bluuebunny/crossref_metadata_2025 huggingface dataset:
Application of a user-friendly comprehensive circulatory model for estimation of hemodynamic and ventricular variables
Authors: Ferrari G. , Kozarski M. , Gu Y.J. , De Lazzari C. , Di Molfetta A. , Palko K.J. , Zieliński K. , GÓRczyńska K. , Darowski M. , Rakhorst G.
Published: January 2018

Purpose

Application of a comprehensive, user-friendly, digital computer circulatory model to estimate hemodynamic and ventricular variables.

Methods

The closed-loop lumped parameter circulatory model represents the circulation at the level of large vessels. A variable elastance model reproduces ventricular ejection. The circulatory model has been modified embedding an algorithm able to adjust the model parameters reproducing specific circulatory conditions. The algorithm reads input variables: heart rate, aortic pressure, cardiac output, and left atrial pressure. After a preliminary estimate of circulatory parameters and ventricular elastance, it adjusts the amount of circulating blood, the value of the systemic peripheral resistance, left ventricular elastance, and ventricular rest volume. Input variables and the corresponding calculated variables are recursively compared: the procedure is stopped if the difference between input and calculated variables is within the set tolerance. At the procedure end, the model produces an estimate of ventricular volumes and Emaxl along with systemic and pulmonary pressures (output variables). The procedure has been tested using 4 sets of experimental data including left ventricular assist device assistance.

Results

The algorithm allows the reproduction of the circulatory conditions defined by all input variable sets, giving as well an estimate of output variables.

Conclusions

The algorithm permits application of the model in environments where the simplicity of use and velocity of execution are of primary importance. Due to its modular structure, the model can be modified adding new circulatory districts or changing the existing ones. The model could also be applied in educational applications.
Francis I. Proctor, MD and his wife Elizabeth C. Proctor: Their lives and legacy
Authors: Bohigian George M , Feibel Robert M
Published: January 2018

The Francis I. Proctor Foundation for Research in Ophthalmology is internationally recognized for its research in the fields of ocular inflammatory and infectious diseases. Although the name of one of its founders, Francis I. Proctor, MD (1864–1936) is memorialized, the legacy of his wife, Elizabeth C. Proctor (1882–1975) is not as well known. They were both full partners in this endeavor. Francis, a successful and wealthy ophthalmologist, retired to Santa Fe, New Mexico. After their marriage, they became interested in the problem of blinding trachoma, then an endemic problem on the Native American Indian reservations. The couple selected Phillips Thygeson, MD (1903–2002), a young ophthalmologist with an interest in infectious diseases, as their lead investigator. Using their own funds, the Proctors paid for Thygeson and themselves to study trachoma in Egypt, and then establish a trachoma research laboratory in Arizona where the causative agent of trachoma was identified. Not only did the Proctors fund these studies, they also studied bacteriology so they could help in the laboratory themselves. After Francis’ death, Elizabeth endowed the Foundation in 1947 and continued to support it. She also established the Proctor Medal for The Association for Research in Vision and Ophthalmology.
Dr Catherine Louisa Corbett MB ChB DPH (1877–1960), Diary in Serbia. Her work with the Scottish Women's Hospitals in Serbia and Russia, 1915–1917
Authors: Mohr Peter D
Published: January 2018

Catherine Corbett was the second woman to gain a medical degree from the University of Manchester Medical School in 1905; however, little was known about her life or work, apart from the fact that she was a School Medical Inspector (SMI) and never married. The rediscovery of her Diary in Serbia (1916) has revealed her work for the Scottish Women's Hospitals (SWH) during the First World War in Serbia (1915–1916). Her time alongside her female colleagues was a good experience, however the harsh conditions, especially those she experienced during a further period working in Russia (1916–1917), left her exhausted and psychologically stressed. After the war, her job as a SMI in Burnley and her pursuit of rock climbing helped her adjust to a normal life and allowed her to promote her views on female education.
Combined Indomethacin/Gentamicin Eyedrops to Reduce Pain after Traumatic Corneal Abrasion
Authors: Alberti M.M. , Bouat C.G. , Allaire C.M. , Trinquand C.J.
Published: January 2018

Purpose

To evaluate the analgesic action of combined indomethacin 0.1% / gentamicin eyedrops in traumatic corneal abrasion.

Methods

We evaluated 123 patients presenting traumatic corneal abrasion in a multicentre, randomised, double-masked study comparing two parallel treatment groups: indomethacin / gentamicin (group 1) or gentamicin alone (group 2). Study treatments were administered four times daily for 5–6 days. Pain (visual analogue scale), associated symptoms and safety were assessed.

Results

Starting from a comparable level, pain was reduced by 30% in group 1 and 15% in group 2, one hour after the first instillation, and by 59% and 42% respectively after the second. The global difference in pain relief from day 0 to day 4/5 was significantly better in group 1 (p = 0.015). Associated ophthalmic symptoms showed a greater decrease in group 1 after the first instillation (p = 0.007). Both treatments were well tolerated.

Conclusions

Combined indomethacin/gentamicin eyedrops were effective and well tolerated in reducing the pain and discomfort associated with traumatic corneal abrasion.
Tamoxifen Side Effects, Age-Related Macular Degeneration (AMD) or Cancer Associated Retinopathy (CAR)?
Authors: Sadowski B. , Kriegbaum C. , Apfelstedt-Sylla E.
Published: January 2018

Purpose

Differential diagnosis of maculopathies can be difficult but is important if patients also suffer from other diseases such as breast cancer treated with antiestrogens. The main possible diagnoses, especially in the elderly, are age-related macular degeneration, tamoxifen and cancer-associated retinopathy (CAR).

Methods

We describe an 84-year-old patient with breast and colon cancer, who complained of a decrease in visual acuity after treatment with low-dose antiestrogens. She underwent a general ophthalmological investigation, perimetry and electroretinographic examination with multifocal (m-ERG) and flash-electroretinogram (flash-ERG).

Results

Visual acuity was reduced to 1/50 and 0.3. The ophthalmological examination was normal, except for extensive bilateral maculopathy with shining crystalline deposits, central and peripheral visual field defects, slightly affected scotopic and photopic potentials in the flash-ERG, and an abnormal m-ERG.

Conclusions

The findings are expected with age-related macular degeneration with crystalline drusen, but also with CAR. Even if the single and total dosage of antiestrogens given to the patient is sufficient to cause tamoxifen retinopathy, this diagnosis can be excluded because, in tamoxifen retinopathy unlike in the case presented here, the deposits are not distributed in all retinal layers.
Central Retinal Artery Occlusion Associated with Severe Ovarian Hyperstimulation Syndrome
Authors: Turkistani I.M. , Ghourab S.A. , Al-Sheikh O.H. , Abu El-Asrar A.M.
Published: January 2018

Purpose

Ovarian hyperstimulation syndrome (OHSS) is a serious iatrogenic complication of ovulation induction. It is a potentially lethal condition, with severe complications which include ovarian enlargement, and massive fluid redistribution from the vascular system into free spaces resulting in ascites, pleural effusion, electrolyte imbalance, hemoconcentration, hypovolemia, oliguria, and adult respiratory distress syndrome. Thromboembolism is a rare but extremely serious complication.

Case Report

We report a case of severe OHSS, presenting with central retinal artery occlusion (CRAO).

Discussion

This combination has not been reported previously.
Early Femoral Loosening of the Titanium 3M Capital Cemented Hip: A Lesson Relearned
Authors: Harvey A.R. , Barlow I.W. , Clarke N.M.P.
Published: January 2018

A 4-year follow-up study is presented comparing 3M Capital cemented hip replacements with Charnley low friction arthroplasty controls. The mean radiological follow-up in the Capital and Charnley groups was 47 months (25 to 61) and 47 months (23 to 66) respectively. All cases were performed by the same surgical team over the same period (April 1991-October 1993). The operative technique including femoral preparation and cementing technique was identical in each group. Charnley broaches were used for femoral preparation in both groups and Charnley cups were used in all cases. In all of the 3M Capital cases cobalt-chrome femoral heads were used. There was no case selection for either group. Six of the 21 Capital femoral components were deemed to be loose on radiological criteria. None of the Charnley hips was loose. This represents an unacceptably high incidence of radiological femoral stem loosening in the Capital hip replacement. A previous uncontrolled study has attributed early failures to deficient femoral preparation and/or cementing technique. We suggest that early femoral stem loosening in the Capital hip occurs despite satisfactory operative technique in contrast with the results using the Charnley total hip replacement.
Antibiotic Elution from Bone Cement: A Study of Common Cement-Antibiotic Combinations
Authors: Armstrong M. , Spencer R.F. , Lovering A.M. , Gheduzzi S. , Miles A.W. , Learmonth I.D.
Published: January 2018

The in vitro antibiotic elution characteristics (including the effects of cement fracture) of the following cements were studied: 1) CMW 1 with gentamicin, 2) Palacos R with gentamicin, 3) Palacos LV with gentamicin, 4) CMW 1 with gentamicin and vancomycin, 5) Palacos R with gentamicin and vancomycin, 6) CMW 1 with gentamicin and flucloxacillin, and 7) Palacos R with gentamicin and flucloxacillin. Elution of both gentamicin and vancomycin was satisfactory in all cases. There tended to be a peak of antibiotic release on cement fracture, suggesting sequestration of active antibiotic within deeper layers of the cement. Palacos LV exhibited the best antibiotic elution characteristics but with the highest post-fracture peak. Palacos R was superior to CMW 1. Flucloxacillin was present only until day 4. Adulteration of proprietary Palacos R/gentamicin with flucloxacillin produced prolonged high elution of gentamicin, possibly due to porosity. Flucloxacilloic acid (micro-biologically inactive) was present from day 4 onwards after flucloxacillin was added to cement. These findings suggest that flucloxacillin is not a suitable additive to bone cement in revision surgery.
Massive Wear in a Cocrmo Head following the Fracture of an Alumina Head
Authors: Gozzini P.A. , Schmid C. , Pria P. Dalla
Published: January 2018

The catastrophic fracture of an alumina femoral head is, fortunately, an increasingly rare event. The improvements made in the quality of modern ceramics, together with greater care in the manufacture of femoral stem cones and higher levels of expertise of the surgeons implanting the head itself, have significantly reduced this risk. A statistical analysis by Piconi (1) evaluates the percentage of breakage in modern ceramic heads at less than 0.02% (1 fracture every 5000 implants). We can therefore say that today the use of ceramic heads is highly reliable, but in certain cases, due mostly to negligence or technical errors, the fracture of the head is still possible. In these cases the problem we are facing is how to proceed in the revision of the implant, as simply replacing the head may lead to a further and more severe failure of the implant.
A Combined Intracapsular and Extracapsular Fracture of the Hip
Authors: Shabat S. , Mann G. , Barchilon V. , Kish B. , Fredman B. , Gepstein R. , Nyska M.
Published: January 2018

We report a case of an unusual hip fracture that involved the intracapsular area and continued vertically to the extracapsular region below the trochanteric line. The division between these two types of fractures is based on the anatomical site, the blood supply and the mechanical forces that act on the hip. This division is important and influences the different surgical techniques to treat these individual fractures. Femoral neck fractures (intracapsular), particularly those with displacement, can disrupt the blood supply to the femoral head and may be associated with an increased incidence of complications, especially non-union and avascular necrosis (AVN) of the femoral head. These fractures are usually treated either by reduction and fixation, or by hemiarthroplasty. Non-union and avascular necrosis following extracapsular fractures are rare. Treatment involves reduction of the fracture and insertion of a dynamic hip screw. The combination of these two types of fractures is extremely rare and creates a surgical problem without any optimal solution. The focus of this case report is placed on the mechanical axis and weight-bearing forces that play a role in the hip and on the optional surgical techniques in such a rare type of fracture in an elderly osteoporotic patient.
Bilateral Traumatic Hip Dislocation Associated with Sacro-Iliac Dislocation
Authors: Galois L. , Meuley E. , Pfeffer F. , Mainard D. , Delagoutte J.P.
Published: January 2018

We report a rare injury in an 18-year-old woman who sustained posterior bilateral hip dislocation with sacro-iliac dislocation after a high energy motor vehicle accident. She was treated by closed reduction and skeletal traction. Bilateral traumatic hip dislocation is an uncommon occurrence. Rarer still is bilateral traumatic hip dislocation associated with sacro-iliac dislocation because it combines two different mechanisms of trauma.
In Vivo Tribological Performance of 231 Metal-On-Metal Hip Articulations
Authors: Rieker C. , Köttig P.
Published: January 2018

231 cobalt-chromium metal-on-metal (METASUL design) retrieved articulations (297 retrieved components) were examined for their in vivo wear behaviour. A running-in period of about one year is observed where the in vivo wear rate for the whole articulation is approximately 35 μm/year. After this running-in period, the measured in vivo wear rate of the whole articulation decreases to about 5 μm/year. The metal-on-metal articulation can be considered as a very low wear articulation system. The combination of the specially designed components is mandatory to assure this low wear behaviour. In case of a mismatched bearing (stainless steel head - cobalt-chromium inlay), large amount of wear was measured.
Fixation of Revision Implants is Improved by New Surgical Technique to Crack the Sclerotic Endosteal Rim
Authors: Kold S. , Søballe K. , Mouzin O. , Chen X. , Toft M. , Bechtold J.
Published: January 2018

We used an experimental model producing a tissue response with a sclerotic endosteal neo-cortical rim associated with implant loosening in humans: a 6 mm PMMA cylinder pistoned 500 μm concentrically in a 7.5 mm hole, with polyethylene particles. At a second operation at eight weeks, the standard revision procedure removed the fibrous membrane in one knee, and the crack revision procedure was used to crack the sclerotic endosteal rim in the contralateral knee. Once stability was achieved following the revision procedures, loaded Ti plasma sprayed implants were inserted into the revision cavities of 8 dogs for an additional 4 weeks. Revision implant fixation (ultimate shear strength and energy absorption) was significantly enhanced by cracking the sclerotic endosteal rim. In conclusion, we demonstrated a simple technique of cracking the sclerotic endosteal rim as an additional method for improving revision fixation.
Midterm Outcome of the Plasma Cup in Total Hip Arthroplasty
Authors: Gordon A. , Wilkinson J.M. , Stockley I.
Published: January 2018

One hundred and twenty eight primary total hip arthroplasties (THA) in 104 patients were reviewed to assess mid-term survivorship and clinical outcome of the ‘Plasma’ cup. Outcome was evaluated clinically, radiographically, and by self-administered questionnaires. Patient mean age at surgery was 51 years, and 52 THAs (41%) were performed for secondary arthritis. Prior to surgery the median Merle D'Aubigne score was 8. At 59 (standard deviation 18) months this score had improved to 17, and the median Harris hip score was 85. The mean annual polyethylene wear rate was 0.14mm/year. There were no instances of aseptic loosening but 2 cups had small, focal osteolytic lesions at the site of screw holes. Three cups were revised, two for recurrent dislocations, and one for infection. Cup survivorship at 5 years was 97% (Kaplan-Meier).This data suggests that the Plasma cup performs well in the mid-term and may be used safely in a young population with a high incidence of secondary osteoarthritis.
Friction in Hip Hemiendoprostheses. Review of Literature and Own Model Using Cadaveric Acetabula
Authors: Müller L.P. , Degreif J. , Hely H. , Mehler D. , Otto M. , Rommens P.M.
Published: January 2018

The science of tribology concerning hip arthroplasty has mainly dealt with total endoprosthesis, whereas measurement values of hemiendoprosthetic implants are rare. The small amount of experimental tribologic data concerning hemiendoprosthetic implants in the form of pendulum trials, animal experiments, in vivo measurements on human hip joints and pin on disc studies will be reviewed in the following work. The reported frictional coefficients in these studies were between 0.014–0.57.

In order to test the friction coefficients of different femur head hemiendoprostheses (unipolar ceramic- and metal heads) against fresh cadaveric acetabula, the HEPFlEx-hip simulator (Hemi-EndoProsthesis Flexion Extension) was developed. In the simulator, the various hemiendoprosthetic heads are placed on a special cone and tested against a cadaver acetabulum cast in MCP 47 woodmetal. The plane of movement of the apparatus is uniaxial with a flexion-extension movement of ± 35 degrees. The force is produced pneumatically with amounts of up to 5 kN. Newborn calf serum serves as a lubricant. A PC collects the data from torque-, force-, and angle-sensors on-line and allows the simultaneous processing and visualization of the data. The frictional coefficients produced by the different head materials and the relevance of the play between the hemiendoprothesis head size and acetabulum can be determined. Preliminary results showed that the mean friction coefficient at 1 kN loading was μ=0.024–0.063 for ceramic against cartilage and μ=0.033–0.075 for metal against cartilage.
The Optimal Depth for Femoral Cement Insertion in Total Hip Replacement. An Anatomical and Clinical Study into Cementing Technique in the Proximal Femur
Authors: Owers K.L. , Leaver A.A. , Bannister G.C.
Published: January 2018

In retrograde cementing, blood often rises proximally on the surface of injected cement. This blood contamination weakens the cement-bone interface. The major source of bleeding into the proximal femoral medullary canal is the severed nutrient artery.

The aims of this study were to define the clinically relevant anatomy of the nutrient artery supplying the proximal femur and establish the optimum depth of cement insertion to minimise blood contamination.

Sixty cadaveric femora were radiographed with a wire placed in the nutrient foramen to assess the distance from the tip of the greater trochanter to its entry into the proximal femoral medullary canal. The nutrient artery entered the medullary canal at an average of 13.9 cm from the tip of the greater trochanter and never more proximal than 10.3cm.

In 30 patients undergoing primary total hip replacement, cement was inserted retrogradely at 7.5cm, 10 cm or 15 cm from the tip of the greater trochanter and blood contamination recorded. There was blood in significantly fewer cases when cement was inserted at 10cm.

Cement insertion 10cm distal to the tip of the greater trochanter appears to occlude the bleeding nutrient artery and should give a stronger proximal cement-bone interface.
A Proximal Referencing System for the Charnley Low Friction Arthroplasty
Authors: Fletcher M.D.A. , Webb J.C.J. , Maung T.
Published: January 2018

Dislocation is a serious complication of total hip arthroplasty occurring in up to 9% of cases. Recurrent dislocation accounts for 4% of revisions in the Swedish Hip Arthroplasty Study. Soft tissue balancing is one of the factors, independent of the surgical approach used, that is involved in producing a stable total hip replacement. We describe a proximal referencing system for use with the Charnley low friction arthrosplasty (LFA), which optimises this factor. The dislocation rate, using this method, is 0.3% (in 333 cases performed by a single surgeon over a 5 year period). This system should prove valuable to orthopaedic surgeons in training, ensuring they achieve correct soft tissue balance in total hip arthroplasty.
Growth and Remodelling of the Dysplastic Hip after Conservative Reduction in Congenital Dislocation
Authors: Wierusz-Kozłowska M. , łempicki A. , Kruczyński J.
Published: January 2018

This study presents the development and remodelling of 78 dysplastic hips treated conservatively The hip joints were observed from the end of conservative treatment, during growth until maturity, up to the age of 18 years and beyond.

We used 9 radiological parameters of hip structure. The parameters described the status of the acetabulum, proximal end of the femur and the joint congruity. The values of these parameters were compared with the norms established for healthy hips. The material was divided into groups with regard to the parameter values.

It was found that hip congruity at the age from 2 to 5 years or from 2 to 7 years is the most important factor that determines the development of both the acetabulum and the whole joint. Based on the values of three radiological parameters, describing hip congruity at this period of life, it was found that the remodelling of a dysplastic hip follows one of three definable models. If we attribute the development of a given hip to a given model, then the status of this hip at maturity is predictable. What makes the prediction of the final condition of the hip feasible is the observation of the hip remodelling process from age 2 to 5 or 7 years.

This also permits a decision regarding surgery to eliminate any dysplastic elements from the hip during the child's optimal age for operative treatment.
Safety and Efficacy of Intra-Articular Injection of the Hip
Authors: Waseem M. , Sadiq S. , Gambhir A.K. , Lim J. , Maxwell S. , Bamford D.J.
Published: January 2018

The aim of the present study was twofold: a) to establish the therapeutic efficacy of the hip injection with marcaine and steroid; (b) to establish the safety of the procedure with respect to possible bacterial contamination at the time of passage of needle into the hip joint. Thirty-five patients with osteoarthritis of the hip were injected. All patients were admitted as day cases and the procedure was performed in a laminar flow theatre under full aseptic conditions. The hip was aspirated before injection. Aspirate and injecting needles were sent for microbiological examination. Both aerobic and anaerobic cultures were performed.

All patients were followed up for three months after hip injection. Microbiology results were not revealed to reviewing clinicians. All patients were reviewed at two weeks and at twelve weeks.

Thirty-three patients (94.3%) had no growth in the samples. Two cases out of thirty-five hips had a positive culture but none of the patients went on to develop clinical sepsis. Patient response for pain in the hip was graded using a 10 point visual analogue scale (VAS) with 10 point as maximum pain and 0 points as no pain. Pre-injection the patient VAS for pain was a mean value of 6.4 ±0.77 (median, 6). The mean value of VAS score at 2 weeks dropped to 2.6 ±2.7 with median of 2. This difference was highly significant (p=0.003). At 12 weeks mean VAS score was 2.7 ± 2.5 with median value of 2 (p=001). Three patients were worse after the injection.

We found the hip injection to be safe. The risk of bacterial contamination is low provided a strict aseptic protocol is observed. In this study, one third of the patients had excellent pain relief for 3 months after the injection but in two thirds of cases it failed to provide complete, long-term pain relief (> 3 months).
The Importance of the Thickness of the Femoral Cement Mantle
Authors: Harris W.H.
Published: January 2018

The importance of mantle thickness in the long-term survival of cemented femoral components remains controversial. One complexity in evaluating mantle thickness alone is the dominating fact that so many other factors can influence the incidence of failure.

Nonetheless, a cement grading system has been applied to the assessment of the intermediate and long-term follow-up series of the following cemented femoral stem designs HD-2 (Howmedica, Rutherford, NJ), CAD (Howmedica, Rutherford, NJ), Precoat (Zimmer, Warsaw, IN), Iowa (Zimmer, Warsaw, IN), Ti32 (Zimmer, Warsaw, IN), and DF80 (Zimmer, Warsaw, IN). In each series, a statistically significant increased risk of failure was found in those cases with cement mantles that were thin or deficient. While these data do not mean that all such cases fail, the data strongly support the concept of avoiding such deficiencies in the cement mantle of these stem designs.
A New Approach for Improving the Prediction of Femoral Neck Fracture
Authors: Testi D. , Cappello A. , Sgallari F. , Rumpf M. , Traina F. , Viceconti M.
Published: January 2018

Femoral neck fractures are an important clinical, social, and economical issue. Much effort has been made to improve the accuracy of prediction of fracture risk. However, at present the DEXA standard clinical protocol achieves an accuracy of about 65% in retrospective studies. A new procedure for prediction was developed including not only bone mineral density but also geometric and femoral bone strength information. The retrospective clinical validation has shown an improved accuracy to 80% in classifying 200 patients. The procedure has been employed in efficient, repeatable, and easy to use software for evaluation of femoral neck fracture risk. The software characteristics make it suitable for use in daily clinical practice, providing a useful tool for the improvement of femoral neck fracture prediction.
An Unusual Cause of Common Peroneal Nerve Palsy following Total Hip Arthroplasty: A Case Report
Authors: Hancock N.J. , Latimer P. , Learmonth I.D.
Published: January 2018

An unusual cause of an ipsilateral common peroneal nerve palsy, at the level of the fibula head following left total hip arthroplasty (THA), in a 48-year-old female patient is reported. The complication occurred suddenly on the fifth postoperative day as a result of compression from the securing strap of the Charnley abduction pillow. To our knowledge this well recognised complication of hip surgery has not previously been attributed to this cause. This report emphasises the vigilance that is needed to be aware of the many potential causes of nerve palsy so that this complication can be avoided.
Metallurgical considerations in the wear of metal-on-metal hip bearings
Authors: Nevelos J. , Shelton J.C. , Fisher J.
Published: January 2018

Metal-on-metal bearings offer one possible solution to problems of osteolysis associated with ultra high molecular weight polyethylene (UHMWPE) wear debris generated during articulation in total joint replacements. Designs using larger bearing diameters are also possible with associated improvements in both range of motion and stability. There has been considerable debate as to the optimum metallurgical structure of the cobalt chrome alloys used in these metal-on-metal bearings. This review addresses the main metallurgical design issues in metal-on-metal bearing design and reviews some recent studies from two independent academic centres.

Cobalt chrome alloys with a low carbon content, when paired against themselves, have been shown to have poor wear properties under both simple configuration and simulator testing. Other cobalt chrome alloy couples with higher carbon content, whether wrought, cast or cast and heat-treated, appear to have similar performance in clinically relevant wear simulation studies.
The Incidence, Location and Distribution of Degenerative Subchondral Acetabular Cysts in Primary Osteoarthrosis of the Hip
Authors: Rees R.J. , Hill S.O. , Cassar-Pullicino V. , Cool P.
Published: January 2018

Degenerative subchondral acetabular cysts are a common finding in patients with primary osteoarthritis of the hip. These mainly occur in the superior weight-bearing region of the acetabulum. The aim of this study was to identify the presence and distribution of degenerative acetabular cysts in patients with primary osteoarthritis of the hip. The radiographs of 100 consecutive patients who had a total hip replacement for primary osteoarthritis of the hip were retrospectively analyzed. Eighty-two patients had degenerative subchondral cysts. Of these 44% were solitary. All the cysts occupied the superior zone of the acetabulum with a proportion extending into the middle zone. None involved the inferior zone, the medial acetabular wall. The radiological presence of an acetabular cyst in the inferior zone (medial acetabular wall) warrants further investigation, and should not be presumed to represent a feature of osteoarthritis, even if osteoarthritis is present.
Occult Fractures of the Femoral Head in Children
Authors: Martinez-Serrano A. , Gonzalez-Lopez J.L. , Riquelme-Garcia O. , Cubillo-Martin A.
Published: January 2018

Occult fractures of the hip are rare; they are almost absent from published medical literature and the studies that are reported concern fractures in the elderly population. In this paper the cases of two children, nine and 16 years old are presented who suffered occult fractures of the femoral head during high-energy traumatisms. Conventional X-ray did not reveal bone lesions, although it did show a discrete eccentration of the cephalic nucleus and the diagnosis was delayed until more specific image techniques were applied: bone scanning with Tc99, CT and MRI, revealed fracture from compression in Case 1 and osteochondral fracture in Case 2. The treatment consisted of non-weight-bearing of the joint in the first case and removal of the fragment by arthroscopy in the second. The outcome was good in both patients who had no pain in the hip and complete mobility one year later.
Spontaneous Bilateral Femoral Neck Fracture due to Osteomalacia
Authors: Porcel M.T. , Alejandro I.F. , Quiles M.
Published: January 2018

An 85-year-old woman presented with spontaneous and simultaneous displaced bilateral fracture of the femoral neck. She suffered from nutritional osteomalacia and had had poor exposure to sunlight. Both hips were replaced at the same time by partial hip arthroplasty.
A Useful Technique for the Management of Pelvic Discontinuity in Revision Hip Surgery
Authors: Farooq M.A. , Brady O.H.
Published: January 2018

Pelvic discontinuity is a distinct form of bone loss occurring in association with total hip arthroplasty. The mechanically stable environment, which is prerequisite for successful graft incorporation, cannot be achieved with routine acetabular fixation techniques. A ring made from pelvic reconstruction plate, which is fixed to ilium, ischium and pubis from within the acetabulum, when combined with medial wall mesh cage and impaction bone grafting, not only allows excellent fixation of the pelvic discontinuity but also allows recreation of acetabular bone stock. This versatile technique provides a fundamentally stable construct because of fixation into all three bones of the pelvis.
Medium-Term DEXA Analysis of an Uncemented Femoral Component
Authors: Ahrens P.M. , Gibbons C.E.R. , Peace K.A.L. , Healy J.C. , Scott J.E.
Published: January 2018

We investigated the bone remodelling around the AML uncemented femoral component using DEXA analysis and plain radiography in 19 patients at a mean of 89 months from operation. All patients had previously been analysed at a mean of 32 months after surgery. We found a decrease in bone mineral density around the AML implant between the two scans in Gruen zones 1,2 and 6 of up to 8%, but an increase in zones 4,5 and 7 of up to 36%. The increase in zones 4 and 5 were statistically significant (P<0.05). The relative difference between the operated and unoperated hips also showed a reduction in the bone density ratio with time, except in zones 4 and 5 where an increase was seen.

We confirm the results of previous studies of proximal stress shielding and distal loading around the AML implant and demonstrate that bone remodelling continues in the medium term.
The Uncemented CLS Expansion Cup as a Component of a Hybrid System in Primary Total Hip Arthroplasty: A Prospective Study
Authors: Dayican A. , Unal V. , Ozkan G. , Portakal S. , Tumoz M.A.
Published: January 2018

The purpose of this prospective study is to present the results of 160 primary total hip replacements in 145 patients with a hybrid system composed of the uncemented CLS expansion cup and the cemented MS-30 femoral component. Included in this study were 109 women and 36 men with the mean age of 64.2 years (range 25 to 87) at the time of the surgery. The mean follow-up time was 7.5 years (range 6 to 12). The Harris Hip Score and radiographic analyses were used for the most recent assessment. Five patients died during the follow-up period. Two hips were dislocated and managed by open reduction. The mean Harris Hip Score before surgery was 38.4 (range 15 to 57) and 91.3 (range 64 to 100) at the last follow-up. Although a radiolucent line has been detected around the femoral component in four hips, no revision has been considered yet. No radiological evidence of loosening and detectable migration have been observed in any of the acetabular components. The hybrid replacement, consisting of the uncemented acetabular CLS expansion cup and the cemented MS-30 femoral stem, yielded overall good results after medium-term duration of follow-up.
Late Small Intestine Perforation after Cementless Total Hip Arthroplasty
Authors: Naito Yohei , Hasegawa Masahiro , Sudo Akihiro , Uchida Atsumasa
Published: January 2018

We report a case of late small intestine perforation by an acetabular cup fixation screw after total hip arthroplasty (THA). A 79-year-old-woman underwent THA for hip osteoarthritis 13 years previously at another hospital. Although the acetabular cup fixation screw protruded into the pelvis, she had no symptoms. She later presented with peritonitis and was admitted to the hospital and prescribed antibiotic therapy. Computed tomography showed that the screw was adjacent to the intestine and was the likely cause of her peritonitis. After the peritonitis healed, she was referred to our hospital for surgical treatment of the screw. During laparotomy, we performed a resection of the intra-pelvic portion of the screw. The screw perforated the small intestine, so a small intestinal resection was also performed. The patient had an uneventful recovery.
Unusual Case of Osteosynthesis Failure in a Hip Fracture: Side-Plate Pull-Out
Authors: Seijas Roberto , Orduña Juan Manuel , Castro Maria Concepción , Baliarda Jordi , Granados Nuria , Alcántara Emili
Published: January 2018

Osteoporotic hip fractures are common in our setting. Poor bone quality favors complications of the osteosynthesis procedures used to treat these patients. Lag-screw cut-out through the femoral head is not uncommon (2%), but pull-out of side plate screws is very unusual. We present the case of a patient with a stable osteoporotic fracture treated by osteosynthesis using a four-hole plate, who presented with a pull-out following a low-energy fall.
Septic Arthritis of the Hip – Current Concepts
Authors: Rutz E. , Brunner R.
Published: January 2018

Septic arthritis of the hip is the commonest septic condition during growth, reaching a distinct peak in frequency during infancy. The aetiology is a haematogenous joint infection. Indicative signs are severe pain when moving the joint, septic appearance and a poor general condition of these small and young patients. The diagnosis often can be difficult in infants since septic temperatures are not always present. An ultrasound scan shows the hip joint effusion and the capsular distension. X-ray investigation helps to exclude defective situations. Therapeutic options are: in patients with short history without radiologically visible complications we recommend repeated arthroscopic irrigation and in patients with long history and a radiologically visible defect of the femoral head or dislocation we recommend arthrotomy and open revision or reduction of the hip joint.
Slipped Upper Femoral Epiphysis (SUFE): To do or not to do in sufe
Authors: Pelillo F. , De Sanctis N. , Benazzo F. , Portinaro N.
Published: January 2018

Slipped upper femoral epiphysis (SUFE) is not an uncommon hip disease in adolescence. Usually, diagnosis of SUFE is delayed, has high risk of sequela and poor long-term results. This paper reviews the literature with a focus on epidemiology, aetiology, diagnosis, treatment and results regarding SUFE.
The Hip in Osteochondrodysplasias: General Rules for Diagnosis and Treatment
Authors: Sheridan B. D. , Gargan M. F. , Monsell F. P.
Published: January 2018

The management of hip pathology in osteochondrodysplasia (skeletal dysplasia) is complex and a multidisciplinary approach is vital. Thorough clinical assessment and knowledge of the natural history of the different disorders provides the basis for this.
Osteochondritis Dissecans of the Femoral Head
Authors: Siebenrock Klaus A. , Powell James N. , Ganz Reinhold
Published: January 2018

Seven patients with symptomatic osteochondritic lesions of the femoral head are presented. All were male with a mean age of 26 years (16 – 33 years). Two distinct morphologic appearances of the hip joint could be identified. Five patients presented with a coxa valga deformity, four of whom had signs of epiphyseal dysplasia. There were 2 patients whose hips appeared normal apart from the osteochondrontic lesions. In both cases an additional acetabular rim lesion due to a reproducible femoro-acetabular impingement was diagnosed at arthrotomy. This may have acted as the underlying cause of osteochondritis dissecans in these cases.

All 7 patients underwent surgical treatment. An intertrochanteric osteotomy (I.O.) alone was performed in 2 patients. Follow-up of these patients at 6.5 and 8.5 years after surgery revealed that the osteochondritic lesions had not healed and one individual remained symptomatic. In the remaining 5 patients, treatment consisted of femoral head dislocation and screw fixation of the osteochondritic lesion. This was combined with an I.O. in two of these patients for coxa valga and osteoplasty of a broad femoral neck in 2 other patients. All lesions had healed at an average follow-up of 4.3 years (2 – 8.5 years). Three patients were asymptomatic and 2 patients had minor residual pain. No progressive osteoarthritic changes or signs of avascular necrosis of the femoral head were observed.
Traumatic Hip Dislocation in Childhood
Authors: Coll Guillem Figueras , Del Rio Laura Torrededia , Nuño Laura Garcia , Burniol Jaume Roca , Carol Ramon Huguet
Published: January 2018

We report the outcome of closed reduction of traumatic hip dislocation in 28 children younger than 16 years of age (average age, 8 years 10 months). At an average follow-up of 8 years and 10 months (range, 2 years – 42 years), 18 patients were asymptomatic and enjoying a normal life, and some of them returned to practice sport activities. The remainder had complications related to associated injuries. There were no cases of avascular necrosis of the femoral head during follow-up. The majority of dislocations were attributable to low energy injuries in children younger than 10 years of age. Traumatic hip dislocation in children is uncommon. Management after reduction is not clearly defined in the literature. It is important to perform reduction as soon as possible to avoid later avascular necrosis.
Osteoprogenitor cell adhesiveness to a titanium mesh. A clinically relevant hypothesis for revision surgery in hip replacement
Authors: Cano Juan R. , Santos-Ruiz Leonor , Guerado Enrique , Becerra Jose
Published: January 2018

Bone defects are a major problem in primary and, even worse, revision surgery of the hip. Impacted allograft contained by a metallic mesh has been used for bone reconstruction. However, since allograft has been claimed to reabsorb, and to provoke immunogenic responses with potential viral infection and loosening because of allograft and mesh interface, new bone substitutes are being searched for. In this study we have cultured committed osteoprogenitor cells within a titanium mesh. The cells not only multiplied very easily, but also adhered to the mesh surface. We believe this phenomenon may have great clinical relevance for cell therapy as an alternative to allograft for the treatment of bone defects in acetabular or femoral reconstruction in revision surgery of the hip.
Two-stage revision of hip prosthesis infection using a hip spacer with stabilising proximal cementation
Authors: Gonzalez Sergi Gil , López Fernando Marqués , Ramon Pau Rigol , Cortadellas Carlos Mestre , Palou Enric Cáceres , García Alfonso León
Published: January 2018

Two-stage revision hip arthroplasty for infection using an antibiotic-loaded cement spacer has been used frequently with good results. However, spacer instability is also frequent. Proximal cementation of the spacer could avoid spacer dislocation. We retrospectively assessed 35 patients in whom a 2-stage revision hip arthroplasty for infection was carried out using an antibiotic-loaded cement spacer with gentamicin (Spacer-G) in which the spacer was proximally cemented in 16 patients. The mean follow-up was 32 months. We assessed spacer stability and infection elimination. There were 8 spacer dislocations (22.9%), 5 in hips without proximal cementation and 2 in hips with proximal cementation (p>0.05). There was no fracture in any hip. Reinfection occurred in 5 hips (14.3%), in 3 with the same microorganism, while 2 had a different microorganism. Our results indicate that the proximal cementation of the spacer prevents its dislocation. Infection was eliminated in 86% of the hips.
Central Venous Disease in Hemodialysis Patients: Prevalence, Etiology and Treatment
Authors: Kundu Sanjoy
Published: January 2018

A common problem in the management of hemodialysis patients is central venous occlusive disease. There has been extensive literature on the treatment of this important and prevalent problem. Treatment options to date include percutaneous balloon angioplasty, bare metal stents and surgical bypass. Unfortunately, all the available treatment options have poor long-term patency, requiring repetitive intervention. More recently, covered stents have been mentioned in the literature for the treatment of central venous stenosis and obstruction. There is very little data to date on this technology, and further randomized controlled trials will be needed to compare the efficacy of percutaneous balloon angioplasty, bare metal stents and covered stents. It appears prevention of this difficult problem is paramount, by limiting venous access or intervention of the central venous system.
Arteriovenous Fistulas Constructed Using Side-to-Side Anastomosis with Ligation and Division of Distal Venous Arm; A Tertiary Care Hospital Experience
Authors: Ahsan Zafar-UI , Waheed Abdul , Zaeem Faisal A. , Nazir Farzana
Published: January 2018

Background and Objective

The rising prevalence of end-stage renal disease has added to the demands of renal replacement therapy in the form of hemodialysis (Hd) in lieu of unmitigated needs of renal transplants. The best available angioaccess for HD is the autogenous arteriovenous fistula. Many techniques for arteriovenous anastomosis have been reported, but there is dearth of data which study the side-to-side arteriovenous anastomosis with concomitant ligation and division of the distal venous arm. This study aimed to describe the clinical outcome of the fistulae constructed with this particular technique.

Methods

It is a descriptive and retrospective review in which all patients who underwent the operation with this particular technique in a certain time period were included. The data entry and analysis was done using SPSS 15. Only descriptive statistics are used. Demographic details, primary patency, end point patency and fistula survival were calculated.

Results

There were 77 patients, 61 males and 16 females. Radiocephalic arteriovenous anastomosis was constructed in 65 patients, brachiocephalic in 11 patients and brachiobasilic in one patient. Primary patency was 96.1% and end point patency was 90.9% with a median survival of 44 weeks at the end point.

Conclusion

This particular technique of fistula construction has excellent patency rates, fistula survival and lesser complications when compared to what has been reported for other methods. It is therefore recommended that the technique of angioaccess reported in this study may be considered as a first option.
Cephalic Arch Stenosis in Autogenous Brachiocephalic Hemodialysis Fistulas: Results of Cutting Balloon Angioplasty
Authors: Heerwagen Søren T. , Lönn Lars , Schroeder Torben V. , Hansen Marc A.
Published: January 2018

Purpose

Cephalic arch stenosis is a known cause of hemodialysis access failure in patients with brachiocephalic fistulas (BCFs). Outcomes of endovascular treatment are affected by resistance of the stenosis to balloon dilation, a high vein rupture rate and the development of early restenosis. The purpose of this retrospective study was to report outcomes after cutting balloon angioplasty (CBA) of cephalic arch stenosis.

Methods

In our vascular access database we identified 74 dysfunctional BcFs of which 30 (41%) were caused by cephalic arch stenosis. Seventeen fistulas in 17 patients (13 males and four females; median age 62 yrs; range 52–86) were treated with CBA (June 2005 to January 2008). Twenty-five procedures were performed. In 15 procedures, a cutting balloon was used alone and in 10 procedures CBA was followed by standard or high-pressure balloon angioplasty. Restenosis rates were calculated and patency rates were estimated with the Kaplan-Meier method.

Results

Primary patency rates (±SEE) at 3, 6, 12 and 15 months were 94% (±6%), 81% (±10%), 38% (±14%) and 22% (±15%), respectively. Assisted primary patency rates (±SEE) at the same intervals were 100% (±0%), 94% (±6%), 77% (±12%) and 63% (±13%), respectively. The mean interval between radiological interventions was 13 months (SD=8) and the mean number of interventions required per patient-year of dialysis was 0.9.

Conclusion

Treatment of cephalic arch stenosis with CBA did not improve patency compared to published results of conventional PTA, but our results indicate that CBA may lower the frequency of required re-interventions.
Vascular Access Challenge on a Patient with Cerebral Palsy and Severe Kyphoscoliosis
Authors: Leung sharon , Malhotra Amit D. , Eisen Lewis A.
Published: January 2018

We report a case of vascular assess challenge on a patient with severe kyphoscoliosis and joint contractures. Multiple internal jugular (IJ) central venous catheters (CVC) and a peripherally inserted central catheter (PICC) catheterization were attempted via ultrasound guidance and all resulted in malposition. The PICC attempt fortuitously pushed a malpositioned IJ into the correct position. Computed tomography (CT) demonstrated a narrow thoracic inlet with no definite venous stenoses. Therefore, severe chest wall deformity, a narrow thoracic inlet and inadequate positioning of the patient secondary to his contractures all contributed to the malposition of the PICC and CVCs.