Wear debris pseudotumor following total knee arthroplasty: a case report

<p>Abstract</p> <p>Introduction</p> <p>In patients who have undergone a total joint replacement, any mass occurring in or adjacent to the joint needs thorough investigation and a wear debris-induced cyst should be suspected.</p> <p>Case presentation</p> <p>An 81-year-old man presented with a painful and enlarging mass at the popliteal fossa and calf of his right knee. He had had a total right knee replacement seven years previously. Plain radiographs showed narrowing of the medial compartment. Magnetic resonance imaging showed a cystic lesion at the postero-medial aspect of the knee joint mimicking popliteal cyst or soft tissue sarcoma. Fine needle aspiration was non-diagnostic. A core-needle biopsy showed metallosis. Intraoperative findings revealed massive metallosis related to extensive polyethylene wear, delamination and deformation. Revision knee and patella arthroplasty was carried out after a thorough debridement of the knee joint.</p> <p>Conclusion</p> <p>Long-term follow-up is critical for patients with total joint replacement for early detection of occult polyethylene wear and prosthesis loosening. In these cases, revision arthroplasty may provide a satisfactory knee function.</p

Elastic intramedullary nailing and DBM-Bone marrow injection for the treatment of simple bone cysts

<p>Abstract</p> <p>Background</p> <p>Simple or unicameral bone cysts are common benign fluid-filled lesions usually located at the long bones of children before skeletal maturity.</p> <p>Methods</p> <p>We performed demineralized bone matrix and iliac crest bone marrow injection combined with elastic intramedullary nailing for the treatment of simple bone cysts in long bones of 9 children with a mean age of 12.6 years (range, 4 to 15 years).</p> <p>Results</p> <p>Two of the 9 patients presented with a pathological fracture. Three patients had been referred after the failure of previous treatments. Four patients had large lesions with impending pathological fractures that interfered with daily living activities. We employed a ratio to ascertain the severity of the lesion. The extent of the lesion on the longitudinal axis was divided with the normal expected diameter of the long bone at the site of the lesion. The mean follow-up was 77 months (range, 5 to 8 years). All patients were pain free and had full range of motion of the adjacent joints at 6 weeks postoperatively. Review radiographs showed that all 7 cysts had consolidated completely (Neer stage I) and 2 cysts had consolidated partially (Neer stage II). Until the latest examination there was no evidence of fracture or re-fracture.</p> <p>Conclusion</p> <p>Elastic intramedullary nailing has the twofold benefits of continuous cyst decompression, and early immediate stability to the involved bone segment, which permits early mobilization and return to the normal activities of the pre-teen patients.</p

Detection of somatostatin receptors in human osteosarcoma

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Arthroplasty versus internal fixation for femoral neck fractures in the elderly

We studied 140 patients with femoral neck fractures treated from January 1999 to December 2006. There were 68 men and 72 women with a mean age of 72 years (range 60–80 years). Seventy patients were treated with closed reduction and internal fixation (group A), and 70 patients with hip arthroplasty (group B). The duration of surgery, length of hospitalization, complications, postoperative Harris hip score, and need for reoperation were recorded. Group B had significantly higher blood loss, increased surgical time and length of hospitalization compared to group A patients. The Harris hip score was significantly higher in group B at the 3, 6, and 12-month follow-up evaluations; however, the differences were no longer significant at the 24-month evaluation. The overall complications rate was 18.6% (13 patients) in group A compared to 25.7% (18 patients) in group B; this was not statistically significant (P = 0.309). A statistically significant difference was found regarding reoperation rate in group A (11.4%, eight patients) compared to group B (1.4%, one patient) (P = 0.016). Arthroplasty compared to internal fixation for displaced femoral neck fractures is associated with a significantly higher functional score and lower risk of reoperation at the cost of greater infection rates, blood loss, and operative time

Current trends in the management of extra-abdominal desmoid tumours

Extra-abdominal desmoid tumours are slow-growing, histologically benign tumours of fibroblastic origin with variable biologic behaviour. They are locally aggressive and invasive to surrounding anatomic structures. Magnetic resonance imaging is the modality of choice for the diagnosis and the evaluation of the tumours. Current management of desmoids involves a multidisciplinary approach. Wide margin surgical resection remains the main treatment modality for local control of the tumour. Amputation should not be the initial treatment, and function-preserving procedures should be the primary treatment goal. Adjuvant radiation therapy is recommended both for primary and recurrent lesions. Chemotherapy may be used for recurrent or unresectable disease. Overall local recurrence rates vary and depend on patient's age, tumour location and margins at resection

Osteosynthesis-associated infection of the lower limbs by multidrug-resistant and extensively drug-resistant Gram-negative bacteria: a multicentre cohort study

Purpose: The purpose of this study was the clinical and therapeutic assessment of lower-limb osteosynthesis-associated infection (OAI) by multidrug-resistant (MDR) and extensively drug-resistant (XDR) Gram-negative bacteria (GNB), which have been poorly studied to date. Methods: A prospective multicentre observational study was conducted on behalf of ESGIAI (the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group on Implant-Associated Infections). Factors associated with remission of the infection were evaluated by multivariate and Cox regression analysis for a 24-month follow-up period. Results: Patients (n=57) had a history of trauma (87.7 %), tumour resection (7 %) and other bone lesions (5.3 %). Pathogens included Escherichia coli (n=16), Pseudomonas aeruginosa (n=14; XDR 50 %), Klebsiella spp. (n=7), Enterobacter spp. (n=9), Acinetobacter spp. (n=5), Proteus mirabilis (n=3), Serratia marcescens (n=2) and Stenotrophomonas maltophilia (n=1). The prevalence of ESBL (extended-spectrum β-lactamase), fluoroquinolone and carbapenem resistance were 71.9 %, 59.6 % and 17.5 % respectively. Most patients (n=37; 64.9 %) were treated with a combination including carbapenems (n=32) and colistin (n=11) for a mean of 63.3 d. Implant retention with debridement occurred in early OAI (66.7 %), whereas the infected device was removed in late OAI (70.4 %) (p=0.008). OAI remission was achieved in 29 cases (50.9 %). The type of surgery, antimicrobial resistance and duration of treatment did not significantly influence the outcome. Independent predictors of the failure to eradicate OAI were age &gt;60 years (hazard ratio, HR, of 3.875; 95 % confidence interval, CI95 %, of 1.540–9.752; p=0.004) and multiple surgeries for OAI (HR of 2.822; CI95 % of 1.144–6.963; p=0.024). Conclusions: Only half of the MDR/XDR GNB OAI cases treated by antimicrobials and surgery had a successful outcome. Advanced age and multiple surgeries hampered the eradication of OAI. Optimal therapeutic options remain a challenge.</p

Biodegradable absorabable implants in fracture internal fixatio: experimental study in rabbits

The purpose of the present study was to test the suitability of biodegradable polydioxanone (PDS) threads and pins for the fixation of osteotomies in the cancellous bone in rabbits. Α distal femoral osteotomy on 31 rabbits was fixed with biodegradable polydioxanone (ΡDS) thread am pins. In 15 rabbits the osteotomy was fixed with metallic Kirschner wire and pins. Follow up times were one, three, six, 12 and 24 weeks. Radiographs were taken and the distal part of each femur was removed and macroscopically evaluated. The specimens were fixed, embedded in paraffin am sectioned in 5μm for histological and histomorphometric studies. The fracture union or malunion, the presence of external callus and the dege­nerative changes were studied radiographically. The instability of the osteotomy, the presence of malunion, the degenerative changes and the biodegradable material absorption were studied macroscopically. The fracture healing, the bone repair of the drill holes, the presence of external callus, the tissue reactions and the material absorption were studied histologically and histomorphometrically. Statistical comparison of the two methods of fixation showed no significant difference concerning the radiographic and macroscopic results. Macroscopic studies showed complete ΡDS absorption, in all cases, after 24 weeks. The histological studies have showed new bone present peripherically in the area of the implant after the 3rd. week. There was thinning or disappearance of ·the new bone around the implant after the 24th week, while in some cases the area of implant has not been seen in the cancellous bone. During the first week were minimal bone and synovial reactions. There were clear changes of the growth plate at the site of the pin insertion but we believe that further studies must be done. On the basis of the present study, ΡDS threads and pins may be promising for the fixation of osteotomies or fractures of cancellous metaphysis of small long bones such as metacarpals and phalanges.Ο σκοπός της παρούσης μελέτης ήταν να δοκιμασθεί η καταλληλότητα του βιοαποσυντιθεμένου υλικού της πολυδιοξανόνης ( polydioxanone-PDS) ως ράμματα και βελόνες για την οστεοσύνθεση οστεοτομιών του σπογγώδους οστού σε κονίκλους. Η οστεοτομία του περιφερικού άκρου του μηριαίου οστού οστεοσυντέθηκε σε 31 κονίκλους με απορροφήσιμα ράμματα και βελόνες ΡDS. Σε 15 κονίκλους η οστεοτομία οστεοσυντέθηκε με μεταλλικό σύρμα και βελόνες Kirschner. Ο χρόνος επανεξετάσεως ήταν μία, 3, 6, 12 και 24 εβδομάδες. Λαμβάνοντο ακτινογραφίες και το περιφερικό άκρο εκάστου μηριαίου αφαιρείτο και αξιολογούντο μακροσκοπικά. Τα παρασκευάσματα μονιμοποιήθηκαν, εμβαπτίσθηκαν σε παραφίνη και ελήφθησαν τομές 5μm για ιστολογικές και ιστομορφομετρικές μελέτες. Η πόρωση της οστεοτομίας, η πλημμελής θέση, η παρουσία εξωτερικού πώρου και οι εκφυλιστικές αλλοιώσεις μελετήθηκαν ακτινογραφικά. Η αστάθεια της οστεοσύνθεσης, η πλημμελής θέση της πόρωσης, οι εκφυλιστικές αλλοιώσεις και η απορρόφηση του βιοαποσυντιθέμενου υλικού μελετήθηκαν μακροσκοπικά. Η πόρωση της οστεοτομίας και n ανακατασκευή του οστού στη περιοχή του υλικού, η παρουσία εξωτερικού πώρου οι ιστικές αντιδράσεις και η απορρόφηση του υλικού μελετήθηκαν ιστολογικά και ιστομορφομετρικά. Η σύγκριση των δύο μεθόδων οστεοσύνθεσης δεν έδειξε στατιστικά σημαντική διαφορά που να αφορά τα ακτινολογικά, μακροσκοπικά αποτελέσματα. Μακροσκοπικά τα υλικά PDS είχαν απορροφηθεί πλήρως σε όλες τις περιπτώσεις, την 24n εβδομάδα. Οι ιστολογικές μελέτες έδειξαν σχηματισμό νέου οστίτη ιστού στη περιφέρεια του εμφυτεύματος μετά την 3n εβδομάδα. Την 24n εβδομάδα, υπήρχε λέπτυνση ή πλήρης εξαφάνιση του οστίτη ιστού γύρω από τα εμφυτεύματα, ενώ σε μερικές περιπτώσεις η θέση των εμφυτευμάτων δεν διακρίνετο εντός του σπογγώδους οστού. Κατά την διάρκεια της πρώτης εβδομάδας υπήρχαν ελάχιστες ιστικές αντιδράσεις του οστίτη ιστού και του αρθρικού υμένα. Υπήρχαν σαφείς αλλοιώσεις του συζευκτικού χόνδρου στη περιοχή της διάτρησης του από τις βελόνες PDS, αλλά πιστεύουμε ότι το θέμα χρήζει περαιτέρω ελέγχου. Με βάση την παρούσα μελέτη, τα απορροφήσιμα ράμματα και οι βελόνες, υπόσχονται στη οστεοσύνθεση των οστεοτομιών ή των καταγμάτων της σπογγώδους μεταφύσεως των μικρών οστών, όπως των μετακαρπίων και των φαλάγγων

Modern Rehabilitation in Osteoporosis, Falls, and Fractures

In prevention and management of osteoporosis, modern rehabilitation should focus on how to increase muscular and bone strength. Resistance exercises are beneficial for muscle and bone strength, and weight-bearing exercises help maintain fitness and bone mass. In subjects at higher risk for osteoporotic fractures, particular attention should be paid to improving balance – the most important element in falls prevention. Given the close interaction between osteoporosis and falls, prevention of fractures should be based on factors related to bone strength and risk factors for falls. Fractures are the most serious complication of osteoporosis and may be prevented. The use of modern spinal orthosis helps to reduce pain and improve posture. Vibration platforms are used in rehabilitation of osteoporosis, based on the concept that noninvasive, short-duration, mechanical stimulation could have an impact on osteoporosis risk. Pharmacologic therapy should be added for those at high risk of fracture, and vitamin D/calcium supplementation is essential in all prevention strategies. Success of rehabilitation in osteoporotic and fractured subjects through an individualized educational approach optimizes function to the highest level of independence while improving the overall quality of life