Twenty-three-year outcome of the porous coated anatomic total hip replacement: a concise follow-up of a previous report.

We previously reported the ten to fourteen-year results for 311 Porous Coated Anatomic total hip replacements that had been inserted by two surgeons in 279 patients. The purpose of the present report is to update that study and to report the outcome beyond twenty years. The patients were followed prospectively with clinical assessment with use of the Harris hip score and radiographic analysis, and the results were collected in a database. Two hundred and sixty-eight hips were functioning at the time of death or at the time of the latest follow-up. A total of forty-three hips (14%) underwent major revision for all causes, and an additional four hips underwent minor revision. At a mean of twenty-three years of follow-up, Kaplan-Meier analysis revealed a survival rate of 83% with revision for any reason as the end point. The survival rate was 95% for the femoral component and 88% for the acetabular component with revision for any reason as the end point. The rate of survival of the acetabular component was significantly higher in hips with a 26-mm femoral head than in those with a 32-mm femoral head (91% compared with 80%; p = 0.026).

Triple pelvic osteotomy in Legg-Calvé-Perthes disease using a single anterolateral incision.

Pelvic osteotomy has a small role to play in the management of Legg-Calvé-Perthes disease. Residual acetabular dysplasia or incongruity can be corrected by rotational acetabuloplasty. In skeletally immature patients this can be performed by complete or incomplete innominate osteotomies. We present the case of a 12-year-old child with residual acetabular dysplasia, resulting from Legg-Calvé-Perthes disease, which was treated by a triple pelvic osteotomy performed by a small single anterolateral incision.

Spinal cord injury following osteoporotic vertebral fracture: case report.

STUDY DESIGN: This report details the sudden catastrophic neurologic deterioration concerning a patient with an acute fracture of T5 associated with osteoporosis. OBJECTIVE: To describe a unique presentation of abrupt spinal cord injury in this condition. SUMMARY OF BACKGROUND DATA: Vertebral fractures occur frequently in osteoporosis, but associated spinal cord injury is a rare occurrence. When neurologic injury occurs it is generally of a very low incidence and with a gradual onset, and spontaneous recovery can be expected. Most reports in the literature are of delayed-onset paraplegia after vertebral collapse. We report a unique case of a sudden and catastrophic thoracic spinal cord injury occurring spontaneously. METHODS: An 88-year-old woman had a sudden thoracic vertebral fracture with complete spinal cord injury while attempting to get out of bed. She was treated with continuous oral corticosteroids for >40 years for both rheumatoid arthritis and restrictive lung disease. She was never investigated or treated for osteoporosis. RESULTS: Plain radiographs indicated multilevel osteoporotic fractures throughout the spine with diffuse, marked osteopenia. Magnetic resonance imaging scans showed changes in keeping with severe vertebral osteoporosis and spinal cord injury. She was treated nonoperatively in view of the extremely osteoporotic spine and her overall poor medical condition. Despite an initial improvement in her respiratory condition with medical therapy, she died 72 hours following admission. CONCLUSION: With increasing awareness of the morbidity attached to the osteoporotic spine, investigation and pharmacologic treatment are warranted and may reduce the possibility of catastrophic neurologic impairment as occurred in this case.