Background: The treatment of acute patellar dislocation in children is controversial. Some investigators have advocated early repair of the medial structures, whereas others have treated this injury nonoperatively. The present report describes the long-term subjective and functional results of a randomized controlled trial of nonoperative and operative treatment of primary acute patellar dislocation in children less than sixteen years of age. Methods: The data were gathered prospectively on a cohort of seventy-four acute patellar dislocations in seventy-one patients (fifty-one girls and twenty boys) younger than sixteen years of age. Sixty-two patients (sixty-four knees) without large (>15 mm) intra-articular fragments were randomized to nonoperative treatment (twenty-eight knees) or operative treatment (thirty-six knees). Operative treatment consisted of direct repair of the damaged medial structures if the patella was dislocatable with the patient under anesthesia (twenty-nine knees) or lateral release alone if the patella was not dislocatable with the patient under anesthesia (seven knees). All but four patients who underwent operative treatment had a concomitant lateral release. The rehabilitation protocol was the same for both groups. The patients were seen at two years, and a telephone interview was conducted at a mean of six years and again at a mean of fourteen years. Fifty-eight patients (sixty-four knees; 94%) were reviewed at the time of the most recent follow-up. Results: At the time of the most recent follow-up, the subjective result was either good or excellent for 75% (twenty-one) of twenty-eight nonoperatively treated knees and 66% (twenty-one) of thirty-two operatively treated knees. The rates of recurrent dislocation in the two treatment groups were 71% (twenty of twenty-eight) and 67% (twenty-four of thirty-six), respectively. The first redislocation occurred within two years after the primary injury in twenty-three (52%) of the forty-four knees with recurrent dislocation. Instability of the contralateral patella was noted in thirty (48%) of the sixty-two patients. The only significant predictor for recurrence was a positive family history of patellar instability. The mode of treatment and the existence of osteochondral fractures had no clinical or significant influence on the subjective outcome, recurrent patellofemoral instability, function, or activity scores. Conclusions: The long-term subjective and functional results after acute patellar dislocation are satisfactory in most patients. Initial operative repair of the medial structures combined with lateral release did not improve the long-term outcome, despite the very high rate of recurrent instability. A positive family history is a risk factor for recurrence and for contralateral patellofemoral instability. Routine repair of the torn medial stabilizing soft tissues is not advocated for the treatment of acute patellar dislocation in children and adolescents. Level of Evidence: Therapeutic Level II. See Instructions to Authors for a complete description of levels of evidence.

The survival of total hip arthroplasties (THAs) has been considered to be poor in young patients. We evaluated the population-based survival of uncemented THA for primary osteoarthritis (OA) in patients under 55 years of age and the factors affecting survival. The Finnish Arthroplasty Register was established in 1980. Between that year and 2003, 92,083 primary THAs were entered in the register, 5,607 of which were performed for primary OA in patients under 55 years of age. Using records from these 5,607 THAs, we selected uncemented femoral and acetabular components that had been used in more than 100 operations during the study period. Survival of both components (cup/stem) and their combinations were analyzed separately with the Kaplan-Meier analysis and the Cox regression model. All uncemented stems studied showed a survival rate of over 90% at 10 years. The Biomet Bi-Metric stem had a 95% (95% CI 93- 97) survival rate even at 15 years. Overall survival of the extendedly porous-coated Lord Madréporique stem (p = 0.003) and the proximally porous-coated Anatomic Mesh stem (p = 0.0008) were poorer than that of the Biomet Bi-Metric stem. When endpoint was defined as stem revision for any reason, results were generally similar; there was no difference, however, between the survival rates of the Lord Madréporique stem and the Bi-Metric stem. Of the acetabular components, the Biomet Universal, the ABG Il and the Harris-Galante II cups showed < 90% survival rates at 10 years with aseptic loosening as endpoint; at 13 years the corresponding survival rates were 94% (95% CI 91-97) for the Biomet Universal and 95% (95% CI 91-98) for the Harris-Galante II cups with aseptic loosening as endpoint. The PCA Pegged porous-coated uncemented cup showed a poor 13-year survival rate of 68% (95% CI 59-78) with aseptic loosening as endpoint. However, when endpoint was defined as any revision (including exchange of liner), the 10-year survival rates of all brands of cup except Harris-Galante II declined to under 80%. Modern second-generation uncemented stems, with proximal circumferential porous- or HA-coating, seem to be a good choice for young patients with primary OA. Similarly, modern press-fit porous- and HA-coated cups appear to have good endurance against aseptic loosening in these young patients. However, liner revisions were common; thus, survival rates of uncemented cups were unsatisfactorily low. Polyethylene wear and unfavorable locking mechanisms between the metal shell and the polyethylene liner and their sequelae remain matters of concern in this young and active group of patients.

Although athletes' beliefs and values are known to influence whether or not an athlete will use banned drugs, little is known about the athletes' beliefs and attitudes in different sports. The aim of this study was to clarify the beliefs and attitudes of elite athletes towards banned substances and methods in sports. A total of 446 athletes (response rate 90.3 %; 446/494) financially supported by the National Finnish Olympic Committee completed a structured questionnaire during their national team camps in 2002. More than 90 % of the athletes reported to believe that banned substances and methods have performance enhancing effects, and 30 % reported that they personally know an athlete who uses banned substances. Of the male athletes 35 %, and 23 % of females reported they personally know an athlete using banned substances. A total of 15 % of the athletes reported that they had been offered banned substances: 21 % of the speed and power athletes, 14 % of the team sport athletes and of the athletes in motor skills demanding events, and 10 % of the endurance athletes. Stimulants were the most often offered substance group (to 7 % of all the athletes) followed by anabolic steroids (4 %). Subjects who regarded doping as a minor health risk seemed to be more often associated with doping users than those regarding doping as a significant health risk. Athletes in different sports have a different approach to doping. Risk of doping appears to be highest in speed and power sports and lowest in motor skills demanding sports. Males are at higher risk than females. Controlling doping only by tests is not sufficient. A profound change in the attitudes is needed, which should be monitored repeatedly.

Background Many studies have found a higher risk of revision after hip arthroplasty in younger patients. We evaluated the population-based survival of total hip arthroplasty (THA) in patients under 55 years of age and the factors affecting survival. Methods The Finnish Arthroplasty Register was established in 1980, and 74 492 primary THAs were entered into the register between 1980 and 2001. 4 661 of these were evaluated, all of which had been performed for primary osteoarthrosis on patients under 55 years of age. Results Proximally circumferentially porous-coated uncemented stems implanted between 1991 and 2001 had a 10-year survival rate of 99 (95% CI 98.5–99.6)% with aseptic loosening as endpoint. The risk of stem revision due to aseptic loosening was higher in cemented stems than in proximally porous-coated (RR 5.5, p<0.001) or HA-coated (RR 6.6, p=0.01) uncemented stems implanted during the same period. According to Cox regression analysis of cups implanted 1991–2001, the risk of revision for all-polyethylene cemented cups was 3.0 times as high as that for press-fit porous-coated uncemented cups with aseptic loosening as endpoint (p=0.01). However, when the endpoint was defined as any revision (including exchange of liner), there was no longer any difference between these two concepts, the 10-year survival rates being 94 (92.1–95.5)% for press-fit porous-coated uncemented cups and 93 (88.5–97.6)% for all-polyethylene cemented cups (p=0.9). Interpretation Modern uncemented stems seem to have better resistance to aseptic loosening than cemented stems in younger patients. Thus, for younger patients, uncemented proximally circumferentially porous- and HA-coated stems are the implants of choice. Press-fit porous- and HA-coated uncemented cups may have better endurance against aseptic loosening than cemented cups in younger patients. However, when all revisions (including exchange of liner) are taken into account, the survival of modern uncemented cups is no better than that of all-poly cemented cups.

Background: Traditional growing rods have a reported wound and implant complication rate as high as 58%. It is unclear whether the use of magnetically controlled growing rods (MCGR) will affect this rate. This study was performed to characterize surgical complications following MCGR in early onset scoliosis. Methods: A multicenter retrospective review of MCGR cases was performed. Inclusion criteria were: (1) diagnosis of early onset scoliosis of any etiology; (2) 10 years and younger at time of index surgery; (3) preoperative major curve size >30 degrees; (4) preoperative thoracic spine height <22 cm. Complications were categorized as wound related and instrumentation related. Complications were also classified as early (6 mo). Distraction technique and interval of distraction was surgeon preference without standardization across sites. Results: Fifty-four MCGR patients met inclusion criteria. There were 30 primary and 24 conversion procedures. Mean age at initial surgery was 7.3 years (range, 2.4 to 11 y), and mean duration of follow-up 19.4 months. Twenty-one (38.8%) of 54 patients had at least 1 complication. Fifteen (27.8%) had at least 1 revision surgery. Six (11.1%) had broken rods (2 to 4.5 and 4 to 5.5 mm rods); two 5.5 mm rods failed early (4 mo) and 4 late (mean=14.5 mo). Six (11.1%) patients experienced 1 episode of lack or loss of lengthening, of which 4 patients subsequently lengthened. Seven patients (13.0%) had either proximal or distal fixation-related complication at average of 8.4 months. Two patients (3.7%) had infections requiring incision and drainage; 1 early (2 wk) with wound drainage and 1 late (8 mo). The late case required removal of one of the dual rods. Conclusions: This study shows that compared with traditional growing rods, MCGR has a lower infection rate (3.7% vs. 11.1%). MCGR does not appear to prevent common implant-related complications such as rod or foundation failure. The long-term implication remains to be determined. Level of Evidence: Level IV.