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Following total hip arthroplasty (THA), femoral periprosthetic bone undergoes a remodeling process that results in bone loss in its proximal regions that may compromise the long-term outcome of THA. Periprosthetic bone loss mainly occurs during the first postoperative months. The question is whether a postoperative treatment with alendronate is effective in reducing periprosthetic bone loss and which doses and duration of treatment are required. In a 12-month prospective, randomized double-blind study, 51 patients undergoing cementless THA were treated postoperatively either with a daily dose of 20 mg alendronate for 2 months and 10 mg for 2 months thereafter (group I), with 20 mg of alendronate for 2 months and 10 mg for 4 months thereafter (group II), or treated with placebo (group III). Proximal femoral bone mineral density (BMD) was measured with dual-energy X-ray absorptiometry (DEXA) and serum biochemical markers of bone turnover bone specific alkaline phosphatase, osteocalcin, and C-terminal telopeptides (CTX-I) were assayed. Six months of alendronate treatment significantly reduced ( p < 0.001) bone loss in proximal medial region (À10%) compared with placebo (À26%). All biochemical markers of bone turnover were suppressed by alendronate. These data suggest that alendronate administered for the first 6 postoperative months following THA was effective in preventing early periprosthetic bone loss. ß

The effect of dilation of the tibial tunnel on the strength of hamstring graft fixation using interference screws was evaluated. In all, 28 RCI screws were tested in male human tibia-hamstring constructs with tibial tunnels reamed or dilated to the respective size of the graft diameter. Dilation of the tibial tunnel failed to significantly enhance hamstring fixation. Grafts secured in dilated tunnels displayed an 11% greater resistance to the initiation of graft slippage (174+/-112 N) compared to their undilated controls (156+/-77 N, P=0.63). Dilation of the tibial tunnel increased the failure load by an average of 4%, independent of screw diameter (dilated specimens: 360+/-120 N, controls: 345+/-88 N, P=0.74). Biomechanical research on the effect of tibial tunnel dilation in hamstring fixation has not provided satisfactory evidence as to the benefits of this additional surgical step during anterior cruciate ligament (ACL) reconstruction.

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IntroductionThe term "dysfunction" as used in manual medicine terminology is defined as a reversible, functional restriction of motion of an individual spinal segment or as a peripheral articular malfunction presenting with hypomobility. The appearance of dysfunctions of the upper cervical spine can be the cause of localised or pseudoradicular pain as well as the cause of vertigo and impaired hearing via disturbances of the proprioception from the neck. The significance of dysfunctions of the upper cervical spine as one cause of vertigo and impaired hearing has been commonly discussed in ENT and neurology literature [5, 9-14, 20, 22-26]. Commentators in the field of manual medicine limit the influence of dysfunctions of the cervical spine as a cause of vertigo to upper cervical spine segments [8,16,27,28]. Dysfunctions below the motion segAbstract To our knowledge, quantitative studies on the significance of disorders of the upper cervical spine as a cause of vertigo or impaired hearing do not exist. We examined the cervical spines of 67 patients who presented with symptoms of dizziness. Prior to the orthopaedic examination, causes of vertigo relating to the field of ENT and neurology had been ruled out. Fifty patients of the above-mentioned group were studied. They followed the outlined treatment protocol with physical therapy and were available for 3 months of follow-up. Thirty-one patients, hereinafter referred to as group A, were diagnosed with dysfunctions of the upper cervical spine. Nineteen patients, hereinafter referred to as group B, did not show signs of dysfunction. Cervical spine dysfunctions were documented as published by Bischoff [4]. In group A dysfunctions were found at level C1 in 14 cases, at level C2 in 6 cases and at level C3 in 4 cases. In seven cases more than one upper cervical spine motion segment was affected. Dysfunctions were treated and resolved with mobilising and manipulative techniques of manual medicine. Regardless of cervical spine findings seen at the initial visit, group A and B patients received intensive outpatient physical therapy. At the final 3-month follow-up, 24 patients of group A (77.4%) reported an improvement of their chief symptom and 5 patients were completely free of vertigo. Improvement of vertigo was recorded in 5 group B patients (26.3%); however, nobody in group B was free of symptoms. We concluded that a functional examination of motion segments of the upper cervical spine is important in diagnosing and treating vertigo, because a non-resolved dysfunction of the upper cervical spine was a common cause of long-lasting dizziness in our population.

IntroductionDisc herniation leading to nerve root displacement with compression and causing radicular symptoms is only one of a variety of possible causes of lumbar and ischiadic pain. Pain radiating into the leg is not necessarily caused by irritation of the root [18,19]; Norman and May [25] identified the sacroiliac joint (SIJ) as one of the possible starting points of such complaints via injection of local anaesthetic. Disc herniations were detected on CT and MR scans in a high percentage of asymptomatic patients [5,16,17,31,32]. Likewise it has been shown that the size of herniations does not correlate with displayed clinical symptoms [6,8, 34]. If, despite the lack of sensory or motor losses, the incidental finding of pathologic disc morphology is concluded to be the source of pain, the wrong therapy may be initiated, e.g. nucleotomy, leading to unsatisfactory postoperative results [7,[28][29][30]. This has to be considered when a choice between surgical and non-surgical treatment is made.The lack of consideration of alternatives to disc-triggered pain is encouraged by the fact that some alternative diagnoses are undetectable by imaging procedures. Functional disorders in general, and dysfunction of the SIJ in specific, cannot be detected by CT or MRI. Reversible Abstract A dysfunction of a joint is defined as a reversible functional restriction of motion presenting with hypomobility according to manual medicine terminology. The aim of our study was to evaluate the frequency and significance of sacroiliac joint (SIJ) dysfunction in patients with low back pain and sciatica and imaging-proven disc herniation. We examined the SIJs of 150 patients with low back pain and sciatica; all of these patients had herniated lumbar disks, but none of them had sensory or motor losses. Forty-six patients, hereinafter referred to as group A, were diagnosed with dysfunction of the SIJ. The remaining 104 patients, hereinafter referred to as group B, had no SIJ dysfunction. Dysfunctions were resolved with mobilizing and manipulative techniques of manual medicine. Regardless of SIJ findings, all patients received intensive physiotherapy throughout a 3-week hospitalisation. At the 3 weeks follow-up, 34 patients of group A (73.9%) reported an improvement of lumbar and ischiadic pain, 5 patients were pain free. Improvement was recorded in 57 of the group B patients (54.8%); however, nobody in group B was free of symptoms. We conclude that in the presence of lumbar and ischiadic symptoms our presented data suggest consideration of SIJ dysfunction, requiring manual medicine examination and, in the presence of SIJ dysfunction, appropriate therapy, regardless of intervertebral disc pathomorphology. This could avoid wrong indications for nucleotomy.

Navigation of the acetabular cup in total hip replacement (THR) is used to improve the reproducibility of acetabular component positioning. When the palpation of anatomic landmarks, which is necessary to determine the pelvic coordinate system, is performed epicutaneously, the question as to how uneven soft tissue distribution can influence navigation accuracy arises. To obtain data, the questionable soft tissue thickness was measured in 72 patients scheduled for THR. In addition, distances between the landmarks were recorded. On the basis of this information, we were able to calculate the expected misinterpretation of the anteversion given by a navigation system for each patient. The calculations suggest that a navigation system would have underestimated the anteversion on average by 2.8 degrees +/- 1.8 degrees. The median of anteversion misinterpretation was 2.4 degrees and its 95% confidence interval was calculated to be 2.2 degrees -3.0 degrees. No correlation with substantial significance between anteversion misinterpretation and the patients' biometrical data could be found. According to the current knowledge, acetabular cups in THR should be positioned within a range of 30 degrees -50 degrees of inclination and 10 degrees -30 degrees of anteversion. In comparison with these permitted +/- 10 degrees windows, the amount of misinterpretation that was found due to uneven soft tissue distribution seems to be acceptable.

The functional outcome of hip replacement following a Girdlestone arthroplasty may be difficult to predict. We reviewed 39 hips in 39 patients with a minimum follow-up of 12 (range 12-208) months from re-implantation total hip arthroplasty. The patients were treated in one institution between 1983 and 2000, and their mean age at conversion was 65 (32-85) years. The main indication for the Girdlestone arthroplasty was peri-prosthetic infection. A post-operative complication occurred in 26 cases and in 17, surgical revisions were performed. The average Harris hip score (HHS) following conversion was 62 (24-93), and only three hips were graded as very good whereas 23 were graded as poor. Microbiological culture, patient age, duration of Girdlestone arthroplasty and the number of preceding surgical procedures did not correlate with the functional outcome after conversion.Résumé Le résultat fonctionnel après conversion d'une arthroplastie de Girdlestone peut être difficile à prédire. Nous avons examiné 39 hanches chez 39 malades avec un minimum de suivi de 12 mois (gamme 12-208 mois) après réimplantation d'une prothèse totale de la hanche. Les malades ont été traités entre 1983 et 2000 dans une institution et leur âge moyen à la conversion était de 65 ans (32-85 ans). La principale indication pour l'arthroplastie de Girdlestone était une infection périprothètique. Une complication postopératoire s'est produite dans 26 cas et 17 révisions chirurgicales ont du être faites. Le score moyen de Harris (HHS) après la conversion était de 62 (24-93) et seulement trois hanches ont été notées comme très bonnes alors que 23 ont été notées comme mauvaises. La culture microbiologique, l'âge du patient, la durée d'arthroplastie de Girdlestone, et le nombre des interventions chirurgicales précédentes n'avait pas de corrélation avec le résultat fonctionnel après conversion.