Late detachment modular femoral component after primary total hip replacement.

Three years after total hip replacement surgery, a patient's modular femoral head separated from the stem portion of a primary total hip replacement while the patient was rising from a chair. The modular femoral head was in a polyethylene acetabular socket. Modular femoral and acetabular components now widely are used in hip replacement. The use of modular components greatly increases the flexibility during primary or revision total hip arthroplasty, but introduces the risks of component dissociation and intraoperative errors in matching. We report an unusually late dislocation of a primary modular total hip replacement.

Severe pelvic pain and extrinsic compression of the rectum: late complication of total hip arthroplasty.

Various pelvic and visceral complications have been reported resulting from total hip arthroplasty. Most of these complications are known to be related to the intrapelvic migration of the acetabular cup or the cement, or to the heat generated by polymerization of the methylmethacrylate. Complications involving almost every pelvic structure have been described. We report a case of progressive limb shortening and severe pelvic pain beginning 6 months after total hip arthroplasty. To close the acetabular defect after removal of the displaced acetabular component, we used a modified extraperitoneal approach adapted from Stoppa's technique, which is commonly used for inguinal, femoral, and obturator hernias. In this article, we aim to describe this modified extraperitoneal approach and to offer advice for the diagnosis and treatment of this serious complication.

Hydatid disease of the left femur: a case report.

Osseous hydatid disease is a rare but serious condition. Treatment is difficult because of the progressive course of the bone involvement and generally admitted algorithm about osseous hydatid disease. We report a six-year follow-up of a case with involvement of the left femur, treated with an unconnected surgical method and albendazole. In this patient a 1 cm segment of the cortex between the trochanteric region to supracondylar area of the left femur was removed. The medullary cavity of the left femur was irrigated for 5 minutes with 20% hypersaline solution, and removed without causing any damage. The medullary cavity was curettaged meticulously and irrigated for 6 minutes with 0.9% saline solution. The bone defect was filled with bone cement. Albendazole was administered during the postoperative period. At the sixth year postoperatively, the patient was pain free. All serological tests were normal. Radiologic evaluation showed no evidence of disease recurrence. Meticulous preoperative planning, excision of all the cysts, and an effective regimen of chemotherapy will reduce recurrence. Bone scintigraphy is an important diagnostic method during the follow-up period.

Mesh repair of a pelvic bone defect caused by a migrated acetabular cup.

Conventional transacetabular removal of the migrated acetabular cup can be hazardous due to intraoperative injury to iliac vessels. We present a case of a migrated acetabular cup, in which we used a combined preperitoneal and acetabular approach for its removal. With a bimanual approach, the procedure was safer and easier and allowed mesh repair of the pelvic bone defect. The preperitoneal mesh repair is a well-known method for inguinofemoral hernias. However, it has not been used before in the repair of an acetabular defect after removal of a migrated cup.

Femoral fixation of patellar tendon grafts using the bone-block locking technique in ACL reconstruction. A biomechanical study.

Anterior cruciate ligament (ACL) reconstruction relies on the security of graft fixation. K-wire fixation, heavy non-absorbable sutures tied to a screw staple post or endo-button are currently used for graft fixation. Kurosaka screw fixation may cause rupture of the graft due to excessive stress at the screw-graft interface in the femoral tunnel. To avoid inherent complications, a new bone-tendon-bone graft fixation technique for ACL reconstruction is described and biomechanically compared with the classical interference screw fixation in sheep knee models. A total of 13 pairs of fresh sheep knee specimens, obtained from a local slaughterhouse, were used in this study. Sheep knee specimens (n = 13) were divided into two groups. The right knees were Group I and the left knees were Group II. The right knees in Group I received interference screw systems and the left knees in Group II received the Bone Block Locking system (BBL). The average maximum load was found to be 275.01 +/- 10.75 N for the interference screw system and 389.92 +/- 7.54 N for the BBL system (p = 0.02). Our results indicate that the BBL technique allows a more secure fixation than interference screw fixation. The complications and technical pitfalls of interference screw fixation are not seen in BBL technique. We believe that the BBL technique is more advantageous in comparison to other fixation systems.

The femoral sulcus angle in neonatal cadavers: a macroscopical and ultrasonographical study.

The shape of the femoral sulcus is an important factor in patellofemoral congruence. The aim of the present study was to investigate the femoral sulcus angle using neonatal cadavers through ultrasonographic and macroscopic observations, in order to evaluate the differences between those two methods and also in order to compare them with adult data published previously. Both knees of 20 neonatal cadavers were examined to measure the femoral sulcus angle. The mean cartilaginous femoral sulcus angle was 145.77 degrees on the macroscopic measurements, and 146 degrees in the ultrasonographic examinations. There was no significant difference between neonatal and adult values and between ultrasonographic and macroscopic measurements (P > 0.05). In the most of the knees two condyles were symmetrical (92.5%). In conclusion the cartilaginous femoral sulcus angle is completely formed in the neonatal age group. Internal and external factors during childhood may be responsible for condylar dysplasia.

A further morphological study of the persistent median artery in neonatal cadavers.

Persistent median artery was studied in 60 upper limbs of 30 neonatal cadavers. It was found in 12 (20%) specimens while partial atrophy in the distal part of the median artery was detected in 9 (15%) specimens. These findings correlated well with those of other series including the authors' previous study which covered both adults and neonates. There was no significant difference statistically between the authors' current and previous studies (p > 0.05). Therefore both studies were combined. The incidence of persistent median artery in this enlarged series (100 specimens) was 17%. This rate of persistent median artery was higher than those of most other published series. We believe this may be due to evolutionary and racial trends; the neonatal origin of our specimens would be another differing factor. Partial atrophy of the median artery, and the different incidences in neonates and adults raised the possibility that the median artery regresses at a later age, possibly during perinatal and early infancy period.

Vertebral hemangioma presenting with intermittent claudication.

The case of a patient with vertebral hemangioma and unusual clinical presentation is reported, with an attempt to explain these unusual clinical complaints. Vertebral hemangioma is a common and often asymptomatic tumor. Neurologic symptoms may appear due to pressure on the neural tissue caused by extraosseous extension. The patient reported here presented with intermittent claudication. Conventional radiography CT, and MRI revealed vertebral hemangioma at T5 and extraosseous extension compressing the spinal cord. Gravity-related vascular dilatation may induce further compression of the spinal cord and, thus, is thought to be the underlying event in the induction of the intermittent clinical symptoms. The lesion was treated with subtotal corpectomy after embolization and fusion with a strut iliac crest graft. At the 9-month follow-up, the patient was without complaints. We conclude that a diagnosis of vertebral hemangioma should be considered in cases of intermittent neurologic symptoms of the lower extremities.

Persistent median artery: an anatomical study in neonatal and adult cadavers.

To examine the association of the median artery with the median nerve, 110 forearms from 20 neonatal and 35 adult cadavers of Turkish populations were dissected and compared with those of adult cadavers. In neonatal cadavers, the persistent median artery was found unilaterally in 5 (12.5%) forearms, in 4 of which the artery arose from the ulnar artery and in one from the common interosseous artery. In adult cadavers, however, no persistent median artery was observed. From these results, it could be suggested that this artery undergoes regression even after birth.

Morphologic variants of acromion in neonatal cadavers.

In this study, the morphology of the acromion in neonatal cadavers was investigated. The hooked-type acromions (Bigliani and Morrison type III), which are said to be responsible for rotator cuff lesions in adults, were found to have a very low incidence in this age group (5%). This finding challenges the validity of the assumption that some individuals have a congenital tendency for rotator cuff lesions, depending on their acromion types.

Sagittal contour restoration and canal clearance in burst fractures of the thoracolumbar junction (T12-L1): the efficacy of timing of the surgery.

The efficacy of timing of surgery (short segment fixation using transpedicular screws), in burst fractures of thoracolumbar spine was evaluated between May 1993 and October 1994. The patients were divided into two groups according to time elapsed between injury and operation. Cases operated on within the first 24 h were taken as the early surgery group (n = 10) and cases operated on later than 24 h after the injury were considered as the late surgery group (n = 8). The efficacy of treatment was assessed by evaluation of the sagittal index (SI) restoration and reduction of canal compromise. The pre- and postoperative values for SI and canal narrowing (CN) for both groups are as follows: Early preoperative SI-23.40 degrees, late preoperative SI-24.50 degrees, p = 0.53; early preoperative CN-0.47, late preoperative CN 0.52, p = 0.33; early postoperative SI-4.20 degrees, late postoperative SI-13.50 degrees, p = 0.0001; early postoperative CN-0.10, late postoperative CN-0.39, p = 0.0000. There is still controversy concerning the relationship between canal narrowing and neurologic deficit, and the effect, if any, of decompression on neural recovery. Nevertheless, if the main aim of the surgical procedure is to restore the SI and decompress the neural canal, then other alternatives of decompression and realignment should be preferred to indirect reduction using short segment transpedicular fixation in cases to be operated on later than 24 h after injury.

Salter's innominate osteotomy in the treatment of congenital hip dislocation: a long-term review.

We reviewed 39 patients with 52 congenitally dislocated hips, all managed by open reduction and Salter's innominate osteotomy. Mean follow-up period was 13 years (range, 8 to 25 years); 78.9% of the hips had a good or excellent clinical result, and 71.1% were good or excellent radiologically. The patients who underwent Salter's innominate osteotomy before the age of 4 had better clinical and radiological results (88.4 and 81.4%, respectively). The radiographs of the unilateral normal hips were compared to the surgically treated hips according to their acetabular index angles, center-edge angles of Wiberg, and femoral neck-shaft angles. No statistical differences were found between these two groups. The Bucholz-Ogden classification was used for the diagnosis and classification of avascular necrosis. The late radiographic signs of types 2, 3, and 4 avascular necrosis were seen in 34.6% of this series. The results show that Salter's innominate osteotomy provides good lateral coverage of the femoral head. The results are better if the operation is performed between the ages 18 months and 4 years.

Morphological variants of the suprapatellar septum. An anatomical study in neonatal cadavers.

In order to study the incidence and variations of the suprapatellar septum, 100 knee joints of 50 neonatal cadavers were examined anatomically. In 26% of the neonatal knee joints, a complete septum was found. Perforated septa with different shapes and residual septa were seen in 64% knees. A complete involution of the former septum was found in 10 of our cases. A suprapatellar septum combined with a mediopatellar plica was found in 18 knees.