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Objective: To investigate the efficacy and safety of drilling and injection of concentrated bone barrow in the treatment of Osteonecrosis of the Femoral Head (ONFH). Patients and Methods: 12 patients (20 hips) with ONFH were recruited in this study. All these patients were treated with drilling and injection of concentrated bone marrow. The concentrated autologous bone marrow was harvested from posterior iliac crest and then injected into the femoral head after drilling. ARCO (Associated Research Circulation Osseous) stage was used to classify the stage of ONFH. Harris hip score was used to evaluate the clinical symptoms of osteonecrosis. Modified Kerboul angle was used to assess radiological development of osteonecrosis. ARCO stage, Harris Hip Score and Modified Kerboul angle were assessed at the onset of treatment and at 6, 12, 24 months after the initial treatment. Results: A follow-up on the patient was done at the end of two years (mean 1.8 years ranging from 1.5 to 2 years). Despite short term follow up, clinical and radiological improvement on X-rays and MRI was detected, eleven out of twelve patients reported improvement from symptoms. There was a significant postoperative increase in the HHS (92.3 ± 3.1 points) compared to preoperative HHS (68.5 ± 9.7 points). There was a significant postoperative decrease in modified Kerboul angle (140 ±41.3) compared to preoperative (219 ±27). All patients stated that they are satisfied about the results and that they had better quality of life post-operatively. No complications were found in any patients. Conclusions: Drilling and Injection of Concentrated Bone Marrow can relieve symptoms, improve hip function and delay the progression of ONFH. The clinical outcome is better when it is applied prior to collapse of the femoral head. This work demonstrates that this method is a safe, effective and minimally invasive treatment strategy for early-stage ONFH.

Background: Total hip arthroplasty (THA) has proven to be one of the most successful operations done in orthopedic surgery. Preoperative planning including meticulous history, examination and preoperative templating is quite important and must be done to all cases as a routine. Numerous studies used surrogates for clinical success rates that included satisfaction of the patient, reduced pain, improvement of function, and the absence of the need for further surgery. Minimizing leg length discrepancy and restoring offset to normal is very important for good functional outcome, patient satisfaction and quality of life. Aim of the Study: Radiological and functional assessment of restoring the leg length and hip offset after total hip replacement. Also, to compare different methods used to decrease leg length discrepancy with the method used in this study. Patients and Methods: Prospective study of 50 patients (31 males and 19 females) with arthritic hips for various reasons undergoing either cemented or uncemented total hip arthroplasty. The mean age was 47 years old. Preoperative history and examination for all patients was done, pre-and post-operative evaluation of offset and limb length was done for all patients, pre-and post-operative evaluation of hip function using Harris Hip Score was done in addition to evaluation of abductor muscles power. Variable intraoperative methods were used to minimize the limb length discrepancy after the operation. Results: There was a statistical significance between hip offset pre-and post-operative and between limb length discrepancy pre- and post-operative. Harris Hip Score was improved post-operative. Conclusion: Limb length restoration is very important for improvement of Harris Hip Score. The intraoperative clinical method is much effective to minimize limb length discrepancy as other methods, although it is much easier to apply.

Background: Total hip arthroplasty (THA) has proven to be one of the most successful operations done in orthopedic surgery. Preoperative planning including meticulous history, examination and preoperative templating is quite important and must be done to all cases as a routine. Numerous studies used surrogates for clinical success rates that included satisfaction of the patient, reduced pain, improvement of function, and the absence of the need for further surgery. Minimizing leg length discrepancy and restoring offset to normal is very important for good functional outcome, patient satisfaction and quality of life. Aim of the Study: Radiological and functional assessment of restoring the leg length and hip offset after total hip replacement. Also, to compare different methods used to decrease leg length discrepancy with the method used in this study. Patients and Methods: Prospective study of 50 patients (31 males and 19 females) with arthritic hips for various reasons undergoing either cemented or uncemented total hip arthroplasty. The mean age was 47 years old. Preoperative history and examination for all patients was done, pre-and post-operative evaluation of offset and limb length was done for all patients, pre-and post-operative evaluation of hip function using Harris Hip Score was done in addition to evaluation of abductor muscles power. Variable intraoperative methods were used to minimize the limb length discrepancy after the operation. Results: There was a statistical significance between hip offset pre-and post-operative and between limb length discrepancy pre- and post-operative. Harris Hip Score was improved post-operative. Conclusion: Limb length restoration is very important for improvement of Harris Hip Score. The intraoperative clinical method is much effective to minimize limb length discrepancy as other methods, although it is much easier to apply.

Background: Antibiotic loaded cement spacers are the gold standard in managing infected hemi or total hip arthroplasty in many centers. In our study, we applied the principles of antibiotic loaded spacers in a different indication with a relatively new, economic and reproducible method. Patients & Methods: Between June 2012 and September 2013 we used the new idea in managing 13 cases of infection (5 cases) and open fractures (8 cases) in the lower limb. After thorough debridement of the infected bone or neat tissue cleaning in open fracture we were always left with a gap. The idea is to put the cement in a 50 ml syringe in the doughy state where a Steinmann pin is in the core. We tailored the length of the spacer according to the left gap guided by the graded syringe; 3-4 grams of vancomycin were put in an already loaded gentamycin cement pack. Results: We succeeded in having a clean field in 11 cases where we proceeded to a final reconstruction, 2 cases (infection) needed further debridement and re-application of the spacer for more 6 weeks but at the end the laboratory tests were negative and reconstruction took over. Conclusion: The new economic application of the antibiotic loaded cement spacer could be a solution for developing areas to cut short the budget other than the expensive ready-made spacers or beads.

Background: Antibiotic loaded cement spacers are the gold standard in managing infected hemi or total hip arthroplasty in many centers. In our study, we applied the principles of antibiotic loaded spacers in a different indication with a relatively new, economic and reproducible method. Patients & Methods: Between June 2012 and September 2013 we used the new idea in managing 13 cases of infection (5 cases) and open fractures (8 cases) in the lower limb. After thorough debridement of the infected bone or neat tissue cleaning in open fracture we were always left with a gap. The idea is to put the cement in a 50 ml syringe in the doughy state where a Steinmann pin is in the core. We tailored the length of the spacer according to the left gap guided by the graded syringe; 3-4 grams of vancomycin were put in an already loaded gentamycin cement pack. Results: We succeeded in having a clean field in 11 cases where we proceeded to a final reconstruction, 2 cases (infection) needed further debridement and re-application of the spacer for more 6 weeks but at the end the laboratory tests were negative and reconstruction took over. Conclusion: The new economic application of the antibiotic loaded cement spacer could be a solution for developing areas to cut short the budget other than the expensive ready-made spacers or beads.

Background: Antibiotic loaded cement spacers are the gold standard in managing infected hemi or total hip arthroplasty in many centers. In our study, we applied the principles of antibiotic loaded spacers in a different indication with a relatively new, economic and reproducible method. Patients & Methods: Between June 2012 and September 2013 we used the new idea in managing 13 cases of infection (5 cases) and open fractures (8 cases) in the lower limb. After thorough debridement of the infected bone or neat tissue cleaning in open fracture we were always left with a gap. The idea is to put the cement in a 50 ml syringe in the doughy state where a Steinmann pin is in the core. We tailored the length of the spacer according to the left gap guided by the graded syringe; 3-4 grams of vancomycin were put in an already loaded gentamycin cement pack. Results: We succeeded in having a clean field in 11 cases where we proceeded to a final reconstruction, 2 cases (infection) needed further debridement and re-application of the spacer for more 6 weeks but at the end the laboratory tests were negative and reconstruction took over. Conclusion: The new economic application of the antibiotic loaded cement spacer could be a solution for developing areas to cut short the budget other than the expensive ready-made spacers or beads.

Background: Antibiotic loaded cement spacers are the gold standard in managing infected hemi or total hip arthroplasty in many centers. In our study, we applied the principles of antibiotic loaded spacers in a different indication with a relatively new, economic and reproducible method. Patients & Methods: Between June 2012 and September 2013 we used the new idea in managing 13 cases of infection (5 cases) and open fractures (8 cases) in the lower limb. After thorough debridement of the infected bone or neat tissue cleaning in open fracture we were always left with a gap. The idea is to put the cement in a 50 ml syringe in the doughy state where a Steinmann pin is in the core. We tailored the length of the spacer according to the left gap guided by the graded syringe; 3-4 grams of vancomycin were put in an already loaded gentamycin cement pack. Results: We succeeded in having a clean field in 11 cases where we proceeded to a final reconstruction, 2 cases (infection) needed further debridement and re-application of the spacer for more 6 weeks but at the end the laboratory tests were negative and reconstruction took over. Conclusion: The new economic application of the antibiotic loaded cement spacer could be a solution for developing areas to cut short the budget other than the expensive ready-made spacers or beads.