BackgroundNontraumatic osteonecrosis of the femoral head (ONFH) is treated with a series of methods. High-energy extracorporeal shock wave therapy (ESWT) is an option with promising mid-term outcomes. The objective of this study was to determine the long-term outcomes of ESWT for ONFH.MethodsFifty-three hips in 39 consecutive patients were treated with ESWT in our hospital between January 2005 and July 2006. Forty-four hips in 31 patients with stage I–III nontraumatic ONFH, according to the Association Research Circulation Osseous (ARCO) system, were reviewed in the current retrospective study. The visual analog pain scale (VAS), Harris hip score, radiography, and magnetic resonance imaging were used to estimate treatment results. The progression of ONFH was evaluated by imaging examination and clinical outcomes. The results were classified as clinical success (no progression of hip symptoms) and imaging success (no progression of stage or substage on radiography and MRI).ResultsThe mean follow-up duration was 130.6 months (range, 121 to 138 months). The mean VAS decreased from 3.8 before ESWT to 2.2 points at the 10-year follow-up (p < 0.001). The mean Harris hip score improved from 77.4 before ESWT to 86.9 points at the 10-year follow-up. The clinical success rates were 87.5% in ARCO stage I patients, 71.4% in ARCO stage II patients, and 75.0% in ARCO stage III patients. Imaging success was observed in all stage I hips, 64.3% of stage II hips, and 12.5% of stage III hips. Seventeen hips showed progression of the ARCO stage/substage on imaging examination. Eight hips showed femoral head collapse at the 10-year follow-up. Four hips in ARCO stage III and one hip in ARCO stage II were treated with total hip arthroplasty during the follow-up. Three were performed 1 year after ESWT, one at 2 years, and one at 5 years.ConclusionsThe results of the current study indicated that ESWT is an effective treatment method for nontraumatic ONFH, resulting in pain relief and function restoration, especially for patients with ARCO stage I–II ONFH.
Chondroblastoma of the patella is rare. Aneurysmal bone cysts, which develop from a prior lesion such as a chondroblastoma, are seldom seen in the patella. The authors report a case of a 36-year-old man who presented with 2 years of right knee pain without calor, erythema, pain on palpation, or abnormal range of motion. Radiological studies suggested aneurysmal bone cyst. The lesion was excised with curettage and the residual cavity filled with autogenous bone graft. Histopathology revealed chondroblastoma associated with a secondary aneurysmal bone cyst. In the follow-up period, the patient demonstrated normal joint activities with no pain. Normal configuration of the patella and bone union were shown on plain radiographs. The authors present a review of the literature of all cases of patellar chondroblastoma with aneurysmal bone cyst. This case is the 14th report of aneurysmal bone cyst arising in a chondroblastoma of the patella. According to the literature, computed tomography and magnetic resonance imaging are useful in the study of these lesions. The pathologic diagnosis is based on the presence of chondroblastoma and aneurysmal bone cyst. Treatment of this lesion includes patellectomy, curettage alone, and curettage with bone grafting. Despite the risk of recurrence of this lesion in the patella, the authors first recommend curettage followed by filling the cavity with bone graft. To protect the anterior tension of the patella intraoperatively, the bone window should be made at the medial edge of the patella to perform the curettage and bone grafting.
Background: The occurrence of oscillating saw malfunction, power shortage, or contamination occurs frequently when implementing femoral neck osteotomy during total hip arthroplasty (THA). This study aimed to introduce the fretsaw as a novel substitute osteotomy tool with various advantages.Methods: Twenty patients (20 hips) who underwent primary THA were included. Ten patients underwent femoral neck osteotomy using a fretsaw, while the other 10 patients underwent the procedure using an oscillating saw. Intraoperative evaluation and radiographic data were obtained for all patients during and after surgery.Results: The mean osteotomy time was 20.60 ± 1.08s (range 16–27) and 22.10 ± 1.49s (range 16–31) in the oscillating saw and fretsaw groups, respectively. The mean osteotomy height was 1.21 ± 0.16 (range 1.01–1.43) cm and 1.14 ± 0.08 (range 1.02–1.28) cm in the oscillating saw and fretsaw groups, respectively. The use of fretsaw did not result in bone notch or blood splashes.Conclusion: The fretsaw can be a substitute femoral neck osteotomy tool with various advantages in THA while oscillating saw malfunction.
Background: Mechanical failure, power shortage, and unexpected contamination of oscillating saw occasionally happened in actualizing femoral neck osteotomy during total hip arthroplasty, while no appropriate alternative solution be available presently. This study aimed to introduce a novel osteotomy instrumentation (fretsaw, jig, cable passer hook) as a substitute tool while oscillating saw was unavailable in THA.Methods: This study included 40 patients (40 hips) who underwent femoral neck osteotomy during primary THA using the new osteotomy instrumentation (n=20) and oscillating saw (n=20). Clinical data and intraoperative findings of all patients were evaluated.Results: The mean osteotomy time was 22.3 ± 3.1 s (range, 17–30 s) and 29.4 ± 3.7 s (range, 25–39 s) in the oscillating saw group and the new osteotomy instrumentation group, respectively (P<0.001). The Harris Hip Score (HHS) improved in both groups; the mean HSS was 82.3 ± 2.5 and 83.3 ± 3.5 in the oscillating saw group and new osteotomy instrumentation group at 6 months after surgery, respectively (P=0.297).Conclusion: The original osteotomy instrumentation can be an ideal substitute tool for femoral neck osteotomy in THA, especially when the oscillating saw is unavailable or malfunctional.
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