bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changes in Visual Acuity and Refraction in the Exfoliation Syndrome. A Five-Year Follow-up Study
Authors: Puska P.M. , Tarkkanen A.H.A. 
Published: January 2018

Purpose To examine changes in visual acuity (VA) and refraction in non-glaucomatous patients with unilateral exfoliation syndrome (EXS). Methods The best corrected values for VA (Snellen acuity cards) subjectively adjusted for refraction, and IOP were measured, and the development of lens opacities was examined in 46 non-glaucomatous patients with unilateral EXS. Results After five years the rate of conversion to bilateral exfoliation was 22% and to exfoliative glaucoma 30%. There was a significant decrease in VA in the exfoliative (E) eyes (median; QI, QIII, range: 1; 0.8, 1, 0.4-1.3 vs. 0.55; 0.4, 1, 0.05-1.4, p<0.0001) and the fellow, initially non-exfoliative (NE), eyes (1; 0.9, 1, 0.3–1.3 vs. 0.7; 0.5, 0.9, 0.1–1.4, p<0.0001) and a significant myopic change in refraction in the E eyes (+1.02 ± 2.48 vs. +0.11 ± 3.06, p=0.0001) and the NE eyes (+0.99 ± 2.25 vs. +0.43 ± 2.55 D, p<0.01). At study entry the difference in refraction between the fellow eyes (refraction in the NE eye – refraction in the E eye) was −0.27 ± 1.00D. After five years it was +0.32 ± 1.44 (p 0.016), reflecting greater myopic changes in the E eyes. The main type of lens opacification was nuclear sclerosis. Conclusions In five years, significant decreases in VA and myopic shifts in refraction occurred in the E and fellow eyes. The E eyes showed significantly greater myopic changes than the fellow eyes; the cause was clearly nuclear sclerosis, which must be taken into account in the long-term management of patients with EXS.
Is the Birmingham Hip Resurfacing Worthwhile?
Authors: Pollard T.C.B. , Basu C. , Ainsworth R. , Lai W. , Bannister G.C. 
Published: January 2018

The highest failure rates of cemented hip replacement are in males under 50 years of age, usually from acetabular loosening and polyethylene wear. The metal-on-metal Birmingham Resurfacing offers potential advantages to this group because of its wear properties. It also has a low dislocation rate and consequently less restricted activity. The aim of this study was to compare early outcome in young patients, treated for osteoarthritis, either by the Birmingham Resurfacing or hybrid cemented stem with an uncemented cup and press-fit polyethylene liner. 54 patients in each arm were matched for age, sex, body mass index, and pre-operative activity. Outcome was measured by the Oxford Hip Score, with supplementary questions about sporting activity and manual work. 37% of hybrid hip replacements undertook sport or heavy manual work despite specific instruction to the contrary. The Birmingham Resurfacings scored significantly better than the hybrid hip replacements (Mean 3.4 points, 1.3–5.5, 95% Confidence Interval, p<0.05.). Age and duration of symptoms pre-operatively were associated with outcome in the resurfacing group. In the early stages there appears to be justification for using the Birmingham Resurfacing in active young patients. Only long-term follow-up will indicate whether metallosis and neck fracture are lesser complications than polyethylene wear and whether activity can be maintained.
Resurfacing Hip Replacement - An Audit of Activity in the United Kingdom 2002–2003
Authors: White S. P. , Beard D.J. , Smith E. J. 
Published: January 2018

The level of use of resurfacing hip replacement (RHR) and specific training undertaken was previously unknown in the United Kingdom. Consultant orthopaedic surgeons were audited by postal questionnaire regarding their RHR activity, training undertaken and evidence of specialisation in hip arthroplasty. Results 19% of surgeons had performed RHR in the previous 12 months. 33% of revision hip surgeons had performed RHR. The majority of consultants performed 6–10 cases per year. 73% performed less than 20 cases per year. For training, 30% had observed RHR surgery and 23% had attended a formal course. 7.8% of those performing RHR had neither been on a course nor observed surgery. Both British Hip Society membership and the completion of a hip fellowship were associated with the frequency of RHR. Those who had completed previous hip fellowship or were BHS members performed significantly more RHR. Conclusions RHR is currently performed by specialists. The level of use is increasing rapidly and the standard of implantation needs to be safeguarded in order to ensure that the current successful short term results are maintained in the long term. Given the steep learning curve, the lack of long-term outcome and concerns regarding metal-on-metal bearings, we believe that the implant should continue to be used in accordance with NICE guidelines and that implantation should be performed by surgeons with a specialist interest in hip arthroplasty and specific training.
Short-Term Results of Hemi-Resurfacing for Osteonecrosis of the Femoral Head
Authors: Calder P.R. , Hynes M.C. , Scott G. 
Published: January 2018

Published evidence has supported the use of femoral head resurfacing for patients with osteonecrosis of the femoral head. Between June 1999 and April 2001 we prospectively studied 15 femoral heads resurfaced in 12 patients with the Conserve Resurfacing Hemiarthroplasty. The male to female ratio was 8:4 and the mean age 38.7 years (range 26–60). The mean follow-up was 22.8 months (range 4–36). The senior author performed all procedures. There was one case of Ficat stage II, 9 cases of stage III and 5 cases of early stage IV. The mean time from onset of symptoms to surgery was 33.5 months (range 9–60). There were no intra or post-operative complications associated with any of the hemiarthroplasty procedures. Results Nine of the fifteen patients had a poor result that warranted revision surgery within two years of prosthesis implantation. We conclude that in our hands the results of femoral resurfacing hemiarthroplasty are unpredictable and advise caution when recommending the procedure to patients with osteonecrosis of the femoral head.
Hip Resurfacing through a Modified Anterolateral Approach, as Compared with the Ganz Trochanteric Flip Osteotomy: A Two Year follow-up Study
Authors: Khan Rashid M. , Cooper Gillian , Hull Jonathan B. 
Published: January 2018

Hip resurfacing arthroplasty has conventionally been undertaken through the posterior approach. There has been evidence in the recently published literature to suggest that the posterior approach may compromise the blood supply to the femoral head, by disruption of the posterolateral hip capsule. Ganz et al have proposed the trochanteric ‘flip’ osteotomy through a lateral approach, to permit surgical dislocation of the hip without damaging the blood supply. The disadvantages, however, are that early full weight bearing is not permitted and there is an incidence of trochanteric delayed or non-union, which may require further treatment. We describe a technique of hip resurfacing through a modified anterolateral approach preserving the posterolateral capsular blood supply. We describe our experience using this approach, and compare the results with our previously used Ganz trochanteric osteotomy. At a mean follow-up of two years, the outcome scores were not significantly different, and both groups had similar abductor strength. There were two cases of delayed union in the Ganz group, one of which required revision; there were no complications in the modified anterolateral group.
Surgical Repair of Chronic Tears of the Hip Abductor Mechanism
Authors: Davies Hywel , Zhaeentan Sohelia , Tavakkolizadeh Adel , Janes Gregory 
Published: January 2018

Lateral sided hip pain frequently presents to the orthopaedic clinic. The most common cause of this pain is trochanteric bursitis. This usually improves with conservative treatment. In a few cases it doesn't settle and warrants further investigation and treatment. We present a series of 28 patients who underwent MRI scanning for such pain, 16 were found to have a tear of their abductors. All 16 underwent surgical repair using multiple soft tissue anchors inserted into the greater trochanter of the hip to reattach the abductors. There were 15 females and 1 male. All patients completed a self-administered questionnaire pre-operatively and 1 year post-operatively. Data collected included: A visual analogue score for hip pain, Charnley modification of the Merle D'Aubigne and Postel hip score, Oxford hip score, Kuhfuss score of Trendelenburg and SF36 scores. Of the 16 patients who underwent surgery 5 had a failure of surgical treatment. There were 4 re ruptures, 3 of which were revised and 1 deep infection which required debridement. In the remaining 11 patients there were statistically significant improvements in hip symptoms. The mean change in visual analogue score was 5 out of 10 (p=0.0024) The mean change of oxford hip score was 20.5 (p=0.00085). The mean improvement in SF-36 PCS was 8.5 (P=0.0020) and MCS 13.7 (P=0.134). 6 patients who had a Trendelenburg gait pre-surgery had normal gait 1 year following surgery. We conclude that hip abductor mechanism tear is a frequent cause of recalcitrant trochanteric pain that should be further investigated with MRI scanning. Surgical repair is a successful operation for reduction of pain and improvement of function. However there is a relatively high failure rate.
Is there an Association between Epiphyseal Scar and Osteonecrosis of the Femoral Head?
Authors: Huang Guo-Shu , Lee Herng-Sheng , Yao Min-Szu , Chan Wing P. 
Published: January 2018

Purpose To investigate statistical association between epiphyseal scar and osteonecrosis of the femoral head (ONFH) with magnetic resonance (MR) imaging. Patients and Methods: We retrospectively reviewed 71 consecutive patients who underwent MR imaging of bilateral hips that showed nontraumatic ONFH. There were 110 hips with ONFH and 31 normal hips; one hip received bipolar arthroplasty before the MR studies. All cases of ONFH had typical MR findings. The epiphyseal scars in the femoral head were classified as type I (a sealed-off scar) or type II (a perforated scar). Bone marrow edema, if present, in the proximal femur was identified on coronal T2-weighted or STIR MR images. Results The type of femoral epiphyseal scar was clearly delineated in 97 hips. In cases with ONFH, a type I scar occurred in 46 hips (64%), and a type II scar in 26 hips (36%). In cases of ONFH with bone marrow edema, 69% of hips (24/35) had a type I scar and 31% of hips (11/35) had a type II scar. There was no statistical association between the type of epiphyseal scar and ONFH, regardless of staging (P=0.29), or the type of scar and bone marrow edema (P=0.42). Conclusion There is not a significant statistical association between a sealed-off scar and ONFH.
Proximal Focal Femoral Deficiency (PFFD): Management Options and Controversies
Authors: Westberry D.E. , Davids J.R. 
Published: January 2018

Proximal focal femoral deficiency (PFFD) is a rare congenital anomaly characterised by failure of normal development of the proximal femur and hip joint. Significant variability in the clinical presentation and degree of deficiency is common. Current management strategies aimed at improving functional ambulation are largely dependent on the degree of femoral shortening and the status of the hip and knee joint. Treatment of acetabular deficiency and proximal femoral deformity in cases of PFFD must be individualised. Reconstruction of the hip joint with pelvic and femoral osteotomies may be possible in mild cases of PFFD. Stability of the hip and knee joint must be achieved prior to consideration for limb lengthening strategies. Severe cases of PFFD may be beyond surgical correction and warrant alternative strategies such as rotationplasty or selective amputation to facilitate prosthetic fitting.
Tumours and Tumour-Like Lesions of the Hip in the Paediatric Age: A Review of the Rizzoli Experience
Authors: Ruggieri P. , Angelini A. , Montalti M. , Pala E. , Calabró T. , Ussia G. , Abati C.N. , Mercuri M. 
Published: January 2018

Bone tumours and tumour-like lesions of the hip in children are rare. Signs and symptoms of these tumours are generally nonspecific. Delay of diagnosis is not uncommon. A high index of suspicion in young patients presenting with persistent pain and without history of trauma, that is unresolved with conservative therapy should prompt further investigation, including radiographs or computed tomography scan of the pelvis. In the experience of the Istituto Rizzoli, in patients less than 14 years (mean 9 years, ranged from 6 months to 14 years), 752 tumours and tumours-like lesions occurred in the pelvis or proximal femur, involving the hip. Tumour-like lesions accounted for 322 cases (simple bone cyst in 255, eosinophilic granuloma in 43, aneurismal bone cyst in 34), benign tumours for 340 cases (osteoid osteoma in 229, fibrous dysplasia in 63, exostosis in 48) and malignant tumours for 80 cases (Ewing's sarcoma in 53 and osteosarcoma in 27). The epidemiology, pathology, clinical presentation, and radiograph findings are discussed for each of these tumours. Treatment of these tumours differs from observation or minimally invasive treatment for most pseudo-tumoural lesions, intralesional excision or termoablation for benign bone tumours and wide resection for malignant bone tumours. In this latter group, chemotherapy is required and often administered pre- and postoperatively.
In Vivo Polyethylene Wear of Bilateral Total Hip Replacements - Cemented versus Uncemented Modular Sockets
Authors: Kampa Rebecca J. , Hacker Andrew , Griffiths Emmett , Rosson John W. 
Published: January 2018

We assessed polyethylene wear and osteolysis in 15 patients (30 hips) undergoing staged bilateral total hip arthroplasties, who had a cemented arthroplasty on one side and a hybrid arthroplasty on the other. All factors apart from mode of acetabular component fixation were matched. Wear was measured radiographically using Livermore's technique. The mean clinical and radiological follow-up was 11.2 years for the cemented and 10.7 years for the hybrid arthroplasties. Mean annual linear wear rate was 0.09mm/year in the cemented sockets and 0.14mm/year in the uncemented sockets. This difference was statistically significant (p=0.03), confirming previous reports that the rate of polyethylene wear is increased in uncemented sockets. No periacetabular osteolysis was noted. Femoral osteolysis in zone 7 occurred in 3 hybrid arthroplasties. It appears not all patients are equally affected. These results are further discussed.
Correlation of Technetium-99m Scintigraphy, Progressive Acetabular Osteolysis and Acetabular Component Loosening in Total Hip Arthroplasty
Authors: Geerdink Carel H. , Grimm Bernd , Rahmy Ali I. A. , Vencken Wendy , Heyligers Ide C. , Tonino Alphons J. 
Published: January 2018

In total hip arthroplasty (THA) Technetium scintigraphy can help to diagnose a loose implant by detecting elevated osteoblastic activity. It has been used for timing the revision of cemented implants. In uncemented cups progressive radiological acetabular osteolysis can be present before loosening accurs, but it is probably unwise to await cup loosening before embarking on revision. We explored the possible relationship between such osteolysis and positive findings on technetium scintigraphy, to see if the technique could predict the need for revision. Between 1990 and 1996 500 hydroxyapatite-coated hip prostheses were implanted (follow-up range: 9–15 years), and technetium scintigraphy and plain radiography were performed annually postoperatively. 32 cups were revised for progressive acetabular osteolysis. We compared the introperative findings at revision with the pre-operative scintigraphic and radiographic results. The sensitivity and specificity for diagnosing progressive acetabular osteolysis by technetium scintigraphy were 34% and 0% respectively. The sensitivity and specificity of the technique for detecting loosening were 38% and 73% respectively. The sensitivity and specificity of technetium scintigraphy for detection of a either loosening or progressive acetabular osteolysis are worse than reported for plain radiography. Despite negative scintigraphy, there may be progressive bone loss at a critical level. Scintigraphy has no additional value to plain radiography as a reliable indicator for timing cup revision in the process of progressive acetabular osteolysis.
Secondary Capsular Laxity of the Hip
Authors: Blakey Caroline M. , Field Michael H. , Singh Parminder J. , Tayar Rene , Field Richard E. 
Published: January 2018

We describe a hip condition with a recognisable pattern of clinical signs and radiological findings thought to result from chronic capsular injury. Between June 2006 and October 2009, ten patients (11 hips), four men and six women, were identified with an abnormality of external rotation at the hip joint. A detailed history and clinical examination was undertaken for each patient. Dynamic magnetic resonance imaging of symptomatic and control hips were evaluated for bony and soft tissue appearances. The relative positions of the femoral head and the acetabulum were assessed through a range of hip rotation. In affected hips, a loss of normal log roll recoil was observed. Three distortions of the iliofemoral ligament were identified on axial MR images; thinning at the lateral insertion of the ligament, attenuation of the iliofemoral ligament most noticeably on maximum external rotation (60°) and the appearance of laxity despite full external rotation. Stability of the hip is dependent on the interaction of bony and soft tissue structures. Hip instability is recognised in dysplasia and is known to lead to premature degeneration of the joint. Chronic capsular injury may destabilise previously asymptomatic hips with subsequent development of pain in young, active patients.
Narrowing of the Femoral Neck after Resurfacing Arthroplasty of the Hip: A Comparison of Cemented and Uncemented Femoral Components
Authors: Ho Kevin K. W. , Beazley James , Parsons Nicholas , Costa Matthew L. , Foguet Pedro 
Published: January 2018

We performed a radiographic review of a consecutive series of 87 resurfacing arthroplasties of the hip, performed between 2004 and 2006. There were 54 cemented femoral components and 33 uncemented femoral components. All of the procedures were performed by the same surgeon using the same approach. There was no difference between the groups with regards to gender, age, pre-operative diagnosis and the average diameter of the components. The primary outcome measured was the neck-prosthesis ratio on standard anterior-posterior pelvis radiographs taken post-operatively and at a minimum follow up of two years. The difference between the immediate post-operative ratio and the most recent radiograph was statistically significant in patients with cemented femoral components (p=0.006), but not in the group with uncemented components (p=0.173). We have demonstrated a difference in narrowing of the femoral neck between cemented and uncemented femoral components in the first two years following surgery.
Prevention of Unrecognized Joint Penetration during Internal Fixation of Hip Fractures: A Geometric Model Based on Steinmetz Solid
Authors: Mao Yujiang , Song Jie , Wei Jie , Wang Manyi 
Published: January 2018

Unrecognized joint penetration (UJP) by screw penetration through the articular surface undetectable on routine anteroposterior (AP) and lateral radiographs can cause serious complications. We have developed a geometric model to analyze UJP, and methods for the prevention of the problem. A Steinmetz Solid (SS) is the overlapping portion between two identical, vertically intersecting cylinders. The AP and lateral radiographs of a femoral head (simplified as a sphere) are projections of two cylinder-shaped images. A screw that appears to be within the femoral head in fact only lies within the cylinder. A screw apparently within the femoral head on both AP and lateral images is only confined to the SS generated by two cylinders, but not necessarily confined to the femoral head itself. We have therefore analyzed UJP using a geometric model based on SS. The geometric basis of UJP lies in the fact that the SS is larger than the sphere (femoral head) with a volume ratio of 4: π. The theoretical risk of UJP for any screw therefore can be as high as 21.5% ((4-π)/4). In reality, screws are always carefully placed to ensure a distance between the screw's tip and the edge of femoral head (tip-to-edge distance, or TED). This TED effectively lowers the risk of UJP by reducing the size of the screw-confining SS. When the SS entirely fits into (internally tangential to) the femoral head, the risk of UJP approaches zero. A TED fulfilling this requirement can be regarded as safe (approximately 0.29 × femoral head radius). With a femoral head diameter of 5 cm, the safe TED is approximately 7 mm.
Learning curve and short-term results with a short-stem CFP system
Authors: Pons Miquel 
Published: January 2018

In conservative hip replacement it is important to remove only pathological tissue to preserve as much healthy bone as possible. The collum femoris preserving (CFP) system preserves the femoral neck and metaphyseal cancellous bone. We present our learning curve with this system and our preliminary results and conclusions. During 2001–2009 we placed 138 CFP prostheses in 90 men and 38 women (10 bilateral). The mean age of the patients was 57.1 years (range 22–76 years) and the mean follow-up 38.3 months. Seventy-three patients were active workers at the time of surgery. All patients began partial weight bearing at 24–36 hours and total weight bearing was allowed at 3 weeks postoperative. We have had 1 infection, 2 intraoperative partial shaft fractures that did not require treatment, 1 acetabular loosening, and 2 periprosthetic traumatic fractures treated by osteosynthesis in one case and femoral revision in the other. All but 3 active workers returned to work and 54.5% of the studied patients practice some sport or physical activity. The stem size was correct in 125 hips. Resorption at the prosthetic rim was found in 9 out of 134 hips. No clinical symptoms were found in these patients. There have been no stem revisions for aseptic loosening in the follow-up study. Although the current follow-up is too short to allow definitive conclusions, the CFP system has provided excellent short-term results.
Hospital at home in elective total hip arthroplasty
Authors: Bori Guillem , Aibar Jesus , Lafuente Sarah , Gallart Xavier , Valls Silvia , Suso Santiago , Hernandez Carme , Riba Josep 
Published: January 2018

With the recent trend towards reducing hospital stay, it has become increasingly important to ensure that early patient discharge after total hip replacement is a safe practice. We evaluated complications and length of hospital stay associated with primary unilateral hip arthroplasty in 47 patients undergoing a new early discharge protocol consisting of at home based specialized care after hospital discharge. The mean length of stay (and standard deviation) in hospital was 4.59±0.68. The mean length of stay of home-based hospitalization was 3.7±1. The prevalence of postoperative complications was 12.8% and the readminssion rate was 6.4%. We saw a reduction of hospital stay with no difference in outcomes in comparison with previous data. On the basis of our findings we recommend the use of the early discharge protocol following elective primary total hip replacement and ongoing evaluation of the process.