Cementless total hip arthroplasty using a spongy metal surface hip prosthesis with a collarless, proximally porous-coated stem.

A collarless, proximally porous-coated type of Spongiosa Metal II hip prosthesis was used for cementless total hip arthroplasty in 52 hips, and 48 hips were followed and assessed during a mean follow-up period of 6.3 years (minimum 5 years). There were 8 hips (16.7%) that had stress shielding, and 2 hips (4.2%) that had thigh pain. In terms of stability, the stem was bony stable in 39 hips, fibrous stable in 6, and unstable in 3. The stability of the stem was significantly correlated with the stem canal filling ratio. It was suggested that the much more proximal transfer of loading stress by a collarless, proximally porous-coated stem is not suitable for the Spongiosa Metal II series because it may unacceptably reduce the stability of the stem.

Quality of life evaluated by Short Form-8 in patients with rheumatoid arthritis who were receiving infusion of infliximab.

In this study, influences of infliximab to health-related quality of life (HRQOL) and active status of RA were assessed. Between 2003 and 2006, 22 patients with rheumatoid arthritis (RA) began receiving infusion of infliximab. Of all the patients, 17 patients who were followed for at least 30 weeks (102 weeks at maximum) after the start of infliximab were included in this study. The mean age was 54.6+/-10 years. HRQOL was evaluated with use of the SF-8trade mark, which is a simple version of the Medical Outcome Study Short Form 36. As an index of active status of RA, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and rheumatoid factor (RF) were collected. CRP and ESR significantly improved at the final follow-up, but RF did not. All subscales of the SF-8 were significantly improved after the start of infliximab. However, there were three patients whose laboratory data were improved, but HRQOL was not. We should not be prepossessed only with laboratory data in treating patients with RA. We recommend that the SF-8 to evaluate HRQOL of patients with RA in busy outpatient clinics because it is both simple and convenient.

Limb-length measurement in total hip arthroplasty using a calipers dual pin retractor.

BACKGROUND: Limb-length inequality is not uncommon after total hip arthroplasty (THA) and may cause subjective problems for patients. During THA a stable reference point must be established to determine changes in leg length. Several methods have been useful in minimizing the incidence and magnitude of this problem. The equalization of leg-length discrepancy during THA can be achieved through the use of a simple measuring device, the calipers dual pin retractor (CDPR). MATERIALS AND METHODS: The CDPR was developed to establish a fixed point on the pelvis that would remain constant throughout the procedure and from which the distance to the greater trochanter could be measured prior to dislocation of the hip. Limb lengths were measured in 56 patients undergoing primary THA, between 2004 and 2006. The CDPR was used in all cases. RESULTS: The preoperative diagnoses were osteoarthritis in 44 patients, osteonecrosis in five, and rheumatoid arthritis in seven. Average postoperative limb-length inequality was 4.2 mm. None of the patients had to use shoe lifts for equalization of limb lengths or complained of limb-length inequality. CONCLUSION: This method of measurement is beneficial with most THA approaches, and the technique is helpful for minimizing limb-length inequality during THA.

Radio-opaque marker of a surgical sponge appearing as an intra-articular foreign body after total hip arthroplasty.

We report a 73-year-old female patient who underwent total hip arthroplasty for osteoarthritis of the right hip. An anteroposterior radiograph obtained 1 week after surgery showed an intra-articular striated foreign body. This was subsequently removed and found to be a radio-opaque marker of a surgical sponge that had been used during the operation. The patient made an uneventful recovery. In recent years, cases of retained surgical sponge after surgery have been reported occasionally. Counting surgical sponges and using sponges with radio-opaque markers are methods for preventing them from being accidentally left in situ. However, to our knowledge, there has been no report of retention of a surgical sponge radio-opaque marker at the operation site, appearing as a foreign body on an X-ray film.

Morcellized bone grafting for acetabular deficiency in cementless total hip arthroplasty.

Morcellized bone grafting was performed to significant acetabular deficiency in 35 hips of 29 patients in cementless total hip arthroplasty (THA). Bridging trabeculation across the graft-host interface, remodeling of the graft, and trabecular reorientation were observed at 4 weeks, 3.7 months, and 10.7 months postoperatively, respectively. These remodeling processes were observed in all cases. Morcellized bone grafting for acetabular deficiency in cementless THA stock, which is necessary to make the cup stable, revealed encouraging early trabecular reorientation and recovery of acetabular bone even in cases in which structural bone grafting is needed.

Successful joint arthroplasty after treatment of destructive MRSA arthritis of the knee using antibiotic-loaded hydroxyapatite blocks: a case report.

Methicillin-resistant Staphylococcus aureus (MRSA) septic arthritis is frequently associated with a poor clinical outcome. Joint reconstruction may be worth attempting in patients with a history of persistent MRSA infection. Here we report an unusual case of MRSA septic arthritis of the knee joint that was treated successfully by joint replacement after initial placement of antibiotic-loaded hydroxyapatite (HA) blocks.

The therapeutic outcome of minimally invasive synovectomy assisted with arthroscopy in the rheumatoid knee.

The purpose of the present study was to retrospectively evaluate the therapeutic outcome of minimally invasive synovectomy assisted with arthroscopy (MISAA). From 1995 to 2003, MISAA was performed on 30 knees of 18 rheumatoid arthritis patients. The mean follow-up period was 74.4 months. Radiographic assessment according to Larsen's radiological classification, the conversion ratio to total knee arthroplasty (TKA), and postoperative change of the range of flexion were evaluated retrospectively. There were 10 knees in grade I, 14 knees in grade II, and 6 knees in grade III, preoperatively. All the knees in grade I and 8 of 14 knees in grade II maintained the same grade until the latest follow-up. The other 6 knees in grade II and all the knees in grade III deteriorated to grade IV and were converted to TKA after MISAA. The mean range of flexion significantly increased postoperatively except the knees that were converted to TKA. MISAA is effective for rheumatoid knees in grade I or II, and improves range of flexion.

An unusual meniscal ganglion cyst that triggered recurrent hemarthrosis of the knee.

A 58-year-old woman suffered spontaneous recurrent hemarthrosis of the knee. In the clinical course, pigmented villonodular synovitis was mostly suspected, but in arthroscopic surgery the lateral meniscus appeared to be upturned and stuck into the lateral pouch with the meniscal ganglion cyst. It was suggested that meniscal tear with meniscal ganglion cyst was related with recurrent hemarthrosis. Generally, both the meniscal ganglion cysts and spontaneous recurrent hemarthrosis are highly rare conditions. In this case, we speculated that a negligible power could induce the meniscal tear with recurrent hemarthrosis in the particular situation in which the meniscal ganglion cyst existed. In other words, the meniscal ganglion cyst might basically and physically relate with hemorrhagic condition. Arthroscopically, the meniscal ganglion cyst was removed together with the anterior segment of the lateral meniscus. Recurrent hemarthrosis was treated successfully by resection of the meniscus.