bluuebunny/crossref_metadata_2025_split huggingface dataset:
One Stage Bilateral Total Hip Arthroplasty, is it Safe? A Meta-Analysis
Authors: Haverkamp Daniël , van den Bekerom Michel P.J. , Harmse Ivo , Schafroth Matthias U. 
Published: January 2018

Controversy has prevailed for many years relating to the safety of one-stage and two-stage total hip arthroplasty (THA) for bilateral disease. We performed a meta-analysis of 1460 studies of which 5 prospective studies met our inclusion criteria. A total of 579 patients had two-stage procedures and 334 had one-stage surgery. The studies showed a low heterogeneity (I2 =0%) allowing pooling of data. No differences were found in the incidence of major complications (odds ratio 0.72 95%CI: 0.45–1.15). One-stage bilateral THA may therefore be a safe procedure.
Gait Analysis in Adults with Severe Hip Dysplasia before and after Total Hip Arthroplasty
Authors: Marangoz Salih , Atilla Bülent , Gök Haydar , Yavuzer Güneş , Ergin Süreyya , Tokgözoğlu A. Mazhar , Alpaslan Mümtaz 
Published: January 2018

Anatomical reconstruction of high riding hips by total hip arthroplasty (THA) and subtrochanteric shortening osteotomy aims to normalise gait pattern and improve functional hip scores. We present the medium-term clinical results of a group of patients with high riding dislocated hips in whom a cementless THA and subtrochanteric shortening osteotomy had been performed. We compared them with their preoperative status, with patients who had undergone a cementless THA for primary osteoarthritis, and also with a group of healthy gender and age-matched controls. Prospective computerized, three-dimensional gait analyses were performed in 8 female patients with uni-/ or bilateral severe developmental dysplasia of the hip (Group I). Gait analysis was performed preoperatively and at a mean of 12.5 months postoperatively. A group of 8 individuals who received cementless hip replacement for primary osteoarthritis (Group II), and a control group of 8 able-bodied individuals (Group III) were recruited for comparison. Patients in Group I improved and approached the values of Group II. However both were behind Group III. Limb length discrepancy was reduced from a mean of 4.3 cm (range, 1 – 8 cm) to a mean of 0.8 cm (range, 0 – 2 cm) at the latest follow-up. Pain was reliably relieved and activities of daily living were improved in patients with high riding developmental dysplasia of the hip, but they were still behind the normal population average. Nevertheless, the results can be as satisfactory as those in patients who undergo a THA for primary osteoarthritis.
Perception of Imposed Leg Length Inequality in Normal Subjects
Authors: O'Brien Seamus , Kernohan George , Fitzpatrick Claire , Hill Janet , Beverland David 
Published: January 2018

Lower limb length differences of up to 10mm exist in 60% - 95% of the population. There are usually no symptoms or functional effects. Following Total Hip Arthroplasty (THA), satisfactory clinical results can be spoiled by dissatisfaction due to a change in leg length. Although the change in leg length may be modest in comparison to the normal variation, the patient may perceive this as a leg length discrepancy. To study the average threshold for perception, artificial leg length discrepancies of 5 mm to 25 mm were created in 30 young healthy adults using calibrated wooden blocks. Responses were recorded and analysed using a chi-squared test for independence and an independent measures t-test. Awareness of leg length discrepancy was related to the magnitude of the discrepancy (X2 (15)= 156.6, P<0.05 on the right side, and X2 (15)= 178.725 P<0.05 on the left side). It was shown that no subject reported a 5mm increase in leg length to be uncomfortable while all subjects were aware of leg length discrepancies of 20 mm and 25 mm. When there was a discrepancy of 10 mm in either lower limb, 29 out of 30 subjects (96.7%) thought there was a difference in leg length. Consequently it is suggested that during total hip arthroplasty the surgeon should aim for a leg length discrepancy of less than 10 mm.
A Reproducible and Inexpensive Method of Measuring Hip Abductor Strength
Authors: Traina Francesco , Cristofolini Luca , De Fine Marcello , Brunetti Ludovico , Frakulli Ideal , Abati Caterina Novella , D'Uva Lorenzo , Toni Aldo 
Published: January 2018

The evaluation of hip abductor strength is useful in assessing of the outcome of hip surgery. Hand-held dynamometers are available, but they are less reliable in assessing hip abductor strength than some other muscle groups. We describe a new device designed to measure hip abductor strength, which is practical in a clinical setting. A system of constraints, pads and reference points was devised to make force measurements as little examiner–dependent as possible. Reproducibility was assessed in a controlled setting. The abductor strength of ten healthy young subjects (average age 28 years) was tested twice on each side by two independent examiners. Tests were performed in a supine position, eliminating the influence of gravity and examiner intervention. The results indicated high reproducibility, the maximal measurement uncertainty being within 1 N. Intra-class correlation coefficients ranged from 0.85–0.98 for intra-rater reproducibility, and 0.81–0.96 for inter-rater reporoducibility. The coefficient of variation was lower than 10%. The device described may be suitable for routine clinical assessment of patients after hip surgery.
The Influence of Aetiology of Hip Instability on the Results of Pelvic Support Osteotomy
Authors: Gursu Sarper , Demir Bilal , Yildirim Timur , Oke Ramadan , Bursali Aysegul , Sahin Vedat 
Published: January 2018

Pelvic support osteotomy and femoral lengthening are sometimes employed in cases of hip instability. We assessed the efficacy of surgery following sepsis and congenital dislocation in relation to functional results. Between March 2005 and May 2007 we performed pelvic support osteotomy and femoral lengthening for 21 hips in 20 patients. Preceding pathology included congenital dislocation in 13 hips (12 patients) and sequelae of sepsis in 8 hips. All surgical procedures were performed as described by Ilizarov. The mean follow-up period was 33.5 months. There was no significant difference between the final Harris Hip Scores of the 2 groups. The number of patients with persisting abductor weakness was similar between the 2 groups. Complications were more frequent following congenital dislocation, and additional physiotherapy to restore knee motion was required in almost half of these. Patient satisfaction was higher in cases with sequelae of sepsis.
Incidence of Deep Infection in Aseptic Revision THA using Vancomycin-Impregnated Impacted Bone Allograft
Authors: Buttaro Martin A. , Guala Agustin J. , Comba Fernando , Suarez Federico , Piccaluga Francisco 
Published: January 2018

The addition of antibiotic to cement is a frequent practice in aseptic revision hip surgery There is concern about adding vancomycin to cement due to potential effects on mechanical properties and prolonged elution of subtherapeutic levels antibiotic. Bone allografts can store and provide high levels of vancomycin to surrounding tissues. We analyzed the incidence of infection after one-stage aseptic revision hip reconstruction utilizing acetabular and/or femoral vancomycin-impregnated impacted bone allograft and a THA fixed with cement containing no antibiotic. We hypothesized that the infection rate may be similar to that reported in the literature following traditional impaction grafting using antibiotic loaded cement. Seventy five consecutive patients (80 hips) with a preoperative Merle D'Aubigné and Postel functional score averaging 4.8 points were followed up for a mean of 36 months (range 24 - 59 months). The incidence of infection was 1.25% (CI 95%=96.26–100%). A deep infection (thought to be haematognous in origin) occurred in 1 patient 2 years after the index surgery. The average postoperative Merle D'Aubigne score was 16.2 points. The last radiographic evaluation demonstrated a less than 5 mm acetabular migration and a less than 5 mm femoral subsidence in all cases. Vancomycin-supplemented allografts restored bone stock and provided sound fixation with a low incidence of infection. This incidence of deep sepsis is similar to that reported with antibiotic-loaded PMMA but without the reported mechanical and pharmacological disadvantages.
Patient Compliance with Extended Low Molecular Weight Heparin Injections following Hip and Knee Arthroplasty
Authors: Deakin Dan E. , Mishreki Andrew , Aslam Nadim , Docker Charles 
Published: January 2018

The use of extended duration thromboprophylaxis following hip and knee arthroplasty is becoming widespread. The aim of our study was to determine patient compliance with extended duration thromboprophylaxis using low molecular weight (LMWH) injections following hip and knee arthroplasty. 42 consecutive patients undergoing hip and knee arthroplasty were prospectively contacted during their fifth post operative week. A fully anonymised questionnaire was completed by each patient. All patients responded. One was excluded having been prescribed warfarin for pre existing atrial fibrillation. Twenty nine (71%) patients were discharged with the intention of self administering LMWH injections. Eight (20%) and four (9%) patients were discharged with the intention of administration by a relative or district nurse respectively. No patient required the person administering the injections to be changed after discharge from hospital. 90% (n=37) of patients reported not missing any doses. 10% (n=2) of patients missed one dose and 10% (n=2) missed two doses. Patient compliance with extended duration thromboprophylaxis using LMWH injections is extremely high. Oral thromboprophylaxis may be useful in the minority of patients requiring daily visits by a nurse to administer injections.
How to avoid injuries of the superior gluteal nerve
Authors: Miguel-Pérez Maribel , Ortiz-Sagristà Juan Carlos , López Ingrid , Pérez-Bellmunt Albert , Llusé Manuel , Alex Lazaro , Combalia Andrés 
Published: January 2018

Background Injuries to the superior gluteal nerve are a common complication in hip replacement surgery. They can be avoided with a good anatomical knowledge of the course of the superior gluteal nerve. Methods We dissected 29 half pelvises of adult cadavers. The distance and the angle from the entry points of branches of the superior gluteal nerve into the deep surface of the gluteus medium and minimus muscles to the midpoint of the superior border of the greater trochanter were measured. Results The dissections revealed that the nerve divided into 2 branches (86.20%) or 3 branches (13.8%). The more caudal branch was responsible for innervation of the tensor fascia latae. Conclusions A 2-3-cm safe area above the greater trochanter is appropriate to prevent nerve damage.
Bedding-in and true wear in two different generations cementless porous-coated acetabular cups
Authors: García-Rey Eduardo 
Published: January 2018

Radiographic measurement of polyethylene wear cannot distinguish between so-called bedding-in and true wear in porous-coated cups. In this study, sequential wear performance was compared in two different generations of two cementless porous-coated cups. Group 1 consisted of 42 Harris-Galante I cups (HG I; 32-mm femoral head) and 37 Harris-Galante II cups (HG II; 28 mm); group 2 comprised 30 ACS liners using Profile or Trilock cups (32 mm) and 53 Duraloc cups (28 mm). All liners were made of conventional polyethylene sterilised by gamma irradiation in air. All cups showed radiographic bone ingrowth. Follow-up ranged from 5 to 17 years. Anteroposterior pelvic radiographs were scanned digitally and sequential femoral head penetration was estimated using a software package based on Kim's method. Bedding-in was 0.17±0.09 mm for HG I and 0.09±0.02 for HG II cups (p=0.035) in group 1, and 0.60±0.50 for the ACS liners and 0.11±0.41 for the Duraloc cups (p<0.01) in group 2. Femoral head penetration at the end of follow-up was 1.50±0.28 mm for HG I (mean 14 years) and 0.85±0.01 for HG II (8 years) in group 1, and 2.86±0.68 for ACS (12 years) and 0.90±0.41 for Duraloc (8 years) in group 2. Mean wear was 0.09 mm/year for HG I and 0.10 for HG II in group 1, and 0.20 for the ACS liners and 0.09 for the Duraloc cups in group 2. In conclusion, sequential femoral head penetration using Kim's digitised method allows us to distinguish between bedding-in and true wear.
A Novel Fluoroscopic-Assisted Balloon Thrombectomy: Technique for Thrombosed Hemodialysis Prosthetic Grafts
Authors: Kakkos Stavros K. , Haddad Joseph A. , Haddad Georges K. 
Published: January 2018

Background Previous studies have shown that stenosis of the arterial anastomosis of thrombosed hemodialysis (HD) grafts, unmasked after conventional thrombectomy, very often necessitate subsequent arterial angioplasty. The aim of this study was to describe a novel fluoroscopic-assisted balloon thrombectomy technique which permits simultaneous arterial angioplasty (should this is required) for thrombosed HD grafts. Methods Thirty patients with 36 thrombotic episodes of their prosthetic HD grafts participated in this study. A balloon angioplasty catheter is placed beyond the arterial anastomosis, over a guidewire; the balloon is inflated with contrast solution under fluoroscopy and pulled back to remove the arterial thrombus from the anastomosis. Any coexisting stenosis revealed by balloon indentation is completely dilated at that time, rather than after the thrombectomy. Mechanical thrombolysis of the graft and venous outflow is then performed with the AngioJet catheter (Possis Medical, Inc). Results Technical and clinical success rates (the latter defined as one subsequent HD session) of the procedure were 100% and 94%, respectively. No complications, including arterial embolism, vessel rupture or pulmonary embolism, were encountered. Primary assisted patency at 3 and 6 months was 51% and 32%, respectively, while functional secondary patency at the same follow-up points was 78%. Conclusions our technique is safe and also effective in both short- and long-term follow-up. Because it offers convenience, since the treatment of arterial anastomotic stenoses is accomplished in one (rather than two) steps, this method deserves further investigation.
Long-Term Effect of an Ethanol/Sodium Citrate Locking Solution on the Mechanical Properties of Hemodialysis Catheters
Authors: Vercaigne Lavern M. , Takla Teresa A. , Raghavan J. 
Published: January 2018

Purpose To investigate the effect of a 30% ethanol/4% sodium citrate catheter locking solution on the mechanical properties of hemodialysis (HD) catheters over 36 weeks. Methods Twenty-one HD catheters were used in this study. Three catheters, not exposed to locking solutions, underwent mechanical testing to determine baseline properties. Nine of the remaining 18 catheters were filled with normal saline and underwent mechanical testing in groups of three at 12, 24 and 36 weeks. Similarly, nine catheters were filled with the 30% ethanol/4% sodium citrate locking solution and tested in a similar manner. Results The average force required to break the catheter lumens tended to be smaller in the catheters exposed to 30% ethanol/4% sodium citrate compared to saline controls at 12 and 24 weeks; however, there were no statistically significant differences between the groups after 36 weeks of exposure. The forces required to break these HD catheters are magnitudes greater than forces generated during a typical HD session. Conclusions We conclude that the 30% ethanol/4% sodium citrate locking solution had an effect on the mechanical properties of the catheters investigated, but not to the degree that would preclude further in vivo investigation. Further studies are necessary to determine the safety and efficacy of this catheter locking solution.
Totally Implantable Ports Connected to Valved Catheters for Chemotherapy: Experience from 350 Groshong Devices
Authors: Nishinari Kenji , Wolosker Nelson , Vinicius Bernardi Christiano , Yazbek Guilherme 
Published: January 2018

Purpose There are few studies regarding the use of totally implantable valved ports for chemotherapy. The objective of this study was to analyze the results obtained from consecutive implantation of 350 devices. Methods Adult patients submitted to port insertion in veins of the superior vena cava system over a 17-month period (July 2006 to December 2007) were considered. The device used was composed of a titanium and silicone rubber port (Dome Port™; Bard Inc, Salt Lake City, UT) connected to an 8.0 Fr silastic Groshong™ catheter tube. Follow-up was conducted on outpatient data and during clinical readmissions, until the device was removed or the patient died. Results Three hundred and fifty devices, total of 74,691 days in situ, were inserted, with a median follow-up of 176 days. There were 11 early complications (3.1%) and 49 late complications (14%), 21 of these (6%) were considered major ones. Early complications comprised four instances of phlebitis of the external jugular, three of pocket infection, two of technical failure and two of ecchymosis. Late complications comprised 33 instances of withdrawal difficulty, 12 of port-related bacteremia, two of deep venous thrombosis, one of occlusion and one of catheter fracture. Out of the 350 catheters implanted, 258 (73.5%) were still being used, 73 (21%) remained in use until the patient died, five (1.5%) were removed at the end of the treatment and 14 (4%) were removed because of complications. Conclusions There was a low rate of major complications associated with this valved system justifying its use.
The Brachio-Brachial Arteriovenous Fistula: Mid-Term Results
Authors: Florin Dorobantu Lucian , Anton Iliescu Vlad , Stiru Ovidiu , Bubenek Serban , Novelli Eugenio 
Published: January 2018

Objective To evaluate the mid-term results of the brachio-brachial arteriovenous fistula in patients without adequate superficial venous circulation in the upper limb. Methods Retrospective analysis included 49 patients, in whom a brachio-brachial fistula had been created in an end-to-side configuration. After the maturation period (1 month), the brachial vein was transposed into the subcutaneous tissue. Follow-up study was performed in patients with functional brachio-brachial fistula after the superficialization. Results Forty-nine patients underwent 49 brachio-brachial fistula constructions. All fistulas were functional. One month after surgery, 40 (81.6%) of these patients had a functional fistula, but in only 39 (79.6%) cases was the fistula suitable for hemodialysis (HD) following transposition to subcutaneous tissue. During the 1–month maturation period, the fistula became occluded in nine patients, and in one case the vein was permeable, so the fistula was functional, but too small to permit HD. Seventeen patients developed temporary edema of the forearm during the first month, in three cases the edema was extended to the entire arm, but no other complications were associated with the procedure. Follow-up lasted 18.0 ± 11.1 (3–37) months, during which 7/39 patients presented with fistula occlusion. Three patients died and another three were out of the study for various reasons. Conclusions the brachio-brachial fistula is a good alternative to prosthetic grafts in patients without superficial venous circulation in the upper limb.
Patient-Centric Analysis of Dialysis Access Outcomes
Authors: Solesky Beverly C. , Huber Thomas S. , Berceli Scott A. 
Published: January 2018

Objective Dialysis access literature has traditionally focused on fistula patency as the primary outcome measure, but this approach falls short in describing the entire spectrum of dialysis access care. Using our prospectively maintained vascular access data base, a comprehensive, patient-centered analysis of arteriovenous access placement and interventions, central venous catheter use, and associated complications is performed. Methods Twenty-six patients receiving 39 arteriovenous fistula (AVF), eight prosthetic grafts and 52 catheters were followed longitudinally for an average of 4.1 yrs to determine the time of initial cannulation, need for revision, and the time of abandonment for each AV access. Access complications secondary to infection, thrombosis, stenosis, and aneurysmal degeneration were tabulated. The time of permanent dialysis catheter placement and removal was collected, along with infection and thrombotic complications related to their use. Results Fifty-four percent of the AVFs matured without the need for intervention, while 13% required revision to promote maturation. One-third of the AVFs failed primarily or following revision and were never used for dialysis. Fistulae were initially cannulated an average of 9.5 months following implantation and lasted 27.2 months before abandonment. AVF revisions were performed an average of 7.5 months following maturation and provided an additional 19.8 months of usability. Fifty percent of prosthetic grafts could be used without intervention, while 25% were used only after revision and 25% were abandoned without being used. Grafts were accessed an average of 2.7 months after implantation and lasted 14.1 months after the initial cannulation. Twenty-three patients received a total of 52 catheters during the study, with an average implantation time of 6.5 months. Sixty-three percent of the catheters developed one or more complications, for a rate of 1.3 complications per year of indwelling catheter. Conclusion The current study provides a novel approach for the comprehensive evaluation of access care for patients undergoing hemodialysis through the development of a patient-centric approach to examine the complexities and shortcomings in dialysis access care. Despite some difficulties in achieving fistula maturation, an AVF prevalence rate was 66%, meeting the 65% goal set by the Fistula First Initiative. Unfortunately, a significant portion of the remainder of the dialysis support was provided by catheters, with a 27% catheter prevalence rate.
An Easy Technique for the Removal of a Hemodialysis Catheter Stuck in Central Veins
Authors: Hong Joon H. 
Published: January 2018

Background Central venous catheters are currently used for long-term hemodialysis (HD) in a large number of patients. When the catheter needs to be removed, the removal is usually achieved without difficulty after dissection of the cuff from the tunnel. However, when the catheter is stuck in the central vein, the removal becomes complex or unsuccessful. Herein, a simple and easy technique is described for the removal of an HD catheter stuck in the central vein. Case Report Attempts were made to remove an HD catheter from a 65-year-old male by making an incision in the skin over the exit site of the catheter to dissect the cuff from the tunnel and by pulling the catheter, but without success because the catheter was stuck in the central vein. Through a second skin incision in the neck, the subcutaneous portion of the catheter was retrieved from the tunnel and then an introducer sheath was inserted over the catheter into the internal jugular vein while the catheter was held in place. The sheath was advanced around the catheter into the central vein. The catheter was then easily pulled out from the central vein. Comment The reported cases of stuck catheters in the literature were reviewed to acknowledge the difficulties encountered in the removal attempts. The technique described herein can be used for the removal of a variety of catheters and wires stuck in the central vein.