Ankle arthrodesis and tibial lengthening for congenital sensory neuropathy with anhidrosis.

This report describes a patient with congenital sensory neuropathy with anhidrosis (CSNA) with destructive arthropathy of the left ankle joint that was treated with ankle arthrodesis and tibial lengthening, using an Ilizarov external fixator. The fusion at the ankle joint was successful, but, at the lengthening site, loosening of the apparatus occurred and formation and maturation of the distracted callus were delayed. Intramedullary nailing was used after the removal of the external fixator, and a low-intensity ultrasound device was employed, after which the distracted callus matured gradually. During the maturation period, the patient's dysplastic right hip joint was destroyed, without the occurrence of any severe symptoms. Distraction osteogenesis in patients with CSNA may lead to good results if rigid fixation, nonweight-bearing (i.e., adequate rest), and appropriate biological stimulation can be employed.

Total knee arthroplasty covered with pedicle peroneal flap.

Three cases of total knee arthroplasty (TKA) covered with pedicle peroneal flaps are reported. One peroneal flap was performed after TKA to correct post-TKA skin necrosis. Two peroneal flaps were performed before TKA to replace previous traumatic scar formed around the knee. All three TKAs were successful after the procedure. The thickness, elasticity, appearance, and durability of the peroneal flaps were more suitable for the skin around the knee than the gastrocnemius muscle flap or the local fasciocutaneous flap. As the peroneal flap was elevated as a pedicle flap, freedom of transfer was good, microanastomosis was not necessary, and no donor sites were needed from the contralateral limb. Scar tissue around the knee can be effectively replaced by the pedicle peroneal flap before TKA.

Patellar clunk syndrome in total knee arthroplasty without patellar resurfacing.

In a series of 647 total knee arthroplasties, the patella was not resurfaced if bony geometry of the patella was good enough to maintain good congruency of the patella undersurface to the femoral component and the patella was tracking normally at the femoral component groove at the time of surgery. Three hundred seventy-two total knee arthroplasties were done with a femoral component that had the same geometry as the original total condylar prosthesis. None of these knees resulted in patellar catching, whether the patella was resurfaced or not. Two hundred seventy-five total knee arthroplasties were done with a more contemporary femoral component with wider intercondylar space and shorter posterior extension of the intercondylar notch. Eleven of these 275 knees demonstrated catching of the patella at 60 degrees to 90 degrees of flexion when the knee was tested from flexion to extension during the surgery. All of these 11 knees did not have patellar resurfacing during surgery at first. Of these 11 knees with patellar catching noted during surgery, at first, patellar catching was eliminated with patellar resurfacing in 4 and by shaving of the superior pole of the patella in 7. None of the knees with the patella resurfacing in this series showed patellar catching.

Bioabsorbable osteosynthetic implants of ultra high strength poly-L-lactide. A clinical study.

We have developed reasonably strong but bioabsorbable osteosynthetic screws, pins and nails made of ultra high strength poly-L-lactide (PLLA) and evaluated their use in 143 patients. The PLLA implants have the highest strength among those reported to date. They lose about 10% of their initial strength within 8 weeks, about 40% within 4 weeks and nearly 100% within 20 weeks in vivo. The patients were aged from 9 to 78 years, and the follow up was from 2 to 6 years. The implants were used for fixation of bone grafts in 84 patients, peri- and intra-articular fractures in 49, after osteotomy in 8, and in 2 others. Bony union was not achieved in only one case. In the early stages of the study, breakage of screws occurred in 12 cases (8%), mostly because of an inappropriate size of tap; these problems have not occurred after improvement of the tapping system. There were no cases with abnormal blood tests, infection or foreign body reaction.

Use of latissimus dorsi flap for reconstruction with prostheses after tumor resection.

Five latissimus dorsi musculocutaneous flaps (LD flap) were used for reconstruction with prostheses after resection of tumors between 1984 and 1991 in our hospital. Bony structures were reconstructed with prostheses and in three cases autoclaved autobone grafts were also needed. The prostheses and adjacent grafts were then wrapped by the LD flaps. Tumor sites included one humerus, two thighs, and two knees. All but one case healed primarily. The sole case of infection was successfully treated with debridement and irrigation. Due to the LD flaps' plentiful blood supply, we believe infection of the prosthetics can be avoided and good clinical results can be achieved using the flap with autoclaved autograft prosthetic composite reconstruction.

Two cases of dorsal defect of the patella with arthroscopically visible cartilage surface perforations.

Dorsal defect of the patella is an approximately 1-cm, circular, radiolucent, well-marginated benign lesion invariably located in the superlateral aspect of the patella. Only approximately 50 cases have been described in the world literature, of which < 10 cases have been studied histologically. We report two patients with bilateral, virtually symmetrical, dorsal defects of the patella and describe the arthroscopic and histologic findings. Case 1 was a 14-year-old girl and case 2 was a 35-year-old man. Cartilage perforations were seen via arthroscopy on the cartilage surface of both knees. The pathophysiology of this disorder remains to be clarified, although van Holsbeeck et al. proposed that vastus lateralis traction injury in the ossification process of the patella may be involved, as in the case of bipartite patella. The present arthroscopic and histological findings support this hypothesis.

Improvement of human tumor clonogenic assay using cell culture in soft part sarcoma of the extremity.

The human tumor clonogenic assay (HTCA = standard HTCA) gives poor results in sarcomas compared to carcinomas. In order to overcome this problem, a cultivated HTCA, using single-cell suspensions obtained from short-term culture, was developed. In forty specimens taken from 32 patients with soft part sarcomas of the extremities, both standard and cultivated HTCA were performed. Colony-forming ability was low in standard HTCA (0.0053 +/- 0.0051%) while it was high in cultivated HTCA (0.0231 +/- 0.0186%). The number of clonogenic assays suitable for sensitivity tests was low (23.7%) in standard HTCA, while the number was much higher (70.0%) in cultivated HTCA. The histological grade of malignancy (low, moderate, high) was correlated with the growth of colonies in both methods of HTCA; cultivated HTCA, versus HTCA, increased the number of colonies produced in the high and moderate groups of malignant sarcomas. The results of the sensitivity of 8 anticancer drugs on sarcomas were almost the same between the two methods. A retrospective study on the results of the cultivated HTCA and clinical chemotherapeutic effectiveness proved a significant overall correlation rate (91.7%, p less than 0.025). It was concluded that in tumors of a low colony-forming ability such as soft part sarcomas, cultivated HTCA can provide a useful chemosensitivity test.

[The clinical correlation of human tumor clonogenic assay for malignant bone and soft tissue sarcoma of the extremities].

To improve the plating efficiency (PE) of cells used in the standard human tumor clonogenic assay (standard HTCA), an HTCA was developed using single-cell suspensions obtained from short-term cultures of surgical specimens of malignant bone and soft tissue tumors of the extremities. Consequently, the percentage possibility of application for the chemosensitivity test for anticancer drugs as well as the PE improved from 29.7% to 65.7% for bone tumors (37 specimens) and from 30.0% to 72.4% for soft tissue tumors (31 specimens). In bone tumors the correlation between these drug sensitivity tests and the clinical effectiveness of the drugs was retrospectively evaluated in 17 specimens from 13 cases mainly of osteosarcoma; they were well correlated with the true positive rate (71.0%) and the true negative rate (90%). In soft tissue sarcomas, retrospective evaluations were possible only in 9 cases and their true positive and negative rated were 75.0% and 100% respectively. These results indicate that cultivated HTCA seemed to be a clinically useful chemosensitivity test: the anticancer drugs judged useless by this test were likely to be clinically useless. Drugs such as resistance-acquired or non-sensitive drugs should be excluded from multidrug combination chemotherapy in the treatment of bone and soft tissue sarcoma.