Effects of Age and Body Mass Index on the Results of Transtrochanteric Rotational Osteotomy for Femoral Head Osteonecrosis

Background: Advanced-stage osteonecrosis and a large area of necrotic bone are known risk factors for failure of transtrochanteric rotational osteotomy of the hip in patients with osteonecrosis. The purpose of this study was to determine whether there are other risk factors for failure of this osteotomy. Methods: One hundred and five patients (113 hips) underwent an anterior transtrochanteric rotational osteotomy for the treatment of femoral head osteonecrosis and were followed for a mean of 51.3 months postoperatively. Radiographic failure was defined as secondary collapse or osteoarthritic change. Multivariate analysis was performed to assess factors associated with secondary collapse and osteophyte formation. The Kaplan-Meier product-limit method was used to estimate survival. Results: Secondary collapse occurred in twenty-seven hips (24%), and fourteen hips (12%) were converted to a total hip arthroplasty. At the time of the most recent follow-up, the hip scores according to the system of Merle d`Aubigne et al. ranged from 6 to 18 points (mean, 15.8 points). Multivariate analysis showed that the stage of the necrosis (III or greater) (hazard ratio = 3.28; 95% confidence interval = 1.49 to 7.24), age of the patient (forty years or older) (hazard ratio = 1.08; 95% confidence interval = 1.02 to 1.14), body mass index ( >= 24 kg/m(2)) (hazard ratio = 1.19; 95% confidence interval = 1.03 to 1.38), and extent of the necrosis (a combined necrotic angle of >= 230 degrees) (hazard ratio = 1.08; 95% confidence interval = 1.04 to 1.11) were associated with secondary collapse. Seven of the eighty-six hips without collapse showed progression to osteoarthritis. The survival rate at 110 months was 63.4% (95% confidence interval 51.1% to 75.7%) with total hip arthroplasty or radiographic failure as the end point and 56.0% (95% confidence interval 44.6% to 67.4%) with total hip arthroplasty, radiographic failure, or loss to follow-up as the end point. Conclusions: Our study showed that age, body mass index, and the stage and extent of the osteonecrosis were determining factors for secondary collapse, unsatisfactory clinical results, and conversion to total hip arthroplasty. These factors should be considered when selecting patients for a transtrochanteric rotational osteotomy. Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.Nam KW, 2008, J BONE JOINT SURG AM, V90A, P477, DOI 10.2106/JBJS.F.01582Kearns SR, 2006, CLIN ORTHOP RELAT R, P103, DOI 10.1097/01.blo.0000238868.22852.ddHa YC, 2006, J BONE JOINT SURG AM, V88A, P35, DOI 10.2106/JBJS.F.00535Yoo JJ, 2006, J BIOMED MATER RES B, V78B, P70, DOI 10.1002/jbm.b.30457Jacobsen S, 2004, OSTEOARTHR CARTILAGE, V12, P692, DOI 10.1016/j.joca.2004.05.010.Daniel J, 2004, J BONE JOINT SURG BR, V86B, P177, DOI 10.1302/0301-620X.86B2.14600Hisatome T, 2004, ARCH ORTHOP TRAUM SU, V124, P77, DOI 10.1007/s00402-003-0610-0Flugsrud GB, 2002, ARTHRITIS RHEUM, V46, P675, DOI 10.1002/art.10115Nishii T, 2002, J ORTHOPAED RES, V20, P130Koo KH, 2001, J BONE JOINT SURG BR, V83B, P83HOUGAARD P, 2000, ANAL MULTIVARIATE SUInao S, 1999, CLIN ORTHOP RELAT R, P141Steinberg ME, 1999, CLIN ORTHOP RELAT R, P262Langlais F, 1997, CLIN ORTHOP RELAT R, P110Smith SW, 1996, J BONE JOINT SURG AM, V78A, P1702KIM YH, 1995, CLIN ORTHOP RELAT R, P73HOLMAN AJ, 1995, J RHEUMATOL, V22, P1929HOUGAARD P, 1995, LIFETIME DATA ANAL, V1, P255DEAN MT, 1993, J BONE JOINT SURG BR, V75, P597SUGANO N, 1992, J BONE JOINT SURG BR, V74, P734KATZ RL, 1992, CLIN ORTHOP RELAT R, P145SUGIOKA Y, 1992, CLIN ORTHOP RELAT R, P111SAITO S, 1989, CLIN ORTHOP RELAT R, P198TOOKE SMT, 1987, CLIN ORTHOP RELAT R, P150FICAT RP, 1985, J BONE JOINT SURG BR, V67, P3CORNELL CN, 1985, ORTHOP CLIN N AM, V16, P757PARFITT AM, 1984, CALCIFIED TISSUE INT, V36, pS123TOTTY WG, 1984, AM J ROENTGENOL, V143, P1273SUGIOKA Y, 1978, CLIN ORTHOP RELAT R, P191SWEZEY RL, 1976, RHEUMATOL REHABIL, V15, P10KERBOUL M, 1974, J BONE JOINT SURG BR, VB 56, P291MERLEDAUBIGNE R, 1965, J BONE JOINT SURG B, V47, P612KAPLAN EL, 1958, J AM STAT ASSOC, V53, P457

Large Oncocytic Adrenocortical Tumor with Uncertain Malignant Potential

Oncocytoma is a neoplasm consisting of oncocytes that is found in the salivary gland, kidney, and thyroid. Adrenocortical oncocytoma is particularly uncommon, and most cases reported are benign and nonfunctioning. Here, we report a 20 cm adrenal mass associated with necrosis that was identified as an oncocytic adrenocortical tumor with uncertain malignant potential through histopathological evaluation after its resection

Little Impact of Antiplatelet Agents on Venous Thromboembolism after Hip Fracture Surgery

Since the late 1980s, low dose aspirin has been used to prevent stroke and ischemic heart disease. However, prophylactic effect of antiplatelets against venous thromboembolism (VTE), in patients who undergo hip fracture surgery (HFS) is controversial. Our purpose was to determine the incidence of symptomatic VTE after HFS and to evaluate whether antiplatelets reduce the development of symptomatic VTE following HFS. We retrospectively reviewed 858 HFS in 824 consecutive patients which were performed from May 2003 to April 2010 at an East Asian institute. We compared the incidence of symptomatic VTE in antiplatelet users and non-users using multivariate logistic regression analyses. Overall incidences of symptomatic pulmonary embolism including fatal pulmonary embolism, and symptomatic deep vein thrombosis in this study were 2.4% (21/858), and 3.5% (30/858), respectively. The incidence of symptomatic VTE was 4.8% (12/250) in antiplatelet users and 4.3% (26/608) in non-users (P = 0.718). It is suggested that antiplatelet agents are not effective in prevention of symptomatic VTE after HFS

Simple Monodimensional Model for Linear Growth Rate of Photosynthetic Microorganisms in Flat-Plate Photobioreactors

The current study proposes a simple monodimensional model to estimate the linear growth rate of photosynthetic microorganisms in flat-plate photobioreactors (FPPBRs) during batch cultivation. As a model microorganism, Chlorella kessleri was cultivated photoautotrophically in FPPBRs using light-emitting diodes (LEDs) as the light sources to provide unidirectional irradiation in the photobioreactors. Various conditions were simulated by adjusting both the intensity of the light and the height of the culture. The validity of the proposed model was examined by comparing the linear growth rates measured with the predicted ones obtained from the proposed model. Accordingly, the value of was proposed as an approximate index for strategies to obtain the maximal lightn yield under light-limiting conditions for high-density algal cultures and as a control parameter to improve the photosynthetic productivity and efficiency

Effect of the solvent used for fabrication of perovskite films by solvent dropping on performance of perovskite light-emitting diodes

Organic-inorganic hybrid perovskites have emerged as a next-generation candidate for light-emitting device applications due to their excellent optical and electrical properties with narrow band emission compared to organic emitters. The morphological control of perovskite films with full surface coverage and few defect sites is essential for achieving highly efficient perovskite light-emitting diodes (PeLEDs). Here, we obtain a highly uniform perovskite film with a remarkably reduced number of defect sites in a perovskite crystal using chlorobenzene dropping. This effort leads to the enhanced performance of PeLEDs with a CH3NH3PbBr3 film using chlorobenzene dropping with a maximum luminance of 14 460 cd m(-2) (at 3.8 V) and a maximum external quantum efficiency (EQE) of 0.71% (at 2.8 V). This research confirms that the role of the solvent in the solvent dropping method is to fabricate a dense and uniform perovskite film and to passivate the defect sites of the perovskite crystal films.clos

Normative study of the Stroop Color and Word Test in an educationally diverse elderly population

OBJECTIVE: The purpose of this study was to explore the effects of demographic variables on Stroop Color and Word Test (SCWT) performance in an educationally diverse elderly population and to provide normative information. METHODS: SCWT was administered to 564 community-dwelling volunteers aged 60-90 years with an educational history of from zero to 25 years of full-time education. People with serious neurological, medical and psychiatric disorders (including dementia) were excluded. RESULTS: Age, education and gender were found to be significantly associated with performance on all three pages of the SCWT. Based on the results obtained, SCWT norms were stratified by age (four overlapping tables), education (three strata), and gender. CONCLUSIONS: In the present study, normative information on SCWT was obtained from an educationally diverse elderly population. SCWT would appear to be more useful in poorly educated elderly, and could be used in future cross-cultural comparisons of geriatric populations