Surgical hip dislocation with femoral osteotomy and bone grafting prevents head collapse in hips with advanced necrosis.

QUESTIONS Does surgical hip dislocation with drilling or bone grafting, cartilage treatment and femoral osteotomy in avascular necrosis of the femoral head (AVN) result in: (1) progression of osteonecrosis or osteoarthritis; (2) pain relief and improved function; and (3) subsequent surgery and complications? METHODS We retrospectively reviewed 12 patients (13 hips, mean age 29 ± 9 years) undergoing surgical hip dislocation for AVN. Preoperative ARCO stages were: 1 hip ARCO II, 8 hips ARCO III early, 4 hips ARCO III late. Drilling was performed in 4 hips, 9 hips underwent curettage, drilling and autologous bone grafting. Cartilage was sutured in 5 hips, autologous matrix-induced chondrogenesis was performed in 3 hips, an osteochondral autograft was used in 1 hip. Femoral osteotomy was performed in 10 hips. Mean follow-up was 3 ± 2 years. Progression of AVN and osteoarthritis was assessed preoperatively and at latest follow-up using Tönnis and ARCO staging. Pain and function were assessed with the Merle d'Aubigné-Postel score. Complications were graded according to Sink et al. RESULTS 1 hip had AVN progression and converted to THA. 9 hips showed no AVN- or advanced osteoarthritis progression and 3 hips improved at least 1 ARCO stage. The Merle d'Aubigné-Postel score increased from preoperatively 14.1 ± 3.2 to 16.6 ± 1.2 (p = 0.012). Subsequent surgery were performed in 3 hips, complications occurred in 3 hips. CONCLUSION Although the first results are promising a longer follow-up with more patients is needed to draw a definite conclusion regarding the joint preserving potential in AVN

Early kinetics of cardiac troponin in suspected acute myocardial infarction.

INTRODUCTION AND OBJECTIVES Release kinetics of high-sensitivity cardiac troponin (hs-cTn) T and I in patients with acute myocardial infarction (AMI) are incompletely understood. We aimed to assess whether hs-cTnT/I release in early AMI is near linear. METHODS In a prospective diagnostic multicenter study the acute release of hs-cTnT and hs-cTnI within 1 and 2hours from presentation to the emergency department was quantified using 3 hs-cTnT/I assays in patients with suspected AMI. The primary endpoint was correlation between hs-cTn changes from presentation to 1 hour vs changes from presentation to 2hours, among all AMI patients and different prespecified subgroups. The final diagnosis was adjudicated by 2 independent cardiologists, based on serial hs-cTnT from the serial study blood samples and additional locally measured hs-cTn values. RESULTS Among 2437 patients with complete hs-cTnT data, AMI was the adjudicated diagnosis in 376 patients (15%). For hs-cTnT, the correlation coefficient between 0- to 1-hour change and 0- to 2 hour change was 0.931 (95%CI, 0.916-0.944), P <.001. Similar findings were obtained with hs-cTnI (Architect) with correlation coefficients between 0- to 1-hour change and 0- to 2 hour change of 0.969 and hs-cTnI (Centaur) of 0.934 (P <.001 for both). Findings were consistent among type 1 and type 2 AMI and in the subgroup of patients presenting very early after chest pain onset. CONCLUSIONS Patients presenting with early AMI showed a near linear release of hs-cTnT and hs-cTnI. This near linearity provides the pathophysiological basis for rapid diagnostic algorithms using 0- to 1-hour changes as surrogates for 0- to 2 hour or 0- to 3 hour changes. Registered at ClinicalTrials.gov (Identifier: NCT00470587)

Early kinetics of cardiac troponin in suspected acute myocardial infarction Cinética temprana de troponina en pacientes con sospecha de infarto agudo de miocardio

Introduction and objectives: Release kinetics of high-sensitivity cardiac troponin (hs-cTn) T and I in patients with acute myocardial infarction (AMI) are incompletely understood. We aimed to assess whether hs-cTnT/I release in early AMI is near linear. Methods: In a prospective diagnostic multicenter study the acute release of hs-cTnT and hs-cTnI within 1 and 2 hours from presentation to the emergency department was quantified using 3 hs-cTnT/I assays in patients with suspected AMI. The primary endpoint was correlation between hs-cTn changes from presentation to 1 hour vs changes from presentation to 2 hours, among all AMI patients and different prespecified subgroups. The final diagnosis was adjudicated by 2 independent cardiologists, based on serial hs-cTnT from the serial study blood samples and additional locally measured hs-cTn values. Results: Among 2437 patients with complete hs-cTnT data, AMI was the adjudicated diagnosis in 376 patients (15%). For hs-cTnT, the correlation coefficient between 0- to 1-hour change and 0- to 2 hour change was 0.931 (95%CI, 0.916-0.944),