Tuberculous arthritis of the knee presenting as a meniscal tear.

Nonspinal skeletal tuberculosis is a rare, indolent disease that is often difficult to diagnose. The incidence in the United States has recently increased. Pain and swelling are common symptoms. Radiographs may reveal normal findings, or in more advanced cases, demonstrate osteopenia, marginal erosions, and eventually, joint space narrowing and destruction. Treatment depends on the extent of the disease. Prolonged therapy with antitubercular agents is the mainstay of treatment. Synovectomy, osseous debridement, and arthrodesis also have a role in the treatment of this infection.

The effect of aging on the shape of the proximal femur.

The design of cementless femoral prostheses is based on the assumption that age and gender do not affect the shape of the proximal femur. To test this hypothesis, standard anteroposterior and lateral radiographs were prepared of 4 sets of 20 femora, obtained from young (range, 40-60 years) and elderly (range, 60-90 years) donors of both genders. The intracortical and extracortical borders of each femur were digitized electronically, and key parameters were measured to define the shape and dimensions of the medullary canal and the position of the femoral head. Systematic differences were observed between the size and shape of male and female femora. Extracortical dimensions were larger in the male femora by 14% to 19%, and endosteal dimensions by 11% to 24%. However, there were no significant differences between the canal shape of young male and young female femora in the coronal, sagittal, or transverse planes. The male femora displayed no significant differences in canal shape or endosteal width as a function of age. Profound differences were observed in the endosteal shape and diaphyseal dimensions of the young and old female femora. The older female femora had wider canals at the level of the isthmus, with a significant reduction in the canal flare index (the ratio between the canal width proximal to the lesser trochanter and at the isthmus). This study demonstrates that cementless femoral prostheses of 1 standard shape cannot provide a close fit to the endosteal contours of young and elderly women.