bluuebunny/crossref_metadata_2025 huggingface dataset:
Macular Congenital Hypertrophy of the Retinal Pigment Epithelium: A Case Report
Authors: Zucchiatti Llaria , Parodi Mauhzio Battaglia , Pala Michela , Bandello Francesco Maria
Published: January 2018

Purpose.

To describe autofluorescence, microperimetry, and electrophysiology findings in a case of macular congenital hypertrophy of the retinal pigment epithelium (CHRPE).

Methods.

A 58-year-old man was referred to the Department of Ophthalmology of the University of Udine for the evaluation of a pigmented macular lesion in the right eye. The patient underwent blue-light autofluorescence (BL-AF), near-infrared autofluorescence (NIR-AF), electrooculogram, full-field electroretinogram and multifocal electroretinogram (mfERG), microperimetry computerized visual field, and optical coherence tomography (OCT).

Results.

BL-AF performed using Heidelberg Retinal Angiograph II revealed a homogeneous hypoautofluorescence, surrounded by a hyperautofluorescent halo. NIR-AF showed a heterogeneous response combining an increased signal in the center of the lesion bordered by a decreased and darker signal. Electrooculogram and full-field electroretinogram were normal in both eyes. mfERG revealed only a limited area of reduced function in the right eye, which matched to location of CHRPE. The segments most functionally altered on mfERG corresponded to the area showing an increased signal in the NIR-AF, possibly reflecting the presence of increased pigment density within a more viable retinal pigment epithelium-Bruch membrane complex.

Conclusions.

In essence, macular CHRPE is associated with slight defect in retinal sensitivity and outer retinal dysfunction secondary to the anatomic changes characteristic of the lesion.
Electrolysis Treatment of Trichiasis by Using Ultra-Fine Needle
Authors: Sakarya Yasar , Sakarya Rabia , Yildihm AyDin
Published: January 2018

Purpose.

To determine the safety and efficacy of electrolysis treatment of trichiasis by using ultrafine needle.

Methods.

The medical records of 24 lids of 24 patients who underwent electrolysis treatment for trichiasis by the same surgeon (Y.S.) during the period from May 2006 through December 2008 were reviewed. The average age of the 24 patients was 59.2 years (range, 43 to 76 years). Thirteen of the patients were women.

Results.

The results were considered satisfactory if no recurrence of trichiasis occurred for at least 6 months after the last electrolysis procedure. Sixteen of the 24 patients (66.6%) had a satisfactory result with 1 treatment. Of the 8 patients (33.3%) who had an unsatisfactory result, while 5 (20.8%) responded well to 1 additional electrolysis, 3 (12.5%) responded well to 2 additional electrolyses to the recurrent cilia. The procedure was well tolerated by the patients. All eyelids healed within 2 weeks after treatment without any scarring. Faint hypopigmentation was visible in 2 patients (8.3%). Mild notching of eyelid occurred in 4 patients (16.6%).

Conclusions.

Electrolysis treatment by using ultrafine (55-μm thickness) needle is an effective and safe method for treatment of trichiasis with many advantages over other recognized modalities of therapy.
Cataract Surgery in the United Kingdom: A Postal Survey
Authors: Olali Carpi A. , Priya Anita , Gupta Mohit , Ahmed Sohail
Published: January 2018

Purpose.

A postal questionnaire study to evaluate the current practice of cataract surgery delivery in the United Kingdom including strategies for postoperative review was performed.

Methods.

A cataract questionnaire was sent to all hospital departments delivering ophthalmic services in the United Kingdom based on a list from the Royal College of Ophthalmologists. It included questions about the staffing level, number of cases operated on per list, and the different strategies employed postoperatively. The results were statistically analyzed.

Results.

A total of 248 questionnaires were sent and 106 (43%) replies were received. The mean number of consultant teams was 11 (2–20). The average number of cases per list was 6–7 (range 4–9). In 65 hospitals, all patients are reviewed postoperatively in the hospital and some consultant teams review patients postoperatively in 18 hospitals. In 15 hospitals, patients were seen by the community optician. Most hospitals review their patients postoperatively within the first 3 weeks with more hospitals seeing them at 2–3 weeks. A wide variety of health professionals review the postoperative cases and they include doctors, nurses, and opticians (in house and community).

Conclusions.

There are varied practices for cataract surgery in the United Kingdom including the number of cases on the list and postoperative review protocols. There is room for better service organization in some hospitals in terms of patient flow and better use of medical staff time to improve output.
PRPH2 (Peripherin/RDS) Mutations Associated with Different Macular Dystrophies in a Spanish Population: A New Mutation
Authors: Coco Rosa M. , Tellena Juan J. , Sanabria M. Rosa , Rodríguez-Rúa Enrique , García M. Teresa
Published: January 2018

Purpose.

To assess the occurrence of PRPH2 mutations in patients presenting macular dystrophies and to describe their phenotype-genotype correlation.

Methods.

A total of 32 sporadic cases and 13 individuals from 5 families were studied. The patients presented early onset drusen, suspected pattern dystrophy (including adult-onset foveomacular vitelliform dystrophy [AOFVD]), or any presumed macular dystrophy producing neovascularization or atrophic changes documented before patients reached 50 years of age. In case of atrophy, this could be confined to the macula, which was considered to be central areolar choroidal dystrophy (CACD), or extend to the midperiphery of the retina, which we called diffuse macular dystrophy (DMD). Clinical workup and analysis of PRPH2, EFEMP1, and TIMP3 genes were done.

Results.

Four mutations of the PRPH2 gene were found in 3 sporadic cases and 3 families (n=11). A p.R46X mutation, previously described in CACD, was found in 3 members of a family with AOFVD and in a sporadic case with DMD. A p.L45F mutation, described before in retinitis pigmentosa, was found in a sporadic case of AOFVD. A p.R195L mutation previously described in CACD was found in 2 members of a family with CACD. The latter was found in a family and a sporadic case (from the same village as the family) and all of them presented DMD. A new p.V209l mutation was found in a patient with AOFVD.

Conclusions.

New phenotypes were found for known mutations. No phenotype variation was observed in the members of the 3 families. A new mutation in PRPH2 gene was found.
Ranibizumab for Idiopathic Retinal Vasculitis, Aneurysms, and Neuroretinitis: Favorable Results
Authors: Karagiannis Dimithos , Soumplis Vasileios , Georgalas Ilias , Kandarakis Artemios
Published: January 2018

Purpose.

Idiopathic retinitis, vasculitis, aneurysms, and neuroretinitis (IRVAN) is a rare syndrome that can progress rapidly to severe visual loss mainly due to the development of proliferative retinopathy despite aggressive therapeutic retinal photocoagulation or pars plana vitrectomy. We report a case of IRVAN treated with ranibizumab as an adjunctive treatment of IRVAN.

Methods.

Interventional case report. A 50-year-old woman was diagnosed with IRVAN. Complete ocular and systemic examination and fundus fluorescein angiography were performed to evaluate the patient. Treatment with 2 monthly intravitreal injections of 0.5 mg ranibizumab was initiated for each eye followed by panretinal photocoagulation (PRP) in the right eye (RE) and pars plana vitrectomy, endolaser, and additional PRP in the left eye (LE).

Results.

Immediate regression of optic nerve neovascularization in the RE was noted after ranibizumab treatment. One year after initial presentation, best-corrected visual acuity was 20120 in the RE and 20/50 in the LE and results of fundus examination have shown complete regression of neovascularization bilaterally.

Conclusions.

We propose a modified treatment modality for stage 3 IRVAN with the adjunctive use of ranibizumab. Our patient has shown complete regression of posterior segment neovascularization accompanied with significant improvement of her visual acuity. Ranibizumab seems to have encouraging results as an adjunctive treatment of IRVAN.
Treatment of Allergic Conjunctivitis: Results of a 1-Month, Single-Masked Randomized Study
Authors: Figus Michele , Fogagnolo Paolo , Lazzeri Stefano , Capizzi Fedehca , Romagnoli Mahachiara , Canovetti Annalisa , Iester Michele , Ferreras Antonio , Rossetti Luca , Nardi Marco
Published: January 2018

Purpose

To compare the effects of topical antiallergic eyedrops in relieving the signs and symptoms of patients with allergic conjunctival pathology.

Methods

In this multicenter, single-masked, randomized study, 240 patients with signs and symptoms of allergic conjunctivitis were randomized to receive 1 of the following 8 treatments twice daily: cromolyn sodium/chlorpheniramine maleate, diclofenac, epinastine, fluorometholone, ketotifen, levocabastine, naphazoline/antazoline, and olopatadine. Clinical signs and symptoms were evaluated by a masked operator using a 10-point scale at the moment of enrollment (day 0) and at weeks 1, 2, and 4. The percentage of patients achieving at least a small (at least 50% reduction of the total scale score) or a good (at least 75%) improvement of signs and symptoms was calculated at each visit. Tolerability was also evaluated as the duration of discomfort after instillation.

Results

All drugs gave some improvement in symptoms in more than 85% of cases. Epinastine and olopatadine obtained at least a good relief of symptoms in 37% and 33% of cases at week 1. At the end of the study, good improvement of symptoms was obtained in at least 70% of patients by epinastine, ketotifen, fluorometholone, and olopatadine, whereas a 75% improvement for signs was obtained only by fluorometholone and ketotifen. Naphazoline/antazoline induced higher discomfort compared to the other study treatments (p<0.0001).

Conclusions

The efficacy of epinastine, ketotifen, and olopatadine in the treatment of allergic conjunctivitis was comparable to fluorometholone. Naphazoline/antazoline had lower tolerability than the other study treatments.
Comparison of Tearscope-Plus versus Slit Lamp Measurements of Inferior Tear Meniscus Height in Normal Individuals
Authors: Fodor Eszter , Hagyó Krisztina , Resch Miklós , Somodi Dóra , Németh János
Published: January 2018

Purpose

To measure the lower tear meniscus height (LTMH) with image by Tearscope and using slit-lamp biomicroscopy with or without fluorescein staining.

Methods

The lower tear meniscus height was measured in 31 eyes of 31 healthy volunteers (mean age 31.29 years; SD 4.83) with Tearscope and slit lamp with and without fluorescein staining. The mean values of LTMH were measured with different methods and the repeatability of the measurements was statistically analyzed. Measurement of fluorescein tear film break up time (FBUT) and Schirmer test were also performed.

Results

The mean value of LTMH was 0.21 mm (SD 0.07) with Tearscope, 0.20 mm (SD 0.06) with slit lamp without fluorescein staining, and 0.23 mm (SD 0.07) with fluorescein staining. There was no significant difference among the mean values of LTMH with these 3 different measurement methods. Based on the random effect analysis of variance (p=0.05), the measurements were more repeatable with Tearscope-plus than with the other 2 methods. No correlation was found between the LTMH and the results of Schirmer test or FBUT.

Conclusions

The LTMH could be reliably measured with slit-lamp biomicroscopy without staining, but the measurements were more repeatable with Tearscope.
Deep Anterior Lamellar Keratoplasty with Intacs Explantation in Keratoconus
Authors: Titiyal Jeewan S. , Chawla Bhavna , Sharma Namrata
Published: January 2018

Purpose

To describe the surgical technique and clinical outcome of deep anterior lamellar keratoplasty (DALK) with Intacs explantation in patients with poor visual outcome after Intacs implantation for keratoconus correction.

Methods

TWO patients with bilateral keratoconus underwent Intacs segment implantation. Due to poor visual outcome and patient dissatisfaction, the Intacs segments were explanted and a big bubble-assisted DALK procedure was performed at the time of Intacs removal.

Results

DALK could be successfully completed in both cases. There were no postoperative complications. At 2 years follow-up, the grafts were clear in both patients, with a best spectacle-corrected visual acuity of 20/25.

Conclusions

A modified big bubble-assisted DALK procedure can be performed in keratoconic eyes requiring Intacs explantation and may provide a better alternative to a penetrating keratoplasty.
Comparison of the Transpalpebral Tonometer TGDc-01 with Goldmann Applanation Tonometry
Authors: Waisbourd Michael , Shemesh Gabi , Top Lea Baras , Lazar Moshe , Loewenstein Anat
Published: January 2018

Purpose

This study aimed to compare intraocular pressure (IOP) measurements obtained by the transpalpebral tonometer TGDc-01 and by the Goldmann applanation tonometer (GAT).

Methods

IOP was measured by the conventional GAT and the TGDc-01 tonometer. Central corneal thickness (CCI) was measured for all eyes.

Results

Sixty-seven consecutive patients (123 eyes) participated. The mean difference between the 2 techniques (TGDc-01-GAT) was −0.93 mmHg, SD=2.74 (p=0.0002, paired t-test), and 70% of the measurements were within ±2 mmHg. The correlation coefficient was 0.67 (p<0.0001). A subgroup analysis according to CCT was conducted. For CCT <520 μm, the mean IOP difference was 0.67 mmHg (p=0.13); r=0.75 (p<0.001). For CCT 520 μm-580 μm, the mean IOP difference was −1.08 mmHg (p=0.001); r=0.69 (p<0.0001). For CCT>580 μm, the mean IOP difference was −2.29 mmHg (p=0.0003); r=0.57 (p=0.003).

Conclusions

TGDC-01 may estimate IOP with a fair agreement to the Goldmann tonometer, although caution should be used for patients who require precise IOP measurements. TGDc-01 measured higher IOPs than Goldman tonometry for thinner corneas, a trend that was reversed for thicker corneas. This tonometer is a portable device, easy to use, does not require anesthetic drops, and may be suitable for IOP screening.
Familial Clustering of Diabetic Retinopathy in Chongqing, China, Type 2 Diabetic Patients
Authors: Zhang Xuedong , Gao Yan , Zhou Zhongqiang , Wang Jing , Zhou Qingyun , Li Qi
Published: January 2018

Purpose

To investigate whether there is familial aggregation of diabetic retinopathy (DR) among type 2 diabetes mellitus (T2DM) patients in Chongqing, the municipality in southwest China.

Methods

From December 2004 to December 2006, 167 T2DM families with at least 2 diabetic siblings were investigated. In all 414 subjects, the sibling with the longest duration of diabetes was defined as the proband. The occurrence of retinopathy was compared between the siblings of probands with and without retinopathy. DR risk factors of the siblings of probands were studied by multiple logistic regression analysis.

Results

DR was diagnosed in 7.1% of the siblings of the probands without DR and in 29.7% of the siblings of the probands with DR. The difference reached statistical significance in probands with DR and probands without DR (p<0.0001). Nonesterified fatty acid (NEFA) was a risk factor for DR (odds ratio = 2.108, 95% confidence interval 1.077–4.127). It appeared that regardless of probands with DR, siblings with history of smoking had less risk for developing DR than those with no history of smoking.

Conclusions

Familial clustering of DR existed in the patients with T2DM in Chongqing, China. In DR siblings, NEFA is a risk factor of DR, while smoking may reduce DR occurrence.
Ex-PRESS Miniature Glaucoma Device in Vitrectomized Eyes
Authors: Vetrugno Michele , Ferren Paolo , Sborgia Carlo
Published: January 2018

Purpose

To evaluate the clinical efficacy and safety of the Ex-PRESS miniature glaucoma device placed under scleral flap for the treatment of ocular hypertension in eyes that underwent vitreoretinal surgery.

Methods

Vitrectomized patients who required glaucoma surgery for persistent ocular hypertension were included. The Ex-PRESS miniature glaucoma device was implanted under scleral flap. Postsurgical clinical outcomes and intraocular pressure (IOP) was monitored for 6 months after surgery.

Results

At 6 months, all the patients had an IOP lower than 18 mmHg, 3 of them without topical therapy.

Conclusions

The use of the Ex-PRESS implant under scleral flap in eyes that underwent vitreoretinal surgery was effective for lowering IOP
Bilateral Uveitis with Hypopyon as a Presenting Symptom of Metastatic Peritoneal Carcinomatosis
Authors: Iannetti Ludovico , Corsi Cinzia , Iafrate Franco , Sammartino Paolo , Di Giorgio Angelo , Pezzi Paola Pivetti
Published: January 2018

Purpose

To report the association between bilateral uveitis with hypopyon and metastatic peritoneal carcinomatosis.

Methods

A 76-year-old woman presented bilateral diffuse uveitis with hypopyon. She was in good health. She reported breast cancer history 20 years before with no recurrence of tumor at periodic examinations.

Results

The patient had visual acuity of count fingers in both eyes, hypopyon, and vitritis with no chorioretinal lesions. After 1 week of steroids, visual acuity and intraocular inflammation improved significantly. Given the late age at uveitis onset, clinical picture of uveitis, and breast cancer history, we suspected associated malignancy. Total body computed tomography revealed peritoneal carcinomatosis, which was removed 1 month later. After 12 months, visual acuity was 0.8 bilaterally and bilateral uveitis resolved completely.

Conclusions

Excluding a masquerade syndrome and a paraneoplastic syndrome on the basis of clinical features, uveitis represents an immune response to the concurrent tumor. The good response to steroid therapy is in accordance with this hypothesis. This is the first case of uveitis with hypopyon as presenting symptom of a metastatic peritoneal carcinomatosis developing 20 years after the removal of primitive breast cancer.
Calcification of a Rayner Centerflex 570H hydrophilic Acrylic Intraocular Lens following Vitrectomy for Retinal Detachment: A Clinicopathologic Report
Authors: Purbrick Robert M.J. , Stavrakas Panagiotis , Porooshani Hamid , Patel Chetan K. , Ferguson David J.P.
Published: January 2018

Purpose

The case of a 71-year-old man who complained of progressive, unilateral visual blurring following vitrectomy for retinal detachment due to opacification of his Rayner Centerflex 570H intraocular lens (IOL) implant is reported. Intraocular lens exchange was carried out and the explanted lens analyzed. The same model lens in his fellow eye has remained clear.

Methods

Clinicopathologic case report.

Results

Scanning electron microscopy and energy-dispersive x-ray analysis confirmed the presence of hydroxyapatite deposits within the anterior surface of the IOL.

Conclusions

To our knowledge, this is the first clinicopathologic case report of calcification of this model IOL in an adult patient. The sequence of events, unilaterality and pathologic findings suggest secondary calcification, which could have been related to severe postoperative inflammation and associated blood-aqueous barrier breakdown.
Hip replacement in patients younger than 65 years: Results of the CLS prosthesis
Authors: Radcliffe G.S. , Wilson J.I. , Ashford R.U. , De Boer P.G.
Published: January 2018

We present the results of a retrospective review of 65 CLS uncemented total hip replacements in 47 patients all of whom were less than 65 years of age at the time of surgery. The mean follow-up was 6.5 years and only one case was lost to follow-up. The clinical results were good. The mean (95% confidence interval) Merle d'Aubigne Postel score for pain (max. 6) was 5.42 ± 1.13 (5.13 – 5.71) and for mobility (max. 6) 5.55 ± 0.71 (5.37 – 5.73). The mean score for patient satisfaction (max. 5) was 4.89 ± 0.46 (4.77 – 5.00). The mean total score was therefore 15.97 ± 1.70 (95% confidence interval 15.54 - 16.40) from a maximum of 17 points. There were three revisions over the study period giving a mean (95% confidence interval) survivorship of 96.5% (91.9% - 100%) at five years. We present the results of a radiological review, which show that the surviving implants show evidence of osseointegration. This was achieved despite the lack of a porous or hydroxyapatite coating.
A biomechanical evaluation of cortical onlay allograft struts in the treatment of periprosthetic femoral fractures
Authors: Haddad F.S. , Dehaan M.N. , Brady O. , Masri B.A. , Garbuz D.S. , Goertzen D.J. , Oxland T.R. , Duncan C.P.
Published: January 2018

Periprosthetic femoral fractures are increasingly addressed through the use of cortical onlay allografting. This study was designed to determine the effect of allograft cortical strut length, configuration, cable number, cable tension and the use of wire or cable on the fixation of periprosthetic femoral fractures. Ten cadaveric femora-strut constructs were tested using anteroposterior and axial loads to simulate the forces at the hip during gait. A transverse fracture at the level of the tip of the femoral stem was simulated. A biaxial servohydraulic testing machine was used to apply one hundred cycles of craniocau-dal load of 1.53 × bodyweight at a frequency of one Hz, along with an anteroposterior load of 0.15 × bodyweight at one half Hz. Variables for different constructs included the strut length (twelve cm, sixteen cm, or twenty cm), the number of cables (two, three, or four above and below the fracture site), cable tension, strut configurations and orientation (single strut or two struts, adjacent or opposite), and the use of wires instead of cables. Cable tension was measured using a calibrated tensioner. Movement at the fracture site was measured using a precision optoelectronic camera system. There was significantly less motion when cables were used rather than wires (p<0.05). Increasing the number of cables decreased fracture motion in some directions (p<0.05) and increasing cable tension showed a trend towards decreased fracture motion. We observed strut fractures in four cases when a single strut alone was used to stabilise the fracture. There was a significant decrease in fracture motion if two struts were used rather than one (p<0.01), but there was no significant difference between the anterior and lateral, and the medial and lateral strut configurations. Decreasing the strut length from twenty cm to twelve cm led to a significant decrease in axial rotation (p<0.05). Our data strongly favour the use of two struts, rather than a single strut alone. Cables enhance fracture stability compared to wires, presumably due to increased tension and to different surface characteristics. Increasing the cable tension gave greater stability although this may not fully translate to the clinical situation because the cable may garrotte or fracture the strut. Increased cable number and decreased strut length also enhanced fracture stability. The cortical struts essentially represent biological bone plates. If appropriately selected and prepared they can be customised to fit any femur. Our improved understanding of this technique should contribute to high rates of fracture union with an increase in bone stock and overall bone strength.
The Modified Tonnis Triple Pelvic Osteotomy in the Young Adult - Early Results
Authors: De Roeck N. , Hashemi-Nejad A.
Published: January 2018

Acetabular dysplasia may present as previously undiagnosed or as a sequel to treated DDH in a young adult, with a natural history of subsequent development of early osteoarthritis.

Patients with acetabular dysplasia, a normal neck shaft angle, no significant leg length inequality and who demonstrate congruency at arthrogram are considered suitable for realignment pelvic osteotomy.

We report the results of 15 young adults who underwent a modified Tonnis triple osteotomy with a mean 22-month follow-up. The modification was that the ischial osteotomy was performed through a groin incision.

The only common complication was the requirement of catheterisation post-operatively (60%). There were no infections. There was one delayed union but no non-unions. One patient developed a deep vein thrombosis. All patients reported an improvement in their symptoms and level of activity, with a mean post-operative Harris hip score of 92. All showed an improved centre-edge angle of 28° (mean increase of 18°) and acetabular angle of 37° (mean decrease of 13°).

The early results of this procedure show it to be a safe and useful option to delay the natural history of early osteoarthritis in the young adult.
The Zweymüller cementless total hip prosthesis in patients aged 50 years and younger
Authors: Vervest T.M.J.S. , Anderson P.G.
Published: January 2018

Sixty-eight young patients (74 prostheses), mean age 43 years (standard deviation 7.7) at the time of the index operation, with a Zweymüller cementless total hip prosthesis were evaluated with a mean follow-up time of 75 months (SD 15.7). At follow-up, the mean Harris Hip Score was 94 (SD 8.1). Six stem prostheses had vertical subsidence and nine cups showed signs indicating possible loosening. The Oxford Hip Score averaged 19 points (SD 8.7). Revision surgery was performed for septic loosening (n=3 stem and cup prostheses), for aseptic loosening of the cup (n=2), and for a traumatic periprosthetic fracture (n=1 stem). Worst case survival analysis for aseptic loosening of the cup showed a probability for revision of 3% (CI95 0 – 7.2%) with a cumulative survival of 96% (CI95 100 – 90.3%) after 84 months. For the stem prostheses the probability for revision was 1% (CI95 0 – 4.3%) after 114 months with a cumulative survival of 99% (CI95 100 – 95.8%) after 72 months. Worst case cumulative survival for any reason of revision was 94.5% (CI95 99.9 – 89.2%) after 81 months. Promising results of the Zweymüller cementless hip prosthesis for the younger patient were obtained, although longer follow-up will be necessary.
Mid-Term Behaviour of Cemented Titanium Stems: A Seven to Eleven Year Clinical Radiographic and Retrieval Study
Authors: Vlatis G. , Georgiades G. , Magnissalis E.A. , Hartofilakidis G.
Published: January 2018

A controversy exists regarding the results of cemented Ti-alloy femoral stems. Although most authors reported unfavourable results, there is no clear evidence of the exact reason for the increased failure rate. We studied 35 arthroplasties in 30 patients with a mean age at the time of surgery of 49.7 years (range 27 to 67 years). In most of them (23 hips) the pre-operative diagnosis was hip dysplasia or dislocation. The femoral component used in this study was the Optifix stem. Survival analysis showed a cumulative rate of success at nine years of 90.4% (±15.3) with 25.5 femoral components remaining at risk. Three femoral components were retrieved during revision surgery: due to fatigue fracture, fracture of the femur and aseptic loosening respectively. Given that most publications refer to different designs of stems we presume that the problem could be focused on the design rather than the material or the method of fixation. Further information is necessary before Ti-alloy stems fixed with cement are withdrawn from use.
IMHS in peritrochanteric fractures
Authors: Fischer J. , Chee Y. , Waseem M. , Barnes K.
Published: January 2018

Internal fixation of fractures of the proximal femur is one of the most common trauma operations in the UK. While stable fractures have been successfully treated with sliding hip screws for many years with a low rate of complications, there has been much debate about the right choice of implant for the treatment of unstable and sub-trochanteric fractures. We present a series of 45 patients with inter- and sub-trochanteric fractures and pathological lesions who were treated with the Intramedullary Hip Screw (IMHS). All notes and radiographs were reviewed and there was an emphasis on the quality of reduction and the position of the metalwork. The commonest postoperative complication was superior cut-out of the sliding screw in four patients (8.8%). Varus position after reduction and superior screw position were present in these patients. Two of the patients were converted to IMHS fixation after previous failure of dynamic hip screw (DHS)/dynamic condylar screw (DCS) fixation. All four patients were treated non-operatively until the fractures were healed. We conclude that IMHS fixation is a viable option for unstable and pathological inter- and sub-trochanteric fractures of the femur. Varus reduction and superior position of the sliding screw have to be avoided. In revision cases there is a high rate of failure.
Extensively Hydroxyapatite-Coated Stems in Revision Hip Arthroplasty: A Radiological Mid-Term follow-up Study
Authors: Hernández-Vaquero D. , Suarez-Vazquez A. , Cima-Suarez M. , Garcia-Sandoval M. A. , Gava R.
Published: January 2018

Femoral revision surgery involves the placement of a stable stem and the regeneration of the damaged bone structure. We retrospectively reviewed 36 cases of femoral revision surgery in which an extensively hydroxyapatite-coated porous stem was implanted with a five-year minimum follow-up. Nine of the cases had type I defects, 12 had type II defects, six had III-A defects and nine had III-B defects. The mean follow-up was 7.7 years (range 5–11). No cases of revision surgery, subsidence or displacement were detected. In 35 cases the integration of the stem had been achieved, the bone structure had been restored and there was no fibrous interface visible between the implant and the bone. The fully hydroxyapatite-coated stems thus proved a valuable alternative for femoral revision surgery in mild and moderate bone defects.
Polyethylene wear rates with Zirconia and cobalt chrome heads in the ABG hip
Authors: Skyrme A.D. , Richards S. , John A. , Chia M. , Walter W.K. , Walter W.L. , Zicat B.
Published: January 2018

We report a radiological analysis of 281 primary cementless ABG total hip arthroplasties performed between 1991 and 1994, with a mean follow-up of 78 months. We compare the polyethylene wear in hips with Zirconia ceramic heads manufactured prior to the introduction of hot isostatic pressing and hips with cobalt chrome heads. The mean linear wear rate was 0.19 mm/yr with 28mm Zirconia heads (n=203), 0.20 mm/yr with 32mm Zirconia heads (n=47) and 0.14mm/yr with 28mm cobalt chrome heads (n=31). We matched each of the 31 patients with 28mm cobalt chrome heads with a patient from the 28mm Zirconia group for gender and age. The mean linear wear rates in these two groups were 0.14mm/yr and 0.19mm/yr respectively (p<0.05). There were 19 revisions for osteolysis in 250 hips with Zirconia heads (7.6%) and no revisions in 31 hips with metal heads. We advocate regular review of patients with Zirconia on polyethylene bearing surfaces due to the high linear wear rates and associated osteolysis.
Porous-Coated Anatomic Uncemented Total Hip Arthroplasty. A 10–17-Year follow-up
Authors: Cruz-Pardos A. , Garcia-Cimbrelo E. , Cordero-Ampuero J.
Published: January 2018

A total of 91 PCA total hip arthroplasties were analysed with a mean follow-up of 13.5 years. Thirty-one cups and six stems were revised. If the patients excluded from the follow-up study are included (113 hips), the cumulative probability of having revision of any prosthetic component for any cause was 16.0% (0.1%-31.9%) at 14 years in the “best case” scenario. Thigh pain (17 hips) was correlated with unstable fixation. Radiographic loosening occurred in 21 cups and 12 stems. Cup loosening was related to acetabular polyethylene wear equal to or more than 2mm per year and also to cup size and thereby polyethylene thickness. Stem loosening was related to poor femoral canal filling. Fifty hips had femoral osteolysis which was related to polyethylene wear of more than 2 mm, poor femoral filling and unstable fixation.
Radiographic evaluation of the hip rotation centre after total joint replacement in hip dysplasia
Authors: D'angelo F. , Molina M. , Giudici M. , Cherubino P.
Published: January 2018

A retrospective study was conducted to correlate the clinical result of joint replacement in dysplastic hips with the obtained modifications of the rotation centre.

Sixty primary total hip arthroplasties were performed on 46 patients suffering from hip dysplasia at our institution. The radiographic evaluation of the hip rotation centre was performed using the method proposed by Pierchon. The clinical assessment was by Harris Hip Score. Our results revealed that it was possible to modify the position of the pathological rotational centre with a statistically significant difference (p<0.05) for both coordinates. The general clinical evaluation relates well to the radiological evaluation as the average HHS increased to 92.683 (p<0.05). The data from our study are in accordance with the most recent literature and confirm the importance of a suitable biomechanical position of the hip rotation centre in a distal and medial sense.
The influence of incision length on immediate postoperative rehabilitation after total hip replacement
Authors: Lilikakis A. K. , Villar R. N.
Published: January 2018

It has been suggested that smaller skin incisions may be associated with a better short-term outcome after total hip replacement, including a more rapid rehabilitation. The definition of mini-incision is still unclear as publications with incisions ranging from five to 20cm appear in the literature. We therefore prospectively studied 42 consecutive patients who had undergone 44 total hip replacements using a posterolateral approach, through skin incisions of between 10 and 21cm. The patients were assessed for their speed of postoperative rehabilitation and their length of hospital stay. Age, body mass index, length of incision, duration of procedure, muscles detached and repaired, and blood loss were also recorded. We found no evidence of a correlation between incision size and blood loss, postoperative rehabilitation, or the length of hospital stay. Similarly, the degree of surgical muscle trauma showed no evidence of a correlation with the speed of post-operative rehabilitation or the length of hospital stay. In contrast, the age of the patient did significantly correlate with the length of hospital stay and rehabilitation scores. Our study showed no evidence that the size of the incision, or the muscles detached or repaired at surgery, influenced the immediate postoperative rehabilitation after total hip replacement performed through a posterior approach. Only the patient's age showed a correlation with the speed of rehabilitation.
Successful excision of neurogenic heterotopic ossification around the hip in cerebral palsy
Authors: Utukuri M.M. , Ramachandran M. , Monsell F.
Published: January 2018

We present the case of an 11-year-old girl with cerebral palsy, who developed bilateral spontaneous ankylosis of the hips as a result of heterotopic ossification following hip surgery. This was treated successfully by a combination of surgical excision, single dose radiotherapy and bisphosphonate treatment at five months from the time of the original surgery. A review of the literature shows that a combination treatment can be recommended in severe cases of heterotopic ossification to prevent recurrence. A review of neurogenic heterotopic ossification is presented.
Blood analysis for trace metals in metal-on-metal, ceramic-on-ceramic and metal-on-cross-linked PE bearings in total hip arthroplasty
Authors: Karamat L. , Pinggera O. , Knahr K.
Published: January 2018

We obtained postoperative blood concentrations of Co, Cr, Mo, Ti, Al and Nb in 75 patients undergoing primary THA at our institution between January 1998 and December 2000. All patients were treated with the same prosthetic device (Alloclassic® VARIALL™, Zimmer, Winterthur, Switzerland) using three types of articulations: metal-on-metal (METASUL™), ceramic-on-ceramic (CERASUL™) and metal-on-cross linked polyethylene (DURASUL™). 25 patients out of each articulation-group were evaluated by blood analysis 24–38 months after surgery. The patients were submitted to strict criteria of inclusion. Comparing the three articulation-groups there were no significant differences in the categories age, follow-up time and preoperative blood level of creatinine. The Al-, Ti- and Nb-blood levels were all below their detection limit. Regarding the median blood concentrations of Mo, we found no statistically significant differences comparing the three articulations (p>0.05). The median Co blood concentration in the ceramic group was 0.19 ng/mL, 0.69 ng/mL in the metal group and 0.19 ng/mL in the cross-linked PE group. The difference between the metal and ceramic group and between the metal and polyethylene group is statistically significant (p=0.001 in both comparisons). The median blood concentration of Cr was 0.19 ng/mL in the ceramic and in the cross-linked PE group, and 0.47 ng/mL in the metal group, the difference being statistically significant (p=0.003 and p=0.0002). Although the blood concentrations of Co and Cr were significantly higher in patients with a metal-on-metal articulation they were far from reaching toxic levels.
Offset acetabular cups: A solution to wear?
Authors: Ioannidis T. T. , Gkantaifis N. D. , Themistocleous G. S. , Boscainos P. J. , Soucacos P. N.
Published: January 2018

Change of tribological properties has been the main goal in the effort to augment the longevity of total hip arthroplasty, while the reduction of forces acting across the artificial joint space has received little attention. Spurred by recent reports of wear behaviour and good clinical results of the offset low friction arthroplasty cups, the authors, using the simplified free body technique, estimated the resultant hip joint reaction force and the angle of its application on 100 individual anteroposterior pelvic radiographs, by templating on the same hip a conventional concentric cup and an offset eccentric one. The results showed a highly significant reduction (p<0.0001) of the resultant hip joint reaction force in the offset group by 28.8% or 1.02 body weight and of the angle of the hip joint reaction force by 2.8 degrees. The authors believe that the reduction of the resultant hip joint reaction force in the offset cup group is the result of lowering and medialising the centre of rotation of the hip, a previously reported fact on non-clinically applicable conditions. They are also tempted to propose the generalized use of the offset type acetabular cup, since adverse events are not anticipated.
Early failure modalities in hip resurfacing
Authors: Cutts S. , Datta A. , Ayoub K. , Rahman H. , Lawrence T.
Published: January 2018

Between 1996 and 2002, we treated 60 patients (65 hips) by hip resurfacing. The notes and radiographs of these cases were studied retrospectively and the modalities of failure identified. At a mean follow-up of 51 months, 14 of these cases (22%) required revision surgery. One patient had died from unrelated causes and one was lost to follow-up. At the time of primary surgery, the mean age of the patients in our series was 55 years. The commonest mechanism of failure in our series was fractured neck of femur (six cases). Four of these occurred in females over the age of 60. None of the fractured necks of femur were associated with trauma. There were four cases of loose acetabular components and one case of progressive AVN (avascular necrosis). Two patients required revision surgery for ongoing hip pain and one required a two-stage revision for early deep infection.
Femoral Neuropathy Resulting from Acetabular Cement Extrusion - a Case Report
Authors: Wilson R. , McConway J. , O'Brien S. , Thompson N.W. , Beverland D.E.
Published: January 2018

Acetabular extrusion of cement during total hip arthroplasty is a well-recognised occurrence. We report a case of femoral neuropathy secondary to an extruded cement mass nine years after primary cemented total hip arthroplasty. Removal of the cement resulted in resolution of the patient's symptoms.
Gluteal fascial transposition for trochanteric bursitis
Authors: Baker R.P. , Mackeith S.A.C. , Bannister G.C.
Published: January 2018

We report a new surgical technique for refractory trochanteric bursitis, performed in 43 patients between May 1988 and December 2003. Fourteen patients had developed trochanteric bursitis after primary total hip arthroplasty (THA), six after revision THA, 17 for no definable reason (idiopathic) and seven after trauma. Follow-up ranged from six months to 15 years (mean five years). Outcome was measured by the patient's symptoms at interview and whether the patient would have had the procedure again. Outcome depended on aetiology: 100% of traumatic, 88% of idiopathic and 64% after primary THA were successful. All operations after revision THA were unsuccessful. Transposition of the gluteal fascia is indicated in patients with idiopathic, traumatic and post primary THA trochanteric bursitis, but not after revision THA.
Metal-on-Metal Joint Arthroplasty: Potential Lifetime Longevity
Authors: Dunstan E. , Sanghrajka A.P. , Whittingham-Jones P. , Tilley S. , Blunn G. , Cannon S.R. , Briggs T.W.R.
Published: January 2018

We have studied a historical group of patients who underwent metal-on-metal hip arthroplasty more than 30 years ago. Those retaining their original metal-on-metal articulation (average follow-up 33 years) had an average Harris Hip Score of 75 (range 53–93) and an average Musculoskeletal Tumour Outcome Score of 75 (range 63–90). Those that have been revised (at an average of 22 years) maintain good functional outcome. The original implant is still in situ in five of the 11 survivors (follow-up 26–38 years).

Retrieval analysis using a Mitutoya form tracer and an electron microscope demonstrated the self-polishing capacity of the metal-on-metal articulation. The surface roughness (Ra) of the worn articulating surface (Ra 0.05 mm) was smoother than that of the original unworn surface (Ra 0.32 mm). We believe our case series highlights the potential longevity of metal-on-metal articulation.
Fatal Pulmonary Embolism following Hip and Knee Replacement. A Study of 2153 Cases Using Routine Mechanical Prophylaxis and Selective Chemoprophylaxis
Authors: Shepherd A. , Mills C.
Published: January 2018

In order to prevent fatal pulmonary embolism, TED stockings, foot pumps and early mobilisation on the second post-operative day are used at our centre. Only patients deemed to be high risk (previous DVT/PE or obese) are given clexane as inpatients and warfarin for six weeks postop. From the hospital database 1137 primary total hip replacements and 1017 primary total knee replacements were identified and the figures were confirmed with the theatre implant order books. The cause of death for those patients on the database, now deceased, was obtained from the coroner. Where a postmortem had not been performed the patient was assumed to have died of a PE. Within three months of surgery, a fatal PE rate of 0.09% (95% CI 0.00–0.26%) following hip replacement and 0.20% (95% CI 0.00–0.46%) after knee replacement was found. Thirty-four patients had been discharged on warfarin according to the pharmacy records. We would therefore not recommend the routine use of chemical thromboprophylaxis following joint replacement.
Extracting the Tip of a Fractured Dhs wire from the Hip Joint
Authors: Heal J.S. , Spencer R.F.
Published: January 2018

Dynamic Hip Screw fixation is a very commonly performed operation, but one not without complications (1–3). To stabilise the fixation the guide wire can be advanced into the subchondral bone. An unusual complication of this, and one not previously documented in the literature, is that the tip of the guide wire can fracture. We describe a simple method of removing the tip of the guide wire.
Revision Hip Surgery Using the Cls Expansion Shell
Authors: Rozkydal Z. , Janícek P. , Havlícek V. , Deduch J.
Published: January 2018

The aim of our study is to assess the outcomes using the uncemented CLS expansion shell in revision hip surgery for aseptic loosening of the acetabular component.

Between 1991 and 2000 we used the CLS expansion shell in revision hip surgery in 215 patients (230 hips). We were able to evaluate 196 patients (211 hips) with failed acetabular components. The male/female ratio was 82/114 and the mean age of the patients was 63 years (range 38–71). The main reason for revision was aseptic loosening of the PE cup (184 patients). There were 79 hips with Paprosky defect of the acetabulum type I, 62 hips with type 2A, 57 hips with type 2B and 13 hips with type 2C in the study. The mean follow-up was 8.5 years (range 5–14). Plain radiographs using an AP view of the pelvis and AP and lateral views of the affected hip were taken immediately after surgery and at the latest follow-up. Clinical outcomes were determined using the Merlé dAubigné and Postel score and the Harris Hip score.

The mean preoperative Merle dAubigné score was 7.8 points (range 6.9 to 9.9); at the latest follow-up it was 14.9 points (range: 12.5 to 15.9). The mean preoperative Harris Hip score was 38.6 points (range: 32 to 59); at the latest follow-up it was 82.5 points (range: 38 to 95).

Osteointegration of the CLS expansion shell was present in 149 hips (70.6%) at the latest follow-up. There were 31 complications (15%) requiring a second revision. Clinical survivorship of the CLS expansion shell was 90% at five years and 84% at 8.5 years after revision surgery. Radiological survivorship was 78% at five years and 70% at 8.5 years after revision surgery.

The CLS expansion shell offers a viable alternative for revision hip surgery with lower bone quality, insufficient bone at the bottom and cavitary defects of the acetabulum.
Outcome of Bilateral Hip Hemiarthroplasty for Displaced Fracture of the Hip
Authors: Nogales M.A. , Vega G.T. , Quiles M. , Roa C. , Perez S. , Porcel T. , Campos T.
Published: January 2018

Our aim was to evaluate the outcome in patients with bilateral non-simultaneous hip fracture treated with hemiarthroplasty at our institution between 1997 and 2003. We looked for any important modification factor that could change the devastating functional and social results.

Twenty-two patients with a mean age of 79 at the initial fracture and 82 at the subsequent fracture were evaluated; all were Garden grade III-IV. The second fracture happened a mean of 28 months after the first one.

The outcome measurement was the incidence of hip pain, recovery of pre-injury level of ambulation and activities of daily living at a minimum follow-up of one year. Following the first hemiarthroplasty patients deteriorated in their walking capacity and other activities of daily life, and this happened to an even greater extent after the second operation.

With respect to walking ability (measured in metres) we concluded that it improved if a modular hemiarthroplasty was used after both fractures (p<0.05) and that worse functional outcomes were observed when different kinds of hemiarthroplasties were used in the same patient.
Bone Preservation with a Conservative Metaphyseal Loading Implant
Authors: Santori N. , Albanese C.V. , Learmonth I.D. , Santori F.S.
Published: January 2018

Proximal load transfer and the absence of distal fixation of the stem are crucial to obtain the best behaviour of the femoral bone after total hip replacement.

In this study, dual energy X-ray absorptiometry (DEXA) was employed to understand and compare the bone density changes and thus the re-distribution of mechanical forces in two different extra short stems. Two cohorts of ten patients were included in this retrospective study.

Both implants are custom-made and present a well defined lateral flare. The first model is fully coated and presents a short stem (Group A), the second is an unstemmed metaphyseal implant with a polished tip (Group B).

DEXA scans were obtained in all patients at the two-year follow-up. A higher BMD was detected in ROIs 1, 2, 4, 5 in Group B confirming a preservation of the proximal bone mass and thus indirectly a more proximal load transfer.

The results obtained confirm the importance of the geometry of the implant on proximal bone density. Loading both medial and lateral proximal femoral flares and the complete absence of the diaphyseal portion of the stem provide the optimal bone remodelling of the femur after total hip replacement.