after acetabular fracture in which subchondral fracture of the femoral head contributed to the progressive collapse of the femoral head and osteoarthritis. To the best of our knowledge, there has been no previous report of subchondral fracture of the femoral head after acetabular fracture. Case presentation A 58-year-old Japanese man fell from a ladder. He was diagnosed with a left acetabular fracture, which was managed conservatively. He developed left coxalgia six months after injury and was seen at our institution one year after the onset of pain. The left acetabular fracture had fused, but his left femoral head had collapsed. The images at the time of injury showed a fracture of the acetabular roof, and an approximately 2mm step-off existed in the articular surface. Retrospective evaluation of the plain radiographs and computed tomography images showed that his femoral head had progressively collapsed. Our patient underwent total hip arthroplasty. Histopathologic findings demonstrated that the collapse of his femoral head was caused by a subchondral fracture of his femoral head. Conclusion Our experience with this case indicates that in addition to post-traumatic osteonecrosis, subchondral fracture may need to be considered in cases with progressive collapse of the femoral head after acetabular fracture. [ABSTRACT FROM AUTHOR]

Abstract  A 57-year-old woman suffered rapid destruction of both hip joints over a 10 months period. At the first visit, her radiographs demonstrated slight joint space narrowing and acetabular cyst formation in both hips. Five months later, joint space narrowing had further progressed, and intra-articular injection of steroid was given in both hips. However, the hip pain gradually became worse. Five months later, both joint spaces had totally disappeared and both femoral heads had undergone massive collapse. At gross examination, both resected femoral heads showed extensive opaque yellow areas consistent with osteonecrosis. Microscopic examination of these areas revealed evidence of both extensive fracture and callus formation, as well as necrosis throughout, indicating that the osteonecrosis observed in this case was a secondary phenomenon superimposed on pre-existing osteoarthritis and subchondral fracture. There were many pseudogranulomatous lesions in the marrow space and necrotic area, where tiny fragments of bone and articular cartilage, surrounded by histiocytes and giant cells, were embedded, such as are typically seen in rapidly destructive arthrosis. No radiologic or morphologic evidence of primary osteonecrosis was noted. This case indicates that at least some cases of rapidly destructive arthritis are the result of subchondral fracture with superimposed secondary osteonecrosis. [ABSTRACT FROM AUTHOR]

Abstract  We report two cases of subchondral insufficiency fracture of the femoral head observed in younger adults without any history of overexertion. In both cases, MRI revealed an irregular, discontinuous low-intensity band on the T1-weighted images. Both patients were treated operatively, and histological examination confirmed the diagnosis of subchondral fracture. A diagnosis of subchondral insufficiency fracture needs to be put in as one of the diagnoses in younger patients with a hip pain. [ABSTRACT FROM AUTHOR]

Abstract Background  We originally used two or three large cancellous screws for a transtrochanteric rotational osteotomy for osteonecrosis. Since January 2002, a screw and plate system (K-MAX Adjustable Angle Hip Screw) has been used to obtain more rigid fixation at the site of osteotomies. We investigated the clinical and radiological results of a transtrochanteric anterior rotational osteotomy. Methods  Between January 2000 and December 2001, a transtrochanteric anterior rotational osteotomy with large cancellous screws was performed in 25 hips of 22 patients, and between January 2002 and March 2005, the K-MAX Adjustable Angle Hip Screw was used in 44 hips of 40 patients for treatment of osteonecrosis of the femoral head. Japanese Orthopaedic Association (JOA) score, postoperative management, and radiographic appearances were investigated. Results  The mean preoperative JOA score was 60.8 12.1 points in the large cancellous screw group and 61.5 14.4 points in the K-MAX Adjustable Angle Hip Screw group. This improved to 86.1 13.3 points in the large cancellous screw group and 88.7 6.6 points in the K-MAX Adjustable Angle Hip Screw group at the final follow-up. Intentional varus angulations were obtained in 15 of 25 hips in the large cancellous screw group and in 36 of 44 hips in the K-MAX Adjustable Angle Hip Screw group. Altogether, 23 of 25 (92.0%) cases with large cancellous screws started partial weight-bearing 7 weeks after the operation, and 43 of 44 (97.7%) cases with the K-MAX Adjustable Angle Hip Screw started 5 weeks after the operation. Conclusions  The K-MAX Adjustable Angle Hip Screw produced clinical results similar to those with the large cancellous screws. In addition, partial weight-bearing could be started 2 weeks earlier after a transtrochanteric anterior rotational osteotomy with the K-MAX Adjustable Angle Hip Screw. [ABSTRACT FROM AUTHOR]

This report describes the case of a 47‐year‐old woman who was found to have subchondral insufficiency fractures in both femoral heads after renal transplantation. Initially, plain radiographs showed no obvious changes, but magnetic resonance imaging (MRI) revealed an irregular, discontinuous, low‐intensity band on the T1‐weighted image of both hips. The patient was treated nonsurgically. Ten months after onset, the pain in both hips disappeared, and plain radiographs and MRI showed no abnormalities. Subchondral insufficiency fracture should be considered in the diagnosis of patients who have hip pain after renal transplantation. [ABSTRACT FROM AUTHOR]

To investigate the effects of combination treatment with an anticoagulant (warfarin) plus a lipid‐lowering agent (probucol) on the prevention of steroid‐induced osteonecrosis (ON) in rabbits. Adult male Japanese white rabbits were injected once intramuscularly with 20 mg/kg of methylprednisolone acetate into the right gluteus medius muscle. The rabbits were then divided into 4 groups and treated as follows: one group received warfarin plus probucol (WP; n = 25), one received probucol alone (PA; n = 30), one received warfarin alone (WA; n = 26), and one received no treatment (nonprophylactic [NP]; n = 20). Two weeks after the steroid injection, the femora and humeri were examined histopathologically for the presence of ON. The sizes of the bone marrow fat cells were examined morphologically. Hematologic examinations were performed before and after the steroid injection.The incidence of ON in the WP group (5%) was significantly lower than that observed in the NP group (70%). While the incidence rates of ON in the PA (38%) and WA (33%) groups were also significantly lower than that in the NP group, they were significantly higher than that observed in the WP group. The sizes of the bone marrow fat cells in both the WP (53.5 ± 4.1 μm) and the PA (52.0 ± 5.0 μm) groups were significantly smaller than those in the NP group (60.0 ± 4.0 μm). We also observed a prolongation of the prothrombin time and a reduction in the plasma lipid levels in the WP group during the study.This study experimentally confirmed that the combined use of an anticoagulant and a lipid‐lowering agent helps prevent steroid‐induced ON in rabbits. [ABSTRACT FROM AUTHOR]

Introduction/Purpose: Lisfranc ligament is a strong interosseous ligament located between the medial cuneiform (C1) and base of the second metatarsal (M2). Lisfranc injuries occur in approximately 0.2% of all fractures and are often overlooked or misdiagnosed. Weightbearing radiograph of the foot has been used as a diagnostic method for Lisfranc injuries; however, there is no study to evaluate the reliability of the measurement techniques on weightbearing radiographs. While several measurement techniques on weightbearing radiograph have been proposed for evaluating Lisfranc injuries, it remains unclear which measurement is the most reliable. This study aimed to evaluate the intra- and inter-observer reliability of the measurement techniques using weightbearing radiographs. Methods: Seventeen patients who were diagnosed with Lisfranc injuries using weightbearing radiographs and were treated with open reduction and internal fixation in our hospital between January 2013 and April 2019 were included in this study. Patients with multiple fractures were excluded. Four observers were selected, of which two were orthopedic specialists with more than six years of experience, while the remaining two were orthopedic surgeons with less than five years of experience. Observers evaluated the intra- and inter-observer reliability of the five measurement points on weightbearing radiographs on the affected and unaffected sides. The measurement points included the proximal, middle, and distal C1-M2 distance and parallel distance of C1-M2 and C1- the medial cuneiform (C2). Results: The proximal, middle, and distal C1-M2 distance and parallel distance of C1-M2 of The affected sides were wider than those of the unaffected sides with significant difference (p<0.01). The middle C1-M2 distance of the affected sides showed the highest intra-observer reliability (0.92) and the second highest inter-observer reliability (0.8). Other measurements of the affected sides showed comparable intra- (0.76-0.91) and inter-observer reliability (0.62-0.84). In addition, the middle C1-M2 distance of the unaffected sides showed the highest intra- (0.76) and inter-observer reliability (0.64); however, all measurements of the unaffected sides showed lower reliability than all measurements of the affected sides. Conclusion: The most reliable measurement point on the weightbearing radiograph was the middle distance of C1-M2. This result may help avoid overlooking or misdiagnosis of Lisfranc injuries. [ABSTRACT FROM AUTHOR]