Faculty Bibliography

Data are limited regarding large ceramic femoral heads with highly cross-linked polyethylene. We hypothesized that large ceramic head articulation with highly cross-linked polyethylene is safe with a low wear rate, comparable to metal-on-highly cross-linked polyethylene.The study group comprised 63 patients (72 hips) who had undergone total hip replacement (THR) with ceramic-on-highly cross-linked polyethylene between April 2006 and March 2007 with a minimum 2-year follow-up. Postoperative Western Ontario and Mc-Master Universities Arthritis Index (WOMAC) and Hospital for Special Surgery (HSS) scores were used for clinical assessment. Six-week and 2-year radiographs were analyzed by 2 independent observers using Roman 1.70 software. Twenty-six patients (29 hips) had 32-mm and 37 patients (43 hips) had 36-mm Biolox delta ceramic femoral heads (Ceramtec, Plochingen, Germany). Mean patient age was 60.9 +/- 8.9 years, and mean follow-up was 2.9 +/- 0.5 years. Mean postoperative WOMAC and HSS hip scores were 30.4 and 36.6, respectively. Mean wear at 1 and 2 years postoperatively was 0.06 +/- 0.28 and 0.006 +/- 0.12 mm/yr for all hips, respectively. Mean wear at 1 and 2 years postoperatively for the 32-mm femoral head was 0.063 +/- 0.278 and 0.007 +/- 0.126 mm/yr, respectively, and for the 36-mm femoral head was 0.057 +/- 0.292 and 0.006 +/- 0.118 mm/yr, respectively. No patient had any clinical complications, such as reoperation, infection, fractures, or radiographic evidence of osteolysis or loosening. The early results of THR with large ceramic heads demonstrate high safety and efficacy. Our data with 2-year follow-up show low wear rates, similar to published data for metal-on-highly cross-linked polyethylene.

BACKGROUND: The treatment of osteochondral lesion of the talus (OLT) is mainly based upon the stage of the disease so accurate imaging is crucial. SPECT/CT combines bone scan with high-resolution CT and can provide functional-anatomical images in a single stage. The purpose of this study was to assess the value of SPECT/CT in the management of OLT. MATERIALS AND METHODS: From 2004 to 2009, 22 patients with OLT were identified that had both SPECT/CT and MRI of the foot and ankle. All charts were reviewed to ascertain the reason for ordering the SPECT/CT and the additional information obtained. AOFAS outcome scores were calculated at the time of followup. RESULTS: Twelve patients underwent ankle arthroscopy for debridement or drilling of the osteochondral lesion. The mean AOFAS score in these 12 patients was 83.6. SPECT/CT helped preoperative planning by identifying the exact location of the active lesion, especially in multifocal disease or revision surgeries while showing the depth of the active lesion. Ten patients had conservative management due to minimal or no activity over the lesion on SPECT/CT images. The mean AOFAS score in these ten patients was 78.8 which was comparable to the operative group. CONCLUSION: We believe SPECT/CT was able to provide additional diagnostic value by demonstrating a co-existing pathology as a potential cause of pain and in preoperative planning by showing the depth of activity and the precise location of the active segment in multiple lesions.

Twenty-six patients with mean age of 38.5 (range 18-59), from 1998 to 2005, with ulnar impaction syndrome who failed nonoperative treatments were included in our study. Patients' age, history of previous wrist fracture, presence of MRI signs and ulnar variance were recorded as variables. Also, patients' postoperative strength (compared to the contralateral wrist) and pain relief were collected as outcome measurements. Twenty-two patients (84.6%) had either good or excellent pain relief (median 4, range 1-4). Significant correlation was found between MRI findings and postop pain relief (r = 0.53, p </= 0.01). History of previous distal radius fractures was negatively correlated with pain relief (r = -0.50, p </= 0.01). No correlation was found between postop strength and any of the variables. Presence of MRI signs of UIS is a predictor of good outcome in arthroscopic wafer resection