Roman Radl

Thigh pain has been consistently reported with cementless hip arthroplasty. The correlation between thigh pain and radiological findings and the clinical significance of thigh pain have not been studied in any detail. We carried out a retrospective study to analyse the performance of a proximally porous-coated cementless femoral component. Ninety-eight total hip arthroplasties were followed up clinically and radiologically for an average of 33 months (range: 12 to 64) after operation. The clinical results were good or excellent in 85 cases (87%). Thirteen patients (13%) reported thigh pain at latest follow-up. Subsidence of the stem was recorded in 10 cases, cortical thickening occurred in 14 hips (14%), and 17 hips (17%) presented proximal osteopenia. Proximally, radiolucent lines were observed in 11 cases. Thigh pain correlated with radiolucent lines, femoral thickening, fibrous fixation and stem migration. Bone remodelling was noted to continue even five years after implantation. Our observations demonstrated bone ingrowth in the majority of the cases and a low incidence of thigh pain. The correlation between radiological changes and thigh pain suggests implant micromotion and migration in some hips. Patients with thigh pain, changes in the proximal femur and progressive subsidence need further clinical and radiological follow-up.

A twenty-four-year-old man began having neck pain in the summer of 2002. He had no history of a fall or trauma. The symptoms progressed, and he had episodes of paresthesias in both hands and the chest. Later, urinary and bowel dysfunction occurred. A neurological examination at a local hospital revealed hyperreflexia of the upper and lower extremities. Computed tomography scans of the head showed no abnormality. Subsequently, a computed tomography scan and magnetic resonance imaging study of the cervical spine demonstrated a large tumor (2.5 × 2 × 4 cm) in the second cervical vertebra as well as bone destruction and local calcification resulting in severe spinal stenosis (Figs. 1-A and 1-B). The findings on the routine laboratory tests were normal. Because of the neurological symptoms, the patient was managed with intravenous administration of dexamethasone. A computed tomography-guided needle biopsy of the tumor was performed in November 2002, but no representative tissue was obtained. A specimen obtained from a second closed biopsy with use of a trephine needle also showed no signs of a tumor. An open biopsy from …

Background: Bunionette is a common deformity for which a number of operative procedures have been described. The objective of this study was to evaluate the results of a modified distal horizontal metatarsal osteotomy in the correction of symptomatic bunionette. Methods: Metatarsal osteotomies were done in 21 feet in 14 patients (11 females, three males) with an average age of 44 (range 20 to 67) years at the time of operation. The average followup was 32 (range 12 to 52) months. Results: The average Lesser Toe Metatarsophalangeal-Interphalangeal Score of the American Orthopaedic Foot and Ankle Society increased from 42 points (range 24 to 50) preoperatively to 87 points (range 60 to 100) at the last followup. The fifth metatarsophalangeal angle averaged 18 degrees (5 to 38 degrees) preoperatively and 5 degrees (−5 to 26 degrees) at final followup. The 4–5 intermetatarsal angle averaged 14 degrees (10 to 20 degrees) preoperatively and 9 degrees (5 to 12 degrees) at final followup. Hardware was removed from two feet and scheduled for a third foot because of symptomatic skin irritation. Conclusions: The modified distal horizontal metatarsal osteotomy is a stable and reliable method for correction of bunionette. Unsatisfactory results in our patients were related to prominent hardware.

Background Several authors have found poorer outcome after hip replacement for osteonecrosis than after hip replacement for arthrosis. In a retrospective study we evaluated the performance of an uncemented femoral component in patients with osteonecrosis and arthrosis of the hip. Patients and methods 31 patients operated for osteonecrosis, and 49 patients operated for osteoarthrosis were included. The median follow-up time was 6.1 (2–11) years for the patients with osteonecrosis, and 5.9 (4–8) for the arthrosis patients. Results Migration analysis performed by the Einzel-Bild-Roentgen Analysis (EBRA) technique revealed a median stem migration of 1.5 (−8.8–0) mm in the patients with osteonecrosis, but only 0.6 (−2.8–0.7) mm in the patients with arthrosis (p < 0.001). Survivorship analysis with stem revision as endpoint for failure was 74% (95% CI: 55–94) in the osteonecrosis, and 98% (95% CI: 94–100) in the arthrosis group (p = 0.01). Interpretation We suggest that the higher failure rate and stem migration of uncemented total hip replacement in the patients with osteonecrosis is a consequence of the disease. On the basis of these findings, we recommend close monitoring of the patients with osteonecrosis, which should include migration measurements.

We reviewed 29 patients with intraosseous lipoma treated between 1985 and 2002. Mean patient age was 48 (20–75) years. According to Milgram’s classification, ten cases were classified as stage I, 14 as stage II, and three as stage III. All patients were initially treated by curettage. In 11 cases an additional phenolization was performed. The average follow-up was 32 (6–208) months. At the last follow-up, none had any clinical or radiological signs of recurrence. The adequate treatment of a symptomatic intraosseous lipoma is curettage and bone grafting. In the current study, phenolization showed no added benefit. An asymptomatic intraosseous lipoma without impending pathological fracture can be treated conservatively. Nous avons examiné 29 malades avec un lipome intraosseux traité entre 1985 et 2002. L’âge moyen des malades était de 48 ans (20–75). D’après la classification de Milgram, dix cas ont été classés comme stade I, 14 comme stade II, et trois comme stade III. Tous les malades ont été traités initialement par curetage. Dans 11 cas une phénolisation supplémentaire a été faite. Le suivi moyen était de 32 mois (6–208). Àu dernier examen aucun n’avait de signe clinique ou radiologique de récidive. Le traitement adéquat d’un lipome intraosseux symptomatique est un curetage avec greffe osseuse. Dans cette étude, la phénolisation n’a montré aucun avantage supplémentaire. Un lipome intraosseux asymptomatique sans menaçe de fracture pathologique peut être traité d’une manière conservatrice.