Five-year comparison of wear using oxidised zirconium and cobalt-chrome femoral heads in total hip arthroplasty: a multicentre randomised controlled trial.

Oxidised zirconium (OxZi) has been developed as an alternative bearing surface for femoral heads in total hip arthroplasty (THA). This study has investigated polyethylene wear, functional outcomes and complications, comparing OxZi and cobalt-chrome (CoCr) as part of a three-arm, multicentre randomised controlled trial. Patients undergoing THA from four institutions were prospectively randomised into three groups. Group A received a CoCr femoral head and highly cross-linked polyethylene (XLPE) liner; Group B received an OxZi femoral head and XLPE liner; Group C received an OxZi femoral head and ultra-high molecular weight polyethylene (UHMWPE) liner. At five years, 368 patients had no statistically significant differences in short-form-36 (p = 0.176 mental, p = 0.756 physical), Western Ontario and McMaster Universities Osteoarthritis Index (p = 0.847), pain scores (p = 0.458) or complications. The mean rate of linear wear was 0.028 mm/year (standard deviation (SD) 0.010) for Group A, 0.023 mm/year (SD 0.010) for Group B, and 0.09 mm/year (SD 0.045) for Group C. Penetration was significantly higher in the UHMWPE liner group compared with both XLPE liner groups (p < 0.001) but no significant difference was noted between CoCr and OxZi when articulating with XLPE (p = 0.153). In this, the largest randomised study of this bearing surface, it appears that using a XLPE acetabular liner is more important in reducing THA component wear than the choice of femoral head bearing, at mid-term follow-up. There is a non-significant trend towards lower wear, coupling OxZi rather than CoCr with XLPE but long-term analysis is required to see if this observation changes with time and becomes significant.

Proximal anterior cruciate ligament avulsion treated with TightRope® fixation device.

Anterior cruciate ligament injury is an uncommon finding in children but when it does occur it is usually a result of tibial avulsion or, less commonly, a midsubstance tear. It is generally agreed that surgical fixation is a necessity. We present a case of proximal anterior cruciate ligament avulsion and a new method of fixation.

N-heterocyclic dronic acids: applications and synthesis.

Substituted hydroxymethylenebisphosphonic acid derivatives--either as dronic acids or their dronate sodium salts, are important pharmaceuticals in the treatment of diseases arising from excessive bone-resorption. Potential has also been identified in areas ranging from parasite-growth inhibition to immunological and cancer therapeutics. Representative clinically relevant N-heterocyclic derivatives include zoledronic and risedronic acids. The biochemical background and mechanism of action of these drugs are discussed, along with trends in structural development and future prospects. Synthetic routes to dronates are then summarized. The most popular route to valuable dronic acids involves the 3- component condensation of a substituted acetic acid, phosphorous acid, and phosphorus trichloride. However, the protocols recorded in the literature are very diverse. This review gives a critical account of reported methods, explores the contradictions and suggests a practical synthetic procedure after clarifying the inconsistencies described. Possible mechanisms of the reaction are also discussed.

A history of carpal tunnel syndrome.

Carpal tunnel syndrome is the commonest entrapment neuropathy seen in clinical practice. The history of its aetiology and diagnosis gives an interesting insight into how the condition has evolved to also become the best understood neuropathy.

A self-administered questionnaire for basal osteoarthritis of the thumb.

Basal osteoarthritis of the thumb is a common condition for which numerous operations have been proposed without any particular one having been shown to be superior. One of the problems in evaluating the results of surgery is that there is no validated outcome score specifically for the condition. The purpose of this study was to construct a self-administered questionnaire (the Nelson score) to assess the outcome following surgery for this condition and to test its properties. Correlating the questionnaire score with physical findings on clinical examination showed external validity and test-retest reliability was high. Simultaneous administration of the score with the DASH score, both before and after surgery, showed it to be more sensitive to change (P=0.056). In addition, it is shorter than the DASH score, which may make it more acceptable to patients.

Pelvic fractures and high energy traumas.

Pelvic fractures are associated with a high mortality and morbidity and their presence should be considered in all high energy traumas. Early management is directed towards basic advanced trauma life support (ATLS) principles but it is essential to be aware of the diagnosis and management of these complex injuries.

Orthopaedic manifestations of tuberculosis.

An estimated 1 million people will be infected with tuberculosis worldwide in the first 20 years of the 21st century. If the disease is not recognized and treated early the morbidity and mortality of this condition will rise. This article highlights the varying manifestations of tuberculosis from an orthopaedic perspective.

Fascial flap for recurrent ganglion.

INTRODUCTION: Recurrence of a dorsal wrist ganglion following surgery is not uncommon and we propose a technique to deal with the problem. METHOD: A flap of extensor retinaculum is used to fill the defect left in the wrist capsule following repeat radical excision of the recurrent ganglion. The flap is based on a distal arterial pedicle, usually the intercompartmental 2:3 supraretinacular artery or one of its branches. RESULTS: Eight patients have been operated with a mean follow-up of 28 months. So far there have been no recurrences. CONCLUSION: Full recovery of wrist function ocurred in all cases except one who had slight restriction of flexion. We believe this to be a useful technique but a larger series with longer follow up would be needed to show its true value.

Understanding leukotrienes.

The leukotrienes of white cells are powerful pharmacological mediators that are implicated in many immunological reactions. The most powerful effects (bronchoconstriction and mucus secretion) are seen in asthma. The circulatory effects are local, except perhaps in endotoxin shock. Apart from corticosteroids, there are as yet no inhibitors in use in therapeutics.

Kupffer cell phagocytosis in relation to BSP clearance in liver and inflammatory bowel diseases.

Experience using microaggregated human serum albumin for a Kupffer cell phagocytic capacity "stress test" in patients with liver and inflammatory bowel diseases is described. Each result has been related to a 1-hr BSP clearance in order to account for variations in liver blood flow. Kupffer cell clearances are reduced in proportion to BSP clearance in obstructive jaundice and in secondary biliary cirrhosis but are increased in patients with chronic hepatocellular inflmmation. Conversely Kupffer cell phagocytosis is often depressed in patients with alcoholic hepatitis. In Crohn's disease or ulcerative colitis RES function is normal unless patients are receiving corticosteroid suppression.