Revision total hip replacement in severe acetabular bone deficiency

Acetabular bone deficiency is one of the main problems in hip revision. The aim of this study is to evaluate the results of revision hip replacement using stemmed acetabular component. Twenty one hips in 18 patients had revision total hip replacement using the stemmed acetabular reinforcement ring and impaction grafting technique for reconstruction of type III [combined segmental / cavitary] acetabular bone deficiency. A new method of measurements of migration was developed using a personal computer, scanner and a new software [Roman] developed in Robert Jones and Agnus Hunt Orthopaedic Institute, Oswestry, United Kingdom. The overall results revealed satisfactory results in 18 hips [90%] after a mean period of follow-up of 3.8 years. Failure was in 2 cases [10%] due to infection. The mean postoperative hip score improved from 50 points to 87.3 points. The mean vertical migration was 4.57 mm while the mean horizontal migration was 4.11 mm. 2 patients showed significant radiolucent lines and the cup was considered loose. 4 hips [19%] showed grade I heterotopic ossification [HO], one hip [5%] showed grade II HO. and one [5%] had grade III HO. 16 hips [76%] showed complete incorporation of the bone graft. Two hips [10%] had deep infection and considered clinical and radiological failure. Five hips had post operative dislocation and were managed conservatively without the need for any surgical intervention

Conversion from hemiarthroplasty to total HIP replacement: problems and early outcome

Conversion of hemi to total hip replacement [CTHR] is a common but difficult operation. The aim of this study is to evaluate the results of CTHR using long stem femoral prosthesis with or without bone grafting for the acetabulum. Thirty four hemiarthroplasty in 34 patients aged between 54 and 67 years old were converted to total hip arthroplasty. The mean period of follow up was 33 months. The indication of hemiarthroplasty was fracture neck of femur in all cases. There were 20 cemented Thomson and 14 Austin Moore prostheses. Pain was the main indication for conversion arthroplasty. Two types of cemented longstem femoral prostheses were used. Acetabular impaction morselized bone grafting was needed in four cases two of them had reconstruction rings. The mean Harris hip score improved significantly from 55 to 87.3 points. There was high incidence of significant radiolucent lines at the distal end of the stem [47%]. Two failures happened due to infection and recurrent dislocation. We had many intraoperative femoral fracture [18%] but with no direct effect on the results at the last follow-up. We concluded that conversion arthroplasty is a high risk operation but with high success rate. Infection and recurrent dislocation are the most difficult complications to manage. The use of longstem is very helpful but distal cementation technique need to improve

Evaluation of the results of open reduction and internal fixation of intra-articular calcaneal fractures by one third tubular plate

Treatment of intra-articular calcaneal fracture is still controversial. The aim is to evaluate the results of open reduction and fixation of calcaneal fracture using one third tubular plate and small set screws. Twenty patients with intra-articular calcaneal fractures were treated by open reduction and fixation using one third tubular plates. The average age was 32.5 +/- 4.5 years. The majority were manual workers. Falling from height was the causative trauma in all patients. Eleven patients [55%] had associated fractures. Fractures were classified according to Sanders classification into: six type II, twelve type III and two type IV fractures. Our results showed three excellent, eleven good, three fair and three poor outcomes. The results were affected by the height of falling, type of fracture, time elapsed before surgery, presence of infection and the degree of Gissane angle restoration. We concluded that reduction is the main factor to have satisfactory results and that one third tubular plates is an acceptable method of fixation of type II and III intra-articular calcaneal fractures but should not be used in type IV

Evaluation of the results of treatment of transverse patellar fractures with cancellous screws

Tension band wiring [TBW] is the most common method used to treat displaced transverse patellar fractures. While TBW is very efficient to compress the fracture during knee flexion, it is not that effective during knee extension. The aim of this study is to evaluate the results of treatment of transverse patellar fractures with cancellous screws. Twenty patients with displaced transverse patellar fractures were treated by open reduction and fixation by small set cancellous screws. The mean age of patients was 36.6 +/- 1 7.4 years. There were sixteen males. Road traffic accidents accounted for the majority of trauma. The mean time lapse before surgery was 4.5 days. Two screws were used in sixteen, three screws in three and four screws in one patient. The mean time to clinical union was 9 +/- 2.3 weeks while the mean time to radiological union was 13 +/- 3.6 weeks. All Patients completed six months follow up period. Using a modified Hospital for Special Surgery [HSS] knee scoring system, thirteen patients were excellent, five good and two fair results. Patients improved throughout the follow up period. Results were not affected by age, sex, time lapsed before the operation, and the number of screws used. Complications included prominent hardware in one patient, limited range of movements in six patients in which one developed 20° extensor lag. We concluded that the use of cancellous screws in the treatment of transverse patellar fractures yielded satisfactory outcome with low rate of complications in most cases

Bone removed in two different concepts of Hip bone conservative arthroplasty

Bone saving remains a priority in hip arthroplasty. Birmingham hip resurfacing [BHR] and thrust plate arthroplasty [TPA] are two different designs aiming at bone conservation. By measuring bone removed intraoperatively during 11 BHR, eight TPA and a control group of 15 hybrid hip arthroplasty it was found that BHR and TPA saved significant amount of bone if compared to hybrid hip arthroplasty [ANOVA p < 0.001]. Comparing BHR with TPA; BHR saved a significant amount of bone on the femoral side [ANOVA p < 0.001] while TPA saved a significant amount of bone on the acetabular side [ANOVA p = 0.03]. Preference between the two designs will depend on the long-term results and the degree of bone loss resulted from loosening and osteolysis at revision operation

Predictors affecting the results of impaction grafting for revision hip surgery

Twenty eight consecutive hips in 28 patients were evaluated at an average 47 months [range 30-75 months] after revision hip surgery reconstructed with impaction grafting. The principle revision procedure was the first revision in 20 hips [71.4%], the second revision in 4 [14.3%] hips, and the third revision in 4 hips. A collarless double tapered polished stem [CPT; Zimmer, Warsaw, Indiana] was used in 24 femora [85.8%]. Harris hip score was used to evaluate the function of the hip postoperatively. Implant migration was measured using Oswestry Roentgen Monophotogrammetric analysis software [ORMA]. By the time offollowup three hips [10.7%] had been re-revised. Two hips because of periprosthetic fracture femur and one because of recurrent dislocations. On the femora side significant correlations were found between stem tilt and two predictors: the number of previous revisions [p = 0.03] and the degree of femoral bone loss [P = 0.04]. Significant correlation was found between post operative pain and three predictors: vertical cup migration [p = 0.05], graft incorporation [p = 0.05] and the degree of pre-operative acetabular bone deficiency. [p = 0.024]. This study shows durable results using impaction grafting and identified the degree of bone loss, number of re-revision, and cup migration as important predictors in impaction grafting

Circulating mage-1 andmage-3 transcripts as tumour-specific markers for hepatocellular carcinoma

The members of human Melanoma Associated Antigen [MAGE] gene family are highly expressed in human hepatocellular carcinoma [HCC]. The present study aimed to detect tumour cells in the peripheral blood of HCC patients by using mRNA of the MAGE-1 and MAGE-3 genes as specific tumour markers. This study was carried out on 100 subjects included in three groups; group I: HCC patients [n=50], group II: cirrhotic patients [n=25] and group III: apparently healthy subjects as controls [n=25]. Patients of groups I and II were attendants of the Out Patient Clinics of National Liver Institute, Menoufiya University. The mRNA of the MAGE-1 and MAGE-3 genes in peripheral blood mononuclear cells [PBMC] was detected by using nested RT-PCR. Results revealed that of the 50 HCC patients, MAGE-1 and MAGE-3 mRNA were positive in 56% [28/50] and 46% [23/50] of PBMC respectively and 64% [32/50] of HCC samples were detected to express at least one type of MAGE mRNA. The detection of MAGE transcripts in PBMC was correlated with the advanced stages and the tumour size of HCC as 92.9% [26/28] and 100% [23/23] of positive MAGE-1 and MAGE-3 transcripts respectively were detected in HCC cases in stages III and VI. Also, 100% of positive MAGE-1 and MAGE-3 mRNA detected were related to HCC cases having sizes > 4cm. In addition, expression of MAGE-3 was correlated to the evidences of metastasis. On the other hand, detection of MAGE-1 and/or MAGE-3 transcripts was not detected in the PBMC of cirrhotic patients or in the PBMC of healthy controls. No statistical significant correlation was observed between the expression of MAGE genes and the increased levels of alphafoeto protein [AFP], the presence of liver cirrhosis or viral hepatitis. Therefore, these tumour specific antigens can be used as molecular markers for early diagnosis and possible targets for immunotherapy for patients with HCC