Atypical acetabular bone loss in chronic septic total hip arthroplasty loosening.

Background: When a periprosthetic infection is diagnosed, the surgical treatment is usually performed as soon as possible to avoid further bone damage or life threatening complications. There is no report on the radiographic change in patients with untreated infected total hip arthroplasty (THA) for several years. Objective: Report radiographic change in patients with untreated infected THA. Method: Two patients presented with chronic septic loosening of cemented acetabular fixation after total hip replacement at King Chulalongkorn Memorial Hospital. Both patients had mild hip pain and had been lost for follow-up until the bone destruction became very severe. Serial radiographs after the surgeries were evaluated. The Paprosky’s acetabular bone loss classification was used to classify the radiographic findings. Results: Based on the Paprosky’s classification for acetabular bone loss, there were two similar atypical radiographic findings found in both patients. These included pelvic discontinuity from extensive medial acetabular bone loss beyond the Kohler’s line, and minimal superior and inferior acetabular bone loss. Conclusion: These atypical radiographic findings were rarely observed in septic acetabular loosening patients, as infection usually causes patients to present earlier. Following the septic acetabular loosening of THA, surgical procedure should be performed before massive bone damage was demonstrated.

Reliability of digital compass goniometer in knee joint range of motion measurement.

OBJECTIVE: To compare the reliability of range of motion measurement in the knee joint using a digital compass goniometer combined with inclinometer with standard range of motion measurement from roentgenographic picture. MATERIAL AND METHOD: Range of flexion and extension of the knee joint in volunteer participants was measured by the newly developed digital compass goniometer combined with inclinometer (DCG). The results were compared with range of knee joint motion obtained from standard roentgenographic picture by intraclass correlation coefficient. RESULTS: Range of motion of knee joint measured by DCG correlated very well with the data obtained from standard knee roentgenographic picture. The intraclass correlation coefficient equals 0.973. CONCLUSION: The digital compass goniometer was a reliable tool to measure knee joint range of motion in flexion and extension plane.

Randomized controlled trial between surgery and aspiration combined with methylprednisolone acetate injection plus wrist immobilization in the treatment of dorsal carpal ganglion.

Dorsal carpal ganglion is one of the most common benign tumors of the hand. Many treatment modalities had been proposed and yielded the same success rate. In the present study, the authors conducted a randomized controlled trial to compare the success of treatment between surgery and aspiration combined with methylprednisolone acetate injection plus wrist immobilization. There were 28 patients enrolled and randomized into two treatment groups. Only 24 patients were available for the final follow up at 6 months. According to the present study, dorsal carpal ganglion was more common in females (83.3%) at an average age of 30 years. Pain was the most common presenting symptom (58.3%). The success by excision was 81.8% and by aspiration combined with methylprednisolone acetate injection plus wrist immobilization was 38.46%. The p-value was 0.047 by Fisher exact test. The present study has clearly shown that surgical excision gave a better success rate in the treatment of dorsal carpal ganglion.

Acetabular position setting in total hip arthoplasty by using V-inclinometer.

The abduction angle of the acetabular implant position is important in the process of total hip arthroplasty. The authors evaluated the potential benefit of a V-inclinometer in the prediction of the abduction angle. To evaluate the accuracy of the V-inclinometer, acetabular cups were inserted in 50 cadaveric pelvises. The abduction angle from V-inclinometer and digital photograph were compared and analyzed using paired t-test. There was no statistical difference of the acetabular abduction angle between digital photograph and V-inclinometer (P > 0.05). The V-inclinometer can be used to predict the abduction angle on a cadaveric pelvis, suggesting that it could be a useful adjunct in clinical practice.