Long-term follow-up after intertrochanteric varus osteotomy for haemophilic arthropathy of the hip

In view of an increasing tendency in prosthetic management of haemophilic arthropathy, we intended to evaluate the efficacy of corrective osteotomy of the hip, specifically taking long-term clinical and radiographic results into consideration. Eleven hips affected by haemarthropathy in nine patients suffering from severe haemophilia A were treated with an intertrochanteric varus osteotomy. The average follow-up period was 15 small middle dot4 years. The preoperative clinical score of the Advisory Committee of the World Federation of Haemophilia was 5 small middle dot3 points (range 4-7) and the Pettersson score was 6 small middle dot4 points (range 2-10). The average WFH score at follow-up had increased to 3 small middle dot6 points. Seven hips showed clinical improvement, two hips showed a postoperative deterioration while a further two hips remained unchanged. The Petterson score increased to an average of 7 small middle dot7 points. Here the radiographs of six patients indicated postoperative deterioration, three remained unaltered and two showed improvement. Our study cannot conclusively answer whether intertrochanteric varus osteotomy for haemophilic arthropathy of the hip is always a feasible alternative to joint arthroplasty. The decision for or against this procedure must be individually assessed and the patient must be thoroughly informed about the advantages and disadvantages of both procedures.     

Going forward with reverse shoulder arthroplasty

Rotator cuff is a vital structure of glenohumeral joint, the dysfunction of which leads to debilitating pain and restricted movement. Arthroplasty using unconstrained anatomical prosthesis for treating these conditions have not been successful in the past. Reverse Shoulder Arthroplasty (RSA) is a novel technique specifically designed to address end stage glenohumeral arthritis in rotator cuff deficient joint. Short and mid-term studies have demonstrated a significant improvement in pain and range of motion of the shoulder joint. However there is a very high complication rate in comparison to total and hemiarthroplasty of shoulder joint. Over the years, there has been a steady increase in RSAs performed, both in volume and the indications for its use. This article discusses the biomechanical aspects, indications and critically reviews the clinical outcome following Reverse Shoulder Arthroplasty.     

Reliability and construct validity of the compatible MRI scoring system for evaluation of elbows in haemophilic children

Summary. We assessed the reliability and construct validity of the Compatible MRI scale for evaluation of elbows, and compared the diagnostic performance of MRI and radiographs for assessment of these joints. Twenty‐nine MR examinations of elbows from 27 boys with haemophilia A and B [age range, 5–17 years (mean, 11.5)] were independently read by four blinded radiologists on two occasions. Three centres participated in the study: (Toronto, n = 24 examinations; Atlanta, n = 3; Cuiaba, n = 2). The number of previous joint bleeds and severity of haemophilia were reference standard measures. The inter‐reader reliability of MRI scores was substantial (ICC = 0.73) for the additive (A)‐scale and excellent (ICC = 0.83) for the progressive (P)‐scale. The intrareader reliability was excellent for both P‐scores (ICC = 0.91) and A‐scores (ICC = 0.93). The total P‐ and A‐scores correlated poorly (r = 0.36) or moderately (r = 0.54), but positively, with clinical‐laboratory measurements. The total MRI scores demonstrated high accuracy for discrimination of presence or absence of arthropathy [P‐scale, area‐under‐the‐curve (AUC) = 0.94 ± 0.05; A‐scale, AUC = 0.89 ± 0.06], as did the soft tissue scores of both scales (P‐scale, AUC = 0.90 ± 0.06; A‐scale, AUC = 0.86 ± 0.06). Areas‐under‐the‐curve used to discriminate severe disease demonstrated high accuracy for both P‐MRI scores (AUC = 0.83 ± 0.09) and A‐MRI scores (AUC = 0.87 ± 0.09), but non‐diagnostic ability to discriminate mild disease. Similar results were noted for radiographic scales. In conclusion, both MRI scales demonstrated substantial to excellent reliability and accuracy for discrimination of presence/absence of arthropathy, and severe/non‐severe disease, but poor to moderate convergent validity for total scores and non‐diagnostic discriminant validity for mild/non‐mild disease. Compared with radiographic scores, MRI scales did not perform better for discrimination of severity of arthropathy.     

Avascular necrosis not Charcot's.

BACKGROUND: A case of avascular necrosis (AN) of the navicular bone, in a 24-year-old woman with Type 1 diabetes with peripheral neuropathy, in the absence of any history of direct trauma is presented. The clinical and radiological features at presentation suggested an evolving Charcot arthropathy (CA), but subsequent serial X-rays clearly confirmed AN. CONCLUSIONS: Swelling and foot deformity in association with long-standing diabetic peripheral neuropathy is suggestive of CA, although AN, a less common condition, may show the same clinical features. It is therefore important to undertake further confirmatory radiological investigations if there is any doubt about the diagnosis.     

Bilateral total knee arthroplasty for haemochromatosis arthropathy

Haemochromatosis, a hereditary disorder of iron metabolism, is associated with abnormal tissue iron deposition and polyarthropathy. Arthritis usually affects the small joints of the hand but can also occur in large weight bearing joints. A 63-year-old man who developed haemochromatosis arthropathy of both knees presented with severe joint erosions, articular deformity and soft tissue contracture. Operative treatment was successful but required surgical techniques commonly used during revision total knee arthroplasty.