A novel ceramic coating for reduced metal ion release in metal-on-metal hip surgery

Abstract: An ovine total hip arthroplasty model was developed to evaluate metal ion release, wear, the biological response and adverse tissue reaction to metal-on-metal (MoM) bearing materials. The performance of an advanced superlattice ceramic coating (SLC) was evaluated as a bearing surface and experimental groups divided into; (1) MoM articulating surfaces coated with a SLC coating (SLC-MoM), (2) uncoated MoM surfaces (MoM), and (3) metal on polyethylene (MoP) surfaces. Implants remained in vivo for 13 months and blood chromium (Cr) and cobalt (Co) metal ion levels were measured pre and postoperatively. Synovial tissue was graded using an ALVAL scoring system. When compared with the MoM group, sheep with SLC-MoM implants showed significantly lower levels of chromium and cobalt metal ions within blood over the 13-month period. Evidence of gray tissue staining was observed in the synovium of implants in the MOM group. A significantly lower ALVAL score was measured in the SLCMoM group (3.88) when compared with MoM components (6.67) (p = 0.010). ALVAL results showed no significant difference when SLC-MOM components were compared to MoP (5.25). This model was able to distinguish wear and the effect of released debris between different bearing combinations and demonstrated the effect of a SLC coating when applied onto the bearing surface

Percutaneous Vertebral Augmentation: The Status of Vertebroplasty and Current Controversies

International audienceVertebroplasty is a cost-effective procedure for the relief of pain and suffering in the appropriate patient when done by a skilled practitioner under good image guidance. No study has ever shown any cost benefit of any balloon-based osteoporotic spine intervention over simple vertebroplasty. No study has ever shown any benefit of any intravertebral implant over vertebroplasty for osteoporotic compression fracture. Recent controversy has highlighted weaknesses in our practice of technology evaluation, and we need to address these issues across the board in the future more scientifically then we have done in the past

Musculoskeletal Injuries Related to Yoga: Imaging Observations

International audienceOBJECTIVE. The purpose of this article is to describe the imaging appearances of musculoskeletal injuries related to yoga. We performed an automated search in the database of a large tertiary care center and conducted a retrospective analysis of the imaging findings in 38 patients over a 9-year period. CONCLUSION. The most frequently encountered musculoskeletal injuries were tendinous lesions, including tears of the supraspinatus, Achilles, and peroneus brevis tendons and fibrocartilaginous tears involving the medial meniscus, acetabular labrum, glenoid labrum, and lumbar disk with extrusion

Primary intraosseous glomus tumor in a middle phalanx

International audienceno abstrac

Volumetric MRI is a promising outcome measure of muscle reinnervation

Abstract The development of outcome measures that can track the recovery of reinnervated muscle would benefit the clinical investigation of new therapies which hope to enhance peripheral nerve repair. The primary objective of this study was to assess the validity of volumetric Magnetic Resonance Imaging (MRI) as an outcome measure of muscle reinnervation by testing its reproducibility, responsiveness and relationship with clinical indices of muscular function. Over a 3-year period 25 patients who underwent nerve transfer to reinnervate elbow flexor muscles were assessed using intramuscular electromyography (EMG) and MRI (median post-operative assessment time of 258 days, ranging from 86 days pre-operatively to 1698 days post- operatively). Muscle power (Medical Research Council (MRC) grade) and Stanmore Percentage of Normal Elbow Assessment (SPONEA) assessment was also recorded for all patients. Sub-analysis of peak volitional force (PVF), muscular fatigue and co-contraction was performed in those patients with MRC > 3. The responsiveness of each parameter was compared using Pearson or Spearman correlation. A Hierarchical Gaussian Process (HGP) was implemented to determine the ability of volumetric MRI measurements to predict the recovery of muscular function. Reinnervated muscle volume per unit Body Mass Index (BMI) demonstrated good responsiveness (R2 = 0.73, p < 0.001). Using the temporal and muscle volume per unit BMI data, a HGP model was able to predict MRC grade and SPONEA with a mean absolute error (MAE) of 0.73 and 1.7 respectively. Muscle volume per unit BMI demonstrated moderate to good positive correlations with patient reported impairments of reinnervated muscle; co- contraction (R2 = 0.63, p = 0.02) and muscle fatigue (R2 = 0.64, p = 0.04). In summary, volumetric MRI analysis of reinnervated muscle is highly reproducible, responsive to post-operative time and demonstrates correlation with clinical indices of muscle function. This encourages the view that volumetric MRI is a promising outcome measure for muscle reinnervation which will drive advancements in motor recovery therapy

MRI Classification of subtalar and talonavicular joint osteoarthritis

Category: Hindfoot Introduction/Purpose: The sublatar joint is formed by the articulation of the talus and the calcaneus. The Calcaneus had three facets; posterior, middle and anterior that articulate with the talus. The anterior facet is also continuous with the Talonavicular joint. Plain radiography of the foot and ankle is the usual method to detect degeneration in these joints, however plain films do not permit full characterisation of non-ossified structures, such as articular cartilage, marrow tissue and synovial fluid. MRI is a better way to detect these changes. The aim of this study was to develop a quantitative way to score arthritic changes to the subtalar and talonavicular joints using MRI that was usable, repeatable and reliable. Methods: The MRI scans of thirty consecutive subjects with foot and ankle pain were retrospectively evaluated. MRI images were obtained using 1.5-T MRI. Images were interpreted independently by three musculoskeletal radiologists. In order to determine intra-observer reliability as well as the inter-observer reliability two of the readers independently scored the studies twice, more than 14 days apart. Five features of osteoarthritis were scored in the Subtalar joint and the Talonavicular joint. These were; cartilage morphology, subarticular marrow, subarticular cyst, marginal osteophytes and synovitis. The Subtalar joint was scored in eight different regions and Talonavicular joint in two The maximum score for both regions was 100. Scores were summarised and Inter- and Intra-observer agreement was calculated. Intraclass coefficient values less than 0.40 were poor, fair between 0.40 and 0.59 were fair, values between 0.60 and 0.74 were good, and values between 0.75 and 1 excellent. Results: For the 30 MRI scans the mean score for the Subtalar joint ranged from 11.7 to 14.4 and for the Talonavicular joint ranged from 3.7 to 5.6. The inter-observer correlation for the Subtalar joint between the three readers ranged between 0.53 and 0.83 for the individual features but overall was excellent at 0.76. For the Talonavicular joint the total correlation was good at 0.67. The inter-observer ICC for the total score was 0.75 which showed excellent agreement between the three readers. The total intra-observer correlation was excellent. Conclusion: We have designed a novel scoring system subtalar and talonavicular arthritis that is easy to perform and demonstrates excellent reliability and may be an extremely useful tool for clinical trials on ankle arthritis and other studies to diagnose and monitor disease progression