Early migration characteristics of a 180° porous-coated cup with 1-mm press fit

Introduction

Evaluation of early cup movement is an important diagnostic tool to predict the likelihood of long-term implant loosening and clinical failure. The investigated cementless cup is clinically proven over 10 years, but there is a paucity of information that accurately describes the migration characteristics of this component.

Materials and methods

We retrospectively analysed the clinical outcome and migration behaviour of 60 Pinnacle 100 shells after an average 3.8-year follow-up (range 2.1–5.4 years). For migration measurement, EBRA (Einzel-Bild-Röntgen-Analyse) digital software was applied. Clinical assessment was performed using the HHS, the UCLA score and the SF-36 health survey.

Results

The clinical outcome showed excellent results with a mean HHS of 95.4 (SD 7.1) and mean UCLA of 6.9 (SD 1.3). All implants were radiologically stable within the observation period and none of the cups was at risk for aseptical loosening. EBRA analysis revealed a mean total migration of 1.4 mm (SD 0.9) (95 % CI 1.1–1.6) at 3 years. Eight cups migrated more than 1 mm within the first three postoperative months, thereafter the migration curves flattened down.

Conclusion

Surgeons may expect to find a variable amount of early migration when using the Pinnacle cup. To our knowledge, these are the first results, which show an early “impaction” of a cementless cup, followed by subsequent osseointegration. We believe that an appropriate long-term outcome of the investigated cup is ensured. The data of the present investigation will provide clinicians with useful baseline information with which to compare new cup designs.     

Intramuscular haemangioma of the head and neck—a diagnostic dilemma

Intramuscular haemangiomas (IMHs) are acquired lesions and account for 0.8% of all haemangiomas. Fewer than 80 cases of IMHs have been reported, and most of them were located in the trunk or extremities. Head and neck region represents 13.5% of IMHs. They are frequently misdiagnosed as parotid lesions or even temporomandibular joint dysfunction. When a history of an enlarging vascular mass is present, a high index of suspicion for invasive tumour is required.     

Phlebotomy: a treatment of ischaemic necrosis of the femoral head? Analysis of a hypothesis

The treatment of non-traumatic ischaemic osteonecrosis of the femoral head (ONFH) remains problematical and there is evidently scope to seek for a medical treatment of this disease which often leads to a surgical procedure for hip prosthesis. If we exclude the context of hemoglobin disorders, necrosis appears mainly in adults, when their limb bones contain a fatty marrow. Investigations such as intramedullary pressure measurement and transosseous phlebography suggest a disorder of the intraosseous blood circulation. Various studies in animals and man have provided arguments indicating that a kind of intraosseous 'obesity' due to hyperplasia and/or hypertrophy of the fatty tissue of the femoral marrow play a role in the development of necrosis. In this respect, the blood flow of the yellow marrow is close to ischemia, whereas red marrow flow can be very high. In various conditions, mainly hemolytic anemias, the femoral yellow marrow can convert to red marrow, which has also been described in anemias induced by blood loss. If it is not thought unreasonable to consider ONFH an 'ischemic' disease, these observations are an encouragement to attempt treatment by repeated phlebotomies. This procedure may locally restore red marrow, and then an adequate blood flow which could stabilize or even reverse the lesions if they are diagnosed early.     

The anatomy of the short head of biceps – not a tendon

Background:

The short head of biceps brachii has been the subject of little investigation when compared to the long head or distal biceps tendons. The aim of this study was to dissect and describe the origin and proximal portion of the short head of biceps brachii.

Materials and Methods:

Three left and two right (n = 5) fresh-frozen human cadaver shoulders were dissected and the proximal short head was measured and photographed.

Results:

The origin of the short head of biceps consisted of muscle fibres attaching directly to the tip of the coracoid process, with a thin, tendinous aponeurosis covering its anterior surface, rather than a true tendon as previously described.

Conclusion:

The short head of biceps does not attach to the coracoid process via a true tendon. These findings have implications for procedures that utilise the short head of biceps.

Level of Evidence:

Basic science study.     

Sentinel node metastasectomy in thin ≤1-mm melanoma

Background and aims Sentinel lymph node biopsy (SLNB) has been widely accepted as a precise tool to stage melanoma. In thin T1 melanomas (1 mm), the indication of SLNB is controversial since the risk of nodal metastasis is low. The aim of this study was to assess if SLNB detects occult nodal metastases among patients with thin melanomas.Patients and methods SLNB was performed prospectively in 135 patients with invasive melanoma in any depth category, including 56 T1 melanomas.Results Nodal metastases were detected in 18% by SLNB, and there were three sentinel-positive thin melanomas, constituting 5% of the T1 cases. Histopathologically, there were no factors of the primary tumors that would have predicted these metastases.Conclusion SLNB is a precise method to detect clinically silent nodal metastases in thin invasive melanoma. Certain histopathologic features of a thin primary lesion may correlate with the predictive probability of the sentinel node status. We were unable to identify these predictors, but the conclusions from this study are limited by the small sample size. Advanced melanoma is a lethal disease, and accurate staging is essential also in the T1 group. For stage III patients with occult nodal metastases, metastasectomy is a better option for cure than observation.     

Seminoma – a unique case of tumor located in the head of epididymis

We report a very rare case of tumor in the head of left epididymis without localized primary foci of tumor in the testis.     

A prospective, randomized, single-blind trial of 5-mm versus 3-mm ports for laparoscopic cholecystectomy: is smaller better?

Background

Single-incision laparoscopic cholecystectomy (SILC) is said to provide improved cosmesis with a reduction in postoperative pain, but SILC involves a change in operative technique. A single-blind, randomized controlled trial compared cosmetic outcomes and postoperative pain between 3- and 5-mm ports used for laparoscopic cholecystectomy (LC).

Methods

For this study, 80 patients with symptomatic gallstones were recruited from a single center and randomized to a LC using either a 5-mm port and three 3-mm ports (group A) or a 10-mm port and three 5-mm ports (group B). Operative details; pain scores at 1 h, 6 h, and 1 week; and analgesia required during the first week were collected. Cosmetic outcome was assessed at 6 months using a validated questionnaire.

Results

For each group, 40 patients were recruited. The two groups were well matched except for sex. Group A had 11 males, and Group B had 4 males. The mean operative time was 49 ± 12 min (range, 24–120 min) in the 3-mm group versus 46 ± 19 min (range, 21–124 min) in the control group (p = 0.40). The two groups did not differ statistically in the day case rate. The pain scores in Group A were 2.5 ± 2.1 at 1 h, 3.2 ± 2.2 at 6 h, and 0.8 ± 2.2 at 1 week versus 4.2 ± 2.9 at 1 h, 3.3 ± 2.4 at 6 h, and 2.1 ± 2.4 at 1 week in Group B (p = 0.003, 0.63, and 0.002, respectively). No difference in the analgesia consumption was observed during the first postoperative week. The patients in Group A had significantly better cosmetic outcome scores at 6 months.

Conclusion

The use of 3-mm ports is technically feasible in patients undergoing LC for gallstones. The operating times are comparable with those for conventional LC, whereas the pain scores are reduced, and the cosmetic outcome is better.     

Is cyclosporine in renal-transplant recipients more effective when given twice a day than in a single daily dose?

BACKGROUND: It is still unknown whether it is better to administer cyclosporine (CsA) once or twice a day to renal-transplant patients. METHODS: Fifty-four patients were randomized to receive CsA once a day (OD group, 28 patients) or twice a day (BD group, 26 patients). Clinical parameters and pharmacokinetic studies were regularly monitored over the first year. RESULTS: Two patients lost their grafts because of renal vascular thrombosis. A patient in the BD group died. The other 51 patients were alive with graft functioning after a minimum follow-up of 1 year. Five patients per group had reversible acute rejection. There was a not significant trend toward a lower mean serum creatinine in OD than in BD (1.38 +/- 0.38 and 1.7 +/- 0.80 mg/dL at 1 year posttransplant, respectively). In 47 patients, 319 pharmacokinetic studies were performed. We measured the area under the concentration-time curve during the first 4 hours (AUC0-4) and CsA blood levels at 0, 2, and 4 hours after dosing. C0 was significantly lower in OD than in BD (P=0.0011), whereas C2 (P<0.0001) and C4 (P<0.0001) were significantly higher in OD than in BD. In OD, the AUC was higher than in BD (P<0.0001). OD allows us to reach high levels of C2 and AUC for several hours after dosing, whereas BD showed persistently high levels throughout the whole day. CONCLUSION: No difference in survival and rejection rates were observed between OD and BD groups.     

Does the size of the rod affect the surgical results in adolescent idiopathic scoliosis? 5.5-mm versus 6.35-mm rod

Background ContextFavorable clinical outcomes of surgical treatment with Cotrel-Dubousset instrumentation (CDI) or instrumentations that follow the principles of CDI, for adolescent idiopathic scoliosis (AIS) have been reported. However, there are few studies concerning the results with rods of different sizes.PurposeTo find out whether the rod size affects the surgical results for AIS.Study designA retrospective cohort study based on the same spinal system with different sizes of rod.Patient sampleA consecutive series of 93 patients, who underwent posterior correction with posterior instrumentation and fusion for AIS, were included and retrospectively analyzed.Outcome measuresPostoperative radiologic outcomes were evaluated using coronal curves, percentage of curve correction, and coronal global balance.MethodsNinety-three patients treated during the period January 2000 to December 2008 were included in this study; 48 patients were treated with the Cotrel-Dubousset Horizon (CDH) M10 system with a 6.35-mm rod from January 2000 through December 2004, and a CDH M8 was used with a 5.5-mm rod in another 45 patients from January 2005 through December 2008. The Cobb angle, Risser grade, coronal curves, flexibility of curve, percentage of curve correction, coronal global balance, operative time, and estimated blood loss were measured and analyzed. The same parameters were used when the patient was followed at the OPD. All of the patients underwent regular follow-up for at least 2 years.ResultsNo statistical significance was observed in the demographic data, including age, sex, BMI, and Risser grade, between these 2 groups. The overall average percentage of correction was 60.0%±12.7%: 60.7%±12.5% for the CDH M10 group, and 59%±13.1% for the CDH M8 group. At the final follow-up, the overall average loss of correction was 4.8±3.9° for the CDH M10 group, and 4.3±4.0° for the CDH M8 group. The average percentage of correction at the final follow-up was 50.9%±15.1% for the CDH M10 group, and 51.1%±16.1% for the M8 group. No statistical significance could be observed in the radiologic parameters between these 2 groups.ConclusionThe radiologic results for the 5.5-mm rod and the 6.35-mm rod were comparable in terms of correction, loss of correction, and coronal global balance.     

Interleukin-33: a novel player in osteonecrosis of the femoral head?

Osteonecrosis of the femoral head (ONFH) is a disabling disease affecting young adults, which usually leads to the destruction of the hip joint. It is mainly due to an inadequate blood supply that causes the death of osteocytes and bone marrow cells. Joint salvaging procedures are numerous but relatively inefficient, justifying the need for new therapeutic strategies. In this regard, the recently discovered interleukin (IL)-33 alarmin appears as a possible target. Indeed, IL-33 seems to be specifically released by necrotic cells, and interestingly, is constitutively expressed in human bone, in particular by osteocytes, osteoblasts and marrow adipocytes. Moreover, recent reports suggesting that IL-33 modulates angiogenesis, vascular permeability, osteoclastogenesis and bone resorption, indicate that IL-33 may play a role in ONFH.     

Radial head fixation under arthroscopy for Mason Ⅱ radial head fractures

Objective To evaluate the early therapeutic effects of arthroscopic procedure used for Mason Ⅱ radial head fractures. Methods From October 2006 to October 2008, 36 cases of fresh Mason Ⅱ radial head fractures were treated under arthroscopy by 2 protocols. Group A (16 cases) used prone position, brachial plexus anaesthesia and 4 portals while group B (20 cases) side-lying position, general anaesthesia and 3 portals. After debridement and anatomical reduction, the fractures were fixed by absorbable screws. The range of motion (ROM) was compared at 12 and 24 weeks postoperatively among all the patients.Comparisons were also done between the 2 groups at 12 and 24 weeks postoperatively in the ROM and Mayo elbow performance score(MEPS). Results Fine union was achieved in all the 36 cases without complications. The average ROM of flexion-extension was 128.4°± 12. 7° at 12 weeks and 132.5°± 10. 2°at 24weeks, without any significant difference ( t = 2. 713, P = 0. 539); the average ROM of rotation was 115.3°± 24.0° at 12 weeks and 118.1 °± 19. 3° at 24 weeks, without any significant difference ( t = 5.120, P =0. 778) . No significant differences were found between the 2 groups at either 12 or 24 weeks in ROM of flexion-extension, ROM of rotation or MEPS points ( P ＞ 0. 05). Conclusions Short term results show that a satisfactory functional outcome can be achieved by arthroscopy via proper portals in treatment of Mason Ⅱ radial head fractures. Advantages of arthroscopy are minimally invasive approaches, direct visualization of the fracture and early recovery.     

Radial head fixation under arthroscopy for Mason Ⅱ radial head fractures

Objective To evaluate the early therapeutic effects of arthroscopic procedure used for Mason Ⅱ radial head fractures. Methods From October 2006 to October 2008, 36 cases of fresh Mason Ⅱ radial head fractures were treated under arthroscopy by 2 protocols. Group A (16 cases) used prone position, brachial plexus anaesthesia and 4 portals while group B (20 cases) side-lying position, general anaesthesia and 3 portals. After debridement and anatomical reduction, the fractures were fixed by absorbable screws. The range of motion (ROM) was compared at 12 and 24 weeks postoperatively among all the patients.Comparisons were also done between the 2 groups at 12 and 24 weeks postoperatively in the ROM and Mayo elbow performance score(MEPS). Results Fine union was achieved in all the 36 cases without complications. The average ROM of flexion-extension was 128.4°± 12. 7° at 12 weeks and 132.5°± 10. 2°at 24weeks, without any significant difference ( t = 2. 713, P = 0. 539); the average ROM of rotation was 115.3°± 24.0° at 12 weeks and 118.1 °± 19. 3° at 24 weeks, without any significant difference ( t = 5.120, P =0. 778) . No significant differences were found between the 2 groups at either 12 or 24 weeks in ROM of flexion-extension, ROM of rotation or MEPS points ( P ＞ 0. 05). Conclusions Short term results show that a satisfactory functional outcome can be achieved by arthroscopy via proper portals in treatment of Mason Ⅱ radial head fractures. Advantages of arthroscopy are minimally invasive approaches, direct visualization of the fracture and early recovery.     

Osteonecrosis of the femoral head after osteosynthesis of a proximal femur fracture with a 95° condylar plate

Avascular necrosis of the femoral head is a frequent complication after osteosynthesis of femoral neck fractures. It is rarely seen after proximal femur fractures with intact trochanteric area. The choice of the implant varies from different blade systems (DHS, DCS and condylar plates) to intramedular nailing systems (gamma nail, classic nail). The complication of avascular necrosis of the femoral head after internal fixation of subtrochanteric and proximal femur fractures is reported following intramedullary nailing. We report a case of a femoral head necrosis after osteosynthesis of a proximal femur fracture with a 95 degree condylar plate.     

Osteonecrosis of the femoral head after osteosynthesis of a proximal femur fracture with a 95° condylar plate

Summary Avascular necrosis of the femoral head is a frequent complication after osteosynthesis of femoral neck fractures. It is rarely seen after proximal femur fractures with intact trochanteric area. The choice of the implant varies from different blade systems (DHS, DCS and condylar plates) to intramedular nailing systems (gamma nail, classic nail). The complication of avascular necrosis of the femoral head after internal fixation of subtrochanteric and proximal femur fractures is reported following intramedullary nailing. We report a case of a femoral head necrosis after osteosynthesis of a proximal femur fracture with a 95 degree condylar plate.      

Duodenum-preserving pancreatic head resection in solid pseudopapillary neoplasm—Report of a case

INTRODUCTION

Solid pseudopapillary neoplasm (SPPN) was first characterized by Virginia Frantz in 1959. The duodenum-preserving pancreatic head resection (DPPHR) has been described as treatment for low-grade malignant tumors of the head of the pancreas including eight cases of SPPN.PRESENTATION OF CASE: A 16-year-old white female patient presented with abdominal pain and dyspepsia. Computed tomography scan of abdomen showed a 10 × 9 × 10 cm³ lesion on the pancreatic head. After radiological diagnosis of SPPN the patient was submitted to DPPHR. Resection was achieved with clear margins. Immunohistochemical study demonstrated positivity for progesterone receptor, β-catenin, cytoplasmic paranuclear dot-like CD99, negativity for chromogranin and S100 protein and Ki 67 index of 1%.

DISCUSSION

A large encapsulated pancreatic mass with well-defined borders that contains areas of calcifications and intratumoral hemorrhage on CT scan in a young female is virtually diagnostic of an SPPN. A particular dot-like intracytoplasmic expression of CD99 appears to be highly unique for SPPN

CONCLUSION

DPPHR should be considered in cases of SPPN in the pancreas head if there is no compromise with oncologic radicality.     

Intradiploic frontal epidermoid cyst in a patient with repeated head injuries: is there a causative relationship?

Summary Epidermoid cysts are rare disontogenetic tumoral lesions in the cranial compartment (1% of all intracranial tumors) and are usually located in relation to the cranial sutures; the intradiploic location is the less frequent. We report a clinical case in which the post-traumatic etiology of a frontal intradiploic epidermoid is considered. The histological findings revealed the presence of an epidermoid tumor associated with a typical foreign body inflammatory reaction, after repeated head traumas at the site of the tumour. This is the first case in whom the association between this tumoral lesion and a tissue inflammatory reaction due to foreign bodies is demonstrated.