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Currently, there is no imaging procedure for radionuclide therapy utilizing Erbium-169 (Er-169). We have recently published the first post-radiosynovectomy imaging of Er-169 citrate in a case report (Farahati et al., 2017). In this study, we performed in-vitro and in-vivo studies to evaluate the feasibility to assess the distribution of Er-169 citrate after radiosynovectomy in fourteen patients with seventeen affected joints treated for refractory chronic synovitis. Post-radiosynovectomy imaging revealed the feasibility of post-radiosynovectomy detection and distribution utilizing Er-169 citrate in all cases. However, additional in-vitro studies including in-vitro imaging, gamma spectrometry and analysis of half-life indicated that emitted gamma-rays of the Ytterbium-169 in the radiopharmaceutical together with bremsstrahlung induced by Er-169 are the imaging source of emitted counts. Post-radiosynovectomy imaging utilizing Er-169 citrate is feasible and should be implemented in the guidelines for theranostics for quality control, patient safety and therapy monitoring., (Copyright © 2019. Published by Elsevier Ltd.)

Currently, there is no protocol for the detection of intra-articular distribution of Er-169 citrate after radiosynovectomy. We propose post-therapeutic imaging using scintigraphy and cobalt-57 pen-marker autoradiography. This technique evaluates the efficacy of the radiosynovectomy and patient safety and could be utilized for dosimetric protocol.

Twenty-five consecutive children (29 hips) who had slipped capital femoral epiphysis of a mild degree (slip angle less than 30 degrees) were treated with dynamic screw fixation. The goal of dynamic screw fixation is to achieve physeal stability to prevent additional slippage and to avoid premature physeal closure. Seventeen boys and eight girls were followed up for an average of 7 years (range, 4-13 years). There were 25 chronic slips, three acute slips, and one preslip. The average age at the time of surgery was 11.7 years for the girls (range, 11.1-12.9 years) and 13.9 years for the boys (range, 9.4-16.1 years). The average time to physeal closure was almost the same in both genders (boys, 3.0 years; girls, 3.2 years), ranging from 1.1 years to 6.3 years. No increase in the degree of slippage occurred; there were no perioperative complications, and avascular necrosis and chondrolysis were not apparent. In all 29 hips, no growth disturbance, including greater trochanteric overgrowth, coxa brevis, or coxa vara, was seen. According to the clinical criteria of Heyman and Herndon, 26 hips were rated either excellent or good, and two were rated fair. One was rated poor because of the presence of slight pain after strenuous exercise. The technique of dynamic screw fixation provides sufficient immediate and long-term fixation, does not promote premature physeal closure, and permits normal hip development.

This study reports the first case of a subtrochanteric stress fracture of the femur after total knee arthroplasty. A 61-year-old obese woman was treated by right total knee arthroplasty for osteoarthrosis. Four months after the surgery and 1 month after full weight bearing, she complained of tenderness in the right groin and proximal thigh. There was no history of trauma. Radiographs of the right hip and of the right proximal femur were interpreted as unremarkable, and nonsteroid anti-inflammatory drugs were administered. Three months later, she had a sudden onset of increased pain with instability and giving way of the right leg. Radiographs revealed a subtrochanteric transverse fracture of the right femur. Histologic workup of the bone and tissue specimen taken at open reduction, as well as the laboratory data were consistent with the radiologic and clinical diagnosis of a stress fracture. It is most likely that a decrease in the tension band effect of the iliotibial tract in combination with coxa vara and changes in static and dynamic forces of the femur and an increased level of activity after a period of relative inactivity secondary to the knee arthroplasty are responsible for this very uncommon fracture type.

Intertrochanteric osteotomies produce a rate of 1 to 7% delayed union and pseudarthrosis, mainly as a result of the quality of the surgical procedure employed. In this retrospective and prospective study we have divided the models of bone healing after intertrochanteric osteotomy into 4 groups based on the postoperative x rays, and have taken into account only the factors of sclerosis, radiolucency and fragment contact in the osteotomy plane. This grouping enables us to evaluate the quality of the surgical procedure and to predict the postoperative course at an early stage, thus facilitating timely modification of the postoperative rehabilitation.

For the anchorage of femoral prosthesis stems in total hip arthroplasty, various cement application techniques are used. Experimental comparison of these techniques requires a set-up in which only the cementing technique itself is tested. We used a computer-controlled implantation device based on a milling machine and standardized artificial femur models. The stems are reproducibly positioned by the machine and any influence of manual positioning during the implantation is excluded. The results can be evaluated macroscopically and radiologically with no interference by disturbing bone--with sufficient sensitivity to objectify differences in cement quality. The increase in pressure in the peripheral medullary cavity, which is responsible for the embolisation, can be determined experimentally for the individual cementing technique. The experimental implantation device described enables a standardized comparison of various cementing techniques.

The displacement of the femoral epiphysis in epiphyseolysis capitis femoris is usually determined by measuring both the epiphysis-diaphysis angle (ED angle) in the plane of the dislocation and the epiphysis-torsion angle (ET angle) in the torsional plane. In this paper we define an epiphyseal version angle (EV angle) in the sagittal plane of the femur, calculate it trigonometrically and show it in diagrams and tables. The clinical application of the EV angle indicates that in cases of displacement with an ED angle of less than 135 degrees, absolute displacement is better shown than with the ET angle. Additionally, the EV angle improves our comprehension of the 3-D displacement due to the fact that, in the "Lauenstein" x-ray, the femur is increasingly projected more in a sagittal plane with increasing abduction. The essential correction using the Imhäuser-osteotomy is also done in the sagittal plane. The ability of the orthopaedic surgeon to visualize the situation in three dimensions is also improved by this additional standard plane.