bluuebunny/crossref_metadata_2025 huggingface dataset:
Optogenetic investigation of the variable neurovascular coupling along the interhemispheric circuits
Authors: Iordanova Bistra , Vazquez Alberto , Kozai Takashi DY , Fukuda Mitsuhiro , Kim Seong-Gi
Published: January 2018

The interhemispheric circuit connecting the left and the right mammalian brain plays a key role in integration of signals from the left and the right side of the body. The information transfer is carried out by modulation of simultaneous excitation and inhibition. Hemodynamic studies of this circuit are inconsistent since little is known about neurovascular coupling of mixed excitatory and inhibitory signals. We investigated the variability in hemodynamic responses driven by the interhemispheric circuit during optogenetic and somatosensory activation. We observed differences in the neurovascular response based on the stimulation site – cell bodies versus distal projections. In half of the experiments, optogenetic stimulation of the cell bodies evoked a predominant post-synaptic inhibition in the other hemisphere, accompanied by metabolic oxygen consumption without coupled functional hyperemia. When the same transcallosal stimulation resulted in predominant post-synaptic excitation, the hemodynamic response was biphasic, consisting of metabolic dip followed by functional hyperemia. Optogenetic suppression of the postsynaptic excitation abolished the coupled functional hyperemia. In contrast, light stimulation at distal projections evoked consistently a metabolic response. Our findings suggest that functional hyperemia requires signals originating from the cell body and the hemodynamic response variability appears to reflect the balance between the post-synaptic excitation and inhibition.
Systematic Review and Meta-analysis of Outcomes After Hip Arthroscopy in Femoroacetabular Impingement
Authors: Minkara Anas A. , Westermann Robert W. , Rosneck James , Lynch T. Sean
Published: January 2018

Background:

Femoroacetabular impingement (FAI) has become a more commonly recognized cause of limited hip range of motion and hip pain among young adults and athletes. Hip arthroscopy is recommended for the surgical treatment of this disorder, unless specific contraindications exist. Despite the increasing rate of published studies in this area, there remains no aggregate data for outcomes after this approach.

Purpose:

To evaluate risk factors and outcomes after arthroscopic management of FAI, including return to play, revision rate, surgical and nonsurgical complications, change in α-angle, intraoperative bone resection, and patient-reported outcomes.

Study Design:

Meta-analysis and systematic review.

Methods:

A review of the current literature was performed with the terms “femoroacetabular impingement,” “hip arthroscopy,” and numerous variations thereof in PubMed, EMBASE, BioMed Central, Cochrane, Science Direct, and Scopus, yielding 1723 abstracts. After screening by eligibility criteria, 31 articles were included. The incidence of bilateral FAI was determined by enrollment data, and pooled estimates were calculated for postoperative patient-reported outcome measures, α-angles, return to sport, postoperative complications, and reoperation risk.

Results:

A total of 1981 hips among 1911 patients were identified, with a mean ± SD age of 29.9 ± 1.9 years and 29.5 ± 14.0 months of follow-up. The incidence of bilateral FAI in these studies that required operative intervention was 3.6%. The pooled risk of reoperation after hip arthroscopy, including revision surgery or subsequent total hip arthroplasty, was 5.5% (95% CI, 3.6%-7.5%). The risk of clinical complications was 1.7% (95% CI, 0.9%-2.5%). In total, 87.7% of patients demonstrated return to sport after surgery (95% CI, 82.4%-92.9%, P < .001), and all patient-reported outcomes improved postoperatively, with the highest increase observed in the Hip Outcome Score sports scale (41.7 points; 95% CI, 34.1-49.4; P < .001). The α-angle decreased by an average of 23.6° (95% CI, 18.2°-29.0°; P < .001). We identified 11 factors associated with the success of hip arthroscopy in FAI and 16 factors associated with failure or negative outcomes.

Conclusion:

A high percentage of patients return to sport activities after hip arthroscopy for FAI, with a low rate of complications and reoperation. All patient-reported outcome measures, except for mental health, significantly improved after surgery.
The Role of the Vascular and Structural Response to Activity in the Development of Achilles Tendinopathy: A Prospective Study
Authors: Wezenbeek Evi , Willems Tine , Mahieu Nele , De Muynck Martine , Vanden Bossche Luc , Steyaert Adelheid , De Clercq Dirk , Witvrouw Erik
Published: January 2018

Background:

Several risk factors have been suggested in the development of Achilles tendinopathy, but large-scale prospective studies are limited.

Purpose:

To investigate the role of the vascular response to activity of the Achilles tendon, tendon thickness, ultrasound tissue characterization (UTC) of tendon structure, and foot posture as possible risk factors in the development of Achilles tendinopathy.

Study Design:

Cohort study; Level of evidence, 2.

Methods:

The study began with 351 first-year students at Ghent University. After 51 students were excluded, 300 were tested in the academic years 2013-2014 and 2014-2015 and were followed prospectively for 2 consecutive years by use of a multilevel registration method. Of those, 250 students were included in the statistical analysis. At baseline, foot posture index and UTC were investigated bilaterally. Blood flow and tendon thickness were measured before and after a running activity. Cox regression analyses were performed to identify significant contributors to the development of Achilles tendinopathy.

Results:

During the 2-year follow-up, 27 of the included 250 participants developed Achilles tendinopathy (11%). Significant predictive effects were found for female sex and blood flow response after running ( P = .022 and P = .019, respectively). The risk of developing Achilles tendinopathy increased if the blood flow increase after running was reduced, regardless of sex, foot pronation, and timing of flow measurements. The model had a predictive accuracy of 81.5% regarding the development of Achilles tendinopathy, with a specificity of 85.0% and a sensitivity of 50.0%.

Conclusion:

This prospective study identified both female sex and the diminished blood flow response after running as significant risk factors for the development of Achilles tendinopathy. UTC of tendon structure, Achilles tendon thickness, and foot posture did not significantly contribute to the prediction of Achilles tendinopathy. A general evaluation of tendon structure by UTC, measurement of tendon thickness, or determination of the foot posture index will not allow clinicians to identify patients at risk for developing Achilles tendinopathy. Furthermore, it may be possible to improve blood flow after activity by using noninvasive techniques (such as prostaglandins, compression stockings, heat, massage, and vibration techniques). These techniques may be useful in the prevention and management of Achilles tendinopathy, but further research is needed.
Improvement of monocyte function and immune homeostasis by high volume continuous venovenous hemofiltration in patients with severe acute pancreatitis
Authors: Yu C. , Liu Z.-H. , Chen Z.-H. , Gong D.-H. , Ji D.-X. , Li L.S.H.
Published: January 2018

Background

Continuous renal replacement therapy (CRRT) showed promising results in the management of critically ill patients with systemic inflammatory response syndrome (SIRS)/sepsis. However, the underlying mechanism is still not very clear. A change of immune homeostasis in critically ill patients during CRRT was observed only to a smaller degree.

Objective

The purpose of this study was to test the hypothesis that high-volume continuous venovenous hemofiltration (HV-CVVH) treatment could improve monocyte function and restore immune homeostasis in patients with severe acute pancreatitis (SAP).

Methods

This was a prospective clinical trial in the surgical intensive care unit of a teaching hospital. Subjects were 16 patients with severe acute pancreatitis: sepsis group (n=7): positive culture result and in the late phase of disease (from onset of SAP to receiving CVVH therapy: more than 3 days); and nonseptic group (n=9): negative culture result and early phase of disease (less than 3 days). Patients received 72 hours of HV-CVVH. We measured the change in mean arterial pressure, APACHE II score, monocyte functions (including antigen-presenting and cytokine production ability), and plasma cytokines. Results: Mean arterial pressure were stable accompanied with APACHE II score improvements. HLA-DR expression on monocytes (antigen-presenting ability) were markedly decreased (p<0.0001) in all patients. Lipopolysaccharide (LPS)-induced TNF-α, interleukin-6 (IL-6), and IL-10 production from patients' monocytes markedly decreased in septic patients, but significantly increased in nonseptic patients. During HV-CVVH treatment, HLA-DR expression was markedly increased in nonseptic patients in 24 hours (p<0.05), and in septic patients in 72 hours (p<0.05). LPS-induced cytokine production was decreased in nonseptic patients, but not significantly changed in septic patients. The change of plasma cytokines showed the same trend.

Conclusions

In patients with SAP, HV-CVVH was associated with improved hemodynamics. HV-CVVH restores monocytes functions, especially in patients in the early phase of the disease and without sepsis. These findings suggest a potential role for HV-CVVH in the treatment of SAP.
Living with asthma in 19th-century France: The doctor, Armand Trousseau, and the patient, Emile Pereire
Authors: Davies Helen M
Published: January 2018

Major advances in the French medical system following the French Revolution have stimulated a rich historiography of which Michel Foucault’s Naissance de la clinique: une archéologie du regard médical (1963) and Erwin H. Ackerknecht’s Medicine at the Paris Hospital, 1794–1848 (1967) are of lasting significance. Changes in the organisation and structure of hospitals accompanied the development and availability of new medical technologies and procedures and encouraged a more intense study of the aetiology and pathology of disease. Theories about asthma and its treatment profited from this dynamic environment as Classical Greek doctrines about the effect of the humours on bodily imbalance gave way to an increasingly more precise understanding of the nature and cause of asthma. The clinician and teacher, Armand Trousseau (1801–1867), who held the chair of Clinical Medicine at the Hôtel-Dieu in Paris and was himself an asthmatic, promoted new theories about the illness and developed innovative ways of dealing with its effects. Among his patients was the banker and financier, Emile Pereire (1800–1875), a lifelong asthmatic. Based on the Pereire Family Archives (hereafter AFP), the case of Emile Pereire provides a preface to the later case of that other, more famous, asthmatic, Marcel Proust.
Head First, Not Feet First
Authors: Poling Mikaela I. , Dufresne Craig R.
Published: January 2018

The historical and clinical basis for classification of Freeman-Sheldon syndrome as a craniofacial syndrome and explanation of the rationale underlying this decision is provided. Correctly classifying the condition will avoid confusion and may help to clarify the vernacular employed and eventually aid in improving diagnosis.
Conventional or Endoscopic Probing for Congenital Nasolacrimal Duct Obstruction
Authors: Orhan M. , Çal P. , Önerci M. , Írkeç M.
Published: January 2018

Purpose

To compare conventional and endoscopic probing for congenital nasolacrimal duct obstruction in infants.

Methods

Conventional probing was performed in 22 eyes of 18 patients, age range 7–14 months (mean 11.4 months). Probing was done with intranasal endoscopic visualization in 18 eyes of 14 patients, age range 7–13 months (mean 11.2 months). All were primary probing cases.

Results

After conventional probing 2 of the 22 cases required reprobing. After endoscopic probing only 1 of the 18 cases required reprobing.

Conclusions

In most cases of congenital nasolacrimal duct obstruction endoscopy is not required; however, in failed cases direct visualization of the inferior meatus with endoscopic guidance may be helpful.
Measuring the Lacunar Sulci as a New Indicator of Shrinkage of the Ocular Surface
Authors: Murube J. , Chenzhuo L. , Murube E. , Rivas L. , Shalaby O.
Published: January 2018

Purpose

To present a new indicator that measures the sulci of the lacrimal lake of the eye according to the degrees of ocular abduction at which they vanish. This new approach will help determine the severity and progression of mucosal retraction in ocular surface diseases.

Methods

A total of 181 eyes of 94 healthy persons, 130 eyes of 65 patients with Sjögren's syndrome, and 30 eyes of 15 patients with ocular pemphigoid were examined using the slit lamp. We recorded the vanishing point of the three main lacunar sulci (plico-bulbar, plico-caruncular and dermo-caruncular) while abducting.

Results

In healthy persons, the average vanishing points for the first and second lacunar sulci were respectively, 53.2° ± 12.3 and 54.5° ± 9.8. In patients with Sjögren's syndrome, 49.53° ± 10.81 and 53.17° ± 7.28 and in patients with incipient ocular cicatricial pemphigoid, 42.69° ± 14.33 and 44.46° ± 16.85. Statistical significance was p < 0.005.

Conclusions

The lacunar sulci are shallower and vanish sooner in ocular cicatricial pemphigoid and Sjögren syndrome than in normals. Investigating the vanishing point of the lacunar sulci while abducting is useful for grading the shrinkage of the conjunctiva, caruncle and medial canthus.
Changes in Visual Acuity and Refraction in the Exfoliation Syndrome. A Five-Year Follow-up Study
Authors: Puska P.M. , Tarkkanen A.H.A.
Published: January 2018

Purpose

To examine changes in visual acuity (VA) and refraction in non-glaucomatous patients with unilateral exfoliation syndrome (EXS).

Methods

The best corrected values for VA (Snellen acuity cards) subjectively adjusted for refraction, and IOP were measured, and the development of lens opacities was examined in 46 non-glaucomatous patients with unilateral EXS.

Results

After five years the rate of conversion to bilateral exfoliation was 22% and to exfoliative glaucoma 30%. There was a significant decrease in VA in the exfoliative (E) eyes (median; QI, QIII, range: 1; 0.8, 1, 0.4-1.3 vs. 0.55; 0.4, 1, 0.05-1.4, p<0.0001) and the fellow, initially non-exfoliative (NE), eyes (1; 0.9, 1, 0.3–1.3 vs. 0.7; 0.5, 0.9, 0.1–1.4, p<0.0001) and a significant myopic change in refraction in the E eyes (+1.02 ± 2.48 vs. +0.11 ± 3.06, p=0.0001) and the NE eyes (+0.99 ± 2.25 vs. +0.43 ± 2.55 D, p<0.01). At study entry the difference in refraction between the fellow eyes (refraction in the NE eye – refraction in the E eye) was −0.27 ± 1.00D. After five years it was +0.32 ± 1.44 (p 0.016), reflecting greater myopic changes in the E eyes. The main type of lens opacification was nuclear sclerosis.

Conclusions

In five years, significant decreases in VA and myopic shifts in refraction occurred in the E and fellow eyes. The E eyes showed significantly greater myopic changes than the fellow eyes; the cause was clearly nuclear sclerosis, which must be taken into account in the long-term management of patients with EXS.
Preliminary Experience of the Cannulok Revision Hip Prosthesis in Late Periprosthetic Fracture Management
Authors: Charnley G. , Anderson G.
Published: January 2018

We report our preliminary experience of a cannulated, distally locked revision femoral component to manage peri-prosthetic fractures in the elderly. The majority of cases in our series were further complicated by osteolysis secondary to aseptic loosening, the original hip arthroplasties having been in situ for several years. Sixteen patients with an average age of 77 underwent treatment of periprosthetic fractures with the Cannulok Hip. The device combines techniques of revision hip surgery with locked intramedullary nailing. We describe our initial evaluation of this modular prosthesis which has enabled us to satisfactorily treat periprosthetic fractures with early mobilisation and discharge from hospital. In all of our surviving patients the fractures have united within four to six months. All cases were in addition treated with proximal femoral impaction allografting leading to improved local bone stock. We believe this implant may provide a satisfactory alternative for the management of periprosthetic fracture in the presence of a loose femoral component.
Demographic and Occupational Effects on the Activity Levels of Normal Subjects in the United Kingdom
Authors: Smith S.L. , McNie C.M. , Duddy S.M. , Goldsmith A.A.J. , Bennett D. , Orr J.F. , Dowson D.
Published: January 2018

A study of activity levels, measured in steps per day, was made of 293 subjects from several parts of the United Kingdom. Each subject wore a pedometer adjacent to the hip for two weeks. The average number of steps taken each day over a two-week period was recorded together with additional details such as age and occupation. A general decline in activity with age was observed, which varied slightly for men and women. At twenty years of age the sample of men typically walked about 9,000 steps per day and women 9,200 steps per day, declining to 6,100 and 5,750 steps per day for men and women respectively at sixty years of age. Activity was observed to vary considerably from day to day and was more pronounced for men. The mean number of steps per day for a wide range of occupational groups varied from around 4,500 steps per day for retired persons to 12,700 steps per day for postmen. The activity data was re-analysed to remove the influence of age and gender. The activity of most occupational groups then fell within a relatively narrow range of approximately 7,700 to 8,850 steps per day. The exceptions to this were postmen, nurses and technicians, with averages of 12,750, 9,950 and 9,900 steps per day respectively, and software programmers averaging only 5,250 steps per day. Activity levels for groups of subjects from different parts of the United Kingdom were compared, including Leeds and Bradford, Belfast, Teesside, County Durham and Edinburgh. When the number of subjects in each group was sufficiently large with a wide spread of ages and occupational types, it was found that demography had little effect upon the level of activity. This study provides a substantial new database, based on the UK population. In addition, the assumption that one million cycles in vitro is equivalent to one year in vivo is well supported and relevant to simulator studies.
The Effect of Hydroxyapatite on Bone Ingrowth into Porous-Coated Titanium Implants
Authors: Moroni A. , Faldini C. , Pegreffi F. , Giannini S.
Published: January 2018

Two different groups of hydroxyapatite (HA) coated and uncoated porous titanium implants, 250–350 μm and 500–700 μm diameter beads, were press-fit in femoral canine cancellous bone. After 12 weeks, the dogs were euthanized and histomorphometric backscattered electron microscopy studies were carried out. Comparing HA-coated versus uncoated implants in the 250–350 μm bead diameter group percentage of bone (P=0.01) and bone index (P=0.01), were higher in the HA-coated implants. Comparing HA-coated versus uncoated implants in the 500–700 μm bead diameter group bone ingrowth (P=0.01) and bone depth penetration (P=0.008), were higher in HA-coated samples. It can be concluded that the HA coating was an effective method to improve bone formation and ingrowth in the porous implants.
Two Different Cementless Femoral Components in Primary Total Hip Arthroplasty
Authors: García-Rey E. , Coello-Nogués A. , Caicoya-Abati E.
Published: January 2018

The results of first (51 Harris-Galante stems with an average follow-up of 12.3 years) and second generation (53 MultiLock stems with an average of 6.4 years) cementless femoral stems in total hip replacement were analysed. Ten Harris-Galante stems were revised (9.8% at 8 years and 22.8% at 13 years) and one unstable MultiLock stem (2.6% at 8 years). Thirty-seven Harris-Galante and 45 MultiLock stems were osseo-integrated. Femoral osteolysis was seen in 21 Harris-Galante (26.6% at 8 years and 43.7% at 13 years) and in 3 MultiLock stems (8.0% at 8 years). At intermediate follow-up, second generation stems show less bone remodelling changes than first generation stems at the same interval. Distal osteolysis and pronounced stress-shielding have not been encountered in second generation stems.
Nice Hips: Shame about the Conclusions
Authors: Toms A.D. , Jiggins M. , Prosser G. , Isbister E.S.
Published: January 2018

In April 2000 the National Institute for Clinical Excellence (NICE) issued their first appraisal in the field of surgery, “Guidance on the selection of prostheses for primary total hip replacement”. NICE has already been heavily criticised for its recommendations in the field of medicine, due to its perceived role in rationing healthcare. This paper examines the conclusions of the appraisal committee (which included only two orthopaedic surgeons), the evidence on which they drew their conclusions and the evidence that was overlooked. We conclude that it is not clear how they determined the important ten-year benchmark and that they over-emphasise the benefits of cheaper cemented prostheses, failing to fully consider the evidence for the more expensive uncemented and hybrid combinations.
Total Hip Arthroplasty for Late Hip Dislocation in Paraplegia
Authors: Mussa S. , Kakar S. , Bentley G.
Published: January 2018

Late hip dislocation is uncommon, particularly in the context of paraplegia. We report a case in which total hip arthroplasty with a semi-constrained acetabular component was a successful treatment for this condition. A review of the literature revealed that this method of treatment had not been previously described in paraplegics. For patients with late hip dislocation in spastic paraplegia, total hip arthroplasty with a semi-constrained acetabular component, combined with adequate adductor release and obturator neurectomy is recommended.
Early Resection of Heterotopic Ossification after Total Hip Arthroplasty: A Review of the Literature
Authors: De Smet K. , Pattyn C. , Verdonk R.
Published: January 2018

Early excision of heterotopic ossification was performed in 8 patients at an average of 10.2 months after total hip arthroplasty. All patients received a single irradiation dose of 7Gy the day before the operation, followed by oral indomethacin (3x25mg/day) for six weeks. Continuous passive mobilization under epidural anesthesia was started immediately post-operatively. At an average follow-up of 2 years none of them had radiographic or clinical evidence of recurrence. Consequently we recommend resection as soon as there are severe clinical implications, even when bone scans indicate immaturity of the heterotopic ossification and provided that the resection is combined with proper non-surgical treatment consisting of irradiation and oral indomethacin and immediate extensive rehabilitation program.
An Unusual Neurological Complication following Internal Fixation of Pertrochanteric Fracture Neck of the Femur
Authors: Dharmarajan R. , Vadivelu R. , Lawrence T.
Published: January 2018

Fracture of the femoral neck is a common injury in the elderly population and may be associated with significant morbidity. More than 25,000 patients per year in the UK receive treatment for femoral neck fractures. Neurological injury associated with pertrochanteric fracture of the neck of the femur is rare. Sciatic nerve injury following isolated pertrochanteric femoral neck fractures is very rare and has not previously been reported in the literature. We describe a case of foot drop secondary to sciatic nerve injury following fracture of neck of the femur, with recovery after surgical exploration and nerve release.
Is the Birmingham Hip Resurfacing Worthwhile?
Authors: Pollard T.C.B. , Basu C. , Ainsworth R. , Lai W. , Bannister G.C.
Published: January 2018

The highest failure rates of cemented hip replacement are in males under 50 years of age, usually from acetabular loosening and polyethylene wear. The metal-on-metal Birmingham Resurfacing offers potential advantages to this group because of its wear properties. It also has a low dislocation rate and consequently less restricted activity.

The aim of this study was to compare early outcome in young patients, treated for osteoarthritis, either by the Birmingham Resurfacing or hybrid cemented stem with an uncemented cup and press-fit polyethylene liner. 54 patients in each arm were matched for age, sex, body mass index, and pre-operative activity. Outcome was measured by the Oxford Hip Score, with supplementary questions about sporting activity and manual work. 37% of hybrid hip replacements undertook sport or heavy manual work despite specific instruction to the contrary.

The Birmingham Resurfacings scored significantly better than the hybrid hip replacements (Mean 3.4 points, 1.3–5.5, 95% Confidence Interval, p<0.05.). Age and duration of symptoms pre-operatively were associated with outcome in the resurfacing group. In the early stages there appears to be justification for using the Birmingham Resurfacing in active young patients. Only long-term follow-up will indicate whether metallosis and neck fracture are lesser complications than polyethylene wear and whether activity can be maintained.
Effects of Dall-Miles Cables on the Cement Mantle in Total Hip Arthroplasty: A Cadaveric Study
Authors: Kingston R. , Noël J. , Murphy B. , Lee T. C , Walsh M.G.
Published: January 2018

Dall-Miles cables are widely used for trochanteric re-attachment in hip arthroplasty, but their effects on the cement mantle have not been reported. We have carried out an ex vivo study to investigate the influence of cables on the mantle. Charnley femoral components were implanted in eight proximal human femora using Palacos cement. Wires (control group, n=4) or 2mm stainless steel Dall-Miles cables (n=4) were passed through holes drilled in the proximal femur before the cement was introduced. The wires or cables were tightened using the appropriate instruments after the cement had hardened. The specimens were sectioned using a diamond saw, and examined by scanning electron microscopy and light microscopy before and after staining with penetrant dye. Deformation of the strands at the tension edge of each cable, with debonding from the cement in two specimens, was observed. There was no damage to cement at the compression edge. Tensioning of Dall-Miles cables passing through Palacos cement does not appear to damage the mantle.
Entrapment of a Torn Flange of a Charnley Ogee Cup
Authors: Haidar S.G. , Dinley R.J.
Published: January 2018

An unusual case of difficult reduction of three successive dislocations of a total hip arthroplasty caused by entrapment of a torn posterior half of a Charnley Ogee cup. The torn half was excised.
Comparative Histological and Morphometric Autopsy Study of Femora and Acetabula with Stable Cemented Hip Prostheses
Authors: Bos I.
Published: January 2018

To gain insight into the tissue reactions leading to non-infectious prosthesis loosening autopsy specimens of 9 stable cemented femoral and acetabular components 1 to 16 years in situ were analysed histomorphologically and morphometrically. In femora and acetabula, bone and cement were separated by an interface membrane composed of connective tissue and granulation tissue after short implant duration. After longer implant duration, infiltrates of macrophages containing wear particles of the bone cement and – though less abundant – polyethylene predominated. The interface membranes of the acetabula appeared three times as broad as in proximal parts of the femora. They showed no topographical variations. In the femora, however, the membranes were proximally considerably thicker than in distal parts. In both femora and acetabula, the adjacent spongiosa were infiltrated by macrophages as well. The cancellous bone showed remodelling with formation of a neocortical layer at the border between the spongiosa and the interface membrane. Focal metaplastic formation of cartilage was also present. The results indicate that in femora and acetabula, basically analogous mechanisms lead to non-infectious late loosening, which is connected with the accumulation of wear particles and macrophages in the interface membrane. A positive correlation of the width of the interface membrane with the implant duration was found only in the acetabulum. This could explain the comparatively frequent socket loosening.
The Wagner SL-Revision Stem for Aseptic Loosening: Clinical and Radiological Results 5 to 7 Years after Femoral Revision
Authors: Diks M.J.F. , Spruit M. , Reimering J.J. , Boer F. Den , Anderson P.G.
Published: January 2018

Aseptic loosening in total hip arthroplasty can lead to proximal femoral periprosthetic bone loss. The non-cemented Wagner revision stem achieves primary fixation in the diaphysis. The purpose of this study is to evaluate the results after medium- to long-term follow-up of the Wagner prosthesis for revision of the femoral component for aseptic loosening in total hip arthroplasty with proximal femoral bone loss. We performed 53 femoral revisions for aseptic loosening with the non-cemented Wagner revision stem. Clinical assessment included a modified Harris Hip Score and a radiological evaluation. The mean follow-up was 65 months. The Harris Hip Score improved significantly (42.9 to 72.3). Radiological evaluation revealed 24.5% subsidence (>5 mm) in our population. Nine re-revisions were done, eight in the first post-operative year. The re-revisions were performed for progressive subsidence (five), recurrent dislocations (one), subsidence with low-grade infection (one), false route (one), and aseptic loosening after 75 months (one). The cumulative survival rate of the Wagner stem after 12 months was 85% and 76% after 75 months. A relatively high re-revision rate was observed during the first post-operative year. Analysis of these failures has shown that subsidence may be the result of insufficient primary stability. Adequate pre-operative planning and intra-operative radiological assistance is necessary for perfect primary stability and fixation of the Wagner stem. The re-revision incidence after the first 12 months is 0.45 per 100 implants per year. The prosthesis has good survival potential after proper introduction.
Radiological Confirmation for Hip Injections. Is it Required?
Authors: Kent M. , Dharmadhikari R. , Braithwaite I.J. , Duffy P.
Published: January 2018

Steroid injection of the hip joint is a common procedure. Radiological confirmation of correct needle placement is believed to be necessary for a successful injection when commonly described approaches are used (1,2). We describe a less commonly used approach for hip injection, which makes it possible to give intra-articular injections without the need for radiological confirmation. We have used this method to inject 100 hips over the past four years with a 90% accuracy rate. This method is easy to learn, reliable, and could potentially be used in the outpatient setting, thus avoiding delays on the waiting lists.
Alternative Bearing Couples in Total Hip Replacements: Solutions for Young Patients
Authors: Fisher J. , Ingham E. , Stone M.H.
Published: January 2018

There is now considerable clinical concern about the effect of polyethylene wear debris induced osteolysis in long term failure of hip replacements. This paper compares the wear of stabilised and crosslinked polyethylene to alternative hard on hard bearings. The volumetric wear rates of stabilised and moderately crosslinked polyethylene 50 to 35 mm3/million cycles were less than previously reported for historical gamma irradiated in air polyethylene, but still of a level that in the long term could cause osteolysis. The moderately crosslinked polyethylene produced less wear than non-crosslinked polyethylene, but particles were smaller and more reactive resulting in little change in the osteolytic potential. Alumina ceramic on ceramic produced substantially less wear and osteolytic potential. Metal on metal also produced less wear than polyethylene but the particles adversely influence cell viability.
Giant Synovial Cysts of the Hip Joint: An Important but Rare Differential Diagnosis of an Inguinal Swelling
Authors: Bhargava A. , Singh S. , Shrivastava R.K.
Published: January 2018

Synovial cysts around the hip joint are commonly mistaken for other more common causes of an inguinal swelling. We present a report on two patients in whom abnormal pulsatile masses in the groin caused diagnostic difficulty. Patients were initially admitted under vascular surgeons with a clinical diagnosis of aneurysm. Ultrasound examination was useful in excluding aneurysm. Detailed clinical examination revealed painful restricted hip movements and a radiograph showed evidence of arthritis in the hip joint. CT scan confirmed it to be a synovial cyst. Computed arthrotomogram or arthrography showed communication of the cyst with the hip joint. Synovial cysts and iliopsoas bursa enlargement may be more common than previously reported and should be considered as a differential diagnosis in patients with unusual inguinal swelling.
Resurfacing Hip Replacement - An Audit of Activity in the United Kingdom 2002–2003
Authors: White S. P. , Beard D.J. , Smith E. J.
Published: January 2018

The level of use of resurfacing hip replacement (RHR) and specific training undertaken was previously unknown in the United Kingdom.

Consultant orthopaedic surgeons were audited by postal questionnaire regarding their RHR activity, training undertaken and evidence of specialisation in hip arthroplasty.

Results

19% of surgeons had performed RHR in the previous 12 months. 33% of revision hip surgeons had performed RHR. The majority of consultants performed 6–10 cases per year. 73% performed less than 20 cases per year. For training, 30% had observed RHR surgery and 23% had attended a formal course. 7.8% of those performing RHR had neither been on a course nor observed surgery. Both British Hip Society membership and the completion of a hip fellowship were associated with the frequency of RHR. Those who had completed previous hip fellowship or were BHS members performed significantly more RHR.

Conclusions

RHR is currently performed by specialists. The level of use is increasing rapidly and the standard of implantation needs to be safeguarded in order to ensure that the current successful short term results are maintained in the long term. Given the steep learning curve, the lack of long-term outcome and concerns regarding metal-on-metal bearings, we believe that the implant should continue to be used in accordance with NICE guidelines and that implantation should be performed by surgeons with a specialist interest in hip arthroplasty and specific training.
Short-Term Results of Hemi-Resurfacing for Osteonecrosis of the Femoral Head
Authors: Calder P.R. , Hynes M.C. , Scott G.
Published: January 2018

Published evidence has supported the use of femoral head resurfacing for patients with osteonecrosis of the femoral head.

Between June 1999 and April 2001 we prospectively studied 15 femoral heads resurfaced in 12 patients with the Conserve Resurfacing Hemiarthroplasty. The male to female ratio was 8:4 and the mean age 38.7 years (range 26–60). The mean follow-up was 22.8 months (range 4–36). The senior author performed all procedures. There was one case of Ficat stage II, 9 cases of stage III and 5 cases of early stage IV. The mean time from onset of symptoms to surgery was 33.5 months (range 9–60). There were no intra or post-operative complications associated with any of the hemiarthroplasty procedures.

Results

Nine of the fifteen patients had a poor result that warranted revision surgery within two years of prosthesis implantation. We conclude that in our hands the results of femoral resurfacing hemiarthroplasty are unpredictable and advise caution when recommending the procedure to patients with osteonecrosis of the femoral head.
A Minimally Invasive Single Incision Anterior Approach for Total Hip Arthroplasty: Early Results in 49 Cases
Authors: Memminger M. , Bombelli M.
Published: January 2018

A modified and limited Smith Petersen approach was used for prosthetic hip replacement. The exposure of the proximal femur required the use of a traction table. We operated on 49 patients: 15 of them underwent cemented bipolar hemiarthroplasty, and 34 had a total hip arthroplasty. Skin incision ranged from 6 to 11 cm (average 7.8 cm). Patients' subjective grading was evaluated according to a pain scale (0–10); early functional outcome was rated on postoperative days two, seven and 30 according to a functional scale of active flexion and abduction. Average active flexion on the second postoperative day was 68.4°, and active abduction 14.7°. Progressive increment of average active flexion and abduction was observed on day 7 (78.7° flexion - 22.3° abduction) and day 30 (88.4° flexion – 29.2° abduction). All patients were allowed progressive weight-bearing depending on their postoperative pain. Most of them were fully weight bearing from the first day. This surgical approach, characterized by preservation of the muscular insertions, is associated with reduced postoperative pain and fast functional recovery.
Unusual Cause of Deep Vein Thrombosis following Dynamic Hip Screw Fixation
Authors: Tai C.C. , Ramachandran M. , Young S.W , Nathan S.S.
Published: January 2018

We report a case of profunda femoris false aneurysm following internal fixation of an intertrochanteric neck of femur fracture, caused by proximal migration of a fracture fragment. The case is unique in that the mode of presentation was that of deep venous thrombosis, due to extrinsic compression of the venous system by the false aneurysm.
Large Diameter Metal-On-Metal Total Hip Arthroplasty for Crowe IV Developmental Dysplasia of the Hip
Authors: Parmaksizoglu Atilla Sancar , Ozkaya Ufuk , Bilgili Fuat , Basilgan Seckin , Kabukcuoglu Yavuz
Published: January 2018

The short-term results of middle-aged patients with severe developmental dysplasia of the hip treated with subtrochanteric femoral shortening and cementless large diameter metal-on-metal total hip arthroplasty were retrospectively evaluated. Clinical and radiological results of 15 hips of 13 patients with Crowe IV developmental dysplasia of the hip were enrolled in this study. The average follow-up period was 49 months (36–62 months). The average age of patients at the time of surgery was 45.5 years (range, 36–65 years). Radiographs were evaluated for component position, subsidence, loosening, and osteolysis. Intraoperatively, two patients had a small proximal femoral shaft split that was held with a cable wire. The average preoperative Harris hip score was 58; at 3 years, 82. Trendelenburg sign was negative in 11 hips at the last assessment. Loosening, subsidence, infection, dislocation, hypersensitivity and neurovascular complications were not observed. One hip had to be revised 1 year after surgery because of nonunion at the osteotomy site. Our study shows that large diameter metal-on-metal total hip arthroplasty, incorporating subtrochanteric femoral shortening, decreases dislocation rate and provides excellent results for the completely dislocated hip.
Hip Resurfacing through a Modified Anterolateral Approach, as Compared with the Ganz Trochanteric Flip Osteotomy: A Two Year follow-up Study
Authors: Khan Rashid M. , Cooper Gillian , Hull Jonathan B.
Published: January 2018

Hip resurfacing arthroplasty has conventionally been undertaken through the posterior approach. There has been evidence in the recently published literature to suggest that the posterior approach may compromise the blood supply to the femoral head, by disruption of the posterolateral hip capsule. Ganz et al have proposed the trochanteric ‘flip’ osteotomy through a lateral approach, to permit surgical dislocation of the hip without damaging the blood supply. The disadvantages, however, are that early full weight bearing is not permitted and there is an incidence of trochanteric delayed or non-union, which may require further treatment.

We describe a technique of hip resurfacing through a modified anterolateral approach preserving the posterolateral capsular blood supply. We describe our experience using this approach, and compare the results with our previously used Ganz trochanteric osteotomy. At a mean follow-up of two years, the outcome scores were not significantly different, and both groups had similar abductor strength. There were two cases of delayed union in the Ganz group, one of which required revision; there were no complications in the modified anterolateral group.
Surgical Repair of Chronic Tears of the Hip Abductor Mechanism
Authors: Davies Hywel , Zhaeentan Sohelia , Tavakkolizadeh Adel , Janes Gregory
Published: January 2018

Lateral sided hip pain frequently presents to the orthopaedic clinic. The most common cause of this pain is trochanteric bursitis. This usually improves with conservative treatment. In a few cases it doesn't settle and warrants further investigation and treatment. We present a series of 28 patients who underwent MRI scanning for such pain, 16 were found to have a tear of their abductors. All 16 underwent surgical repair using multiple soft tissue anchors inserted into the greater trochanter of the hip to reattach the abductors.

There were 15 females and 1 male. All patients completed a self-administered questionnaire pre-operatively and 1 year post-operatively. Data collected included: A visual analogue score for hip pain, Charnley modification of the Merle D'Aubigne and Postel hip score, Oxford hip score, Kuhfuss score of Trendelenburg and SF36 scores.

Of the 16 patients who underwent surgery 5 had a failure of surgical treatment. There were 4 re ruptures, 3 of which were revised and 1 deep infection which required debridement. In the remaining 11 patients there were statistically significant improvements in hip symptoms. The mean change in visual analogue score was 5 out of 10 (p=0.0024) The mean change of oxford hip score was 20.5 (p=0.00085). The mean improvement in SF-36 PCS was 8.5 (P=0.0020) and MCS 13.7 (P=0.134). 6 patients who had a Trendelenburg gait pre-surgery had normal gait 1 year following surgery.

We conclude that hip abductor mechanism tear is a frequent cause of recalcitrant trochanteric pain that should be further investigated with MRI scanning. Surgical repair is a successful operation for reduction of pain and improvement of function. However there is a relatively high failure rate.
Is there an Association between Epiphyseal Scar and Osteonecrosis of the Femoral Head?
Authors: Huang Guo-Shu , Lee Herng-Sheng , Yao Min-Szu , Chan Wing P.
Published: January 2018

Purpose

To investigate statistical association between epiphyseal scar and osteonecrosis of the femoral head (ONFH) with magnetic resonance (MR) imaging. Patients and Methods: We retrospectively reviewed 71 consecutive patients who underwent MR imaging of bilateral hips that showed nontraumatic ONFH. There were 110 hips with ONFH and 31 normal hips; one hip received bipolar arthroplasty before the MR studies. All cases of ONFH had typical MR findings. The epiphyseal scars in the femoral head were classified as type I (a sealed-off scar) or type II (a perforated scar). Bone marrow edema, if present, in the proximal femur was identified on coronal T2-weighted or STIR MR images.

Results

The type of femoral epiphyseal scar was clearly delineated in 97 hips. In cases with ONFH, a type I scar occurred in 46 hips (64%), and a type II scar in 26 hips (36%). In cases of ONFH with bone marrow edema, 69% of hips (24/35) had a type I scar and 31% of hips (11/35) had a type II scar. There was no statistical association between the type of epiphyseal scar and ONFH, regardless of staging (P=0.29), or the type of scar and bone marrow edema (P=0.42).

Conclusion

There is not a significant statistical association between a sealed-off scar and ONFH.
Dislocation of a Total Hip Arthroplasty following Hip Arthroscopy
Authors: Jones Carl W. , Biant Leela C. , Field Richard E.
Published: January 2018

Arthroscopy is used increasingly in the diagnosis and treatment of hip disorders of both natural and prosthetic hip joints. Complications tend to be transient and self-resolving. This is the first report of a hip arthroscopy destabilizing a prosthetic hip resulting in dislocation of the joint.
Developmental Dysplasia of the Hip: Ultrasound Screening and Treatment. How are They Related?
Authors: Paton R.W.
Published: January 2018

An assessment of the current clinical and ultrasound screening programmes. Early treatment by splintage is advocated for instability and Graf type III dysplasia of the hip.
Proximal Focal Femoral Deficiency (PFFD): Management Options and Controversies
Authors: Westberry D.E. , Davids J.R.
Published: January 2018

Proximal focal femoral deficiency (PFFD) is a rare congenital anomaly characterised by failure of normal development of the proximal femur and hip joint. Significant variability in the clinical presentation and degree of deficiency is common. Current management strategies aimed at improving functional ambulation are largely dependent on the degree of femoral shortening and the status of the hip and knee joint.

Treatment of acetabular deficiency and proximal femoral deformity in cases of PFFD must be individualised. Reconstruction of the hip joint with pelvic and femoral osteotomies may be possible in mild cases of PFFD. Stability of the hip and knee joint must be achieved prior to consideration for limb lengthening strategies. Severe cases of PFFD may be beyond surgical correction and warrant alternative strategies such as rotationplasty or selective amputation to facilitate prosthetic fitting.
Tumours and Tumour-Like Lesions of the Hip in the Paediatric Age: A Review of the Rizzoli Experience
Authors: Ruggieri P. , Angelini A. , Montalti M. , Pala E. , Calabró T. , Ussia G. , Abati C.N. , Mercuri M.
Published: January 2018

Bone tumours and tumour-like lesions of the hip in children are rare. Signs and symptoms of these tumours are generally nonspecific. Delay of diagnosis is not uncommon. A high index of suspicion in young patients presenting with persistent pain and without history of trauma, that is unresolved with conservative therapy should prompt further investigation, including radiographs or computed tomography scan of the pelvis. In the experience of the Istituto Rizzoli, in patients less than 14 years (mean 9 years, ranged from 6 months to 14 years), 752 tumours and tumours-like lesions occurred in the pelvis or proximal femur, involving the hip. Tumour-like lesions accounted for 322 cases (simple bone cyst in 255, eosinophilic granuloma in 43, aneurismal bone cyst in 34), benign tumours for 340 cases (osteoid osteoma in 229, fibrous dysplasia in 63, exostosis in 48) and malignant tumours for 80 cases (Ewing's sarcoma in 53 and osteosarcoma in 27). The epidemiology, pathology, clinical presentation, and radiograph findings are discussed for each of these tumours.

Treatment of these tumours differs from observation or minimally invasive treatment for most pseudo-tumoural lesions, intralesional excision or termoablation for benign bone tumours and wide resection for malignant bone tumours. In this latter group, chemotherapy is required and often administered pre- and postoperatively.
Periprosthetic Femoral Fractures in Total Hip Arthroplasty – a Review
Authors: Rayan Faizal , Haddad Fares
Published: January 2018

Periprosthetic femoral fractures (PFF) are among the more difficult and expensive complications of total hip arthroplasty. A rise in the elderly population and increase use of primary hip replacement has led to an escalating incidence. They can occur intra operatively and post operatively. The treatment algorithm defined by the Vancouver classification has universal acceptance. The epidemiology, etiology, classification and the management of periprosthetic femoral fractures in total hip arthroplasty are reviewed.