BACKGROUND: The relationship between osteoarthritis (OA) and osteoporosis (OP) is complicated and it may differ according to the site or stage of disease. The purpose of this cross-sectional study is to examine the relationship between the severity of radiological knee OA and the degree of OP in the ipsilateral proximal femur as denoted by bone mineral density (BMD) in a Korean population, especially among women. METHODS: One hundred ninety-five female patients who had knee pain and radiological knee OA were investigated with respect to the relationship of knee OA severity with BMD. The BMD of the proximal femur and spine was measured by dual energy X-ray absorptiometry, and the severity of knee OA was evaluated based on Kellgren-Lawrence (K-L) radiographic criteria, joint space narrowing (JSN) and mechanical axis of knee alignment. Partial correlation analysis and ANCOVA adjusted for confounding factors (age and body mass index) were performed to assess the relationship. RESULTS: There was a statistically significant relationship between the BMD of the proximal femur and JSN, and the BMD of the proximal femur was positively associated with increased joint space width. There was a lack of association between the spine BMD and JSN. The BMD of the proximal femur was also significantly lower in patients who had a higher K-L grade. CONCLUSIONS: The radiographic finding of severe OA in the knee is associated with decreased BMD of the ipsilateral proximal femur including the femoral neck, trochanter, intertrochanter, and region of the entire hip (neck, trochanter, and Ward's triangle).
Absorptiometry, Photon ; Adult ; Aged ; Aged, 80 and over ; *Bone Density ; Cross-Sectional Studies ; Female ; Femur/physiopathology/*radiography ; Humans ; Knee Joint/physiopathology/radiography ; Middle Aged ; Osteoarthritis, Knee/physiopathology/*radiography ; Osteoporosis/physiopathology/*radiography ; Republic of Korea

OBJECTIVETo analysis the effects of restoring neck length and femoral calcar of femoral component on the reconstruction of femoral offset and its affection on soft tissue balance in total hip arthroplasty with standard femoral components.

METHODSSixty-eight patients (71 hips, 30 male and 38 female,ranging in age from 17 to 89 years,with an average of 63.5 years)undergone primary total hip arthroplasty were followed up. The postoperative hip scored according to Harris hip score symtem, and femoral offset,femoral calcar restored as well as neck length of femoral component were measured from the postoperative X-ray image, and the adductor muscle force was measured by Cybex-6000 isokinetic muscle strength testing system.

RESULTSFemoral neck length had highly significant and positive correlation with femoral offset (r = 0.64, P < 0.001), and had more effects on femoral offset than restoring femoral calcar (t = 3.07, P < 0.01), but had no significant difference on postoperative Harris score. The postoperative femoral offset of patients operated for the femoral head osteonecrosis was less than those for the hip osteoarthrosis (t = 2.91, P < 0.01) and the femoral neck fracture (t = 3.31, P < 0.01). The adductor muscle force in patients who restored femoral offset were better than those failed to restore femoral offset.

CONCLUSIONThere are several factors affecting femoral offset restoration for soft tissue balance in total hip arthroplasty with standard femoral components, among them, the key factor is the neck length of femoral component which is more significant than femoral calar restoration for reconstruction of femoral offset. The role of femoral offset on soft tissue balance in total hip arthroplasty was strengthening the postoperative adductor muscle.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Hip ; Cartilage ; physiopathology ; Female ; Femur ; diagnostic imaging ; physiopathology ; surgery ; Follow-Up Studies ; Hip ; physiopathology ; surgery ; Humans ; Male ; Middle Aged ; Radiography

Adult ; Aged ; Female ; Femur ; injuries ; Humans ; Male ; Manipulation, Orthopedic ; methods ; Middle Aged ; Patellar Dislocation ; diagnostic imaging ; pathology ; physiopathology ; therapy ; Radiography

BACKGROUND: The treatment of unstable intertrochanteric fractures in elderly is still controversial. The purpose of this study is to present treatment strategies for unstable intertrochanteric fractures with hemiarthroplasty using standard uncemented collared femoral stems and at the same time preserving the fractured calcar fragment. METHODS: Fifty-four patients aged 75 years or older with unstable intertrochanteric fractures were included in this prospective cohort study. All patients were treated with calcar preserving hemiarthroplasty using cementless collored femoral stems. Fractured calcar fragment was stabilized either by compaction between the implant and femur or fixed with cable grip system. Follow-up evaluations were performed at least 24 months and later. Palmer and Parker mobility score and visual analogue scale (VAS) pain score were assessed. We also analyzed radiographs of the operated hip at each follow-up visit. RESULTS: The patients were 15 males and 39 females with a mean age of 81.3 years (range, 75 to 93 years). The average operative time was 86.6 minutes. The mean transfused blood units were 1.2 units. The average duration of hospital stay was 5.3 days. The preoperative mean mobility score was 6.20. This score was found to be 4.96 on postoperative third day and 5.90 at 24 months postoperatively. The results of the statistical analysis revealed significant increase in the mobility scores at each follow-up after three days. Radiological interpretation revealed no loosening in the cable-grip systems, and no significant subsidence (> 5 mm) of prosthesis was observed. CONCLUSIONS: Calcar preservation arthroplasty is a good option for elderly patients with severe osteoporosis, frail constitution and the patients who are at higher risk for second operation due to unstable intertrochanteric fractures.
Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Hip/adverse effects/*methods ; Female ; Femur/pathology/radiography/surgery ; Hemiarthroplasty/adverse effects/*methods ; Hip/pathology/radiography/surgery ; Hip Fractures/physiopathology/radiography/*surgery ; Humans ; Male ; Pain Measurement ; Postoperative Complications ; Prospective Studies

BACKGROUND: We retrospectively investigated the prevalence of femoral anterior notching and risk factors after total knee arthroplasty (TKA) using an image-free navigation system. METHODS: We retrospectively reviewed 148 consecutive TKAs in 130 patients beginning in July 2005. Seventy knees (62 patients) underwent conventional TKA, and 78 knees (68 patients) received navigated TKA. We investigated the prevalence of femoral anterior notching and measured notching depth by conventional and navigated TKA. Additionally, the navigated TKA group was categorized into two subgroups according to whether anterior femoral notching had occurred. The degree of preoperative varus deformity, femoral bowing, and mediolateral suitability of the size of the femoral component were determined by reviewing preoperative and postoperative radiographs. The resection angle on the sagittal plane and the angle of external rotation that was set by the navigation system were checked when resecting the distal femur. Clinical outcomes were compared using range of motion (ROM) and the Hospital for Special Surgery (HSS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAX) scores between the two groups. RESULTS: The prevalence of anterior femoral notching by conventional TKA was 5.7%, and that for navigated TKA was 16.7% (p = 0.037). Mean notching depth by conventional TKA was 2.92 +/- 1.18 mm (range, 1.8 to 4.5 mm) and 3.32 +/- 1.54 mm (range, 1.55 to 6.93 mm) by navigated TKA. Preoperative anterior femoral bowing was observed in 61.5% (p = 0.047) and both anterior and lateral femoral bowing in five cases in notching group during navigated TKA (p = 0.021). Oversized femoral components were inserted in 53.8% of cases (p = 0.035). No differences in clinical outcomes for ROM or the HSS and WOMAX scores were observed between the groups. A periprosthetic fracture, which was considered a notching-related side effect, occurred in one case each in the conventional and navigated TKA groups. CONCLUSIONS: Surgeons should be aware of the risks associated with anterior femoral notching when using a navigation system for TKA. A modification of the femoral cut should be considered when remarkable femoral bowing is observed.
Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Knee/*methods ; Female ; *Femur/injuries ; Humans ; Middle Aged ; Postoperative Complications/*epidemiology/physiopathology/radiography ; Prevalence ; Range of Motion, Articular ; Retrospective Studies ; Risk Factors

OBJECTIVETo explore the deep-frozen allograft strut in the rabbits for the sake of finding some evidence to support the clinical practice of cortical strut allograft.

METHODSFifty deep-frozen allograft struts were implanted on the lateral side of the femur in 50 male New Zealand white rabbits. These rabbits were randomly divided into 5 groups. The specimen were retrieved at 2, 4, 8, 16, 24 weeks after surgeries. In each group histomorphology and biomechanic properties were studied.

RESULTSFrom the X ray photography the edge of the strut would turn blunt at the 4th week, union could be found at the 8th week, the inner side of the strut could be absorbed at the 24th week. In the early stage when the strut was implanted in the rabbit, the capillary would be found to grow into the cortical strut from the interior side of it. Then the capillaries were found to converge at the 16th week. This phenomenon is correspondent with the resorption of the dead bone and formation of the new bone. There are few neoformated capillaries on the lateral side of the strut. From the decalcificied section, allograft struts were found to unit to the host at 4 to 8th week. Osteoclast and the new bone formation could be seen at the 8th week, and 3% of the total area of what had been the allograft was replaced by the new bone at that time, 12% was replaced at the 16th week, 21% at the 24th week. There are few resorption or neoformated bone at the lateral side of the strut. The biomechanical property indicated that the strength of the strut decreased at the early time, and only 38% of its original strength remained at 16 weeks.

CONCLUSIONSThe cortical allograft strut can unit to the host by the callus. The capillaries invading into the allograft from the interior side, new bone is formed from the interior side. The biomechanical strength of the strut decreased at early stage.

Animals ; Biomechanical Phenomena ; Bone Transplantation ; diagnostic imaging ; methods ; Femur ; blood supply ; physiopathology ; surgery ; Male ; Rabbits ; Radiography ; Random Allocation ; Time Factors ; Transplantation, Homologous

OBJECTIVETo determine whether bone density is related to osteoarthritis and to compare osteoarthritis with osteoporotic fracture of the femoral neck.

METHODSAll 165 femoral heads removed at joint replacement surgery were divided into 4 groups according to radiographic features of hip (osteophytes, subchondral sclerosis, cysts and femoral head deformity). The individual femoral head was divided into 5 zones histologically. Sections were studied histomorphologically, and quantitation was performed using the computer-assisted system to determine the bone density of the femoral head.

RESULTSThe values of bone density in weight-bearing, super lateral non weight-bearing (SL) and inferior medial non weight-bearing (IM) areas after femoral neck fracture in patients with osteoarthritis were lower than normal. The values of bone density in weight bearing area were increased in patients with osteoarthritis in all four groups but lower than normal in one group (I), and higher than normal in other 2 groups (III, IV). The values of bone density in SL and IM areas except IM area in group IV were lower than normal (P > 0.05). The values of bone density in the central area in the 4 groups were relatively consistent and normal. The density of Haversian canals was increased in the 4 groups indicating osteoporosis of the femoral head. The average age of patients with femoral neck fracture associated with OA (group I) was significantly higher than that of group II, III, IV (P < 0.05).

CONCLUSIONSBone density is different in the femoral head and neck. Dividing the weight bearing joint into distinct zones is a method for laboratory and clinical study. Femoral neck fracture associated with OA was caused by osteoporosis which is related to the age of the patient. The data of this study can be regarded as a potential indicator of implant/host bone relations with morphological, morphometric implications.

Adult ; Aged ; Aged, 80 and over ; Bone Density ; Female ; Femoral Neck Fractures ; etiology ; Femur Head ; diagnostic imaging ; pathology ; physiopathology ; Humans ; Male ; Middle Aged ; Osteoarthritis ; complications ; pathology ; physiopathology ; Osteoporosis ; complications ; physiopathology ; Radiography

Antimicrobial agents played a miraculous role in the treatment of bacterial infections until resistant bacteria became widespread. Besides antimicrobial-resistant bacteria, many factors can influence the cure of infection. Nocardia infection may be a good example which is difficult to cure with antimicrobial agents alone. A 66-year-old man developed soft tissue infection of the right buttock and thigh. He was given prednisolone and azathioprine for pachymeningitis 3 months prior to admission. Despite surgical and antimicrobial treatment (sulfamethoxazole-trimethoprim), the infection spread to the femur and osteomyelitis developed. The case showed that treatment of bacterial infection is not always as successful as was once thought because recent isolates of bacteria are more often resistant to various antimicrobial agents, intracellular parasites are difficult to eliminate even with the active drug in vitro, and infections in some sites such as bone are refractory to treatment especially when the patient is in a compromised state. In conclusion, for the treatment of infections, clinicians need to rely on laboratory tests more than before and have to consider the influence of various host factors.
Aged ; Case Report ; Drug Resistance, Microbial/physiology ; Dura Mater/microbiology* ; Fatal Outcome ; Femur/radiography ; Human ; Male ; Meningitis/microbiology* ; Nocardia Infections/physiopathology ; Nocardia Infections/drug therapy* ; Osteomyelitis/radionuclide imaging ; Osteomyelitis/radiography ; Osteomyelitis/microbiology*

Ascorbic Acid ; administration & dosage ; Child ; Child Nutrition Disorders ; complications ; diet therapy ; Diagnosis, Differential ; Femoral Neoplasms ; diagnosis ; Femur ; diagnostic imaging ; Humans ; Male ; Protein-Energy Malnutrition ; complications ; diet therapy ; Radiography ; Scurvy ; diagnosis ; diet therapy ; etiology ; physiopathology ; Treatment Outcome