Faculty Bibliography

An unusual case of bilateral posterior fracture-dislocation of the hip (Pipkin Type IV) occurred in a 63-year-old man with Paget's disease of the pelvis. Other injuries included a displaced humeral shaft fracture and patellar ligament disruption. Bilateral cemented total hip arthroplasty was performed to avoid the need for prolonged immobilization. Postoperative low-dose irradiation was used because of the risk of heterotopic ossification

Dysprosium-165-ferric hydroxide macroaggregates (165Dy-FHMA) was used as an agent of radiation synovectomy in an antigen-induced arthritis model in New Zealand white rabbits. Animals were killed up to 6 months after treatment. 165Dy-FHMA was found to have a potent but temporary antiinflammatory effect on synovium for up to 3 months after treatment. Treated knees also showed significant preservation of articular cartilage architecture and proteoglycan content compared with untreated controls, but only during the first 3 months after treatment. In animals killed 3 and 6 months after treatment there were only minimal differences between the treated and untreated knees, indicating that the antiinflammatory effects on synovial tissue and articular cartilage preservation were not sustained

Infection following total knee arthroplasty can be one of the most challenging problems in orthopaedic surgery. This article discusses the pertinent clinical factors to be considered and the treatment options in the management of patients with infection following total knee replacement

Because of failure to fully respond to an initial intraarticular injection of dysprosium 165-ferric hydroxide macroaggregates, 17 patients with seropositive rheumatoid arthritis underwent repeat radiation synovectomy using this agent. Of the 13 patients who were evaluated 1 year later, 54% (7 knees) had good results, 31% (4 knees) had fair results, and 15% (2 knees) had poor results. The initial lack of significant benefit from radiation synovectomy did not appear to preclude a favorable response to a second injection

Benign solitary schwannomas of the foot are a rare occurrence; only four cases have been previously reported. A schwannoma associated with the medial plantar nerve present for more than 40 years before the onset of symptoms was diagnosed in a 73-year-old man. Excision of the mass, with preservation of the involved nerve, was possible and successfully relieved symptoms

Part II of this two-part article reviews differential diagnosis of common geriatric knee disorders. Differentiating extra-articular from intra-articular causes of knee pain is stressed, since treatments and prognoses can be quite different. Referred pain from the ipsilateral hip and spine should also be kept in mind. The diagnostic approach to knee pain can be categorized anatomically and according to etiology: Is the pain coming from the bone (patella, femur, tibia, fibula), or the soft tissue (ligament, tendon, capsule, synovium, meniscus, muscle)? Is it degenerative, inflammatory, metabolic, traumatic, infectious, or neoplastic? These issues are included in the discussion

We describe a patient who had septic arthritis caused by Clostridium perfringens. Clostridial organisms are very uncommon causes of septic arthritis. Only 13 cases have been reported previously. The diagnosis should be suspected in patients with a history of penetrating joint trauma and in immunocompromised patients. Successful treatment has usually consisted of surgical synovectomy in combination with high-dose intravenous penicillin therapy. Multiple aspirations of affected joints as a definitive treatment should be used with caution and only in patients who are not candidates for surgery

It is important to remember that knee disorders seen in the elderly are distinctly different from those seen in the younger individual. In the elderly, the problems are generally the result of chronic processes and, occasionally, an acute process on top of a chronic disorder. A careful history and physical examination should enable the physician in most cases to make the correct diagnosis. However, at times, specific laboratory studies may be ordered to confirm the diagnosis. In part I of this two-part review of geriatric knee disorders, the authors will focus on the anatomy, history, and physical examination of the knee joint. Common knee disorders specific to the elderly will be discussed in part II

Hip pain in the elderly can result in severe disability with compromise of independence. The causes of hip pain include many intrinsic and extrinsic disorders. Evaluation of the geriatric patient with pain in the vicinity of the hip requires a complete history and physical, radiographic evaluation and appropriate laboratory studies in order for proper management to be instituted