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We retrospectively identified 18 consecutive patients with synovial chrondromatosis of the shoulder who had arthroscopic treatment between 1989 and 2004. Of these, 15 were available for review at a mean follow-up of 5.3 years (2.3 to 16.5). There were seven patients with primary synovial chondromatosis, but for the remainder, the condition was a result of secondary causes. The mean Constant score showed that pain and activities of daily living were the most affected categories, being only 57% and 65% of the values of the normal side. Surgery resulted in a significant improvement in the mean Constant score in these domains from 8.9 (4 to 15) to 11.3 (2 to 15) and from 12.9 (5 to 20) to 18.7 (11 to 20), respectively (unpaired t-test, p = 0.04 and p < 0.0001, respectively). Movement and strength were not significantly affected. Osteoarthritis was present in eight patients at presentation and in 11 at the final review. Recurrence of the disease with new loose bodies occurred in two patients from the primary group at an interval of three and 12 years post-operatively. In nine patients, loose bodies were also present in the bicipital groove; seven of these underwent an open bicipital debridement and tenodesis. We found that arthroscopic debridement of the glenohumeral joint and open debridement and tenodesis of the long head of biceps, when indicated, are safe and effective in relieving symptoms at medium-term review.

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Osteochondral transplantation requires a careful assessment of the location of donor plugs. A mismatch of cartilage thickness between the donor and recipient site may lead to abnormal stresses and poor function. The objective of this study was to characterize the recommended donor and recipient sites with respect to cartilage thickness in younger individuals. Nineteen arthro CT (13 men, 6 women), which had been carried out in a population of less than 50 years old were studied. Recommended donor sites have included the posterior femoral condyles, the medial and lateral aspect of the trochlea and central, medial and lateral sides of the intercondylar notch. Recipient sites were studied at four regions of interest on the medial femoral condyle usually involved in osteochondritis dissecans. Average cartilage thickness was calculated on the digital version of the reference cuts for each site and compared. The sensitivity of the precision of the measurements to observer variability was evaluated using intra- and inter-observer correlation coefficient tests. The femoral cartilage in the knee was thickest in the recipient sites (2.49 mm, SD 0.64) than in donor sites (1.79 mm, SD 0.43) (P<0.0001). There was no differences between the different donor sites, unless for the antero lateral intercondylar notch which was significantly thinner (1.3 mm, SD 0.29) than the other sites (P<0.05). The cartilage of the donor site was consistently thinner than the cartilage of the recipient sites. Between the different donor sites, the lateral side of the intercondylar notch was significantly thinner than the other donor sites and should not be harvested in priority.

The effect of a simulated leg length discrepancy on foot loading patterns and gait cycle times in normal individuals was investigated. Thirty feet of 15 normal volunteers were evaluated. Leg length discrepancy was simulated using flexible polyurethane soles. As leg length discrepancy increased, the total loading increased from 35.31 to 37.99 kg/cm2/sec, forefoot loading increased from 15.58 to 19 kg/cm2/sec, hindfoot loading remained the same. All subjects, except females with middle loading patterns, demonstrated increased hallux loading. The contact phase of gait decreased from 22% to 13%, the midstance phase remained the same, the propulsion phase increased from 44% to 50%. All findings were statistically significant. Leg length discrepancy has significant effects on the foot. Different adaptive loading patterns amongst subsets of individuals are seen.

Early results of revision acetabular surgery using impaction grafting and the Kerboull shell in patients with severe osteolysis have shown good functional outcome. However, 6 of 35 patients had radiographic evidence of aseptic loosening without progression for 4 years. Long-term follow-up is required to ensure that this loosening does not result in failure.

Hereditary hemochromatosis (HH) results in increased iron absorption and subsequent deposition in tissue. This condition occurs predominantly in individuals of Northern European and Celtic origin with Ireland having one of the highest allele frequencies in the world. This study examines the hypothesis that homozygosity for either the C282Y or H63D mutations in the HFE gene may be associated with aseptic loosening following total hip arthroplasty (THA). Two groups of individuals were screened for the C282Y and H63D mutations associated with HH. Group 1 were individuals who had undergone primary hip arthroplasty and group 2 were individuals who had undergone revision hip arthroplasty for aseptic loosening. Exclusion criteria included rheumatoid or other inflammatory arthropathies and revision due to causes other than aseptic loosening. Significantly more patients in the revision THA group were homozygous for the C282Y genotype ( P = 0.014). Aseptic loosening occurred earlier in these patients (P = 0.009), in particular in the patients who had clinical signs of hemochromatosis. No association was seen with the H63D mutation and revision THA. The incidence of HH in the group of primary THA patients was no higher than the background incidence. Patients who require primary THA and who are homozygous for the C282Y mutation have an increased risk of developing aseptic loosening, leading to revision THA. Moreover C282Y homozygosity appears to be associated with earlier aseptic loosening than in individuals without the C282Y mutation.

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