Correlation of roentgenographic patterns and clinical manifestations of symptomatic idiopathic osteoarthritis of the knee.

A retrospective review of weight-bearing roentgenograms of 2197 knees in 1894 patients with symptomatic idiopathic osteoarthritis (IOA) revealed six different patterns of tibiofemoral deformity. Five of these patterns expand the taxonomic concepts of Ahlback; the sixth, "nonproliferative," was previously undescribed. It was seen exclusively in patients with varus disease and was characterized by a lack of reactive bony changes. Knees with degenerative changes in the medial compartment constituted the majority of cases (63%). The average age of patients was 72 years for those with varus disease, 79 years for those with valgus disease, and 84 years for those with patellofemoral arthritis (PFA). Bilateral involvement was common only in patients with PFA (79%), suggesting a developmental cause for this subset. There was a female predominance in valgus and patellofemoral disease. The authors report here on a classification system of IOA that has been designed and modified to reflect the unique roentgenographic, epidemiologic, and clinical characterization of the six subsets.

Suprascapular nerve palsy.

Isolated traumatic suprascapular nerve palsy without associated fracture is a rare occurrence. Localized segmental muscle atrophy limited to the supraspinatus and infraspinatus muscles associated with weakness in initiating abduction and in external rotation of the shoulder should suggest the diagnosis. Electromyography will confirm the diagnosis by excluding nerve root and brachial plexus involvement with denervation potentials limited to the supraspinatus and infraspinatus muscles.

Arthrodesis of the salvage elbow.

An elbow arthrodesis was performed as a salvage procedure in seven patients with an open elbow arthrosis resulting from open trauma and the multiple surgeries that had followed. Patients had undergone an average of four previous elbow operations since their initial injury. Patients had pain, limited motion and instability that seriously compromised ipsilateral upper extremity function. Hardware was placed posteriorly in five patients, and in two patients with predominantly posterior pathology and infection, it was placed anteriorly. All but one case was fused at 90 degrees of elbow flexion. Wounds were all left open and spontaneously healed by secondary intention. Six patients were available for an average follow up of 4 years. Time to fusion ranged from 4 to 9 months (mean 6 months). Patients were graded in terms of relief of symptoms, clinical fusion, radiographic fusion, return to employment, wound healing, shoulder and hand function, and forearm rotation. Three patients had an excellent result, two good, and in one, the result was fair. In our view, the surgical procedure of choice for a salvage elbow is an elbow arthrodesis.

Assessment of bone grafts used for acetabular augmentation in total hip arthroplasty. A study using roentgenograms and bone scintigraphy.

Total hip arthroplasty was performed in 13 hips with acetabular bone grafts for secure component fixation. The incorporation and healing of acetabular bone grafts were investigated with the aid of roentgenograms, planar bone scans, and a newer scintigraphic technique, three-dimensional single photon emission computed tomography (SPECT). Conventional roentgenograms proved unreliable in evaluating bone graft reconstitution because of overlapping trabecular bone patterns of the graft and iliac wing. There was no evidence of graft failure or acetabular loosening. Bone grafts in the late follow-up group (four to seven years postoperation) exhibited normal radionuclide activity, whereas grafts less than one year postsurgery demonstrated patterns of increased activity. SPECT was helpful in producing an anatomic reconstruction of the acetabulum. The observation that bone grafts exhibited normal biological viability is crucial for ensuring secure acetabular component fixation on a long-term basis.

Septic arthritis of the wrist.

Twenty-eight patients (two of them children) with septic arthritis of twenty-nine wrists were treated with early surgical drainage, parenteral antibiotics, and early motion after surgical decompression. The etiology was trauma in seventeen patients, and Staphylococcus aureus was the organism that was most commonly recovered on culture. In twenty-two patients (twenty-three wrists) who were followed for six months to nine years there were no recurrences. The results were evaluated in terms of range of motion, grip strength, and subjective complaints of discomfort and disability. Of the ten wrists with a good or excellent result, all had had the arthrotomy within ten hours after diagnosis, and of the thirteen with a fair or poor result, surgery had been delayed for sixteen hours or longer. The long-term results deteriorated in direct proportion to increasing time until treatment and the number of procedures performed.