Fat-suppressed three-dimensional spoiled gradient-echo MR imaging of hyaline cartilage defects in the knee: comparison with standard MR imaging and arthroscopy.

OBJECTIVE: The sensitivity of fat-suppressed three-dimensional spoiled gradient-echo (SPGR) images was compared with that of standard MR images for detecting hyaline cartilage defects of the knee, using arthroscopy as the standard of reference. SUBJECTS AND METHODS: We assessed 114 consecutive patients for hyaline cartilage defects of the knee with both standard MR imaging sequences and a sagittal fat-suppressed three-dimensional SPGR sequence. Of these patients, 48 with meniscal or ligament injury, or persistent symptoms, underwent subsequent arthroscopy. The standard MR images and SPGR images of these 48 patients were then retrospectively analyzed for articular defects in a blinded fashion by two independent observers. Sensitivity, specificity, and intraobserver and interobserver agreement were determined for the different imaging techniques. RESULTS: One fourth of the patients who went on to arthroscopy were shown to have isolated hyaline cartilage lesions that were clinically confused with meniscal tears and that were missed on the standard MR images. When looking at all surfaces combined for each reader, the SPGR imaging sequence had a significantly higher sensitivity than the standard MR imaging sequences for detecting hyaline cartilage defects (75-85% versus 29-38%, p < .001 for each comparison). When looking at individual surfaces for each reader, significant differences in sensitivity were shown for each surface except the trochlear and lateral tibial surfaces. We found no difference in specificity (97% versus 97%, p > .99). We also found that combined evaluation of standard MR and SPGR images gave no added diagnostic advantage (sensitivity, 86%; specificity, 97%; p > .42). Except for the lateral tibial surface, the study achieved excellent reproducibility among readings and between readers. CONCLUSION: Fat-suppressed three-dimensional SPGR imaging is more sensitive than standard MR imaging for the detection of hyaline cartilage defects of the knee.

Detection of knee hyaline cartilage defects using fat-suppressed three-dimensional spoiled gradient-echo MR imaging: comparison with standard MR imaging and correlation with arthroscopy.

OBJECTIVE: A preliminary study was done to prospectively compare fat-suppressed three-dimensional spoiled gradient-echo (3D SPGR) MR imaging with standard MR imaging for detection of defects in the hyaline cartilage of the knee, using arthroscopy as the reference standard. SUBJECTS AND METHODS: We studied 43 consecutive patients referred by two orthopedic surgeons for MR imaging of the knee. Twelve had arthroscopic correlation; they formed the basis of our study. Hyaline cartilage was imaged with a fat-suppressed 3D SPGR sequence with previously determined optimal imaging parameters. Our standard MR imaging study consisted of two-dimensional coronal T1-weighted spin-echo, sagittal dual-echo T2-weighted spin-echo, and axial multiplanar gradient-echo sequences. With arthroscopy as the reference standard, sensitivity and specificity of fat-suppressed 3D SPGR and standard MR images for detecting cartilage tears were determined by articular surface (eight surfaces in each patient: medial and lateral patellar facets, trochlear facets, femoral condyles, and tibial plateaus). Statistically significant differences in sensitivity and specificity were determined. RESULTS: Arthroscopy showed 15 cartilage defects in seven patients. The fat-suppressed 3D SPGR images had higher sensitivity (93%) than the standard MR images (53%, p = .03). Specificity was 94% for the fat-suppressed 3D SPGR images compared with 93% for the standard MR images (p > .05). The five false-positive articular surfaces on fat-suppressed 3D SPGR images were from focal signal change within the substance of the cartilage without a contour defect. Smoothly contoured thinning and loss of the trilaminar appearance of the hyaline cartilage at the lateral femoral notch was shown in all subjects and was considered a normal finding. CONCLUSION: Fat-suppressed 3D SPGR imaging is more sensitive than standard MR imaging for the detection of abnormalities of the hyaline cartilage in the knee. Routine use of this technique may strengthen the role of MR imaging for noninvasive evaluation of internal derangements of the knee.

Hip arthroplasty in patients with chronic renal failure.

Patients with chronic renal failure who underwent total hip arthroplasty were retrospectively evaluated. Thirty hips in patients with renal transplants and 16 hips in patients on chronic renal dialysis were reviewed. The average follow-up period was 54 months. The renal transplant patients exhibited generally satisfactory results. Their postoperative course was comparable to that of patients with avascular necrosis undergoing hip reconstruction without underlying renal disease. However, patients undergoing hip arthroplasty while on chronic renal dialysis had poor results (81%), including a deep infection rate of 19%. It was concluded that total hip arthroplasty be reserved for patients who are expecting a renal transplant or preferably those who have already received a successful transplant.

Salvage of the diabetic foot with exposed os calcis.

Fifty consecutive heel ulcers were managed in three groups by debridement, split-thickness skin graft (STSG), bypass procedures, and orthotics. Group I consisted of 24 ulcers in patients with diabetes (DM) and peripheral vascular disease (PVD), 14 patients in Group II with DM only, and 12 patients with PVD only (Group III). Healing occurred in 56.5%, 64.3%, and 83.3%, respectively. An average of 2.2 procedures were performed per patient. Follow-up periods were for a minimum of two years or until amputation. Time for complete healing and the number of amputations performed were similar in all groups. Of the diabetics (combined from Groups I and II), a subgroup of 27% required partial excision of the os calcis to facilitate closure. After saline dressing changes, STSG was accomplished over thin granulation tissue. Forty percent of this subgroup healed, 30% remained open, and 30% were amputated. Aggressive management, soft-tissue coverage, and orthotic use can lead to a functional weight-bearing extremity.

Chopart amputation with percutaneous heel cord lengthening.

When amputation becomes necessary in a patient with peripheral vascular disease, it is important to preserve as much tissue as possible to preserve maximum function. This is especially important because the other extremity may have similar involvement in the future. With appropriate care, an amputation at the Chopart (calcaneocuboid-talonavicular) level can give a good functional result.

Compartment pressures of the leg following intramedullary fixation of the tibia.

A prospective study was performed to determine whether compartment pressures of the leg were affected by intramedullary fixation of the tibia. Ten of the 11 patients studied had surgery for acute diaphyseal fractures and 1 for tibial nonunion. Compartment pressures were measured immediately prior to the procedure and at 12 hours after the procedure. There was no difference between the preoperative and postoperative compartment pressures. Our data suggest that intramedullary stabilization of the tibia does not predictably increase compartment pressures.

Sexual function after total hip arthroplasty.

Eighty-six patients who had successful total hip replacement completed questionnaires on their sexual activity. Preoperatively, 46% of patients attributed significant sexual difficulties to their hip disease, whereas only 1% felt that their hips remained a significant source of problems postsurgery. The majority (55%) of patients were able to resume intercourse one to two months postoperation. Male patients were statistically more likely to resume intercourse sooner than their female counterparts. Patients were also questioned about which coital positions they found comfortable after arthroplasty. The supine position (patient on bottom) was the most preferred. The next most comfortable position for males was prone (patient on top), yet for female it was sidelying on the nonoperative hip. In addition, 89% of patients desired more information regarding sexual function postarthroplasty, preferably in the form of a booklet. Therefore, a booklet was written specifically for postoperative patients and their sexual partners.

Results of acetabular revisions with newer cement techniques.

It is the purpose of this article to evaluate the authors' results of cemented acetabular reconstructions in revision surgery for massive osseous deficiencies with the previously stated techniques. In addition, the authors will examine the results with respect to bone allografting and bone autografting and their compatibility with methyl methacrylate.

Acetabular cup wear in total hip arthroplasty.

Clinical, pathologic, radiographic, and biomechanical factors of 10 severely worn retrieved Charnley acetabular cups were examined to determine whether these factors influenced cup wear. Change in cup thickness was found to be linear with time. It was found that the actual change in cup thickness was not significantly different from the radiographic change in cup thickness. No correlation was found with the other clinical or radiographic factors.