The use of stereophotogrammetry to measure acetabular and femoral anteversion

Stereoradiography with a base shift of the source of illumination was used to produce pairs of radiographs to be measured by stereophotogrammetric techniques. The direction of shift was parallel with the longitudinal axis of the body, so that each radiograph in the stereopair could be used for other clinical purposes. A base shift of 10 centimetres with a distance of 100 centimetres between the focus and the film gave acceptable value of stereoscopic parallax. The radiographs were measured using a Hilger and Watts medical stereometer. This method was checked with test specimens, namely an osteotomised pelvis in which one acetabulum could be rotated and an osteotomised femur in which the whole upper portion could be rotated against the shaft. Measurements made on the acetabulum and its radiographs showed a correlation coefficient of 0.9838 over the range 0 to 30 degrees of anteversion, with a mean error +2.54 degrees and a standard deviation of +/- 1.52 degrees (n = 21). For the femoral neck, over the range from 10 degrees of retroversion to 80 degrees of anteversion, the correlation coefficient was 0.9979, the mean error +2.46 and the standard deviation +/- 1.48 degrees (n = 30).

Dislocation following total hip replacement

An analysis of 142 dislocations from a multicentre study of 6774 total hip replacements is reported. The incidence of dislocation was 2.1 per cent. Patients with neuromuscular disorder, those in a confused mental state, and those undergoing revision operations are at special risk. The commonest surgical error, present in nearly half the patients, was placing the acetabular cup too vertically or too anteverted. A less common fault was placing the femoral component too anteverted. Neither the original pathology nor the approach to the hip appeared to affect the likelihood of dislocation. The dislocations were divided into early and late, single and recurrent, and the success rate of treatment is described in these groups. One hundred and eleven patients (78.2 per cent) eventually obtained stability. Of those with a single dislocation, 62 per cent remained stable after a single manipulation. Thirty-four per cent of the patients required an open operation to achieve stability and it is suggested that, in many cases, open reduction alone is not enough; the mechanical fault needs to be corrected.

The treatment of femoral neck fractures with an isoelastic endoprosthesis implanted without bone cement

We report about our first experiences inserting an "isoelastic" femoral endoprosthesis in cases of a fractured femoral neck. 28 patients have been observed for a period of more than 1 year after surgery. We did not find loosening or incompatibility of the polyacetal-resin material. We believe the implantation of this prosthesis type without cement fixation is especially advantageous. The histologic result of a patient who died 6 weeks after surgery did not reveal any tissue incompatibility. We observed an excellent fixation of the prosthesis by bone growth into the surface indentations of the stem.

Proliferative changes of the hip in juvenile rheumatoid arthritis

A ring of proliferative osteophytes at the junction of the femoral head and neck has been described as a characteristic finding in patients with ankylosing spondylitis. A review of 55 cases of juvenile rheumatoid arthritis, without evidence of sacroiliitis, revealed an identical ridge of osteophytes in 5.

[A simple clinical investigation method for the approximative rapid determination of the antetorsional angle of the neck of femur (author's transl)]

The author comes to the conclusion that palpatory determination of the antetorsional angle, if executed by a skilled diagnostician, can often save an x-ray film and hence cost and radiation exposure, especially in nonadipose children, supplying satisfactory information on the torsional conditions at the end of the femur near the hip, within a few seconds' time, taking the examination technique into consideration. Antetorsion of the femur at the hip is defined. The aetiomorphology of the antetorsional angle cannot be considered as an independent phenomenon, since it can be viewed only within the overall interplay of the torsional conditions of the leg. In this connection it becomes evident that there is a well-defined relationship between antetorsion of the femur near the hip and apical position of the trochanter major. The so-called "antetorsion-ddependent, externorotatory trochanter major effect" ist expressed mathematically by the trochanter major retrotorsional angle, which is in fact the only way to properly determine the antetorsional angle via manual palpation.

Anatomo-radiological study of a case of post-radiotherapeutic osteolysis of the hip

Anatomo-radiological study of a case of osteolysis of the femoral head and neck in a 56-year old male who had recieved, 22 years earlier, an intense radiotherapeutic treatment for a soft tissue tumour of the corresponding hip region. The treatment is considered as being the main etiological factor responsible for the bone lesions. The latter seems to have been favored by an indolent joint due to a thoracic cordotomy for post-irradiation pains; it may have been prepared by a secondary osteodystrophy which preceded the radiotherapy and seems due to two previous surgical excisions.

Appearance of trabecular bone in the femoral neck (Singh index). Relation to vertebral bone mass post mortem

In 89 consecutive cases trabecular bone mass of the second or third lumbar vertabra was subjectively estimated in post mortem specimens, using frontal section 1 cm in thickness. The trabecular appearance of the femoral neck (Singh index) at radiography and the thickness of the femoral cortical bone were also determined. Agreement between vertebral bone mass and either of the two radiologic indices was present in only two thirds of the cases, and most often these indices underestimated the presence of vertebral osteoporosis. The results indicate that neither of these radiologic indices can be used for clinical guidance of the diagnosis of vertebral osteoporosis in the individual case.

[Histopathology of bone lesions in 9 cases of algodystrophy of the hip]

The authors present the results of histo-pathological observations made in 9 cases of sympatic algodystrophy reflex of the hip, subjected to a punch biopsy of the head and neck of the femur. The punch biopsy was decided upon, either because of difficult diagnosis, or because of the abnormally long duration of the pain syndrome. In all cases, there were bone lesions. The most common were in the marrow tissue, with stasis (9 cases), fibrosis (7 cases) and necrosis at small, isolated points (5 cases). There was osteoclastic resorption in the bones in 3 cases, and rapid osteogenesis in 6 cases. The latter anomaly revealed the rapid reconstruction characterizing the syndrome. Finally, the authors comment on the relationship between algodystrophy and necrosis of the hip, and the advantages of punch biopsy.

[Coxarthroses due to ischemia. Ischemic coxarthropathy]

In the first part of their work, the authors present radiological, histopathological and experimental results showing that cartilage of the joint can be originally damaged by articular ischemia. In the second part, they analyze the clinical and radiological features of 40 cases of ischemic coxarthrosis, substantiated by histological examination: these are chronic coxarthropathies with changes in the cartilage without rupture of the femoral head but with medullary necrosis and often trabecular necrosis involving the head and the neck of the femur. These ischemic coxarthroses are most often well centered with a superior or supero-internal pinching and show few osteophytes. They constitute a group of coxarthrosis called "primitive", involving the structure because of a previous weakening of the cartilage.

Shaky leg syndrome and hip lesions in turkeys

A leg weakness condition of turkeys, often called the "shaky leg" syndrome, is described and studies on its pathology reported. There appeared to be no consistent histopathological changes in the nervous, muscular or skeletal systems that were characteristic of the syndrome. During the course of the investigation it became clear that almost all turkeys examined from the age of four weeks, regardless of their locomotor status, strain or management, displayed small degenerative lesions situated medially on the neck of their femurs.

The histological characteristics of congenital coxa vara: a case report of a five year old boy

In a 51/2 year old boy with unilateral coxa vara who died of unrelated causes histological sections were made of the proximal femora and pelvic growth plates. The proximal femora were also perfused to study the pattern of arterial supply. Evidence of active endochondral ossification was not detectable in growth plates of the affected right femur, the clinically and roentgenographically normal left femur and the pelvis, including a Salter Type II fissure fracture. The endochondral ossification defect found in growth plates of the proximal right femur and pelvis was associated with a reduction in the number and caliber of intraosseous arteries supplying the metaphyseal sides of the growth plates in the proximal femur and those supplying the subchondral region and extraosseous medial ascending cervical arteries on the surface of the femoral neck. This deficiency in endochondral ossification resembles a form of dwarfism associated with a coxa vara and a generalized growth plate disorder.

[A simple evaluation of osteoporosis: study of the architecture of the upper extremity of the femur by pelvic radiography]

From the study of the architectural features of the system connecting the neck to the femoral diaphysis on pelvic radio-grams, osteoporosis can be classified into seven stages (7 to 1) of increasing severity. It is thus possible to estimate the risk of fracture, the latter being over 50 per cent from stage 4 onward. The cortex-diaphysis relationship (RCD) follows a parallel course but is less reliable. The investigation of a control group of 20 subjects and 37 patients with osteoporosis, aged 50 to over 80, shows the value of this method, with which it is moreover possible to check the evolution of the disease and the effects of treatment.

Occult osteomalacia in American (U.S.A.) patients with fracture of the hip

Low-grade osteomalacia, detectable only by quantitative histological measurement, was present in eight of 31 femoral heads from normocalcemia American patients having intracapsular fracture of the hip. The histological changes were of a much lower degree than those observed in overt clinical osteomalacia. Further, regional differences between the osteoid content of the proximal femur and iliac crest were demonstrated in 13 age-matched controls. In these, the osteoid content of the femoral bone averaged only 30% of that in the iliac crest.

[Reaction in bone and cartilage to Judet metal prosthesis over 20 years (author's transl)]

A case in which a vitallium head-prosthesis was implanted 20 years before. Changes in the neck of femur: Vitallium proved even after 20 years very passive. Minor metallosis could be seen only microscopically, no inflammatory or foreign-body reaction, no atrophy but sclerosis of cancellous bone, which is considered to be due to adaptation to changed weightbearing. Losening of the implant caused a kind of "pseudarthrosis" on the surface of the bed, definite secondary changes, in parts osteoarthrotic. The causes of "pseudarthrosis" are discussed.

Medial displacement osteotomy for unstable intertrochanteric femoral fractures

The charts and roentgenograms of 86 consecutive patients treated by medial displacement osteotomy between 1970 and 1974 were reviewed. All patients had unstable four-fragment intertrochanteric fractures and were treated by the residents and attending staff of the hospitals served by the University of Alabama Medical Center. Thirty patients had sufficient follow-up to be included in the preliminary retrospective study. There were complications of fixation in 11 patients (37%) and one superficial wound infection (3%). The most significant factors associated with complications of fixation were (1) placement of the nail in a superior and anterior position in the femoral neck and head, and (2) advanced osteoporosis. No correlation was noted with the distance of the tip of the nail from the femoral articular cartilage.

Metaphyseal chondroblastoma of bone

This report documents the ninth example of a chondroblastoma localized to the metaphysis of a long bone. The tumor appeared as a lytic lesion in the femoral neck of an 18-year-old boy and was associated with a periosteal reaction. When such neoplasms occur in an unusual location with associated periosteal reaction, chondroblastoma should be considered in the differential diagnosis.

Acetabular growth potential in congenital dislocation of the hip and some factors upon which it may depend

The factors which determine the rate and amount of acetabular growth in congenital dislocation of the hip are ill-understood. A prospective radiological study has been devised in order to assess the influence of the age of congruity, femoral anteversion and neck/shaft angles on acetabular growth. To be included, the children must have reached at least 8 years of age. Those with associated congenital abnormalities and subluxation were excluded, as were those who had operations for acetabular reconstruction. Seventy-four hips were suitable for analysis, and the age range at follow-up was from 8 to 17 years. The acetabular angle was used as an index of acetabular growth. Measurement of this angle, and the anteversion and neck/shaft angles were made before, and each year after reduction of the hip. Congruity was assessed from a radiograph with the legs in the functional position. A satisfactory acetabulum was obtained in 44 hips and the mean age of congruity was 33 months; the acetabulum was unsatisfactory in 30 hips, with a mean age of congruity of 48 months. Four years is the critical age, for if congruity is obtained later, the risk of producing a moderate or severely dysplastic acetabulum is more than doubled. If congruity is obtained under four years of age, growth of the acetabulum with continue in most patients up to 8 and in some to 11 YEARS OF age; the resulting acetabulum was normal or mildly dysplastic. Fifty-nine per cent of the satisfactory hips at follow-up had a normal anteversion angle, and 6 per cent a normal neck/shaft angle. Correction of these angles by themselves, seems not to be a major importance for promoting acetabular growth.

Malignant osteoblastoma

The clinical, radiographic and pathological features are described of eight cases of a bone tumour which we propose to classify as "malignant osteoblastoma". It presents the characteristics of genuine osteoblastoma but of an aggressive pattern, with more abundant and often plump hyperchromatic nuclei, greater nuclear atypia, and numerous giant cells of osteoclastic type. This rare tumour is regarded as the malignant counterpart of osteoblastoma and appears to be only locally aggressive. It should be separated from conventional osteosarcoma not only because of its peculiar histological pattern, but also because of its different clinical and radiological features and better prognosis. Thus seven of the eight patients were alive and free of disease from one and a half to eleven years after the initial surgical treatment, which in only two cases included amputation. Excision or block resection is the preferred method of treatment.

The role of fatigue in the pathogenesis of senile femoral neck fractures

1. Senile subcapital fractures in osteoporotic patients are due to fatigue, not to the impact of a fall, since they are preceded by the local accumulation of isolated trabecular fatigue fractures.

2. One pathological significance of the isolated trabecular fractures described by Todd, Freeman and Pirie (1972) has been demonstrated.

Pathological fractures of the femoral neck

In a review of subcapital fractures due to metastases in the femoral neck it was found that in the majority of cases pain in the region of the hip developed a few days prior to fracture. While the majority of subcapital fractures are sustained as the result of a single incident of trauma, in cases with metastases trabecular stress fractures occur in increasing numbers until finally femoral neck fracture occurs. It would seem that once a critical number of trabecular stress fractures has been reached the patient develops pain. Immediate radiologic examination should be performed, and if there is evidence of bone destruction approaching 50% of the cortex, prophylactic hip pinning is strongly indicated.

Femoral head alive 16 years after a non-consolidated intracapsular fracture of the femoral neck. An anatomical and radiological study

Images

Giant granulomatous lesions of the femoral head and neck in rheumatoid arthritis

Images