Investigation of the priority among the roentgenogram measurements in acetabular dysplasia.

PURPOSE: There are many radiographic parameters to evaluate developmental dysplasia of the hip joint (DDH); however, the priority between the parameters is unclear. We evaluated the priority of radiographic parameters in DDH. METHODS: We retrospectively reviewed the radiographs of 82 consecutive patients aged above 85 years without hip osteoarthritis (OA; no osteoarthritis (NO) group), and 28 patients with early stage hip OA were set as the control group (OA group). We used the linear discriminant analysis (LDA) to consider the priority of the following parameters: acetabular roof obliquity (ARO), center-edge (CE) angle, Sharp angle, acetabular head index (AHI), and acetabular depth ratio (ADR). RESULTS: The LDA of five different parameters revealed that the NO and OA groups could be almost distinguished with 83.6% accuracy (p < 0.0001, Wilks' lambda test). The standardized scoring coefficients were as follows: ARO, -0.23; CE, -0.43; Sharp, -0.29; AHI, 0.97; and ADR, 0.11. The AHI was particularly noticeable in the NO group. CONCLUSION: Dissociation of the AHI in the OA group was significantly higher than that of the other parameters in the OA group compared to the parameters in the NO group. A small AHI may be a risk parameter for hip OA due to DDH.

The Effect of Air Tourniquet on Interleukin-6 Levels in Total Knee Arthroplasty.

BACKGROUND: Air tourniquet-induced skeletal muscle injury increases the concentrations of some cytokines such as interleukin-6 (IL-6) in plasma. However, the effect of an air tourniquet on the IL-6 concentrations after total knee arthroplasty (TKA) is unclear. We therefore investigated the impact of tourniquet-induced ischemia and reperfusion injury in TKA using the IL-6 level as an index. METHODS: Ten patients with primary knee osteoarthrosis who underwent unilateral TKA without an air tourniquet were recruited (Non-tourniquet group). We also selected 10 age- and sex-matched control patients who underwent unilateral TKA with an air tourniquet (Tourniquet group). Venous blood samples were obtained at 3 points; before surgery, 24 h after surgery, and 7 days after surgery. The following factors were compared between the two groups; IL-6, C-reactive protein (CRP), creatine phosphokinase (CPK), the mean white blood cell (WBC) counts, and the maximum daily body temperatures. RESULTS: The IL-6 level at 24 h after surgery was significantly higher than that at any other point (p<0.01). No significant differences were observed in the WBC count, the body temperature, or the CRP, CPK, or IL-6 levels of the two groups at any of the time points. CONCLUSION: The effect of ischemia and reperfusion due to the use of an air tourniquet on increasing the IL-6 level was much smaller than that induced by surgical stress in TKA.

Revision total hip arthroplasty combined with subtrochanteric shortening osteotomy: case report.

Revision surgery is one of the most difficult reconstructive challenges facing orthopaedic surgeons; therefore, many new techniques and implants are needed to ensure that such patient can be successfully treated. We report a 66-year old female with a chronic dislocated bipolar hip prosthesis. She underwent a revision total hip arthroplasty combined with V-shaped subtrochanteric shortening osteotomy. This report demonstrates that V-shaped subtrochanteric shortening osteotomy can be used for revision surgery. Nevertheless, this technique is not suitable for all hip revisions, and the indications and various possible procedures and devices should be carefully considered to select the best treatment for each patient. We believe that the current report provides evidence supporting a new technical option for complex cases during revision THA.

Serum concentrations of interleukin-6 in patients following unilateral versus bilateral total knee arthroplasty.

BACKGROUND: Surgical stress is known to affect body temperature, white blood cell (WBC) count, C-reactive protein (CRP), and interleukin-6 (IL-6). The aim of the present study was to investigate which parameter is most suitable for quantitative analysis of surgical stress. METHODS: Unilateral total knee arthroplasty (U-TKA) and bilateral TKA (B-TKA) were selected for the subjects of this study because the B-TKA creates approximately double the surgical stress of the U-TKA. The temperature, WBC count, CRP, and IL-6 in the blood were measured pre- and postoperatively in both groups. The IL-6 in the drainage fluid was also measured after the operation. RESULTS: The temperature, WBC count, CRP, and IL-6 in the blood significantly increased on the first day after the operation in both groups. There were significant differences between the two groups in the WBC count (P < 0.05) and the IL-6 level in the blood (P < 0.05) on the first day after the surgery. There were no significant differences between the two groups for the CRP and IL-6 levels in the drainage fluid. The relative proportions--(B-TKA/U-TKA) x 100 (%)--were 170.4% for the operating time, 219.4 % for total blood loss, 200.0% for blood transfusion, 100.3% for temperature, 128.9% for WBC count, 127.4% for CRP, and 246.5% for the IL-6 level in the blood. CONCLUSIONS: The serum IL-6 level may best reflect surgical stress and could therefore be a quantitative marker of surgical stress.