Is acetabular osteoplasty always required in mixed impingement?

Background Mixed femoroacetabular impingement (FAI) is typically managed with both femoral and acetabular rim osteoplasties, but it has not been reported if the rim osteoplasty is always required. Hypothesis/purpose We hypothesized that mixed FAI managed by femoral or combined femoral and acetabular osteoplasties will both attain satisfactory clinical results, provided intraoperative impingement-free functional motion is attained. Methods We retrospectively reviewed 30 hips (23 patients, mean age at surgery 24.3 years, mean follow-up time 1.6 years) with mixed FAI who underwent surgical dislocation of the hip and had femoral osteochondroplasty with rim trim (RT, n = 21) or no rim trim (NRT, n = 9). Physical examination results and Western Ontario and McMaster Universities Osteoarthritis (WOMAC) scores were evaluated. Results Mean (±SD) WOMAC pain scores improved from 6.56 (±2.96) to 2.33 (±3.64) in the NRT group (p = .002) and from 6.86 (±4.15) to 3.86 (±3.95) in the RT group (p = .014). Function improved in both groups, but the difference was significant only for the NRT group (p < .001). Over 50 % of patients in both groups had resolution of impingement sign. Internal rotation increased from 8.6° (±11.8) to 20.0° (±10.4) in the NRT group (p = .043) and from 4.0° (±12.1) to 18.6° (±14.0) in the RT group (p < .001). Both groups had increased flexion post-operatively to normal range, but the change was only significant for the RT group (p = .02). Both groups had insignificant decreases in external rotation. Conclusion Satisfactory clinical outcomes were seen in hips with mixed impingement, regardless of whether RT was performed, provided impingement-free functional motion was attained and no severe cartilage damage was seen

Three-dimensional corrective osteotomies of mal-united clavicles-is the contralateral anatomy a reliable template for reconstruction?

In computer-assisted preoperative planning of corrective osteotomies, the unaffected contralateral bone often serves as three-dimensional template for the reconstruction of mal-united bones. Before applying this approach to new anatomy such as the clavicle bone, it is important to study asymmetry between the sides. The purpose of this study was to investigate bilateral symmetry of the clavicle in healthy cadavers using three-dimensional measurement techniques. Bilateral symmetry of 102 clavicles (51 cadavers, mean age: 52.19 years, 37 male) was measured based on three-dimensional models reconstructed from computed tomography. Besides length, volume, and surface, the side-differences were evaluated by considering the mirrored left clavicle as the reconstruction template and the right clavicle as the one that will be realigned by osteotomy. The relative transformation between the aligned segments was measured to express the difference with to three-dimensional translation and rotation. The same procedure was repeated using mean-sized clavicles, one for each gender, as the template. The contralateral side was a significant more accurate reconstruction template compared to a mean-sized clavicle (P < 0.001). Nevertheless, an average side-differences with respect to rotation and translation of 8.79° ± 5.2° and 3.5 mm ± 2.7 mm, respectively. The left clavicles were significant (P = 0.001) longer with 154 mm compared to the right ones (151 mm). Three-dimensional differences between the left and right clavicles exist, but can be considered as small. Therefore, the contralateral side appears to be a reliable reconstruction template, in particular compared to a mean-sized clavicle. Clin. Anat. 28:865-871, 2015. © 2015 Wiley Periodicals, Inc

Is the contralateral tibia a reliable template for reconstruction:a three‑dimensional anatomy cadaveric study

Purpose: The contralateral anatomy is regularly used as a reconstruction template for corrective osteotomies of several deformities and pathological conditions. However, there is lack of evidence that the intra-individual differences between both tibiae are sufficiently small to use the contralateral tibia as a 3D reconstruction template for complex osteotomies. The aim of this study was to evaluate the intra-individual side differences of the tibia in length, torsion, angulation, and translation using 3D measurement techniques. Methods: 3D surface models of both tibiae were created from computed tomography data of 51 cadavers. The (mirrored) models of the right tibiae were divided into two halves at the centre of the shaft. Thereafter, the proximal and distal segments were aligned to the left (contralateral) tibia in an automated fashion. The relative 3D transformation between both aligned segments was measured to quantify the side difference in 6° of freedom (3D translation vector, 3 angles of rotation). Results: The mean side difference in tibia length was 2.1 mm (SD 1.3 mm; range 0.2-5.9 mm). The mean side difference in torsion was 4.9° (SD 4.1°; range 0.2°-17.6°). The mean side difference in the coronal and sagittal planes was 1.1° (SD 0.9°; range 0.0°-4.6°) and 1.0° (SD 0.8°; range 0.1°-2.9°), respectively. Conclusion: The present study confirms small side differences in torsion between the left and right tibia, while the side differences in the coronal and sagittal plane are probably negligible. The contralateral tibia seems to be a reliable reconstruction template for the 3D preoperative planning of complex corrective osteotomies of the tibia. However, torsional differences should be interpreted with caution, as a single cut-off value of a clinically relevant torsional side difference cannot be defined. The presented results are relevant to surgeons considering the contralateral tibia as a 3D reconstruction template for corrective osteotomies of the tibia. Level of evidence: Basic science

Correlation of systemic inflammatory markers with radiographic stages of charcot osteoarthropathy

BACKGROUND: Charcot osteoarthropathy (COA) is characterized by a progressive destruction of bone and joint associated with neuropathy and is most common in the foot and ankle. Clinical manifestation of COA is frequently indistinguishable from other causes of pain, swelling, and erythema of the affected extremity, in particular, infection. Diagnosis of COA can be challenging in particular in early stages where radiographic changes are sparse. The presence of elevated systemic inflammatory parameters in the context of suspected infection may delay early diagnosis and treatment of COA. The aim of this retrospective analysis was to assess whether elevated systemic inflammatory parameters may be present, in particular in early stages of COA and thus not be used as an exclusion criterion for the diagnosis of COA. METHODS: Forty-two patients (mean age 48.2 ± 9.4 years, 36 male, 6 female) with a diagnosis of unilateral COA were the subject of this retrospective study. The diagnosis of COA was confirmed by plain radiographs, magnetic resonance imaging and clinical course. Systemic inflammatory parameters were recorded at the time of referral. Acute stages (stages 0 and 1) were treated with a total contact cast (TCC) and protected weight bearing for a minimum of 6 weeks. For chronic stages (stages 2 and 3) custom-made shoes were prescribed. The feet were stratified into "acute" (Eichenholz stages 0 and 1) and "subacute/chronic" (Eichenholz stages 2 and 3) groups. RESULTS: Statistically significant differences were observed for all recorded systemic inflammatory parameters (C-reactive protein level, WBC count, erythrocyte sedimentation rate) between the acute and subacute/chronic groups. No statistical difference was observed considering the anatomic pattern of involvement. CONCLUSION: The present study demonstrated that elevated systemic inflammatory parameters may be present in COA and can further be used to distinguish between acute and subacute stages of COA, based on the Eichenholtz classification. Thus, we suggest that elevated inflammatory markers should not be considered an exclusion criterion for the diagnosis of COA. LEVEL OF EVIDENCE: Level III, retrospective comparative series