Periacetabular osteotomy for containment of the nonarthritic dysplastic hip secondary to poliomyelitis

Poliomyelitis results in a flaccid paralysis of muscles that can lead to hip instability. The objective of this study was to determine the results of the Bernese periacetabular osteotomy in patients with paralytic hips secondary to poliomyelitis.

Head Reduction Osteotomy With Additional Containment Surgery Improves Sphericity and Containment and Reduces Pain in Legg-Calvé-Perthes Disease.

BACKGROUND Severe femoral head deformities in the frontal plane such as hips with Legg-Calvé-Perthes disease (LCPD) are not contained by the acetabulum and result in hinged abduction and impingement. These rare deformities cannot be addressed by resection, which would endanger head vascularity. Femoral head reduction osteotomy allows for reshaping of the femoral head with the goal of improving head sphericity, containment, and hip function. QUESTIONS/PURPOSES Among hips with severe asphericity of the femoral head, does femoral head reduction osteotomy result in (1) improved head sphericity and containment; (2) pain relief and improved hip function; and (3) subsequent reoperations or complications? METHODS Over a 10-year period, we performed femoral head reduction osteotomies in 11 patients (11 hips) with severe head asphericities resulting from LCPD (10 hips) or disturbance of epiphyseal perfusion after conservative treatment of developmental dysplasia (one hip). Five of 11 hips had concomitant acetabular containment surgery including two triple osteotomies, two periacetabular osteotomies (PAOs), and one Colonna procedure. Patients were reviewed at a mean of 5 years (range, 1-10 years), and none was lost to followup. Mean patient age at the time of head reduction osteotomy was 13 years (range, 7-23 years). We obtained the sphericity index (defined as the ratio of the minor to the major axis of the ellipse drawn to best fit the femoral head articular surface on conventional anteroposterior pelvic radiographs) to assess head sphericity. Containment was assessed evaluating the proportion of patients with an intact Shenton's line, the extrusion index, and the lateral center-edge (LCE) angle. Merle d'Aubigné-Postel score and range of motion (flexion, internal/external rotation in 90° of flexion) were assessed to measure pain and function. Complications and reoperations were identified by chart review. RESULTS At latest followup, femoral head sphericity (72%; range, 64%-81% preoperatively versus 85%; range, 73%-96% postoperatively; p = 0.004), extrusion index (47%; range, 25%-60% versus 20%; range, 3%-58%; p = 0.006), and LCE angle (1°; range, -10° to 16° versus 26°; range, 4°-40°; p = 0.0064) were improved compared with preoperatively. With the limited number of hips available, the proportion of an intact Shenton's line (64% versus 100%; p = 0.087) and the overall Merle d'Aubigné-Postel score (14.5; range, 12-16 versus 15.7; range, 12-18; p = 0.072) remained unchanged at latest followup. The Merle d'Aubigné-Postel pain subscore improved (3.5; range, 1-5 versus 5.0; range, 3-6; p = 0.026). Range of motion was not observed to have improved with the numbers available (p ranging from 0.513 to 0.778). In addition to hardware removal in two hips, subsequent surgery was performed in five of 11 hips to improve containment after a mean interval of 2.3 years (range, 0.2-7.5 years). Of those, two hips had triple osteotomy, one hip a combined triple and valgus intertrochanteric osteotomy, one hip an intertrochanteric varus osteotomy, and one hip a PAO with a separate valgus intertrochanteric osteotomy. No avascular necrosis of the femoral head occurred. CONCLUSIONS Femoral head reduction osteotomy can improve femoral head sphericity. Improved head containment in these hips with an often dysplastic acetabulum requires additional acetabular containment surgery, ideally performed concomitantly. This can result in reduced pain and avascular necrosis seems to be rare. With the number of patients available, function did not improve. Therefore, future studies should use more precise instruments to evaluate clinical outcome and include longer followup to confirm joint preservation. LEVEL OF EVIDENCE Level IV, therapeutic study.

Development of a PWR-W and an AP1000® containment building 3D model with a CFD code for Best-Estimate Thermal-Hydraulic Analysis

The simulation of design basis accidents in a containment building is usually conducted with a lumped parameter model. The codes normally used by Westinghouse Electric Company (WEC) for that license analysis are WGOTHIC or COCO, which are suitable to provide an adequate estimation of the overall peak temperature and pressure of the containment. However, for the detailed study of the thermal-hydraulic behavior in every room and compartment of the containment building, it could be more convenient to model the containment with a more detailed 3D representation of the geometry of the whole building. The main objective of this project is to obtain a standard PWR Westinghouse as well as an AP1000® containment model for a CFD code to analyze the thermal-hydraulic detailed behavior during a design basis accident. In this paper the development and testing of both containment models is presented.

Lead-containing paint removal, containment, and disposal /

"February 1995."

Technical report No. 6 : containment of fragments from a runaway reactor /

"SRI Project No. GU-2164."

Containment of fragments from a runaway reactor : final report /

"Contract No. AT(04-3)-115 ; Project Agreement No. 2."

Reactor containment /

"Reactor Technology."

Round-robin pretest analyses of a 1:6-scale reinforced concrete containment model subject to static internal pressurization /

"SAND87-0891, R1 and RD."

Technical report no. 2 : containment of fragments from runaway reactor /

"UC-80, Reactors--General ; TID-4500 (14th Edition) and Supplement."

Summary progress report : containment of fragments from runaway reactor /

"Contract AT(04-3)-115."

Technical report no. 3 : containment of fragments from runaway reactor /

"UC-80, Reactors--General ; TID-4500 (15th Edition) and Supplement."

Summary progress report no. 2 : containment of fragments from a runaway reactor /

"SRI Project No. GU-2164."

Technical report no. 4 : containment of fragments from a runaway reactor /

"SRI Project No. GU-2164."