Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Published in
Clinical Orthopaedics and Related Research®
Volume 470 | Issue 9 | Sep, 2012

Environmental Tobacco and Wood Smoke Increase the Risk of Legg-Calvé-Perthes Disease

Anjali Benjamin Daniel MD, Hitesh Shah MS Orth, Asha Kamath PhD, Vasudev Guddettu MSc, Benjamin Joseph MCh Orth

The etiology of Legg-Calvé-Perthes disease (LCPD) remains unknown. A few studies have suggested passive smoke inhalation may be a risk factor, although the association is not confirmed and a causal relationship has not been established.

Reliability and Stability of Three Common Classifications for Legg-Calvé-Perthes Disease

Moon Seok Park MD, Chin Youb Chung MD, Kyoung Min Lee MD, Tae Won Kim MD, Ki Hyuk Sung MD

To predict the course of Legg-Calvé-Perthes disease (LCPD) and select between treatment options in the early stages, it is critical to have a reliable predictive classification.

Do Femoral or Salter Innominate Osteotomies Improve Femoral Head Sphericity in Legg-Calvé-Perthes Disease? A Meta-analysis

Neil Saran MD, MHSc, FRCSC, Renjit Varghese MBBS, MS (Orth), MHSc, Kishore Mulpuri MBBS, MS (Orth), MHSc

Recently, the authors of two prospective multicenter observational studies recommended surgery to improve head sphericity in older children, whereas large retrospective observational studies suggest that surgery does not improve head sphericity in older children. Thus, the treatment for Legg-Calvé-Perthes disease (LCPD) remains controversial.

Varus Femoral Osteotomy Improves Sphericity of the Femoral Head in Older Children With Severe Form of Legg-Calvé-Perthes Disease

Terje Terjesen MD, PhD, Ola Wiig MD, PhD, Svein Svenningsen MD, PhD

In the Norwegian prospective study on Legg-Calvé-Perthes disease (LCPD), we found varus femoral osteotomy gave better femoral head sphericity at a mean of 5 years postoperative than physiotherapy in children older than 6.0 years at diagnosis with femoral head necrosis of more than 50%. That study did not include separate analyses for hips with 100% necrosis and those with a percentage of necrosis between 50% and 100%.

Triple Innominate Osteotomy for Legg-Calvé-Perthes Disease in Children: Does the Lateral Coverage Change With Time?

Harish Hosalkar MD, Ana Laura Munhoz da Cunha MD, Keith Baldwin MD, MPH, Kai Ziebarth MD, Dennis R. Wenger MD

Triple innominate osteotomy (TIO) is one of the modalities of surgical containment in Legg-Calvé-Perthes disease (LCPD). However, overcoverage with TIO can lead to pincer impingement.

Does Shelf Acetabuloplasty Influence Acetabular Growth and Remodeling?

Won Joon Yoo MD, Hyuk Ju Moon MD, Tae-Joon Cho MD, In Ho Choi MD

Shelf acetabuloplasty has the potential to cause iatrogenic acetabular growth arrest, although accelerated acetabular growth has been reported based on plain radiographic evaluations in patients with Legg-Calvé-Perthes disease. Because plain radiographs may be limited in depicting actual acetabular morphology, it is unclear whether there are growth disturbances.

What Is the Evidence Supporting the Prevention of Osteoarthritis and Improved Femoral Coverage After Shelf Procedure for Legg-Calvé-Perthes Disease?

Jason E. Hsu MD, Keith D. Baldwin MD, Moritz Tannast MD, Harish Hosalkar MD

The evidence supporting continued use of shelf acetabuloplasty in Legg-Calvé-Perthes disease (LCPD) is not well-defined, and there is controversy regarding the long-term benefits related to clinical and functional improvement.

LCPD: Reduced Range of Motion Resulting From Extra- and Intraarticular Impingement

Moritz Tannast MD, Markus Hanke, Timo M. Ecker MD, Stephen B. Murphy MD, Christoph E. Albers MD, Marc Puls PhD

Legg-Calvé-Perthes disease (LCPD) often results in a deformity that can be considered as a complex form of femoroacetabular impingement (FAI). Improved preoperative characterization of the FAI problem based on a noninvasive three-dimensional computer analysis may help to plan the appropriate operative treatment.

Low Early Failure Rates Using a Surgical Dislocation Approach in Healed Legg-Calvé-Perthes Disease

Benjamin J. Shore MD, FRCSC, Eduardo N. Novais MD, Michael B. Millis MD, Young-Jo Kim MD, PhD

Hip deformity secondary to Legg-Calvé Perthes disease (LCPD) may result in femoroacetabular impingement (FAI) and ultimately osteoarthritis. Observations made with the surgical hip dislocation approach have improved our understanding of the pathologic mechanics of FAI. However, owing to concerns about complications related to the vascularity, the role of surgical hip dislocation in the treatment of healed LCPD remains controversial.

Joint-preserving Surgery Improves Pain, Range of Motion, and Abductor Strength After Legg-Calvé-Perthes Disease

Christoph Emanuel Albers MD, Simon Damian Steppacher MD, Reinhold Ganz MD, Klaus Arno Siebenrock MD, Moritz Tannast MD

Patients after Legg-Calvé-Perthes disease (LCPD) often develop pain, impaired ROM, abductor weakness, and progression of osteoarthritis (OA) in early adulthood. Based on intraoperative observations during surgical hip dislocation, we established an algorithm for more detailed characterization of the underlying pathomorphologies with a proposed joint-preserving surgical treatment.

Evidence for Using Bisphosphonate to Treat Legg-Calvé-Perthes Disease

Megan L. Young MD, David G. Little FRACS(Orth), PhD, Harry K. W. Kim MD, MS, FRCSC

The rationale for using bisphosphonate (BP) therapy for Legg-Calvé-Perthes disease (LCPD) is the potential to prevent substantial femoral head deformity during the fragmentation phase by inhibiting osteoclastic bone resorption. However, it is unclear whether BP therapy decreases femoral head deformity.

Quantifying Massive Allograft Healing of the Canine Femur In Vivo and Ex Vivo: A Pilot Study

Brandon G. Santoni PhD, Nicole Ehrhart VMD, MS, Ricardo Betancourt-Benitez PhD, Christopher A. Beck PhD, Edward M. Schwarz PhD

Allograft integration in segmental osseous defects is unpredictable. Imaging techniques have not been applied to investigate angiogenesis and bone formation during allograft healing in a large-animal model.

Irradiation Does Not Modify Mechanical Properties of Cancellous Bone Under Compression

Christopher J. Hernandez PhD, Daniel S. Ramsey MS, Stephanie J. Dux MS, Eileen H. Chu MD, Clare M. Rimnac PhD

Gamma radiation sterilization can make cortical bone allograft more brittle, but whether it influences mechanical properties and propensity to form microscopic cracks in structurally intact cancellous bone allograft is unknown.

Surgical Revascularization Induces Angiogenesis in Orthotopic Bone Allograft

Wouter F. Willems MD, Thomas Kremer MD, Patricia Friedrich AAS, Allen T. Bishop MD

Remodeling of structural bone allografts relies on adequate revascularization, which can theoretically be induced by surgical revascularization. We developed a new orthotopic animal model to determine the technical feasibility of axial arteriovenous bundle implantation and resultant angiogenesis.

Adult Stem Cell Mobilization Enhances Intramembranous Bone Regeneration: A Pilot Study

Margaret A. McNulty PhD, Amarjit S. Virdi PhD, Kent W. Christopherson PhD, Kotaro Sena DDS, PhD, Robin R. Frank BS, Dale R. Sumner PhD

Stem cell mobilization, which is defined as the forced egress of stem cells from the bone marrow to the peripheral blood (PB) using chemokine receptor agonists, is an emerging concept for enhancing tissue regeneration. However, the effect of stem cell mobilization by a single injection of the C-X-C chemokine receptor type 4 (CXCR4) antagonist AMD3100 on intramembranous bone regeneration is unclear.

Does Augmentation with a Reinforced Fascia Patch Improve Rotator Cuff Repair Outcomes?

Andrew R. Baker MS, Jesse A. McCarron MD, Carmela D. Tan MD, Joseph P. Iannotti MD PhD, Kathleen A. Derwin PhD

Scaffold devices are used to augment rotator cuff repairs in humans. While the strength of a novel poly-L-lactic acid-reinforced (human) fascia patch has been documented, it is unclear whether such patches will enhance the strength or likelihood of healing of rotator cuff repairs.

Surface Treatment of Flexor Tendon Autograft and Allograft Decreases Adhesion Without an Effect of Graft Cellularity: A Pilot Study

Furkan E. Karabekmez MD, Chunfeng Zhao MD

Flexor tendon grafting is often required to reconstruct a failed tendon repair. Previous reports have demonstrated flexor grafts coated with lubricants such as carbodiimide derivatized hyaluronic acid (cd-HA) decrease adhesion formation and improve digit function. However, whether this surface modification would affect graft adhesion and cellularity is unknown.

Immune and Inflammatory Pathways are Involved in Inherent Bone Marrow Ossification

Umut Atakan Gurkan PhD, Ryan Golden BS, Vipuil Kishore PhD, Catherine P. Riley MS, Jiri Adamec PhD, Ozan Akkus PhD

Bone marrow plays a key role in bone formation and healing. Although a subset of marrow explants ossifies in vitro without excipient osteoinductive factors, some explants do not undergo ossification. The disparity of outcome suggests a significant heterogeneity in marrow tissue in terms of its capacity to undergo osteogenesis.

GNAS1 and PHD2 Short-interfering RNA Support Bone Regeneration in Vitro and in an in Vivo Sheep Model

Carmen N. Ríos BS, Roman J. Skoracki MD, Anshu B. Mathur PhD

Our ability to guide cells in biomaterials for in vivo bone repair is limited and requires novel strategies. Short-interfering RNA (siRNA) allows the regulation of multiple cellular pathways. Core binding factor alpha 1 (Cbfa1) and hypoxia-inducible factor 1 (HIF-1) pathways can be modulated to direct bone formation via siRNA against guanine nucleotide-binding protein alpha-stimulating activity polypeptide 1 (siGNAS1) and prolyl hydroxylase domain-containing protein 2 (siPHD2), respectively.

Neer Modification of Open Bankart Procedure: What are the Rates of Recurrent Instability, Functional Outcome, and Arthritis?

Pascal Boileau MD, E. Fourati MD, Ryan Bicknell MD, MSc

Neer modified the Bankart procedure by combining a superoinferior capsular shift with the labral reattachment. The theoretical advantages of the modification were that such a procedure would restore the patient’s anatomy and also treat the repeated capsular stretching encountered in anteroinferior instability without limiting external rotation and, thereby reducing the risk of arthritis.

Does Carpal Tunnel Release Provide Long-Term Relief in Patients with Hemodialysis-Associated Carpal Tunnel Syndrome?

Ho Jung Kang MD, Il Hyun Koh MD, Won Yong Lee MD, Yun Rak Choi MD, Soo Bong Hahn MD

Carpal tunnel syndrome (CTS) is a common complication in patients receiving long-term hemodialysis. In the short-term however, these patients are less likely to have pain relief and restoration of function after carpal tunnel release. However, it is unclear whether patients who have release for hemodialysis-associated CTS have differing persisting relief of symptoms compared with patients with idiopathic CTS.

What is the Best Way to Apply the Spurling Test for Cervical Radiculopathy?

Yoram Anekstein MD, Ronen Blecher MD, Yossi Smorgick MD, Yigal Mirovsky MD

A diagnosis of cervical radiculopathy is based largely on clinical examination, including provocative testing. The most common maneuver was described in 1944 by Spurling and Scoville. Since then, several modifications of the original maneuver have been proposed to improve its value in the diagnosis of cervical radiculopathy.

High Survival of Dome Pelvic Osteotomy in Patients with Early Osteoarthritis from Hip Dysplasia

Takashi Sakai MD, PhD, Takashi Nishii MD, PhD, Masaki Takao MD, PhD, Kenji Ohzono MD, PhD, Nobuhiko Sugano MD, PhD

The Chiari osteotomy reportedly has a 60% to 91% survival rate at a minimum 20 years followup. The dome pelvic osteotomy (DPO) has the advantage of allowing a larger weightbearing surface, and congruity in the sagittal plane presumably would reduce the joint contact stress and perhaps increase longevity.

Treatment of Adolescents with a Periacetabular Osteotomy After Previous Pelvic Surgery

Adriana Rocha MS, Daniel J. Sucato MD, MS, Kirsten Tulchin MS, David A. Podeszwa MD

Although the success of the Bernese periacetabular osteotomy (PAO) has been reported for primary dysplasia, there is no study analyzing the radiographic, functional, and gait results of the PAO to correct residual hip dysplasia after previous pelvic surgery.

Blood Loss in Cemented THA is not Reduced with Postoperative Versus Preoperative Start of Thromboprophylaxis

Pål O. Borgen MD, Ola E. Dahl MD, PhD, Olav Reikerås MD, PhD

Thrombin formation commences perioperatively in orthopaedic surgery and therefore some surgeons prefer preoperative initiation of pharmacologic thromboprophylaxis. However, because of the potential for increased surgical bleeding, the postoperative initiation of thromboprophylaxis has been advocated to reduce blood loss, need for transfusion, and bleeding complications. Trials on timing of thromboprophylaxis have been designed primarily to detect thrombotic events, and it has been difficult to interpret the magnitude of blood loss and bleeding events owing to lack of information for bleeding volume and underpowered bleeding end points.

Do Dynamic Cement-on-Cement Knee Spacers Provide Better Function and Activity During Two-stage Exchange?

David J. Jaekel MS, Judd S. Day PhD, Gregg R. Klein MD, Harlan Levine MD, Javad Parvizi MD, Steven M. Kurtz PhD

Implantation of an antibiotic bone cement spacer is used to treat infection of a TKA. Dynamic spacers fashioned with cement-on-cement articulating surfaces potentially facilitate patient mobility and reduce bone loss as compared with their static counterparts, while consisting of a biomaterial not traditionally used for load-bearing articulations. However, their direct impact on patient mobility and wear damage while implanted remains poorly understood.

Most Effective Regimen of Tranexamic Acid in Knee Arthroplasty: A Prospective Randomized Controlled Study in 240 Patients

Rajesh N. Maniar MS Orth, MCh Orth, Gaurav Kumar MS, Tushar Singhi MS, Ravi Mohan Nayak MS, Parul R. Maniar MS, FRCO

The antifibrinolytic tranexamic acid reduces surgical blood loss, but studies have not identified an optimal regimen.

Reliability and Relationship of Radiographic Measurements in Hallux Valgus

Kyoung Min Lee MD, Soyeon Ahn PhD, Chin Youb Chung MD, Ki Hyuk Sung MD, Moon Seok Park MD

Although various radiographic measurements have been developed and used for evaluating hallux valgus, not all are universally believed to be necessary and their relationships have not been clearly established. Determining which are related could provide some insight into which might be useful and which would not.

Erratum to: Robotic-assisted TKA Reduces Postoperative Alignment Outliers and Improves Gap Balance Compared to Conventional TKA

Eun-Kyoo Song MD, PhD, Jong-Keun Seon MD, PhD, Ji-Hyeon Yim MD, PhD, Nathan A. Netravali PhD, William L. Bargar MD

A 16-year-old Boy with Multifocal, Painless Osseous Lesions

Ellen M. Dean MD, James C. Wittig MD, Camilo Vilalobos MD, Roberto A. Garcia MD
Back to top