21 CFR 888.3410 - Hip joint metal/polymer or ceramic/polymer semiconstrained resurfacing cemented prosthesis.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Hip joint metal/polymer or ceramic/polymer... Devices § 888.3410 Hip joint metal/polymer or ceramic/polymer semiconstrained resurfacing cemented prosthesis. (a) Identification. A hip joint metal/polymer or ceramic/polymer semi-constrained resurfacing...

Bone mineral density of the femoral neck in resurfacing hip arthroplasty

DEFF Research Database (Denmark)

Penny, Jeannette Østergaard; Ovesen, Ole; Brixen, Kim

2010-01-01

Resurfacing total hip arthroplasty (RTHA) may preserve the femoral neck bone stock postoperatively. Bone mineral density (BMD) may be affected by the hip position, which might bias longitudinal studies. We investigated the dependency of BMD precision on type of ROI and hip position....

Inflammatory pseudotumor causing deep vein thrombosis after metal-on-metal hip resurfacing arthroplasty.

LENUS (Irish Health Repository)

Memon, Adeel Rasool

2013-01-01

Metal-on-metal hip resurfacings have recently been associated with a variety of complications resulting from adverse reaction to metal debris. We report a case of extensive soft tissue necrosis associated with a huge pelvic mass causing extensive deep vein thrombosis of the lower limb secondary to mechanical compression of the iliac vein. This is a rare and unusual cause of deep vein thrombosis after metal-on-metal hip resurfacing arthroplasty.

Augmented Reality Based Navigation for Computer Assisted Hip Resurfacing: A Proof of Concept Study.

Science.gov (United States)

Liu, He; Auvinet, Edouard; Giles, Joshua; Rodriguez Y Baena, Ferdinando

2018-05-23

Implantation accuracy has a great impact on the outcomes of hip resurfacing such as recovery of hip function. Computer assisted orthopedic surgery has demonstrated clear advantages for the patients, with improved placement accuracy and fewer outliers, but the intrusiveness, cost, and added complexity have limited its widespread adoption. To provide seamless computer assistance with improved immersion and a more natural surgical workflow, we propose an augmented-reality (AR) based navigation system for hip resurfacing. The operative femur is registered by processing depth information from the surgical site with a commercial depth camera. By coupling depth data with robotic assistance, obstacles that may obstruct the femur can be tracked and avoided automatically to reduce the chance of disruption to the surgical workflow. Using the registration result and the pre-operative plan, intra-operative surgical guidance is provided through a commercial AR headset so that the user can perform the operation without additional physical guides. To assess the accuracy of the navigation system, experiments of guide hole drilling were performed on femur phantoms. The position and orientation of the drilled holes were compared with the pre-operative plan, and the mean errors were found to be approximately 2 mm and 2°, results which are in line with commercial computer assisted orthopedic systems today.

The Tribology of Explanted Hip Resurfacings Following Early Fracture of the Femur.

Science.gov (United States)

Lord, James K; Langton, David J; Nargol, Antoni V F; Meek, R M Dominic; Joyce, Thomas J

2015-10-15

A recognized issue related to metal-on-metal hip resurfacings is early fracture of the femur. Most theories regarding the cause of fracture relate to clinical factors but an engineering analysis of failed hip resurfacings has not previously been reported. The objective of this work was to determine the wear volumes and surface roughness values of a cohort of retrieved hip resurfacings which were removed due to early femoral fracture, infection and avascular necrosis (AVN). Nine resurfacing femoral heads were obtained following early fracture of the femur, a further five were retrieved due to infection and AVN. All fourteen were measured for volumetric wear using a co-ordinate measuring machine. Wear rates were then calculated and regions of the articulating surface were divided into "worn" and "unworn". Roughness values in these regions were measured using a non-contacting profilometer. The mean time to fracture was 3.7 months compared with 44.4 months for retrieval due to infection and AVN. Average wear rates in the early fracture heads were 64 times greater than those in the infection and AVN retrievals. Given the high wear rates of the early fracture components, such wear may be linked to an increased risk of femoral neck fracture.

The Tribology of Explanted Hip Resurfacings Following Early Fracture of the Femur

Directory of Open Access Journals (Sweden)

James K. Lord

2015-10-01

Full Text Available A recognized issue related to metal-on-metal hip resurfacings is early fracture of the femur. Most theories regarding the cause of fracture relate to clinical factors but an engineering analysis of failed hip resurfacings has not previously been reported. The objective of this work was to determine the wear volumes and surface roughness values of a cohort of retrieved hip resurfacings which were removed due to early femoral fracture, infection and avascular necrosis (AVN. Nine resurfacing femoral heads were obtained following early fracture of the femur, a further five were retrieved due to infection and AVN. All fourteen were measured for volumetric wear using a co-ordinate measuring machine. Wear rates were then calculated and regions of the articulating surface were divided into “worn” and “unworn”. Roughness values in these regions were measured using a non-contacting profilometer. The mean time to fracture was 3.7 months compared with 44.4 months for retrieval due to infection and AVN. Average wear rates in the early fracture heads were 64 times greater than those in the infection and AVN retrievals. Given the high wear rates of the early fracture components, such wear may be linked to an increased risk of femoral neck fracture.

Comparison of Patient-Reported Outcome from Neck-Preserving, Short-Stem Arthroplasty and Resurfacing Arthroplasty in Younger Osteoarthritis Patients

Directory of Open Access Journals (Sweden)

Marius Dettmer

2015-01-01

Full Text Available Hip resurfacing has been considered a good treatment option for younger, active osteoarthritis patients. However, there are several identified issues concerning risk for neck fractures and issues related to current metal-on-metal implant designs. Neck-preserving short-stem implants have been discussed as a potential alternative, but it is yet unclear which method is better suited for younger adults. We compared hip disability and osteoarthritis outcome scores (HOOS from a young group of patients (n=52, age 48.9 ± 6.1 years who had received hip resurfacing (HR with a cohort of patients (n=73, age 48.2 ± 6.6 years who had received neck-preserving, short-stem implant total hip arthroplasty (THA. Additionally, durations for both types of surgery were compared. HOOS improved significantly preoperatively to last followup (>1 year in both groups (p<0.0001, η2=0.69; there were no group effects or interactions. Surgery duration was significantly longer for resurfacing (104.4 min ± 17.8 than MiniHip surgery (62.5 min ± 14.8, U=85.0, p<0.0001, η2=0.56. The neck-preserving short-stem approach may be preferable to resurfacing due to the less challenging surgery, similar outcome, and controversy regarding resurfacing implant designs.

Computer navigation experience in hip resurfacing improves femoral component alignment using a conventional jig.

Science.gov (United States)

Morison, Zachary; Mehra, Akshay; Olsen, Michael; Donnelly, Michael; Schemitsch, Emil

2013-11-01

The use of computer navigation has been shown to improve the accuracy of femoral component placement compared to conventional instrumentation in hip resurfacing. Whether exposure to computer navigation improves accuracy when the procedure is subsequently performed with conventional instrumentation without navigation has not been explored. We examined whether femoral component alignment utilizing a conventional jig improves following experience with the use of imageless computer navigation for hip resurfacing. Between December 2004 and December 2008, 213 consecutive hip resurfacings were performed by a single surgeon. The first 17 (Cohort 1) and the last 9 (Cohort 2) hip resurfacings were performed using a conventional guidewire alignment jig. In 187 cases, the femoral component was implanted using the imageless computer navigation. Cohorts 1 and 2 were compared for femoral component alignment accuracy. All components in Cohort 2 achieved the position determined by the preoperative plan. The mean deviation of the stem-shaft angle (SSA) from the preoperatively planned target position was 2.2° in Cohort 2 and 5.6° in Cohort 1 (P = 0.01). Four implants in Cohort 1 were positioned at least 10° varus compared to the target SSA position and another four were retroverted. Femoral component placement utilizing conventional instrumentation may be more accurate following experience using imageless computer navigation.

Similar range of motion and function after resurfacing large-head or standard total hip arthroplasty

DEFF Research Database (Denmark)

Penny, Jeannette Østergaard; Ovesen, Ole; Varmarken, Jens-Erik

2013-01-01

BACKGROUND AND PURPOSE: Large-size hip articulations may improve range of motion (ROM) and function compared to a 28-mm THA, and the low risk of dislocation allows the patients more activity postoperatively. On the other hand, the greater extent of surgery for resurfacing hip arthroplasty (RHA......° (35), 232° (36), and 225° (30) respectively, but the differences were not statistically significant. The 3 groups were similar regarding Harris hip score, UCLA activity score, step rate, and sick leave. INTERPRETATION: Head size had no influence on range of motion. The lack of restriction allowed...... for large articulations did not improve the clinical and patient-perceived outcomes. The more extensive surgical procedure of RHA did not impair the rehabilitation. This project is registered at ClinicalTrials.gov under # NCT01113762....

Computer navigation experience in hip resurfacing improves femoral component alignment using a conventional jig

Directory of Open Access Journals (Sweden)

Zachary Morison

2013-01-01

Full Text Available Background:The use of computer navigation has been shown to improve the accuracy of femoral component placement compared to conventional instrumentation in hip resurfacing. Whether exposure to computer navigation improves accuracy when the procedure is subsequently performed with conventional instrumentation without navigation has not been explored. We examined whether femoral component alignment utilizing a conventional jig improves following experience with the use of imageless computer navigation for hip resurfacing. Materials and Methods:Between December 2004 and December 2008, 213 consecutive hip resurfacings were performed by a single surgeon. The first 17 (Cohort 1 and the last 9 (Cohort 2 hip resurfacings were performed using a conventional guidewire alignment jig. In 187 cases, the femoral component was implanted using the imageless computer navigation. Cohorts 1 and 2 were compared for femoral component alignment accuracy. Results:All components in Cohort 2 achieved the position determined by the preoperative plan. The mean deviation of the stem-shaft angle (SSA from the preoperatively planned target position was 2.2° in Cohort 2 and 5.6° in Cohort 1 ( P = 0.01. Four implants in Cohort 1 were positioned at least 10° varus compared to the target SSA position and another four were retroverted. Conclusions: Femoral component placement utilizing conventional instrumentation may be more accurate following experience using imageless computer navigation.

Metal-on-Metal Total Hip Resurfacing Arthroplasty: An Evidence-Based Analysis.

Science.gov (United States)

2006-01-01

The objective of this review was to assess the safety and effectiveness of metal on metal (MOM) hip resurfacing arthroplasty for young patients compared with that of total hip replacement (THR) in the same population. Total hip replacement has proved to be very effective for late middle-aged and elderly patients with severe degenerative diseases of the hips. As indications for THR began to include younger patients and those with a more active life style, the longevity of the implant became a concern. Evidence suggests that these patients experience relatively higher rates of early implant failure and the need for revision. The Swedish hip registry, for example, has demonstrated a survival rate in excess of 80% at 20 years for those aged over 65 years, whereas this figure was 33% by 16 years in those aged under 55 years. Hip resurfacing arthroplasty is a bone-conserving alternative to THR that restores normal joint biomechanics and load transfer. The technique has been used around the world for more than 10 years, specifically in the United Kingdom and other European countries. Metal-on-metal hip resurfacing arthroplasty is an alternative procedure to conventional THR in younger patients. Hip resurfacing arthroplasty is less invasive than THR and addresses the problem of preserving femoral bone stock at the initial operation. This means that future hip revisions are possible with THR if the initial MOM arthroplasty becomes less effective with time in these younger patients. The procedure involves the removal and replacement of the surface of the femoral head with a hollow metal hemisphere, which fits into a metal acetabular cup. Hip resurfacing arthroplasty is a technically more demanding procedure than is conventional THR. In hip resurfacing, the femoral head is retained, which makes it much more difficult to access the acetabular cup. However, hip resurfacing arthroplasty has several advantages over a conventional THR with a small (28 mm) ball. First, the large

PMS49 – Empirical comparison of discrete choice experiment and best-worst scaling to estimate stakeholders' risk tolerance for hip replacement surgery

NARCIS (Netherlands)

van Dijk, J.D.; Groothuis-Oudshoorn, Karin; Marshall, D.; IJzerman, Maarten Joost

2013-01-01

Objectives Empirical comparison of two preference elicitation methods, discrete choice experiment (DCE) and profile case best-worst scaling (BWS), regarding the estimation of the risk tolerance for hip replacement surgery (total hip arthroplasty and total hip resurfacing arthroplasty). Methods An

Impact of implant size on cement filling in hip resurfacing arthroplasty.

Science.gov (United States)

de Haan, Roel; Buls, Nico; Scheerlinck, Thierry

2014-01-01

Larger proportions of cement within femoral resurfacing implants might result in thermal bone necrosis. We postulate that smaller components are filled with proportionally more cement, causing an elevated failure rate. A total of 19 femoral heads were fitted with polymeric replicas of ReCap (Biomet) resurfacing components fixed with low-viscosity cement. Two specimens were used for each even size between 40 and 56 mm and one for size 58 mm. All specimens were imaged with computed tomography, and the cement thickness and bone density were analyzed. The average cement mantle thickness was 2.63 mm and was not correlated with the implant size. However, specimen with low bone density had thicker cement mantles regardless of size. The average filling index was 36.65% and was correlated to both implant size and bone density. Smaller implants and specimens with lower bone density contained proportionally more cement than larger implants. According to a linear regression model, bone density but not implant size influenced cement thickness. However, both implant size and bone density had a significant impact on the filling index. Large proportions of cement within the resurfacing head have the potential to generate thermal bone necrosis and implant failure. When considering hip resurfacing in patients with a small femoral head and/or osteoporotic bone, extra care should be taken to avoid thermal bone necrosis, and alternative cementing techniques or even cementless implants should be considered. This study should help delimiting the indications for hip resurfacing and to choose an optimal cementing technique taking implant size into account.

Patient-reported outcome of hip resurfacing arthroplasty and standard total hip replacement after short-term follow-up

DEFF Research Database (Denmark)

Nissen, Nina; Douw, Karla; Overgaard, Søren

2011-01-01

The purpose of this study was to investigate patientreported outcome in terms of satisfaction in two study groups that had undergone hip resurfacing arthro-plasty (HRA) or total hip replacement (THR). The procedure consists of placing a hollow, mushroom-shaped metal cap over the femoral head whil...... a matching metal cup is placed in the acetabulum (pelvis socket)....

Direct to consumer advertising via the Internet, a study of hip resurfacing.

Science.gov (United States)

Ogunwale, B; Clarke, J; Young, D; Mohammed, A; Patil, S; Meek, R M D

2009-02-01

With increased use of the internet for health information and direct to consumer advertising from medical companies, there is concern about the quality of information available to patients. The aim of this study was to examine the quality of health information on the internet for hip resurfacing. An assessment tool was designed to measure quality of information. Websites were measured on credibility of source; usability; currentness of the information; content relevance; content accuracy/completeness and disclosure/bias. Each website assessed was given a total score, based on number of scores achieved from the above categories websites were further analysed on author, geographical origin and possession of an independent credibility check. There was positive correlation between the overall score for the website and the score of each website in each assessment category. Websites by implant companies, doctors and hospitals scored poorly. Websites with an independent credibility check such as Health on the Net (HoN) scored twice the total scores of websites without. Like other internet health websites, the quality of information on hip resurfacing websites is variable. This study highlights methods by which to assess the quality of health information on the internet and advocates that patients should look for a statement of an "independent credibility check" when searching for information on hip resurfacing.

Periacetabular Bone Mineral Density Changes After Resurfacing Hip Arthroplasty Versus Conventional Total Hip Arthroplasty. A Randomized Controlled DEXA Study

NARCIS (Netherlands)

Smolders, J.M.H.; Pakvis, D.F.; Hendrickx, B.W.; Verdonschot, Nicolaas Jacobus Joseph; van Susante, J.L.C.

2013-01-01

A randomized controlled trial was performed to evaluate acetabular bone mineral density (BMD) changes after hip resurfacing (RHA) versus an established conventional total hip arthroplasty (THA). A total of 71 patients were allocated randomly to receive either an RHA press-fit cobalt–chromium cup (n

What Is the Rerevision Rate After Revising a Hip Resurfacing Arthroplasty? Analysis From the AOANJRR.

Science.gov (United States)

Wong, James Min-Leong; Liu, Yen-Liang; Graves, Stephen; de Steiger, Richard

2015-11-01

More than 15,000 primary hip resurfacing arthroplasties have been recorded by the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) with 884 primary procedures requiring revision for reasons other than infection, a cumulative percent revision rate at 12 years of 11%. However, few studies have reported the survivorship of these revision procedures. (1) What is the cumulative percent rerevision rate for revision procedures for failed hip resurfacings? (2) Is there a difference in rerevision rate among different types of revision or bearing surfaces? The AOANJRR collects data on all primary and revision hip joint arthroplasties performed in Australia and after verification against health department data, checking of unmatched procedures, and subsequent retrieval of unreported procedures is able to obtain an almost complete data set relating to hip arthroplasty in Australia. Revision procedures are linked to the known primary hip arthroplasty. There were 15,360 primary resurfacing hip arthroplasties recorded of which 884 had undergone revision and this was the cohort available to study. The types of revisions were acetabular only, femoral only, or revision of both acetabular and femoral components. With the exception of the acetabular-only revisions, all revisions converted hip resurfacing arthroplasties to conventional (stemmed) total hip arthroplasties (THAs). All initial revisions for infection were excluded. The survivorship of the different types of revisions and that of the different bearing surfaces used were estimated using the Kaplan-Meier method and compared using Cox proportional hazard models. Cumulative percent revision was calculated by determining the complement of the Kaplan-Meier survivorship function at that time multiplied by 100. Of the 884 revisions recorded, 102 underwent further revision, a cumulative percent rerevision at 10 years of 26% (95% confidence interval, 19.6-33.5). There was no difference in the rate of

Editorial Commentary: Hip Arthroscopy Plays a Role in Painful Hip Resurfacing Arthroplasty but a Prearthroscopy Diagnosis Is Critical to Outcome.

Science.gov (United States)

Rossi, Michael J

2016-03-01

Whereas hip arthroscopy plays a role in the investigation and treatment of the painful hip resurfacing arthroplasty, a diagnosis before arthroscopy is critical to improved outcome. The rate of conversion to total hip arthroplasty jumps from 7% to 37% when a pre-arthroscopy diagnosis is not known. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Center of Mass Compensation during Gait in Hip Arthroplasty Patients: Comparison between Large Diameter Head Total Hip Arthroplasty and Hip Resurfacing

Directory of Open Access Journals (Sweden)

Vicky Bouffard

2011-01-01

Full Text Available Objective. To compare center of mass (COM compensation in the frontal and sagittal plane during gait in patients with large diameter head total hip arthroplasty (LDH-THA and hip resurfacing (HR. Design. Observational study. Setting. Outpatient biomechanical laboratory. Participants. Two groups of 12 patients with LDH-THA and HR recruited from a larger randomized study and 11 healthy controls. Interventions. Not applicable. Main Outcome Measures. To compare the distance between the hip prosthetic joint center (HPJC and the COM. The ratio (RHPJC-COM and the variability (CVHPJC-COM were compared between groups. Hip flexor, abductor, and adductor muscle strength was also correlated between groups while radiographic measurements were correlated with the outcome measures. Results. In the frontal plane, HR shows less variability than healthy controls at push-off and toe-off and RHPJC-COM is correlated with the muscle strength ratios (FRABD at heel contact, maximal weight acceptance, and mid stance. In the sagittal plane, LDH-THA has a higher RHPJC-COM than healthy controls at push-off, and CVHPJC-COM is significantly correlated with FRFLEX. Conclusions. One year after surgery, both groups of patients, LDH-THA and HR, demonstrate minor compensations at some specific instant of the gait cycle, in both frontal and sagittal planes. However, their locomotion pattern is similar to the healthy controls.

Influence of bone density on the cement fixation of femoral hip resurfacing components.

Science.gov (United States)

Bitsch, Rudi G; Jäger, Sebastian; Lürssen, Marcus; Loidolt, Travis; Schmalzried, Thomas P; Clarius, Michael

2010-08-01

In clinical outcome studies, small component sizes, female gender, femoral shape, focal bone defects, bad bone quality, and biomechanics have been associated with failures of resurfacing arthroplasties. We used a well-established experimental setup and human bone specimens to analyze the effects of bone density on cement fixation of femoral hip resurfacing components. Thirty-one fresh frozen femora were prepared for resurfacing using the original instruments. ASR resurfacing prostheses were implanted after dual-energy X-ray densitometer scans. Real-time measurements of pressure and temperature during implantation, analyses of cement penetration, and measurements of micro motions under torque application were performed. The associations of bone density and measurement data were examined calculating regression lines and multiple correlation coefficients; acceptability was tested with ANOVA. We found significant relations between bone density and micro motion, cement penetration, cement mantle thickness, cement pressure, and interface temperature. Mean bone density of the femora was 0.82 +/- 0.13 g/cm(2), t-score was -0.7 +/- 1.0, and mean micro motion between bone and femoral resurfacing component was 17.5 +/- 9.1 microm/Nm. The regression line between bone density and micro motion was equal to -56.7 x bone density + 63.8, R = 0.815 (p density scans are most helpful for patient selection in hip resurfacing, and a better bone quality leads to higher initial component stability. A sophisticated cementing technique is recommended to avoid vigorous impaction and incomplete seating, since increasing bone density also results in higher cement pressures, lower cement penetration, lower interface temperatures, and thicker cement mantles. Copyright 2010 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Confronting hip resurfacing and big femoral head replacement gait analysis

Directory of Open Access Journals (Sweden)

Panagiotis K. Karampinas

2014-03-01

Full Text Available Improved hip kinematics and bone preservation have been reported after resurfacing total hip replacement (THRS. On the other hand, hip kinematics with standard total hip replacement (THR is optimized with large diameter femoral heads (BFH-THR. The purpose of this study is to evaluate the functional outcomes of THRS and BFH-THR and correlate these results to bone preservation or the large femoral heads. Thirty-one patients were included in the study. Gait speed, postural balance, proprioception and overall performance. Our results demonstrated a non-statistically significant improvement in gait, postural balance and proprioception in the THRS confronting to BFH-THR group. THRS provide identical outcomes to traditional BFH-THR. The THRS choice as bone preserving procedure in younger patients is still to be evaluated.

Ten different hip resurfacing systems: biomechanical analysis of design and material properties.

Science.gov (United States)

Heisel, Christian; Kleinhans, Jennifer A; Menge, Michael; Kretzer, Jan Philippe

2009-08-01

This study gives an overview of the main macro- and microstructural differences of ten commercially available total hip resurfacing implants. The heads and cups of resurfacing hip implants from ten different manufacturers were analysed. The components were measured in a coordinate measuring machine. The microstructure of the heads and cups was inspected by scanning electron microscopy. The mean radial clearance was 84.86 microm (range: 49.47-120.93 microm). The implants were classified into three groups (low, medium and high clearance). All implants showed a deviation of roundness of less than 10 microm. It was shown that all implants differ from each other and a final conclusion about the ideal design and material combination cannot be given based on biomechanical data. Widespread use of specific designs can only be recommended if clinical long-term follow-up studies are performed and analysed for each design.

How accurate is image-free computer navigation for hip resurfacing arthroplasty? An anatomical investigation

International Nuclear Information System (INIS)

Schnurr, C.; Nessler, J.; Koenig, D.P.; Meyer, C.; Schild, H.H.; Koebke, J.

2009-01-01

The existing studies concerning image-free navigated implantation of hip resurfacing arthroplasty are based on analysis of the accuracy of conventional biplane radiography. Studies have shown that these measurements in biplane radiography are imprecise and that precision is improved by use of three-dimensional (3D) computer tomography (CT) scans. To date, the accuracy of image-free navigation devices for hip resurfacing has not been investigated using CT scans, and anteversion accuracy has not been assessed at all. Furthermore, no study has tested the reliability of the navigation software concerning the automatically calculated implant position. The purpose of our study was to analyze the accuracy of varus-valgus and anteversion using an image-free hip resurfacing navigation device. The reliability of the software-calculated implant position was also determined. A total of 32 femoral hip resurfacing components were implanted on embalmed human femurs using an image-free navigation device. In all, 16 prostheses were implanted with the proposed position generated by the navigation software; the 16 prostheses were inserted in an optimized valgus position. A 3D CT scan was undertaken before and after operation. The difference between the measured and planned varus-valgus angle averaged 1 deg (mean±standard deviation (SD): group I, 1 deg±2 deg; group II, 1 deg±1 deg). The mean±SD difference between femoral neck anteversion and anteversion of the implant was 4 deg (group I, 4 deg±4 deg; group II, 4 deg±3 deg). The software-calculated implant position differed 7 deg±8 deg from the measured neck-shaft angle. These measured accuracies did not differ significantly between the two groups. Our study proved the high accuracy of the navigation device concerning the most important biomechanical factor: the varus-valgus angle. The software calculation of the proposed implant position has been shown to be inaccurate and needs improvement. Hence, manual adjustment of the

Hip Replacement Surgery

Science.gov (United States)

... Outreach Initiative Breadcrumb Home Health Topics English Español Hip Replacement Surgery Basics In-Depth Download Download EPUB ... PDF What is it? Points To Remember About Hip Replacement Surgery Hip replacement surgery removes damaged or ...

High incidence of pseudotumours after hip resurfacing even in low risk patients; results from an intensified MRI screening protocol.

NARCIS (Netherlands)

Weegen, W. van der; Smolders, J.M.; Sijbesma, T.; Hoekstra, H.J.; Brakel, K.; Susante, J.L.C. van

2013-01-01

We intensified our screening protocol for the presence of pseudotumours in a consecutive series of patients with a hip resurfacing arthroplasty (HRA), to establish whether we should be alert to the presence of 'silent' pseudotumours. Patients categorised with high risk (11 hips) and low risk (10

Revision rates for metal-on-metal hip resurfacing and metal-on-metal total hip arthroplasty – a systematic review

DEFF Research Database (Denmark)

Ras Sørensen, Sofie-amalie L.; Jørgensen, Henrik L.; Sporing, Sune L.

2016-01-01

Purpose To compare revision rates of metal-on-metal (MoM) hip resurfacing (HRS) and MoM total hip arthroplasty (THA), as well as the primary causes for revisions. Methods The PubMed database was queried for potentially relevant articles addressing MoMTHA and MoMHRS, a total of 51 articles were....... The odds ratio was 1.25 (1.03:1.53) 95% CI (p = 0.03) (MoMHRS vs. MoMTHA). The studies of hip prostheses were separated into 2 categories of short- and long-term (more or less than 5 years). Short-term revision rate for MoMTHA was 4.5% after 4.8 years, and for MoMHRS 4.0% after 4.2 years. The odds ratio...

Dual energy X-ray absorptiometry analysis of peri-prosthetic stress shielding in the Birmingham resurfacing hip replacement.

LENUS (Irish Health Repository)

Harty, J A

2012-02-03

INTRODUCTION: Numerous reports in the literature refer to the femoral neck fracture rate in hip resurfacing. The aim of this study was to determine the bone mineral density and evidence of stress shielding around the femoral component of the Birmingham resurfacing prosthesis. MATERIAL AND METHODS: Twenty-eight patients with primary unilateral osteoarthritis had a Birmingham resurfacing prosthesis. DEXA analysis of the proximal femur and femoral neck was performed and compared with the opposite unaffected side. RESULTS: Total periprosthetic bone mineral density was 0.49% greater than the control, but this did not achieve statistical significance. Although the BMD of the femoral neck was slightly increased on the prosthetic side (1.002 g\\/cm2) as opposed to the control side, this difference did not reach statistical significance. CONCLUSION: The Birmingham resurfacing prosthesis does not appear to reduce femoral neck bone mineral density in comparison to the normal femoral neck bone density. We conclude that femoral neck fractures are unlikely to be due to stress shielding related to the prosthesis.

Periprosthetic fractures in the resurfaced hip--A case report and review of the literature.

LENUS (Irish Health Repository)

Brennan, Stephen A

2013-02-01

Traumatic periprosthetic fractures adjacent a hip resurfacing prosthesis are rare. When proximal fractures are encountered the obvious surgical solution is to revise to a large head stemmed femoral component. A previously well functioning implant may however be retained as various non-operative and operative treatment options exist. This paper reports the case history of a traumatic periprosthetic fracture successfully treated with cannulated screw fixation and reviews the current literature.

Revision of failed hip resurfacing to total hip arthroplasty rapidly relieves pain and improves function in the early post operative period

Directory of Open Access Journals (Sweden)

Muirhead-Allwood Sarah K

2010-11-01

Full Text Available Abstract We reviewed the results of 25 consecutive patients who underwent revision of a hip resurfacing prosthesis to a total hip replacement. Revisions were performed for recurrent pain and effusion, infection and proximal femoral fractures. Both components were revised in 20 cases. There were 12 male and 13 female patients with average time to revision of 34.4 and 26.4 months respectively. The mean follow up period was 12.7 months (3 to 31. All patients reported relief of pain and excellent satisfaction scores. Two patients experienced stiffness up to three months post operatively. Pre operative Oxford, Harris and WOMAC hip scores were 39.1, 36.4 and 52.2 respectively. Mean post operative scores at last follow up were 17.4, 89.8 and 6.1 respectively (p

Inferior outcome after hip resurfacing arthroplasty than after conventional arthroplasty. Evidence from the Nordic Arthroplasty Register Association (NARA) database, 1995 to 2007

DEFF Research Database (Denmark)

Johanson, Per-Erik; Fenstad, Anne Marie; Furnes, Ove

2010-01-01

The reported outcomes of hip resurfacing arthroplasty (HRA) vary. The frequency of this procedure in Denmark, Norway, and Sweden is low. We therefore determined the outcome of HRA in the NARA database, which is common to all 3 countries, and compared it to the outcome of conventional total hip...

Laser Resurfacing Pearls

OpenAIRE

Shah, Sonia; Alam, Murad

2012-01-01

Ablative skin resurfacing using the carbon dioxide laser was long considered the gold standard for treatment of photoaging, acne scars, and rhytids. However, conventional full-face carbon dioxide resurfacing is associated with significant risk of side effects and a prolonged postoperative recovery period. Fractional resurfacing has recently revolutionized laser surgery by offering close to comparable results with minimal side effects and a more rapid recovery. Although fractional devices have...

Femoral component loosening after hip resurfacing arthroplasty

International Nuclear Information System (INIS)

Zustin, Jozef; Sauter, Guido; Hahn, Michael; Morlock, Michael M.; Ruether, Wolfgang; Amling, Michael

2010-01-01

Before the re-introduction of the current generation of total hip resurfacing arthroplasty, component loosening and osteolysis were of great concern to the orthopaedic community. Early, mid- and long-term clinical results are encouraging, but component loosening still exists. Macroscopic, contact radiographic and histopathological analyses after undecalcified preparation of bone tissue specimens were performed. To investigate the frequency and morphological patterns of the loosening of the femoral component, we analysed a series of 190 retrieved femoral remnants that were revised for aseptic failures. Thirty-five (18.4%) hips were revised for clinical and/or radiographic loosening of the femoral component. Pseudoarthrosis (n = 17; median in situ time: 16 weeks, interquartile range [IQR]: 9 to 34), collapsed osteonecrosis (n = 5; median in situ time: 79 weeks, IQR: 63 to 97), cement-socket debonding (n = 3; median in situ time: 89 weeks, IQR: 54 to 97) and at later follow-up bone-cement loosening (n = 10; median in situ time: 175 weeks; IQR 112 to 198; p =0.005) were distinct patterns of the femoral remnant-implant loosening. Fibrocartilaginous metaplasia of interface bone trabeculae (n = 38; median in situ time: 61 weeks, IQR: 32 to 138) was strongly associated with femoral component loosening (p = 0.009). Both the trabecular hyperosteoidosis (n = 32; median in situ time: 71 weeks, IQR 50 to 129) and excessive intraosseous lymphocyte infiltration (n = 12; median in situ time: 75 weeks, IQR 51 to 98) at the bone-cement interface correlated strongly with fibrocartilaginous metaplasia (p = 0.001 and p = 0.016 respectively) and all three lesions were associated with the female gender (p = 0.021, p = 0.009, and p = 0.051). Femoral component loosening at early follow-up was mostly caused by pathological changes of the femoral remnant bone tissue: pseudoarthrosis and collapsed osteonecrosis. Fibrocartilaginous metaplasia was frequently observed in hips with femoral

Laser resurfacing pearls.

Science.gov (United States)

Shah, Sonia; Alam, Murad

2012-08-01

Ablative skin resurfacing using the carbon dioxide laser was long considered the gold standard for treatment of photoaging, acne scars, and rhytids. However, conventional full-face carbon dioxide resurfacing is associated with significant risk of side effects and a prolonged postoperative recovery period. Fractional resurfacing has recently revolutionized laser surgery by offering close to comparable results with minimal side effects and a more rapid recovery. Although fractional devices have grown in popularity, and have essentially replaced traditional resurfacing, fractional resurfacing can still be a challenging modality to control precisely due to hardware variations across comparable devices, the range of settings that can be used, and patient-specific considerations. Certain precautions and rules of thumb can reduce the risk associated with fractional resurfacing, and increase the likelihood of a good outcome.

Usefulness of metal artifact reduction with WARP technique at 1.5 and 3T MRI in imaging metal-on-metal hip resurfacings

Energy Technology Data Exchange (ETDEWEB)

Lazik, Andrea; Lauenstein, Thomas C.; Theysohn, Jens M. [University Hospital Essen, Department of Diagnostic and Interventional Radiology and Neuroradiology, Essen (Germany); Landgraeber, Stefan; Schulte, Patrick [University Hospital Essen, Department of Orthopedics, Essen (Germany); Kraff, Oliver [University of Duisburg-Essen, Erwin L. Hahn Institute for Magnetic Resonance Imaging, Essen (Germany)

2015-03-25

To evaluate the usefulness of the metal artifact reduction technique ''WARP'' in the assessment of metal-on-metal hip resurfacings at 1.5 and 3T in the context of image quality and imaging speed. Nineteen patients (25 hip resurfacings) were randomized for 1.5 and 3T MRI, both including T1 and T2 turbo spin-echo as well as turbo inversion recovery magnitude sequences with and without view angle tilting and high bandwidth. Additional 3T sequences were acquired with a reduced number of averages and using the parallel acquisition technique for accelerating imaging speed. Artifact size (diameter, area), image quality (5-point scale) and delineation of anatomical structures were compared among the techniques, sequences and field strengths using the Wilcoxon sign-rank and paired t-test with Bonferroni correction. At both field strengths, WARP showed significant superiority over standard sequences regarding image quality, artifact size and delineation of anatomical structures. At 3T, artifacts were larger compared to 1.5T without affecting diagnostic quality, and scanning time could be reduced by up to 64 % without quality degradation. WARP proved useful in imaging metal-on-metal hip resurfacings at 1.5T as well as 3T with better image quality surrounding the implants. At 3T imaging could be considerably accelerated without losing diagnostic quality. (orig.)

Usefulness of metal artifact reduction with WARP technique at 1.5 and 3T MRI in imaging metal-on-metal hip resurfacings

International Nuclear Information System (INIS)

Lazik, Andrea; Lauenstein, Thomas C.; Theysohn, Jens M.; Landgraeber, Stefan; Schulte, Patrick; Kraff, Oliver

2015-01-01

To evaluate the usefulness of the metal artifact reduction technique ''WARP'' in the assessment of metal-on-metal hip resurfacings at 1.5 and 3T in the context of image quality and imaging speed. Nineteen patients (25 hip resurfacings) were randomized for 1.5 and 3T MRI, both including T1 and T2 turbo spin-echo as well as turbo inversion recovery magnitude sequences with and without view angle tilting and high bandwidth. Additional 3T sequences were acquired with a reduced number of averages and using the parallel acquisition technique for accelerating imaging speed. Artifact size (diameter, area), image quality (5-point scale) and delineation of anatomical structures were compared among the techniques, sequences and field strengths using the Wilcoxon sign-rank and paired t-test with Bonferroni correction. At both field strengths, WARP showed significant superiority over standard sequences regarding image quality, artifact size and delineation of anatomical structures. At 3T, artifacts were larger compared to 1.5T without affecting diagnostic quality, and scanning time could be reduced by up to 64 % without quality degradation. WARP proved useful in imaging metal-on-metal hip resurfacings at 1.5T as well as 3T with better image quality surrounding the implants. At 3T imaging could be considerably accelerated without losing diagnostic quality. (orig.)

Reliability of using DXA around RTHAs. Bone Mineral Density of the femoral neck in resurfacing hip arthroplasty. Precision biased by region of interest and rotation of the hip

DEFF Research Database (Denmark)

Penny, Jeannette Østergaard; Varmarken, Jens-Erik; Ovesen, Ole

2009-01-01

  Introduction:  Resurfacing Total Hip Arthroplasty (RTHA) may preserve the femoral neck bone-stock post-operatively. Bone Mineral Density (BMD), could theoretically be affected by the hip-position, and bias longitudinal studies. We aimed to investigate BMD precision dependency on type of ROI...... the hip was rotated in increments of 15° and 30°, the mean CVs rose to 7.2%, 7.3% and 11.8%.  Rotation affected the precision most in the model that divided the neck in 6 sub regions, predominantly in the lateral and distal regions. For larger-region models, some rotation could be allowed without...

Reliability of using DXA around RTHAs. Bone Mineral Density of the femoral neck in resurfacing hip arthroplasty

DEFF Research Database (Denmark)

Penny, Jeannette Østergaard; Ovesen, Ole; Brixen, Kim

2010-01-01

  Background and purpose: Resurfacing Total Hip Arthroplasty (RTHA) may preserve the femoral neck bone-stock post-operatively. Bone Mineral Density (BMD), could theoretically be affected by the hip-position, and bias longitudinal studies. We aimed to investigate BMD precision dependency on type...... was rotated in increments of 15° and 30°, the mean CVs rose to 7.2%, 7.3% and 11.8%.  Rotation affected the precision most in the model that divided the neck in 6 sub regions, predominantly in the lateral and distal regions. For larger-region models, some rotation could be allowed without compromising...

Revision hip preservation surgery with hip arthroscopy: clinical outcomes.

Science.gov (United States)

Domb, Benjamin G; Stake, Christine E; Lindner, Dror; El-Bitar, Youseff; Jackson, Timothy J

2014-05-01

To analyze and report the clinical outcomes of a cohort of patients who underwent revision hip preservation with arthroscopy and determine predictors of positive and negative outcomes. During the study period from April 2008 to December 2010, all patients who underwent revision hip preservation with arthroscopy were included. This included patients who had previous open surgery and underwent revision with arthroscopy. Patient-reported outcome (PRO) scores were obtained preoperatively and at 3-month, 1-year, 2-year, and 3-year follow-up time points. Any revision surgeries and conversions to total hip arthroplasty were noted. A multiple regression analysis was performed to look for positive and negative predictive factors for improvement in PROs after revision hip arthroscopy. Forty-seven hips in 43 patients had completed 2 years' follow-up or needed total hip arthroplasty. The mean length of follow-up was 29 months (range, 24 to 47 months). Of the hips, 31 (66%) had either unaddressed or incompletely treated femoroacetabular impingement. There was a significant improvement in all PRO scores at a mean of 29 months after revision (P arthroscopy can achieve moderately successful outcomes and remains a viable treatment strategy after failed primary hip preservation surgery. Preoperative predictors of success after revision hip arthroscopy include segmental labral defects, unaddressed or incompletely addressed femoroacetabular impingement, heterotopic ossification, and previous open surgery. Level IV, therapeutic case series. Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Use of medical tourism for hip and knee surgery in osteoarthritis: a qualitative examination of distinctive attitudinal characteristics among Canadian patients.

Science.gov (United States)

Crooks, Valorie A; Cameron, Keri; Chouinard, Vera; Johnston, Rory; Snyder, Jeremy; Casey, Victoria

2012-11-21

Medical tourism is the term that describes patients' international travel with the intention of seeking medical treatment. Some medical tourists go abroad for orthopaedic surgeries, including hip and knee resurfacing and replacement. In this article we examine the findings of interviews with Canadian medical tourists who went abroad for such surgeries to determine what is distinctive about their attitudes when compared to existing qualitative research findings about patients' decision-making in and experiences of these same procedures in their home countries. Fourteen Canadian medical tourists participated in semi-structured phone interviews, all of whom had gone abroad for hip or knee surgery to treat osteoarthritis. Transcripts were coded and thematically analysed, which involved comparing emerging findings to those in the existing qualitative literature on hip and knee surgery. Three distinctive attitudinal characteristics among participants were identified when interview themes were compared to findings in the existing qualitative research on hip and knee surgery in osteoarthritis. These attitudinal characteristics were that the medical tourists we spoke with were: (1) comfortable health-related decision-makers; (2) unwavering in their views about procedure necessity and urgency; and (3) firm in their desires to maintain active lives. Compared to other patients reported on in the existing qualitative hip and knee surgery literature, medical tourists are less likely to question their need for surgery and are particularly active in their pursuit of surgical intervention. They are also comfortable with taking control of health-related decisions. Future research is needed to identify motivators behind patients' pursuit of care abroad, determine if the attitudinal characteristics identified here hold true for other patient groups, and ascertain the impact of these attitudinal characteristics on surgical outcomes. Arthritis care providers can use the attitudinal

Use of medical tourism for hip and knee surgery in osteoarthritis: a qualitative examination of distinctive attitudinal characteristics among Canadian patients

Directory of Open Access Journals (Sweden)

Crooks Valorie A

2012-11-01

Full Text Available Abstract Background Medical tourism is the term that describes patients’ international travel with the intention of seeking medical treatment. Some medical tourists go abroad for orthopaedic surgeries, including hip and knee resurfacing and replacement. In this article we examine the findings of interviews with Canadian medical tourists who went abroad for such surgeries to determine what is distinctive about their attitudes when compared to existing qualitative research findings about patients’ decision-making in and experiences of these same procedures in their home countries. Methods Fourteen Canadian medical tourists participated in semi-structured phone interviews, all of whom had gone abroad for hip or knee surgery to treat osteoarthritis. Transcripts were coded and thematically analysed, which involved comparing emerging findings to those in the existing qualitative literature on hip and knee surgery. Results Three distinctive attitudinal characteristics among participants were identified when interview themes were compared to findings in the existing qualitative research on hip and knee surgery in osteoarthritis. These attitudinal characteristics were that the medical tourists we spoke with were: (1 comfortable health-related decision-makers; (2 unwavering in their views about procedure necessity and urgency; and (3 firm in their desires to maintain active lives. Conclusions Compared to other patients reported on in the existing qualitative hip and knee surgery literature, medical tourists are less likely to question their need for surgery and are particularly active in their pursuit of surgical intervention. They are also comfortable with taking control of health-related decisions. Future research is needed to identify motivators behind patients’ pursuit of care abroad, determine if the attitudinal characteristics identified here hold true for other patient groups, and ascertain the impact of these attitudinal characteristics on

Metal release and metal allergy after total hip replacement with resurfacing versus conventional hybrid prosthesis 5-year follow-up of 52 patients

DEFF Research Database (Denmark)

Gustafson, Klas; Jakobsen, Stig S; Lorenzen, Nina D

2014-01-01

to an increased incidence of metal allergy. METHODS: 52 hips in 52 patients (median age 60 (51-64) years, 30 women) were randomized to either a MOM hip resurfacing system (ReCap) or a standard MOP total hip arthoplasty (Mallory Head/Exeter). Spot urine samples were collected preoperatively, postoperatively, after....... RESULTS: A statistically significant 10- to 20-fold increase in urinary levels of cobalt and chromium was observed throughout the entire follow-up in the MOM group. The prevalence of metal allergy was similar between groups. INTERPRETATION: While we observed significantly increased levels of metal ions...

[Ex vivo microCT analysis of possible microfractures of the femoral head during implantation of a cementless hip resurfacing femoral component].

Science.gov (United States)

Lerch, M; Olender, G; von der Höh, N; Thorey, F; von Lewinski, G; Meyer-Lindenberg, A; Windhagen, H; Hurschler, C

2009-01-01

Microfractures of the femoral head during implantation of the femoral components are suspected to be a cause of fractures at the implant/neck junction which represent a common failure mode in hip resurfacing arthroplasty. Callus formation observed in femoral head retrievals suggests the occurrence of microfractures inside the femoral head, which might be inadvertently caused by the surgeon during implantation. The aim of this biomechanical study was to analyse whether or not the implantation of a cementless femoral component hip resurfacing system causes microfractures in the femoral head. After the preparation of 20 paired human cadaveric femoral heads, the cementless femoral component ESKA Typ BS (ESKA Implants GmbH & Co., Lübeck) was implanted on 9 specimens with an impaction device that generates 4.5 kN impaction force. On 9 specimens the femoral component was implanted by hand. One head was used as a fracture model, 1 specimen served as control without manipulation. The femoral component used for impaction was equipped with hinges to enable its removal without further interfering with the bone stock. Specimens were scanned with a microCT device before and after impaction and the microCT datasets before and after impaction were compared to identify possible microfractures. Twenty strikes per hand or with the impaction device provided sufficient implant seating. Neither the macroscopic examination nor the 2-dimensional microCT analysis revealed any fractures of the femoral heads after impaction. At least macroscopically and in the 2-dimensional microCT analysis, implantation of the cementless hip resurfacing femoral component ESKA Typ BS with 4.5 kN or by hand does not seem to cause fractures of the femoral head. Georg Thieme Verlag KG Stuttgart, New York.

Bilateral hip arthroplasty: is 1-week staging the optimum strategy?

Directory of Open Access Journals (Sweden)

Willis-Owen Charles A

2010-11-01

Full Text Available Abstract Seventy-nine patients underwent bilateral hip arthroplasty staged either at 1 week (Group 1 or after greater intervals (as suggested by the patients, mean 44 weeks, range 16-88 weeks (Group 2, over a five year period at one Institution. Sixty-eight patients (29 bilateral hip resurfacings and 39 total hip replacements completed questionnaires regarding their post-operative recovery, complications and overall satisfaction with the staging of their surgery. There was no significant age or ASA grade difference between the patient groups. Complication rates in the two groups were similar and overall satisfaction rates were 84% in Group 1 (n = 32 and 89% in Group 2 (n = 36. Cumulative hospital lengths of stay were significantly longer in Group 1 patients (11.9 days vs 9.1 days(p The mean time to return to part-time work was 16.4 weeks for Group 1, and a cumulative 17.2 weeks (8.8 and 8.4 weeks for Group 2. The time to return to full-time work was significantly shorter for Group 1 patients (21.0 weeks, compared with a cumulative 29.7 weeks for Group 2(p Hip resurfacing patients in Group 2 had significantly shorter durations of postoperative pain and were able to return to part-time and full time work sooner than total hip arthroplasty patients. There was a general trend towards a faster recovery and resumption of normal activities following the second operation in Group 2 patients, compared with the first operation. Bilateral hip arthroplasty staged at a 1-week interval resulted in an earlier resolution of hip pain, and an earlier return to full-time work (particularly following total hip replacement surgery, with high levels of patient satisfaction and no increased risk in complications; however the hospital length of stay was significantly longer. The decision for the timing of staged bilateral surgery should be made in conjunction with the patient, making adjustments to accommodate their occupational needs and functional demands.

Clinical and biomechanical assessment of patella resurfacing in total knee arthroplasty.

Science.gov (United States)

Berti, Lisa; Benedetti, Maria Grazia; Ensini, Andrea; Catani, Fabio; Giannini, Sandro

2006-07-01

Currently there is a limited understanding of the factors influencing range of motion by comparing patellar resurfacing vs non-resurfacing in total knee arthroplasty during activities of daily living. A recent meta-analysis of patellar replacement confirms better outcome with patella resurfacing; however, the result can be influenced by many other factors, such as: component design, surgeon experience, and technical aspects of the surgery. This study compares the biomechanics of the knee in patients after total knee arthroplasty with and without patellar resurfacing during stair climbing. Forty-seven patients with total knee arthroplasty were assessed at the mean follow-up of 24 months. In all of them a posterior stabilised fixed bearing prosthesis (Optetrak PS, Exactech) was implanted. Twenty-six patients were treated without patellar resurfacing and 21 with patellar resurfacing. Clinical evaluations were performed using the International Knee Society and the Hospital for Special Surgery scores. Ten patients with patellar resurfacing and 10 patients without patellar resurfacing were also studied with motion analysis during stair climbing; 10 healthy subjects were studied for statistical comparison. Clinical passive knee flexion, International Knee Society Function and Hospital for Special Surgery scores were significantly higher in the patellar resurfacing group. During stair climbing, active knee joint range of motion during the stance phase was greater in patients with patellar resurfacing. The maximum adduction moment was significantly higher in the group without patellar resurfacing. Patients with patellar resurfacing demonstrated better clinical scores, and kinematic and kinetic data while ascending stairs.

Advanced metal artifact reduction MRI of metal-on-metal hip resurfacing arthroplasty implants: compressed sensing acceleration enables the time-neutral use of SEMAC

International Nuclear Information System (INIS)

Fritz, Jan; Thawait, Gaurav K.; Fritz, Benjamin; Raithel, Esther; Nittka, Mathias; Gilson, Wesley D.; Mont, Michael A.

2016-01-01

Compressed sensing (CS) acceleration has been theorized for slice encoding for metal artifact correction (SEMAC), but has not been shown to be feasible. Therefore, we tested the hypothesis that CS-SEMAC is feasible for MRI of metal-on-metal hip resurfacing implants. Following prospective institutional review board approval, 22 subjects with metal-on-metal hip resurfacing implants underwent 1.5 T MRI. We compared CS-SEMAC prototype, high-bandwidth TSE, and SEMAC sequences with acquisition times of 4-5, 4-5 and 10-12 min, respectively. Outcome measures included bone-implant interfaces, image quality, periprosthetic structures, artifact size, and signal- and contrast-to-noise ratios (SNR and CNR). Using Friedman, repeated measures analysis of variances, and Cohen's weighted kappa tests, Bonferroni-corrected p-values of 0.005 and less were considered statistically significant. There was no statistical difference of outcomes measures of SEMAC and CS-SEMAC images. Visibility of implant-bone interfaces and pseudocapsule as well as fat suppression and metal reduction were ''adequate'' to ''good'' on CS-SEMAC and ''non-diagnostic'' to ''adequate'' on high-BW TSE (p < 0.001, respectively). SEMAC and CS-SEMAC showed mild blur and ripple artifacts. The metal artifact size was 63 % larger for high-BW TSE as compared to SEMAC and CS-SEMAC (p < 0.0001, respectively). CNRs were sufficiently high and statistically similar, with the exception of CNR of fluid and muscle and CNR of fluid and tendon, which were higher on intermediate-weighted high-BW TSE (p < 0.005, respectively). Compressed sensing acceleration enables the time-neutral use of SEMAC for MRI of metal-on-metal hip resurfacing implants when compared to high-BW TSE and image quality similar to conventional SEMAC. (orig.)

Advanced metal artifact reduction MRI of metal-on-metal hip resurfacing arthroplasty implants: compressed sensing acceleration enables the time-neutral use of SEMAC

Energy Technology Data Exchange (ETDEWEB)

Fritz, Jan; Thawait, Gaurav K. [Johns Hopkins University School of Medicine, Russell H. Morgan Department of Radiology and Radiological Science, Section of Musculoskeletal Radiology, Baltimore, MD (United States); Fritz, Benjamin [University of Freiburg, Department of Radiology, Freiburg im Breisgau (Germany); Raithel, Esther; Nittka, Mathias [Siemens Healthcare GmbH, Erlangen (Germany); Gilson, Wesley D. [Siemens Healthcare USA, Inc., Baltimore, MD (United States); Mont, Michael A. [Cleveland Clinic Foundation, Department of Orthopedic Surgery, Cleveland, OH (United States)

2016-10-15

Compressed sensing (CS) acceleration has been theorized for slice encoding for metal artifact correction (SEMAC), but has not been shown to be feasible. Therefore, we tested the hypothesis that CS-SEMAC is feasible for MRI of metal-on-metal hip resurfacing implants. Following prospective institutional review board approval, 22 subjects with metal-on-metal hip resurfacing implants underwent 1.5 T MRI. We compared CS-SEMAC prototype, high-bandwidth TSE, and SEMAC sequences with acquisition times of 4-5, 4-5 and 10-12 min, respectively. Outcome measures included bone-implant interfaces, image quality, periprosthetic structures, artifact size, and signal- and contrast-to-noise ratios (SNR and CNR). Using Friedman, repeated measures analysis of variances, and Cohen's weighted kappa tests, Bonferroni-corrected p-values of 0.005 and less were considered statistically significant. There was no statistical difference of outcomes measures of SEMAC and CS-SEMAC images. Visibility of implant-bone interfaces and pseudocapsule as well as fat suppression and metal reduction were ''adequate'' to ''good'' on CS-SEMAC and ''non-diagnostic'' to ''adequate'' on high-BW TSE (p < 0.001, respectively). SEMAC and CS-SEMAC showed mild blur and ripple artifacts. The metal artifact size was 63 % larger for high-BW TSE as compared to SEMAC and CS-SEMAC (p < 0.0001, respectively). CNRs were sufficiently high and statistically similar, with the exception of CNR of fluid and muscle and CNR of fluid and tendon, which were higher on intermediate-weighted high-BW TSE (p < 0.005, respectively). Compressed sensing acceleration enables the time-neutral use of SEMAC for MRI of metal-on-metal hip resurfacing implants when compared to high-BW TSE and image quality similar to conventional SEMAC. (orig.)

Adverse reaction to metal debris in a consecutive series of DUROM™ hip resurfacing: pseudotumour incidence and metal ion concentration.

Science.gov (United States)

Hartmann, Albrecht; Kieback, Jan-Dirk; Lützner, Jörg; Günther, Klaus-Peter; Goronzy, Jens

2017-07-25

The aim of this study was to evaluate the incidence of adverse reactions to metal debris (ARMD) in a consecutive series of DUROM™ Hip Resurfacing Arthroplasty (HRA) at mid-term follow-up. Between October 2003 and March 2007 a total of 134 consecutive DUROM™ HRA in 121 patients were performed at our institution. Follow-up could be obtained in 101 unrevised patients (83%) at a mean time of 8.51 ± 0.97 years postoperatively and included patient-related outcome measurement, plain radiographs, MARS-MRI as well as whole blood metal ion assessment. 17 (16.5%) out of 103 hips revealed pseudotumour occurrence in MRI investigation, 1 (10.6%) with a diameter of ≥2 cm. Higher incidence of pseudotumours was found patients with femoral component size 7 μg/l. In contrast to cobalt determination, only elevated chromium values showed a positive association with pseudotumour occurrence and size. A significant proportion of patients developed pseudotumours and metal ion elevation in a consecutive cohort of DUROM™ HRA after mid-term follow-up. The incidence, however, seems not to differ from results of other well performing resurfacing brands; clinical relevance of our findings is unclear. Regarding potential local as well as systemic effects of metal particle release, close follow-up of patients is essential, even with clinically well-performing implants.

Anaemia impedes functional mobility after hip fracture surgery

DEFF Research Database (Denmark)

Foss, N.B.; Kristensen, M.T.; Kehlet, H.

2008-01-01

mobility in the early post-operative phase after a hip fracture surgery and is an independent risk factor for patients not being able to walk post-operatively. The potential for a liberal transfusion policy to improve the rehabilitation potential in hip fracture patients with anaemia should be investigated......BACKGROUND: the impact of anaemia on the outcome after a hip fracture surgery is controversial, but anaemia can potentially decrease the physical performance and thereby impede post-operative rehabilitation. We therefore conducted a prospective study to establish whether anaemia affected functional...... mobility in the early post-operative phase after a hip fracture surgery. PATIENTS AND METHODS: four hundred and eighty seven consecutive hip fracture patients, treated according to a well-defined multimodal rehabilitation programme with a uniform, liberal transfusion threshold, were studied. Hb...

Predictors of incident depression after hip fracture surgery.

NARCIS (Netherlands)

Oude Voshaar, R.C.; Banerjee, S.; Horan, M.; Baldwin, R.; Pendleton, N.; Proctor, R.; Tarrier, N.; Woodward, Y.; Burns, A.

2007-01-01

OBJECTIVE: Depression after hip fracture surgery is prevalent and associated with increased mortality rates and impaired functional recovery. The incidence of new-onset depressive symptoms in patients initially not depressed after hip fracture surgery and their relationship with functional recovery

Modular femoral component for conversion of previous hip surgery in total hip arthroplasty.

Science.gov (United States)

Goldstein, Wayne M; Branson, Jill J

2005-09-01

The conversion of previous hip surgery to total hip arthroplasty creates a durable construct that is anatomically accurate. Most femoral components with either cemented or cementless design have a fixed tapered proximal shape. The proximal femoral anatomy is changed due to previous hip surgery for fixation of an intertrochanteric hip fracture, proximal femoral osteotomy, or a fibular allograft for avascular necrosis. The modular S-ROM (DePuy Orthopaedics Inc., Warsaw, Ind) hip stem accommodates these issues and independently prepares the proximal and distal portion of the femur. In preparation and implantation, the S-ROM hip stem creates less hoop stresses on potentially fragile stress risers from screws and thin bone. The S-ROM hip stem also prepares a previously distorted anatomy by milling through cortical bone that can occlude the femoral medullar canals and recreate proper femoral anteversion and reduces the risk of intraoperative or postoperative periprosthetic fracture due to the flexible titanium-slotted stem. The S-ROM femoral stem is recommended for challenging total hip reconstructions.

Comparing return to sport activities after short metaphyseal femoral arthroplasty with resurfacing and big femoral head arthroplasties.

Science.gov (United States)

Karampinas, Panagiotis K; Papadelis, Eustratios G; Vlamis, John A; Basiliadis, Hlias; Pneumaticos, Spiros G

2017-07-01

Young patients feel that maintaining sport activities after total hip arthroplasty constitutes an important part of their quality of life. The majority of hip surgeons allow patients to return to low-impact activities, but significant caution is advised to taking part in high-impact activities. The purpose of this study is to compare and evaluate the post-operative return to daily living habits and sport activities following short-metaphyseal hip and high functional total hip arthroplasties (resurfacing and big femoral head arthroplasties). In a study design, 48 patients (55 hips) were enrolled in three different comparative groups, one with the short-metaphyseal arthroplasties, a second with high functional resurfacing arthroplasties and a third of big femoral head arthroplasties. Each patient experienced a clinical examination and evaluated with Harris Hip Score, WOMAC, Sf-36, UCLA activity score, satisfaction VAS, anteroposterior and lateral X-rays of the hip and were followed in an outpatient setting for 2 years. Statistical analysis revealed no notable differences between the three groups regarding their demographic data however significant differences have been found between preoperative and postoperative clinical scores of each group. Also, we fail to reveal any significant differences when comparing data of all three groups at the final 2 years postoperative control regarding their clinical scores. The overall outcome of all three groups was similar, all the patients were satisfied and returned to previous level of sport activities. Short metaphyseal hip arthroplasties in young patients intending to return to previous and even high impact sport activities, similar to high functional resurfacing, big femoral head arthroplasties. Short stems with hard on hard bearing surfaces might become an alternative to standard stems and hip resurfacing.

Cobalt deposition in mineralized bone tissue after metal-on-metal hip resurfacing: Quantitative μ-X-ray-fluorescence analysis of implant material incorporation in periprosthetic tissue.

Science.gov (United States)

Hahn, Michael; Busse, Björn; Procop, Mathias; Zustin, Jozef; Amling, Michael; Katzer, Alexander

2017-10-01

Most resurfacing systems are manufactured from cobalt-chromium alloys with metal-on-metal (MoM) bearing couples. Because the quantity of particulate metal and corrosion products which can be released into the periprosthetic milieu is greater in MoM bearings than in metal-on-polyethylene (MoP) bearings, it is hypothesized that the quantity and distribution of debris released by the MoM components induce a compositional change in the periprosthetic bone. To determine the validity of this claim, nondestructive µ-X-ray fluorescence analysis was carried out on undecalcified histological samples from 13 femoral heads which had undergone surface replacement. These samples were extracted from the patients after gradient time points due to required revision surgery. Samples from nonintervened femoral heads as well as from a MoP resurfaced implant served as controls. Light microscopy and µ-X-ray fluorescence analyses revealed that cobalt debris was found not only in the soft tissue around the prosthesis and the bone marrow, but also in the mineralized bone tissue. Mineralized bone exposed to surface replacements showed significant increases in cobalt concentrations in comparison with control specimens without an implant. A maximum cobalt concentration in mineralized hard tissue of up to 380 ppm was detected as early as 2 years after implantation. Values of this magnitude are not found in implants with a MoP surface bearing until a lifetime of more than 20 years. This study demonstrates that hip resurfacing implants with MoM bearings present a potential long-term health risk due to rapid cobalt ion accumulation in periprosthetic hard tissue. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 1855-1862, 2017. © 2016 Wiley Periodicals, Inc.

The effect of motion patterns on edge-loading of metal-on-metal hip resurfacing.

Science.gov (United States)

Mellon, S J; Kwon, Y-M; Glyn-Jones, S; Murray, D W; Gill, H S

2011-12-01

The occurrence of pseudotumours (soft tissue masses relating to the hip joint) following metal-on-metal hip resurfacing arthroplasty (MoMHRA) has been associated with high serum metal ion levels and consequently higher than normal bearing wear. We investigated the relationship between serum metal ion levels and contact stress on the acetabular component of MoMHRA patients for two functional activities; gait and stair descent. Four subjects with MoMHRA, who had their serum metal ion levels measured, underwent motion analysis followed by CT scanning. Their motion capture data was combined with published hip contact forces and finite element models representing 14% (peak force) and 60% (end of stance) of the gait cycle and 52% (peak force) of stair descent activity were created. The inclination angle of the acetabular component was increased by 10° in 1° intervals and the contact stresses were determined at each interval for each subject. When the inclination angle was altered in such a way as to cause the hip contact force to pass through the edge of the acetabular component edge-loading occurred. Edge-loading increased the contact stress by at least 50%; the maximum increase was 108%. Patients with low serum metal ion levels showed no increase in contact stress at peak force during gait or stair descent. Patients with high serum metal ion levels exhibited edge-loading with an increase to the inclination angle of their acetabular components. The increase in inclination angle that induced edge-loading for these subjects was less than the inter-subject variability in the angle of published hip contact forces. The results of this study suggest that high serum metal ion levels are the result of inclination angle influenced edge-loading but that edge-loading cannot be attributed to inclination angle alone and that an individual's activity patterns can reduce or even override the influence of a steep acetabular component and prevent edge-loading. Copyright © 2011 IPEM

Perioperative transfusion threshold and ambulation after hip revision surgery

DEFF Research Database (Denmark)

Nielsen, Kamilla; Johansson, Pär I; Dahl, Benny

2014-01-01

BACKGROUND: Transfusion with red blood cells (RBC) may be needed during hip revision surgery but the appropriate haemoglobin concentration (Hb) threshold for transfusion has not been well established. We hypothesized that a higher transfusion threshold would improve ambulation after hip revision...... surgery. METHODS: The trial was registered at Clinicaltrials.gov ( NCT00906295). Sixty-six patients aged 18 years or older undergoing hip revision surgery were randomized to receive RBC at a Hb threshold of either 7.3 g/dL (restrictive group) or 8.9 g/dL (liberal group). Postoperative ambulation...... received RBC. CONCLUSIONS: A Hb transfusion threshold of 8.9 g/dL was associated with a statistically significantly faster TUG after hip revision surgery compared to a threshold of 7.3 g/dL but the clinical importance is questionable and the groups did not differ in Hb at the time of testing....

Indications for MARS-MRI in Patients Treated With Metal-on-Metal Hip Resurfacing Arthroplasty.

Science.gov (United States)

Connelly, James W; Galea, Vincent P; Matuszak, Sean J; Madanat, Rami; Muratoglu, Orhun; Malchau, Henrik

2018-06-01

Currently, there are no universally accepted guidelines on when to obtain metal artifact reduction sequence magnetic resonance imaging (MARS-MRI) in metal-on-metal (MoM) hip resurfacing arthroplasty (HRA) patients. Our primary aims were to identify which patient and clinical factors are predictive of adverse local tissue reaction (ALTR) and create an algorithm for indicating MARS-MRI in patients with Articular Surface Replacement (ASR) HRA. The secondary aim was to compare our algorithm to existing guidelines on when to perform MARS-MRI in MoM HRA patients. The study cohort consisted of 182 patients with unilateral ASR HRA from a prospective, multicenter study. Subjects received MARS-MRI at a mean of 7.8 years from surgery, regardless of symptoms. We determined which variables were predictive of ALTR and generated cutoffs for each variable. Finally, we created an algorithm to predict ALTR and indicate MARS-MRI in ASR HRA patients using these cutoffs and compared it to existing guidelines. We found high blood cobalt (Co) (odds ratio = 1.070; P = .011) and high blood chromium (Cr) (odds ratio = 1.162; P = .002) to be significant predictors of ALTR presence. Our algorithm using a blood Co cutoff of 1.15 ppb and a Cr cutoff of 1.09 ppb achieved 96.6% sensitivity and 35.3% specificity in predicting ALTR, which outperformed the existing guidelines. Blood Co and Cr levels are predictive of ALTR in ASR HRA patients. Our algorithm considering blood Co and Cr levels predicts ALTR in ASR HRA patients with higher sensitivity than previously established guidelines. Copyright © 2018 Elsevier Inc. All rights reserved.

Persistently High Hip Circumference after Bariatric Surgery Is a Major Hurdle to Successful Hip Replacement

Directory of Open Access Journals (Sweden)

Menachem M. Meller

2014-01-01

Full Text Available The prevalence of class III obesity (BMI≥40 kg/m2 in black women is 18%. As class III obesity leads to hip joint deterioration, black women frequently present for orthopedic care. Weight loss associated with bariatric surgery should lead to enhanced success of hip replacements. However, we present a case of a black woman who underwent Roux-en-Y gastric bypass with the expectation that weight loss would make her a better surgical candidate for hip replacement. Her gastric bypass was successful as her BMI declined from 52.0 kg/m2 to 33.7 kg/m2. However, her hip circumference after weight loss remained persistently high. Therefore, at surgery the soft tissue tunnel geometry presented major challenges. Tunnel depth and immobility of the soft tissue interfered with retractor placement, tissue reflection, and surgical access to the acetabulum. Therefore a traditional cup placement could not be achieved. Instead, a hemiarthroplasty was performed. After surgery her pain and reliance on external support decreased. But her functional independence never improved. This case demonstrates that a lower BMI after bariatric surgery may improve the metabolic profile and decrease anesthesia risk, but the success of total hip arthroplasties remains problematic if fat mass in the operative field (i.e., high hip circumference remains high.

Imaging of hip arthroplasty

Energy Technology Data Exchange (ETDEWEB)

Miller, Theodore T., E-mail: millertt@hss.edu [Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021 (United States)

2012-12-15

The imaging evaluation of the prosthetic hip begins with radiography, but arthrography, aspiration, scintigraphy, sonography, CT and MR imaging all have roles in the evaluation of the painful prosthesis. This article will review the appearance of normal hip arthroplasty including hemiarthroplasty, total arthroplasty, and hip resurfacing, as well as the appearances of potential complications such as aseptic loosening and osteolysis, dislocation, infection, periprosthetic fracture, hardware failure, and soft tissue abnormalities.

Feasibility of progressive strength training shortly after hip fracture surgery

DEFF Research Database (Denmark)

Overgaard, Jan; Kristensen, Morten T

2013-01-01

To investigate the feasibility of a 6-wk progressive strength-training programme commenced shortly after hip fracture surgery in community-dwelling patients.......To investigate the feasibility of a 6-wk progressive strength-training programme commenced shortly after hip fracture surgery in community-dwelling patients....

Getting your home ready - knee or hip surgery

Science.gov (United States)

Hip or knee surgery - getting your home ready; Osteoarthritis - knee ... Cabrera JA, Cabrera AL. Total hip replacement. In: Frontera WR, Silver JK, Rizzo TD, eds. Essentials of Physical Medicine and Rehabilitation . 3rd ed. Philadelphia, PA: Elsevier Saunders; ...

Laser Resurfacing

OpenAIRE

Janik, Joseph P.; Markus, Jodi L.; Al-Dujaili, Zeena; Markus, Ramsey F.

2007-01-01

In a society desiring images of beauty and youthfulness, the world of cutaneous surgery offers the gifts of facial rejuvenation for those determined to combat the signs of aging. With the development of novel laser and plasma technology, pigmentary changes, scarring, and wrinkles can be conquered providing smoother, healthier, younger-looking skin. This review highlights five of the most popular resurfacing technologies in practice today including the carbon dioxide (CO2) laser, the erbium:yt...

Surgery for hip fractures: Does surgical delay affect outcomes?

Directory of Open Access Journals (Sweden)

Nicole Simunovic

2011-01-01

Full Text Available Hip fractures are associated with a high rate of mortality and profound temporary and sometimes permanent impairment of quality of life. Current guidelines indicate that surgeons should perform surgery for a hip fracture within 24 hours of injury because earlier surgery is associated with better functional outcome and lower rates of perioperative complications and mortality. Proponents of early treatment argue that this approach minimizes the length of time a patient is confined to bed rest, thereby reducing the risk for associated complications, such as pressure sores, deep vein thrombosis, and urinary tract infections. Those favoring delaying surgery beyond the guideline recommendations believe that this approach is required to medically optimize patients, and therefore decrease the risk for perioperative complications. Further challenges to resolving this debate is the lack of an accepted definition of what should constitute an "unacceptable delay" for hip fracture surgery and the fact that outcomes associated with surgical delay are based on observational data alone (i.e., not randomized controlled trials. The effect of preoperative timing on mortality and other patient-important outcomes across various age groups remains controversial and warrants a large randomized controlled trial to offer clear insights into the effects associated with early versus delayed surgery among hip fracture patients.

Improving hip surgery patients’ outcomes:

DEFF Research Database (Denmark)

Bagger, Bettan; Poulsen, Dorthe Varning; Taylor Kelly, Hélène

This presentation focuses upon the improvement of hip surgery patients’ outcomes with respect to health promotion and rehabilitation. The overall aims of the EU financed orthopedic nursing project will be introduced. Speakers highlight the project’s contribution to: -the development of nurse...

Predictors of not regaining basic mobility after hip fracture surgery

DEFF Research Database (Denmark)

Hulsbæk, Signe; Larsen, Rikke Faebo; Troelsen, Anders

2015-01-01

PURPOSE: Regaining basic mobility after hip fracture surgery is a milestone in the in-hospital rehabilitation. The aims were to investigate predictors for not regaining basic mobility at the fifth post-operative day and at discharge after undergoing hip fracture surgery. METHOD: In a prospective...... on first post-operative day (OR = 3.3) (p values: 0.009-surgery, who are not able to complete physiotherapy on first post-operative day, are at a greater risk of not regaining basic mobility during hospitalization....... This highlights the importance of physiotherapy as part of the interdisciplinary treatment. IMPLICATIONS FOR REHABILITATION: Regaining abilities in basic mobility after hip fracture surgery is a primary goal of rehabilitation during hospitalization in the acute ward. The following factors are indentified...

Mini Nutritional Assessment and Mortality after Hip Fracture Surgery in the Elderly.

Science.gov (United States)

van Wissen, J; van Stijn, M F M; Doodeman, H J; Houdijk, A P J

2016-01-01

Hip fracture surgery in elderly patients is associated with a poor postoperative outcome and a high mortality. Malnutrition is a frequent problem in elderly patients and may be associated with mortality after hip fracture surgery. The Mini Nutritional Assessment (MNA) is a valuable tool to identify malnourished patients and those at risk for malnutrition. To evaluate the association between the preoperative MNA score and mortality after surgery for hip fractures in elderly patients. Patients with a hip fracture and an indication for surgery were included in our study. This study was part of a randomized trial on the effect of taurine on postoperative outcome in elderly hip fracture patients. The MNA was assessed on admission before surgery. Length of stay, postoperative complications and mortality were documented. The association of the MNA score on postoperative outcome and mortality was analyzed using Cox regression analysis. The one-year survival rate in 226 elderly hip fracture patients was 79%. In-hospital mortality rates and 1-year mortality were 27% and 46% in malnourished patients, 12% and 26% in patients at risk for malnutrition and 7% and 17% in well-nourished patients as assessed by MNA. Preoperative malnutrition measured by the MNA is associated with mortality in elderly hip fracture patients.

Predicting Early Mortality After Hip Fracture Surgery: The Hip Fracture Estimator of Mortality Amsterdam.

Science.gov (United States)

Karres, Julian; Kieviet, Noera; Eerenberg, Jan-Peter; Vrouenraets, Bart C

2018-01-01

Early mortality after hip fracture surgery is high and preoperative risk assessment for the individual patient is challenging. A risk model could identify patients in need of more intensive perioperative care, provide insight in the prognosis, and allow for risk adjustment in audits. This study aimed to develop and validate a risk prediction model for 30-day mortality after hip fracture surgery: the Hip fracture Estimator of Mortality Amsterdam (HEMA). Data on 1050 consecutive patients undergoing hip fracture surgery between 2004 and 2010 were retrospectively collected and randomly split into a development cohort (746 patients) and validation cohort (304 patients). Logistic regression analysis was performed in the development cohort to determine risk factors for the HEMA. Discrimination and calibration were assessed in both cohorts using the area under the receiver operating characteristic curve (AUC), the Hosmer-Lemeshow goodness-of-fit test, and by stratification into low-, medium- and high-risk groups. Nine predictors for 30-day mortality were identified and used in the final model: age ≥85 years, in-hospital fracture, signs of malnutrition, myocardial infarction, congestive heart failure, current pneumonia, renal failure, malignancy, and serum urea >9 mmol/L. The HEMA showed good discrimination in the development cohort (AUC = 0.81) and the validation cohort (AUC = 0.79). The Hosmer-Lemeshow test indicated no lack of fit in either cohort (P > 0.05). The HEMA is based on preoperative variables and can be used to predict the risk of 30-day mortality after hip fracture surgery for the individual patient. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

A randomized controlled trial of skin care protocols for facial resurfacing: lessons learned from the Plastic Surgery Educational Foundation's Skin Products Assessment Research study.

Science.gov (United States)

Pannucci, Christopher J; Reavey, Patrick L; Kaweski, Susan; Hamill, Jennifer B; Hume, Keith M; Wilkins, Edwin G; Pusic, Andrea L

2011-03-01

The Skin Products Assessment Research Committee was created by the Plastic Surgery Educational Foundation in 2006. The Skin Products Assessment Research study aims were to (1) develop an infrastructure for Plastic Surgery Educational Foundation-conducted, industry-sponsored research in facial aesthetic surgery and (2) test the research process by comparing outcomes of the Obagi Nu-Derm System versus conventional therapy as treatment adjuncts for facial resurfacing procedures. The Skin Products Assessment Research study was designed as a multicenter, double-blind, randomized, controlled trial. The study was conducted in women with Fitzpatrick type I to IV skin, moderate to severe facial photodamage, and periocular and/or perioral fine wrinkles. Patients underwent chemical peel or laser facial resurfacing and were randomized to the Obagi Nu-Derm System or a standard care regimen. The study endpoints were time to reepithelialization, erythema, and pigmentation changes. Fifty-six women were enrolled and 82 percent were followed beyond reepithelialization. There were no significant differences in mean time to reepithelialization between Obagi Nu-Derm System and control groups. The Obagi Nu-Derm System group had a significantly higher median erythema score on the day of surgery (after 4 weeks of product use) that did not persist after surgery. Test-retest photographic evaluations demonstrated that both interrater and intrarater reliability were adequate for primary study outcomes. The authors demonstrated no significant difference in time to reepithelialization between patients who used the Obagi Nu-Derm System or a standard care regimen as an adjunct to facial resurfacing procedures. The Skin Products Assessment Research team has also provided a discussion of future challenges for Plastic Surgery Educational Foundation-sponsored clinical research for readers of this article.

Preoperative warfarin reversal for early hip fracture surgery.

Science.gov (United States)

Moores, Thomas Steven; Beaven, Alastair; Cattell, Andrew Edwin; Baker, Charles; Roberts, Philip John

2015-04-01

To evaluate our hospital protocol of low-dose vitamin K titration for preoperative warfarin reversal for early hip fracture surgery. Records of 16 men and 33 women aged 63 to 93 (mean, 81) years who were taking warfarin for atrial fibrillation (n=40), venous thromboembolism (n=9), cerebrovascular accident (n=3), and prosthetic heart valve (n=3) and underwent surgery for hip fractures were reviewed. The 3 patients with a prosthetic heart valve were deemed high risk for thromboembolism and the remainder low-risk. The international normalised ratio (INR) of patients was checked on admission and 6 hours after administration of vitamin K; an INR of fracture surgery within 36 to 48 hours of admission improves morbidity and mortality.

Determinants of time to surgery for patients with hip fracture.

Science.gov (United States)

Zeltzer, Justin; Mitchell, Rebecca J; Toson, Barbara; Harris, Ian A; Close, Jacqueline

2014-09-01

Guidelines for hip fracture care suggest that patients with hip fracture should undergo surgery on the day of or day after admission to hospital. This study examined factors affecting time to surgery for hip fracture extracted from existing administrative datasets in New South Wales (NSW), Australia. A retrospective analysis of patients with hip fracture aged 65 years and over undergoing surgical intervention in NSW public hospitals between 1 July 2000 and 30 June 2011. A multinomial logistic model was used to identify factors impacting on time to surgery from 1 July 2006 to 30 June 2011. A total of 49,317 hip fracture procedures were recorded during 2000-2001 to 2010-2011. Sixty-four per cent of patients received operative treatment on the day of or day after admission. Co-morbidity, type of surgical procedure and day of presentation all impacted significantly on time to surgery. Fourteen per cent required an inter-hospital transfer prior to receiving operative intervention. Transferred patients were 2.6 (95% confidence interval (CI): 2.31-2.85) times more likely to wait 2-4 days and 3.2 times more likely to wait 5 or more days (95% CI: 2.77-3.76) for surgery compared with patients presenting to an operating hospital. Significant variation exists between hospitals in the time to surgery that is not solely explained by measures of case mix or geography. Opportunities exist to consider other factors contributing to this variation and to ensure timely access to surgical intervention in the future. © 2014 Royal Australasian College of Surgeons.

Hidden blood loss after surgery for hip fracture

DEFF Research Database (Denmark)

Foss, N B; Kehlet, H

2006-01-01

Our aim was to determine the total blood loss associated with surgery for fracture of the hip and to identify risk factors for increased blood loss. We prospectively studied 546 patients with hip fracture. The total blood loss was calculated on the basis of the haemoglobin difference, the number...

Risk factors associated with outcomes of hip fracture surgery in elderly patients.

Science.gov (United States)

Kim, Byung Hoon; Lee, Sangseok; Yoo, Byunghoon; Lee, Woo Yong; Lim, Yunhee; Kim, Mun-Cheol; Yon, Jun Heum; Kim, Kye-Min

2015-12-01

Hip fracture surgery on elderly patients is associated with a high incidence of morbidity and mortality. The aim of this study is to identify the risk factors related to the postoperative mortality and complications following hip fracture surgery on elderly patients. In this retrospective study, the medical records of elderly patients (aged 65 years or older) who underwent hip fracture surgery from January 2011 to June 2014 were reviewed. A total of 464 patients were involved. Demographic data of the patients, American Society of Anesthesiologists physical status, preoperative comorbidities, type and duration of anesthesia and type of surgery were collected. Factors related to postoperative mortality and complications; as well as to intensive care unit admission were analyzed using logistic regression. The incidence of postoperative mortality, cardiovascular complications, respiratory complications and intensive care unit (ICU) admission were 1.7, 4.7, 19.6 and 7.1%, respectively. Postoperative mortality was associated with preoperative respiratory comorbidities, postoperative cardiovascular complications (P bedridden state (P elderly patients undergoing hip fracture surgery.

Prevalence and Impact of Hip Arthroscopic Surgery on Future Participation in Elite American Football Athletes.

Science.gov (United States)

Knapik, Derrick M; Sheehan, Joe; Nho, Shane J; Voos, James E; Salata, Michael J

2018-02-01

Intra-articular injuries to the hip in elite athletes represent a source of significant pain and disability. Hip arthroscopic surgery has become the gold standard for the treatment of disorders involving the hip joint. To examine the incidence of and abnormalities treated with hip arthroscopic surgery as well as the impact on future participation in American football athletes invited to the National Football League (NFL) Scouting Combine with a history of hip arthroscopic surgery. Cohort study; Level of evidence, 3. Athletes invited to the NFL Combine from 2012 to 2015 were evaluated for a history of hip arthroscopic surgery. Athlete demographics, imaging findings, and physical examination results were gathered using the NFL Combine database. Information on prospective participation in the NFL with regard to draft status, games played, games started, and current status was gathered using publicly available databases and compared against all other athletes participating in the combine. Fourteen athletes (15 hips) had a history of arthroscopic hip surgery. Acetabular labral tears were treated in 93% (14 hips), with femoroacetabular impingement decompression performed in 33% (5 hips). Compared with athletes who had no history of hip arthroscopic surgery, those undergoing arthroscopic surgery did not possess a lower likelihood of being drafted (66% vs 71%, respectively; P = .78) or of being on an active roster (52% vs 43%, respectively; P = .44) after their first season in the NFL. Moreover, there was no significant difference in the number of regular-season games played (10.9 ± 4.8 with arthroscopic surgery vs 11.0 ± 5.1 without; P = .96) or started (7.0 ± 3.6 with arthroscopic surgery vs 7.1 ± 5.3 without; P = .98). American football athletes invited to the NFL Combine with a history of hip arthroscopic surgery were not at risk for diminished participation when compared with all other athletes during their first season in the NFL.

Adventure sports and sexual freedom hip replacement: the tripolar hip.

Science.gov (United States)

Pritchett, James W

2018-01-01

Certain athletic activities and lifestyles require a completely stable and very mobile hip. Total hip replacement with a natural femoral head size and two mobile-bearing surfaces (i.e., a "tripolar" prosthesis) is the most stable prosthesis. Elegant design and wear-resistant bearing surfaces are the keys to long-term implant survivorship. The hypothesis is that a ceramic-coated tripolar prosthesis using highly cross-linked polyethylene can provide full function and complete stability with low wear. This study sought to determine: (1) patient-reported outcomes, (2) functional outcomes, (3) implant survivorship and complications, and (4) postoperative sexual limitations. Between 1998 and 2011, the author performed 160 primary total hip replacements using tripolar prostheses in patients participating in adventure sports and other physically demanding activities. The institutional review board approved this study. The inclusion criteria were patients who needed unrestricted activity and who were not candidates for or did not choose hip resurfacing. Patients were followed every second year and assessed with radiographs, Harris Hip Score, WOMAC, SF-12, and UCLA functional outcome scores. Patients were asked about symptoms of instability and satisfaction with their hip replacement. Patients were asked both preoperatively and 2 years postoperatively four questions about their sexual activity. Mean follow-up was 11 years. At 2 years' postoperatively, 98% of patients reported their satisfaction as excellent or good and 99% were not limited for sexual activity following surgery. Seventy-four percent of patients reported they were recovered within 6 weeks of surgery. There were no dislocations. There were three revision procedures for implant loosening, infection, and periprosthetic fracture, but there were no failures of the tripolar articulation. The mean postoperative UCLA score was the highly athletic score of 8. There were no signs of osteolysis, wear, or metal

A review of virtual reality based training simulators for orthopaedic surgery.

Science.gov (United States)

Vaughan, Neil; Dubey, Venketesh N; Wainwright, Thomas W; Middleton, Robert G

2016-02-01

This review presents current virtual reality based training simulators for hip, knee and other orthopaedic surgery, including elective and trauma surgical procedures. There have not been any reviews focussing on hip and knee orthopaedic simulators. A comparison of existing simulator features is provided to identify what is missing and what is required to improve upon current simulators. In total 11 hip replacements pre-operative planning tools were analysed, plus 9 hip trauma fracture training simulators. Additionally 9 knee arthroscopy simulators and 8 other orthopaedic simulators were included for comparison. The findings are that for orthopaedic surgery simulators in general, there is increasing use of patient-specific virtual models which reduce the learning curve. Modelling is also being used for patient-specific implant design and manufacture. Simulators are being increasingly validated for assessment as well as training. There are very few training simulators available for hip replacement, yet more advanced virtual reality is being used for other procedures such as hip trauma and drilling. Training simulators for hip replacement and orthopaedic surgery in general lag behind other surgical procedures for which virtual reality has become more common. Further developments are required to bring hip replacement training simulation up to date with other procedures. This suggests there is a gap in the market for a new high fidelity hip replacement and resurfacing training simulator. Copyright © 2015 IPEM. Published by Elsevier Ltd. All rights reserved.

[Bone surgery for unstable hips in patients with cerebral palsy].

Science.gov (United States)

Poul, J; Pesl, M; Pokorná, M

2004-01-01

The aim of this retrospective study was to compare the efficacy of femoral osteotomy alone with that of osteotomy combined with an acetabular procedure in patients with unstable hips due to spastic cerebral palsy. Sixty-one hip joints in 50 patients who had shown distinct subluxation or dislocation of the joint were operated on. Eleven patients underwent bilateral surgery. Before bone surgery, soft-tissue release involving both the flexors and adductors was performed on 19 hips. Femoral osteotomy alone was performed on 29 hip joints and combined femoral and pelvic osteotomy was carried out on 32 joints.Twelve resections of the proximal femur in seven patients were evaluated as a separate group. All treated hip joints were assessed by clinical and radiographic examination at a follow-up of more than 5 years. The skiagraphs taken in a strictly neutral position of the lower limbs before surgery and at the final examination were evaluated on the basis of Reimers's migration index and Wiberg's centre-edge angle. The locomotor abilities of each child were categorized according to the Vojta scoring system for locomotor development. The range of motion in the treated hip joint was assessed using the standard S. F. T. R. method. The results obtained were statistically analyzed by the Kruskal- Wallis, one-way ANOVA test. A comparison of the results of femoral osteotomy alone with those of combined femoral and pelvic osteotomy showed that the post-operative values of the migration index and centre-edge angle, as compared with the pre-operative ones, were statistically higher (pVojta rating system. There was no change in the range of motion in the treated hip joints after the operation. In 28, out of the 32 joints treated by combined femoral and pelvic osteotomy, Salter osteotomy was performed and it showed a high efficacy in providing hip joint stability. The main emphasis during surgery was placed on the maximum acetabular rotation laterally. Femoral osteotomy alone was less

Total hip replacement surgery in Ethiopia | Gokcen | East and ...

African Journals Online (AJOL)

Background: Total hip replacement (THR) surgery has evolved over years to the point that it has been considered as "the operation of the century". For developed countries, arthroplasty is well established for the management of various joint disorders and has completely revolutionised the treatment of the arthritic hip.

The Role of BMI in Hip Fracture Surgery.

Science.gov (United States)

Akinleye, Sheriff D; Garofolo, Garret; Culbertson, Maya Deza; Homel, Peter; Erez, Orry

2018-01-01

Obesity is an oft-cited cause of surgical morbidity and many institutions require extensive supplementary screening for obese patients prior to surgical intervention. However, in the elderly patients, obesity has been described as a protective factor. This article set out to examine the effect of body mass index (BMI) on outcomes and morbidity after hip fracture surgery. The National Surgical Quality Improvement Program database was queried for all patients undergoing 1 of 4 surgical procedures to manage hip fracture between 2008 and 2012. Patient demographics, BMI, and known factors that lead to poor surgical outcomes were included as putative predictors for complications that included infectious, cardiac, pulmonary, renal, and neurovascular events. Using χ 2 tests, 30-day postoperative complication rates were compared between 4 patient groups stratified by BMI as low weight (BMI BMI = 20-30), obese (BMI = 30-40), and morbidly obese (BMI > 40). A total of 15 108 patients underwent surgery for hip fracture over the examined 5-year period. Of these, 18% were low weight (BMI BMI = 20-30), 13% were obese (BMI = 30-40), and 2% were morbidly obese (BMI > 40). The low-weight and morbidly obese patients had both the highest mortality rates and the lowest superficial infection rates. There was a significant increase in blood transfusion rates that decreased linearly with increasing BMI. Deep surgical site infection and renal failure increased linearly with increasing BMI, however, these outcomes were confounded by comorbidities. This study demonstrates that patients at either extreme of the BMI spectrum, rather than solely the obese, are at greatest risk of major adverse events following hip fracture surgery. This runs contrary to the notion that obese hip fracture patients automatically require additional preoperative screening and perioperative services, as currently implemented in many institutions.

Avascular necrosis in children with cerebral palsy after reconstructive hip surgery

Science.gov (United States)

Phillips, L.; Hesketh, K.; Schaeffer, E. K.; Andrade, J.; Farr, J.; Mulpuri, K.

2017-01-01

Abstract Purpose Progressive hip displacement is one of the most common orthopaedic pathologies in children with cerebral palsy (CP). Reconstructive hip surgery has become the standard treatment of care. Reported avascular necrosis (AVN) rates for hip reconstructive surgery in these patients vary widely in the literature. The purpose of this study is to identify the frequency and associated risk factors of AVN for reconstructive hip procedures. Methods A retrospective analysis was performed of 70 cases of reconstructive hip surgery in 47 children with CP, between 2009 and 2013. All 70 cases involved varus derotation osteotomy (VDRO), with 60% having combined VDRO and pelvic osteotomies (PO), and 21% requiring open reductions. Mean age at time of surgery was 8.82 years and 90% of patients were Gross Motor Function Classification System (GMFCS) 4 and 5. Radiographic dysplasia parameters were analysed at selected intervals, to a minimum of one year post-operatively. Severity of AVN was classified by Kruczynski's method. Bivar- iate statistical analysis was conducted using Chi-square test and Student's t-test. Results There were 19 (27%) noted cases of AVN, all radio- graphically identifiable within the first post-operative year. The majority of AVN cases (63%) were mild to moderate in severity. Pre-operative migration percentage (MP) (p = 0.0009) and post-operative change in MP (p = 0.002) were the most significant predictors of AVN. Other risk factors were: GMFCS level (p = 0.031), post-operative change in NSA (p = 0.02) and concomitant adductor tenotomy (0.028). Conclusion AVN was observed in 27% of patients. Severity of displacement correlates directly with AVN risk and we suggest that hip reconstruction, specifically VDRO, be performed early in the 'hip at risk' group to avoid this complication. PMID:29081846

Avascular necrosis in children with cerebral palsy after reconstructive hip surgery.

Science.gov (United States)

Phillips, L; Hesketh, K; Schaeffer, E K; Andrade, J; Farr, J; Mulpuri, K

2017-10-01

Progressive hip displacement is one of the most common orthopaedic pathologies in children with cerebral palsy (CP). Reconstructive hip surgery has become the standard treatment of care. Reported avascular necrosis (AVN) rates for hip reconstructive surgery in these patients vary widely in the literature. The purpose of this study is to identify the frequency and associated risk factors of AVN for reconstructive hip procedures. A retrospective analysis was performed of 70 cases of reconstructive hip surgery in 47 children with CP, between 2009 and 2013. All 70 cases involved varus derotation osteotomy (VDRO), with 60% having combined VDRO and pelvic osteotomies (PO), and 21% requiring open reductions. Mean age at time of surgery was 8.82 years and 90% of patients were Gross Motor Function Classification System (GMFCS) 4 and 5. Radiographic dysplasia parameters were analysed at selected intervals, to a minimum of one year post-operatively. Severity of AVN was classified by Kruczynski's method. Bivar- iate statistical analysis was conducted using Chi-square test and Student's t-test. There were 19 (27%) noted cases of AVN, all radio- graphically identifiable within the first post-operative year. The majority of AVN cases (63%) were mild to moderate in severity. Pre-operative migration percentage (MP) (p = 0.0009) and post-operative change in MP (p = 0.002) were the most significant predictors of AVN. Other risk factors were: GMFCS level (p = 0.031), post-operative change in NSA (p = 0.02) and concomitant adductor tenotomy (0.028). AVN was observed in 27% of patients. Severity of displacement correlates directly with AVN risk and we suggest that hip reconstruction, specifically VDRO, be performed early in the 'hip at risk' group to avoid this complication.

Revision Hip Arthroscopy Indications and Outcomes: A Systematic Review.

Science.gov (United States)

Sardana, Vandit; Philippon, Marc J; de Sa, Darren; Bedi, Asheesh; Ye, Lily; Simunovic, Nicole; Ayeni, Olufemi R

2015-10-01

To identify the indications and outcomes in patients undergoing revision hip arthroscopy. The electronic databases Embase, Medline, HealthStar, and PubMed were searched from 1946 to July 19, 2014. Two blinded reviewers searched, screened, and evaluated the data quality of the studies using the Methodological Index for Non-Randomized Studies scale. Data were abstracted in duplicate. Agreement and descriptive statistics are presented. Six studies were included (3 prospective case series and 3 retrospective chart reviews), with a total of 448 hips examined. The most common indications for revision hip arthroscopy included residual femoroacetabular impingement (FAI), labral tears, and chondral lesions. The mean interval between revision arthroscopy and the index procedure was 25.6 months. Overall, the modified Harris Hip Score improved by a mean of 33.6% (19.3 points) from the baseline score at 1-year follow-up. In 14.6% of patients, further surgical procedures were required, including re-revision hip arthroscopy (8.0%), total hip replacement (5.6%), and hip resurfacing (1.0%). Female patients more commonly underwent revision hip arthroscopy (59.7%). The current evidence examined in this review supports revision hip arthroscopy as a successful intervention to improve functional outcomes (modified Harris Hip Score) and relieve pain in patients with residual symptoms after primary FAI surgery, although the outcomes are inferior when compared with a matched cohort of patients undergoing primary hip arthroscopy for FAI. The main indication for revision is a candidate who has symptoms due to residual cam- or pincer-type deformity that was either unaddressed or under-resected during the index operation. However, it is important to consider that the studies included in this review are of low-quality evidence. Surgeons should consider incorporating a minimum 2-year follow-up for individuals after index hip-preservation surgery because revisions tended to occur within this

Improving time to surgery for hip fracture patients. Impact of the introduction of an emergency theatre

LENUS (Irish Health Repository)

French-O’Carroll, F

2017-01-01

Hip fractures are a major cause of morbidity and mortality1. Surgery performed on the day of or after admission is associated with improved outcome2,3. An audit cycle was performed examining time to surgery for hip fracture patients. Our initial audit identified lack of theatre space as one factor delaying surgery. A dedicated daytime emergency theatre was subsequently opened and a re-audit was performed to assess its impact on time to surgery. Following the opening of the theatre, the proportion of patients with a delay to hip fracture surgery greater than 36 hours was reduced from 49% to 26% with lack of theatre space accounting for 23% (3 of 13) of delayed cases versus 28.6% (9 of 32) previously. 44% of hip fracture surgeries were performed in the emergency theatre during daytime hours, whilst in-hospital mortality rose from 4.6% to 6%. We conclude that access to an emergency theatre during daytime hours reduced inappropriate delays to hip fracture surgery.

A new small-animal model for the study of acquired heterotopic ossification after hip surgery.

Science.gov (United States)

Anthonissen, Joris; Ossendorf, Christian; Hock, Johanna Lisa; Ritz, Ulrike; Hofmann, Alexander; Rommens, Pol Maria

2015-01-01

Heterotopic ossification (HO)--the formation of bone in soft tissues--is a frequent problem after surgery of the hip and pelvis, but little is known about its underlying pathogenic mechanisms. It is vital to study the underlying pathogenesis in animal models to develop and evaluate new prophylactic regimens directed against HO. However, previously developed small-animal models for the study of HO imitate neither surgery nor trauma-mechanisms that potentially cause HO. Hence, the goal of this study was to develop a novel small-animal model imitating hip surgery that can reliably produce HO. Twenty male Wistar rats were subjected to surgery of the right hip during which the femoral canal was reamed in three steps up to 2 mm, and a muscle lesion was made. Twelve weeks after surgery, the amount of heterotopic bone was assessed using micro-computed tomography. Eighteen of 20 animals showed HO around the hip 12 weeks after surgery. The amount of heterotopic bone varied from very small particles up to near ankylosis. A rat model of hip/pelvic surgery that does not use exogenous osteogenic stimulus and can reliably produce HO was developed.

Choice of implant combinations in total hip replacement: systematic review and network meta-analysis.

Science.gov (United States)

López-López, José A; Humphriss, Rachel L; Beswick, Andrew D; Thom, Howard H Z; Hunt, Linda P; Burston, Amanda; Fawsitt, Christopher G; Hollingworth, William; Higgins, Julian P T; Welton, Nicky J; Blom, Ashley W; Marques, Elsa M R

2017-11-02

Objective  To compare the survival of different implant combinations for primary total hip replacement (THR). Design  Systematic review and network meta-analysis. Data sources  Medline, Embase, The Cochrane Library, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, and the EU Clinical Trials Register. Review methods  Published randomised controlled trials comparing different implant combinations. Implant combinations were defined by bearing surface materials (metal-on-polyethylene, ceramic-on-polyethylene, ceramic-on-ceramic, or metal-on-metal), head size (large ≥36 mm or small meta-analysis for revision. There was no evidence that the risk of revision surgery was reduced by other implant combinations compared with the reference implant combination. Although estimates are imprecise, metal-on-metal, small head, cemented implants (hazard ratio 4.4, 95% credible interval 1.6 to 16.6) and resurfacing (12.1, 2.1 to 120.3) increase the risk of revision at 0-2 years after primary THR compared with the reference implant combination. Similar results were observed for the 2-10 years period. 31 studies (2888 patients) were included in the analysis of Harris hip score. No implant combination had a better score than the reference implant combination. Conclusions  Newer implant combinations were not found to be better than the reference implant combination (metal-on-polyethylene (not highly cross linked), small head, cemented) in terms of risk of revision surgery or Harris hip score. Metal-on-metal, small head, cemented implants and resurfacing increased the risk of revision surgery compared with the reference implant combination. The results were consistent with observational evidence and were replicated in sensitivity analysis but were limited by poor reporting across studies. Systematic review registration  PROSPERO CRD42015019435. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence

Effect of postoperative epidural analgesia on rehabilitation and pain after hip fracture surgery

DEFF Research Database (Denmark)

Foss, Nicolai Bang; Kristensen, Morten Tange; Kristensen, Billy Bjarne

2005-01-01

Hip fracture surgery usually carries a high demand for rehabilitation and a significant risk of perioperative morbidity and mortality. Postoperative epidural analgesia may reduce morbidity and has been shown to facilitate rehabilitation in elective orthopedic procedures. No studies exist...... on the effect of postoperative epidural analgesia on pain and rehabilitation after hip fracture surgery....

Psychometric properties of patient-reported outcome measures for hip arthroscopic surgery

DEFF Research Database (Denmark)

Kemp, Joanne L; Collins, Natalie J; Roos, Ewa M.

2013-01-01

Patient-reported outcomes (PROs) are considered the gold standard when evaluating outcomes in a surgical population. While the psychometric properties of some PROs have been tested, the properties of newer PROs in patients undergoing hip arthroscopic surgery remain somewhat unknown.......Patient-reported outcomes (PROs) are considered the gold standard when evaluating outcomes in a surgical population. While the psychometric properties of some PROs have been tested, the properties of newer PROs in patients undergoing hip arthroscopic surgery remain somewhat unknown....

The spectrum of laser skin resurfacing: nonablative, fractional, and ablative laser resurfacing.

Science.gov (United States)

Alexiades-Armenakas, Macrene R; Dover, Jeffrey S; Arndt, Kenneth A

2008-05-01

The drive to attain cosmetic facial enhancement with minimal risk and rapid recovery has inspired the field of nonsurgical skin rejuvenation. Laser resurfacing was introduced in the 1980s with continuous wave carbon dioxide (CO(2)) lasers; however, because of a high rate of side effects, including scarring, short-pulse, high-peak power, and rapidly scanned, focused-beam CO(2) lasers and normal-mode erbium-doped yttrium aluminium garnet lasers were developed, which remove skin in a precisely controlled manner. The prolonged 2-week recovery time and small but significant complication risk prompted the development of non-ablative and, more recently, fractional resurfacing in order to minimize risk and shorten recovery times. Nonablative resurfacing produces dermal thermal injury to improve rhytides and photodamage while preserving the epidermis. Fractional resurfacing thermally ablates microscopic columns of epidermal and dermal tissue in regularly spaced arrays over a fraction of the skin surface. This intermediate approach increases efficacy as compared to nonablative resurfacing, but with faster recovery as compared to ablative resurfacing. Neither nonablative nor fractional resurfacing produces results comparable to ablative laser skin resurfacing, but both have become much more popular than the latter because the risks of treatment are limited in the face of acceptable improvement. At the completion of this learning activity, participants should be familiar with the spectrum of lasers and light technologies available for skin resurfacing, published studies of safety and efficacy, indications, methodologies, side effects, complications, and management.

Organizational Factors and Long-Term Mortality after Hip Fracture Surgery. A Cohort Study of 6143 Consecutive Patients Undergoing Hip Fracture Surgery

DEFF Research Database (Denmark)

Lund, Caterina A; Møller, Ann M; Wetterslev, Jørn

2014-01-01

OBJECTIVE: In hospital and health care organizational factors may be changed to reduce postoperative mortality. The aim of this study is to evaluate a possible association between mortality and 'length of hospital stay', 'priority of surgery', 'time of surgery', or 'surgical delay' in hip fracture...... surgery. DESIGN: Observational cohort study. SETTING: Prospectively and consecutively reported data from the Danish Anaesthesia Database were linked to The Danish National Registry of Patients and The Civil Registration System. Records on vital status, admittance, discharges, codes of diagnosis......; therefore cluster randomized clinical trials comparing different clinical set ups may be warranted evaluating health care organizational factors....

Feasibility of Progressive Strength Training Implemented in the Acute Ward after Hip Fracture Surgery

DEFF Research Database (Denmark)

Kronborg, Lise; Bandholm, Thomas; Palm, Henrik

2014-01-01

. RESULTS: The strength training was commenced at a mean of 2.4 (0.7) days after surgery. The training loads (kilograms lifted) increased from 1.6 (0.8) to 4.3 (1.7) kg over 4.3 (2.2) training sessions (P....2) to 0.61 (0.3) Nm/kg (Psessions were not performed because of severe hip fracture-related pain. CONCLUSION AND RELEVANCE: Progressive knee-extension strength training......IMPORTANCE: Patients with a hip fracture lose more than 50% knee-extension strength in the fractured limb within one week of surgery. Hence, immediate progressive strength training following hip fracture surgery may be rational, but the feasibility unknown. OBJECTIVE: To examine the feasibility...

SSRIs increase risk of blood transfusion in patients admitted for hip surgery.

Directory of Open Access Journals (Sweden)

Hermien Janneke Schutte

Full Text Available BACKGROUND: Recent studies have shown that an increased bleeding tendency can be caused by Selective Serotonin Reuptake Inhibitors (SSRI use. We aimed to investigate the occurrence and risk of blood transfusion in SSRI users compared to non-SSRI users in a cohort of patients admitted for hip-surgery. METHODS: We conducted a retrospective cohort study of patients who underwent planned or emergency hip surgery from 1996 to 2011 in the Academic Medical Center in Amsterdam. Primary outcome measure was risk of blood transfusion. Secondary outcome measures were pre- and postoperative hemoglobin level. Multivariate logistic regression was used to adjust for potential confounders. RESULTS: One-hundred and fourteen SSRI users were compared to 1773 non-SSRI users. Risk of blood transfusion during admission was increased for SSRI users in multivariate analyses (OR 1.7 [95% CI 1.1-2.5]. Also, pre-operative hemoglobin levels were lower in SSRI users (7.8 ± 1.0 mmol/L compared to non-SSRI users (8.0 ± 1.0 mmol/L (p  =  0.042, as were postoperative hemoglobin levels (6.2 ± 1.0 mmol/L vs. 6.4 ± 1.0 mmol/L respectively (p  =  0.017. CONCLUSIONS: SSRI users undergoing hip surgery have an increased risk for blood transfusion during admission, potentially explained by a lower hemoglobin level before surgery. SSRI use should be considered as a potential risk indicator for increased blood loss in patients admitted for hip surgery. These results need to be confirmed in a prospective study.

Surgery-induced changes and early recovery of hip-muscle strength, leg-press power, and functional performance after fast-track total hip arthroplasty

DEFF Research Database (Denmark)

Holm, Bente; Thorborg, Kristian; Husted, Henrik

2013-01-01

By measuring very early changes in muscle strength and functional performance after fast-track total hip arthroplasty (THA), post-operative rehabilitation, introduced soon after surgery, can be designed to specifically target identified deficits.......By measuring very early changes in muscle strength and functional performance after fast-track total hip arthroplasty (THA), post-operative rehabilitation, introduced soon after surgery, can be designed to specifically target identified deficits....

Optimizing Outcomes in Pharyngoesophageal Reconstruction and Neck Resurfacing: 10-Year Experience of 294 Cases.

Science.gov (United States)

Sharaf, Basel; Xue, Amy; Solari, Mario G; Boa, Olivier; Liu, Jun; Hanasono, Matthew M; Skoracki, Roman; Yu, Peirong; Selber, Jesse C

2017-01-01

Pharyngoesophageal reconstruction is a complex endeavor that poses many challenges. This 10-year series examines factors impacting the need for neck skin resurfacing and evaluates the impact of reconstructive modalities on outcomes. A review identified 294 patients who underwent pharyngoesophageal reconstruction from 2002 to 2012. Patients were divided based on neck skin resurfacing requirements. Patients undergoing neck resurfacing were further subdivided into reconstructive technique, including a second skin paddle or muscle component from the same free flap pedicle, a local flap, or a second free flap. All groups were compared by comorbidities, complications, and functional outcomes. Of 294 patients, 179 (60.9 percent) required neck skin resurfacing. In the resurfaced group, there were 90 circumferential defects (50.3 percent) and 89 partial defects (49.7 percent). In the resurfaced group, 110 (61.4 percent) underwent reconstruction with a second skin paddle from the same free flap pedicle, 21 (11.7 percent) underwent reconstruction with a muscle component from the same pedicle, and 25 (13.9 percent) received a pectoralis major flap. There were five external paddle flap losses in the resurfaced group (2.8 percent) and no internal flap losses. Overall complications were similar among groups. The resurfaced group had a lower pharyngocutaneous fistula rate (4.5 percent) compared with the primary closure group (11.3 percent) (p = 0.026). Prior neck surgery and radiation therapy were strong predictors of neck skin resurfacing (p resurfacing is often required in salvage pharyngoesophageal reconstruction. Providing additional vascularized tissue over the neoconduit is predictive of lower pharyngocutaneous fistula rates. An algorithmic approach to neck resurfacing is presented.

A Randomized Seven-Year Study on Performance of the Stemmed Metal M2a-Magnum and Ceramic C2a-Taper, and the Resurfacing ReCap Hip Implants

DEFF Research Database (Denmark)

Borgwardt, Arne; Borgwardt, Lotte; Zerahn, Bo

2018-01-01

BACKGROUND: The large-diameter metal-on-metal hip prostheses were expected to have low wear and reduced dislocation rate compared to the traditional metal-on-polyethylene implants. We compare 2 such prostheses, the ReCap resurfacing implant and the M2a-Magnum stemmed implant, with the C2a ceramic......-on-ceramic stemmed implant as to clinical performance, serum concentrations of prosthesis metals, and the durability of the implants in a randomized, controlled clinical trial at 7 years of follow-up. METHODS: All included patients had osteoarthritis. Preoperatively, the size of the implants was estimated from...... of the soft tissue adjacent to the implant as well as MRI with metal artifact reduction sequence (MARS-MRI) when indicated. RESULTS: One hundred fifty-two hips in 146 patients were included. The serum cobalt and chromium concentrations were significantly higher for the 2 metal-on-metal prostheses than...

Bone mineral density of the proximal femur after hip resurfacing arthroplasty: 1-year follow-up study

Directory of Open Access Journals (Sweden)

Anttila Esa

2011-05-01

Full Text Available Abstract Background Hip resurfacing arthroplasty (HRA is considered a bone-preserving procedure and may eliminate proximal femoral stress shielding and osteolysis. However, in addition to implant-related stress-shielding factors, various patient-related factors may also have an effect on bone mineral density (BMD of the proximal femur in patients with HRA. Thus, we studied the effects of stem-neck angle, demographic variables, and physical functioning on the BMD of the proximal femur in a one-year follow-up. Methods Thirty three patients (9 females and 24 males with a mean (SD age of 55 (9 years were included in the study. BMD was measured two days and 3, 6, and 12 months postoperatively and 10 regions of interest (ROI were used. Stem-neck angle was analyzed from anteroposterior radiographs. Results Three months postoperatively, BMD decreased in six out of 10 regions of interest (ROI on the side operated on and in one ROI on the control side (p Conclusions After an early drop, the BMD of the upper femur was restored and even exceeded the preoperative level at one year follow-up. From a clinical standpoint, the changes in BMD in these HRA patients could not be explained by stem-neck angle or patient related factors.

Impact of surgical complications on length of stay after hip fracture surgery

DEFF Research Database (Denmark)

Foss, Nicolai Bang; Palm, Henrik; Krasheninnikoff, Michael

2006-01-01

BACKGROUND: Rehabilitation after hip fracture may be lengthy, with bed-day consumption accounting for up to 85% of the total cost of admission to hospital. Data suggest that surgical complications requiring reoperation may lead to an excessively long in-patient stays. However, the overall impact...... of surgical complications has not been examined in detail. METHODS: All 600 consecutive patients included were admitted with primary hip fracture and received primary surgical intervention with multimodal rehabilitation. Surgical complications were audited and classified as being due to a patient fall...... showed that 64 complications (55%) were due to suboptimal surgery, 18 (16%) to infection, 6 (5%) to falls and 28 (24%) to no obvious cause. CONCLUSION: Surgical complications secondary to primary hip fracture surgery account for 27.1% of total hospital bed consumption within 6 months. Approximately, 50...

Fatigue and pain limit independent mobility and physiotherapy after hip fracture surgery

DEFF Research Database (Denmark)

Münter, Kristine H.; Clemmesen, Christopher G.; Foss, Nicolai B.

2017-01-01

Purpose: The patient’s ability to complete their planned physiotherapy session after hip fracture surgery has been proposed as an independent predictor for achieving basic mobility independency upon hospital discharge. However, knowledge of factors limiting mobility is sparse. We therefore examined...... patient reported factors limiting ability to complete planned physiotherapy sessions as well as limitations for not achieving independency in basic mobility early after hip fracture surgery. Methods: A total of 204 consecutive patients with a hip fracture (mean (SD) age of 80 (9.9) years, 47 patients were......; pain, motor blockade, dizziness, fatigue, nausea, acute cognitive dysfunction and “other limitations”, for not achieving a full Cumulated Ambulation Score or inability to complete planned physiotherapy sessions were noted by the physiotherapist on each of the three first postoperative days. This period...

Hip dislocation in cerebral palsy: evolution of the contralateral side after reconstructive surgery

Directory of Open Access Journals (Sweden)

João Caetano Munhoz Abdo

2016-06-01

Full Text Available ABSTRACT OBJECTIVE: To evaluate the progression of the contralateral hip after unilateral reconstruction of hip dislocation in patients classified as GMFCS IV-V; and to identify potential prognostic factors for their evolution. METHODS: This was a retrospective study on 17 patients with spastic cerebral palsy, who were classified on the GMFCS scale (Gross Motor Functional Classification System as degrees IV and V, and who underwent unilateral reconstruction surgery to treat hip dislocation (adductor release, femoral varus osteotomy and acetabuloplasty. The minimum postoperative follow-up was 30 months. The clinical parameters evaluated were sex, age at time of surgery, length of follow-up after surgery and range of abduction. The treatment parameters were use/nonuse of femoral shortening, application of botulinum toxin and any previous muscle releases. The radiographic parameters were Reimer's extrusion index (REI, acetabular angle (AA and the continuity of Shenton's line. RESULTS: Among the 17 patients evaluated, eight presented dislocation (group I and nine did not (group II. Group I comprised three males and five females; group II comprised one male and eight females. The mean age at the time of surgery among the group I patients was 62 months and the mean follow-up was 62 months. In group II, these were 98 and 83 months, respectively. There was a trend in which patients of greater age did not evolve with contralateral dislocation. Among the nine patients with the combination of REI < 30% and AA < 25°, only one presented dislocation during the follow-up. Contralateral subluxation occurred within the first two years after the surgery. CONCLUSION: Hips presenting REI < 30° and AA < 25° do not tend to evolve to subluxation and can be kept under observation. Preoperative clinical and radiographic measurements alone are not useful for indicating the natural evolution of non- operated hips. The critical period for subluxation is the first two

Feasibility of progressive strength training implemented in the acute ward after hip fracture surgery.

Directory of Open Access Journals (Sweden)

Lise Kronborg

Full Text Available Patients with a hip fracture lose more than 50% knee-extension strength in the fractured limb within one week of surgery. Hence, immediate progressive strength training following hip fracture surgery may be rational, but the feasibility unknown.To examine the feasibility of in-hospital progressive strength training implemented in the acute ward following hip fracture surgery, based on pre-specified criteria for feasibility.A prospective cohort study conducted in an acute orthopedic hip fracture unit at a university hospital. A consecutive sample of 36 patients, 18 with a cervical and 18 with a trochanteric hip fracture (27 women and 9 men, mean (SD age of 79.4 (8.3 years were included between June and December 2012.A daily (on weekdays program of progressive knee-extension strength training for the fractured limb, using ankle weight cuffs in 3 sets of 10 repetition maximum loadings.The primary outcome was the change in training load (kg during the knee-extension strength training. The secondary outcomes were changes in hip fracture-related pain and maximal isometric knee-extension strength.The strength training was commenced at a mean of 2.4 (0.7 days after surgery. The training loads (kilograms lifted increased from 1.6 (0.8 to 4.3 (1.7 kg over 4.3 (2.2 training sessions (P<.001. The maximal isometric knee-extension strength of the fractured limb increased from 0.37 (0.2 to 0.61 (0.3 Nm/kg (P<.001, while the average strength deficit in the fractured limb decreased from 50% to 32% (% non-fractured, P<.001. Only 3 of 212 sessions were not performed because of severe hip fracture-related pain.Progressive knee-extension strength training of the fractured limb commenced in the acute ward seems feasible, and may reduce strength asymmetry between limbs without hip pain interfering. The clinical efficacy needs confirmation in a randomized controlled design.ClinicalTrials.gov ID: NCT01616030.

Marker-based or model-based RSA for evaluation of hip resurfacing arthroplasty? A clinical validation and 5-year follow-up.

Science.gov (United States)

Lorenzen, Nina Dyrberg; Stilling, Maiken; Jakobsen, Stig Storgaard; Gustafson, Klas; Søballe, Kjeld; Baad-Hansen, Thomas

2013-11-01

The stability of implants is vital to ensure a long-term survival. RSA determines micro-motions of implants as a predictor of early implant failure. RSA can be performed as a marker- or model-based analysis. So far, CAD and RE model-based RSA have not been validated for use in hip resurfacing arthroplasty (HRA). A phantom study determined the precision of marker-based and CAD and RE model-based RSA on a HRA implant. In a clinical study, 19 patients were followed with stereoradiographs until 5 years after surgery. Analysis of double-examination migration results determined the clinical precision of marker-based and CAD model-based RSA, and at the 5-year follow-up, results of the total translation (TT) and the total rotation (TR) for marker- and CAD model-based RSA were compared. The phantom study showed that comparison of the precision (SDdiff) in marker-based RSA analysis was more precise than model-based RSA analysis in TT (p CAD RSA analysis (p = 0.002), but showed no difference between the marker- and CAD model-based RSA analysis regarding the TR (p = 0.91). Comparing the mean signed values regarding the TT and the TR at the 5-year follow-up in 13 patients, the TT was lower (p = 0.03) and the TR higher (p = 0.04) in the marker-based RSA compared to CAD model-based RSA. The precision of marker-based RSA was significantly better than model-based RSA. However, problems with occluded markers lead to exclusion of many patients which was not a problem with model-based RSA. HRA were stable at the 5-year follow-up. The detection limit was 0.2 mm TT and 1° TR for marker-based and 0.5 mm TT and 1° TR for CAD model-based RSA for HRA.

A new approach to managing patients with problematic metal hip implants: the use of an Internet-enhanced multidisciplinary team meeting: AAOS exhibit selection.

Science.gov (United States)

Berber, Reshid; Pappas, Yannis; Khoo, Michael; Miles, Jonathan; Carrington, Richard; Skinner, John; Hart, Alister

2015-02-18

Over one million patients worldwide are estimated to have a metal-on-metal hip arthroplasty. To improve the management of these patients and reduce surgeon uncertainty regarding decision-making, we designed an Internet-enhanced multidisciplinary team (iMDT) working approach. From August 2012 to April 2014, the iMDT discussed 215 patients with 266 metal-on-metal hip arthroplasties. Of these, 236 primary arthroplasties (132 hip resurfacing and 104 total hip) were analyzed. The remaining thirty cases involved problematic revised hips and were therefore excluded. The possible recommendations of the iMDT were monitoring, further investigation, or surgery. The concordance between the recommendation and the actual management was used to assess the usefulness of this approach in reducing uncertainty in surgeon-level decision-making. The median Oxford Hip Score was 35 (range, 4 to 48), and median cobalt and chromium levels in whole blood were 3.54 ppb (range, 0.18 to 161.46 ppb) and 3.17 ppb (range, 0.20 to 100.67 ppb), respectively. Magnetic resonance imaging revealed abductor muscle atrophy in ninety-two (39%) of the hips and a pseudotumor in eighty (34%). The iMDT recommended monitoring of 146 (61.9%) of the hips, further investigation of thirty (12.7%), and surgery in sixty (25.4%). The actual outcome was concordant with the recommendation in 211 (91.7%) of the hips. Our iMDT approach to the metal-on-metal hip burden combines the tacit knowledge of an expert panel, regulatory guidance, and up-to-date evidence to improve decision-making among surgeons. The high level of concordance between the recommendation and the actual outcome, combined with the feasibility of the methods used, suggest that this method effectively reduces uncertainty among surgeons and may lead to improved patient outcomes. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

Multicenter Analysis of Midterm Clinical Outcomes of Arthroscopic Labral Repair in the Hip: Minimum 5-Year Follow-up.

Science.gov (United States)

Hevesi, Mario; Krych, Aaron J; Johnson, Nick R; Redmond, John M; Hartigan, David E; Levy, Bruce A; Domb, Benjamin G

2018-02-01

The technique of hip arthroscopic surgery is advancing and becoming more commonly performed. However, most current reported results are limited to short-term follow-up, and therefore, the durability of the procedure is largely unknown. To perform a multicenter analysis of mid-term clinical outcomes of arthroscopic hip labral repair and determine the risk factors for patient outcomes. Cohort study; Level of evidence, 3. Prospectively collected data of primary hip arthroscopic labral repair performed at 4 high-volume centers between 2008 and 2011 were reviewed retrospectively. Patients were assessed preoperatively and postoperatively with the visual analog scale (VAS), modified Harris Hip Score (mHHS), and Hip Outcome Score-Sports-Specific Subscale (HOS-SSS) at a minimum of 5 years' follow-up. Factors including age, body mass index (BMI), Tönnis grade, and cartilage grade were analyzed in relation to outcome scores, and revision rates were determined. Failure was defined as subsequent ipsilateral hip surgery, including revision arthroscopic surgery and open hip surgery. A total of 303 patients (101 male, 202 female) with a mean age of 32.0 years (range, 10.7-58.9 years) were followed for a mean of 5.7 years (range, 5.0-7.9 years). Patients achieved mean improvements in VAS of 3.5 points, mHHS of 20.1 points, and HOS-SSS of 29.3 points. Thirty-seven patients (12.2%) underwent revision arthroscopic surgery, and 12 (4.0%) underwent periacetabular osteotomy, resurfacing, or total hip arthroplasty during the study period. Patients with a BMI >30 kg/m 2 had a mean mHHS score 9.5 points lower and a mean HOS-SSS score 15.9 points lower than those with a BMI ≤30 kg/m 2 ( P 35 years at surgery had a mean mHHS score 4.5 points lower and a HOS-SSS score 6.7 points lower than those aged ≤35 years ( P = .03). Patients with Tönnis grade 2 radiographs demonstrated a 12.5-point worse mHHS score ( P = .02) and a 23.0-point worse HOS-SSS score ( P SSS scores after arthroscopic

Return to Play After Hip Arthroscopic Surgery for Femoroacetabular Impingement in Professional Soccer Players.

Science.gov (United States)

Locks, Renato; Utsunomiya, Hajime; Briggs, Karen K; McNamara, Shannen; Chahla, Jorge; Philippon, Marc J

2018-02-01

Arthroscopic hip surgery has been shown to be effective in returning professional athletes back to play at a high level of performance in different sports. Limited information exists regarding professional soccer players and their return to play. To determine the rate and time to return to sport for professional soccer players after hip arthroscopic surgery for the treatment of femoroacetabular impingement (FAI) and to identify possible risk factors associated with a delay in returning to play. Case series; Level of evidence, 4. Professional soccer players who underwent hip arthroscopic surgery for FAI by a single surgeon between 2005 and 2015 were evaluated. Data retrieved from www.mlssoccer.com , www.fifa.com , www.transfermarkt.co.uk , and www.wikipedia.org included information on each player's professional career, participation on the national team, length of professional career before surgery, number of appearances (games) before surgery, time between surgery and first appearance in a professional game, and number of appearances after surgery. Other data were obtained from the patient's medical records. Twenty-four professional soccer players (26 hips) were included. The mean age at surgery was 25.0 ± 4.0 years (range, 19-32 years). A total of 96% of patients were able to return to play at the professional level. The mean time between surgery and the first professional game played was 9.2 months (range, 1.9-24.0 months). On average, players played in 70 games after surgery (range, 0-224). National team players were able to return to play significantly earlier than the rest of the players (median, 5.7 months vs 11.6 months, respectively; P = .018). Severe chondral damage and microfracture did not interfere with return to play. The arthroscopic management of FAI in symptomatic professional soccer players allowed 96% of them to return to play. Players with national team experience were able to return to play earlier than those without it. Severe chondral damage

Management of metal-on-metal hip implant patients: Who, when and how to revise?

Science.gov (United States)

Berber, Reshid; Skinner, John A; Hart, Alister J

2016-05-18

The debate on how best to manage patients with metal-on-metal (MOM) hip implants continues. With over 1 million patients affected worldwide, the impact is far reaching. The majority of the aggressive failures of MOM hip implants have been dealt with by revision hip surgery, leaving patients with a much more indolent pattern of failure of devices that have been in situ for more than 10 years. The longer-term outcome for such patients remains unknown, and much debate exists on how best to manage these patients. Regulatory guidance is available but remains open to interpretation due to the lack of current evidence and long-term studies. Metal ion thresholds for concern have been suggested at 7 ppb for hip resurfacing arthroplasty and below this level for large diameter total hip arthroplasties. Soft tissue changes including pseudotumours and muscle atrophy have been shown to progress, but this is not consistent. New advanced imaging techniques are helping to diagnose complications with metal hips and the reasons for failure, however these are not widely available. This has led to some centres to tackle difficult cases through multidisciplinary collaboration, for both surgical management decisions and also follow-up decisions. We summarise current evidence and consider who is at risk, when revision should be undertaken and how patients should be managed.

Histologic effects of resurfacing lasers.

Science.gov (United States)

Freedman, Joshua R; Greene, Ryan M; Green, Jeremy B

2014-02-01

By utilizing resurfacing lasers, physicians can significantly improve the appearance of sun-damaged skin, scars, and more. The carbon dioxide and erbium:yttrium-aluminum-garnet lasers were the first ablative resurfacing lasers to offer impressive results although these earlier treatments were associated with significant downtime. Later, nonablative resurfacing lasers such as the neodymium:yttrium-aluminum-garnet laser proved effective, after a series of treatments with less downtime, but with more modest results. The theory of fractional photothermolysis has revolutionized resurfacing laser technology by increasing the safety profile of the devices while delivering clinical efficacy. A review of the histologic and molecular consequences of the resurfacing laser-tissue interaction allows for a better understanding of the devices and their clinical effects. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Lowering blood glucose during hip surgery does not influence coagulation activation

Directory of Open Access Journals (Sweden)

Marjolein K. Sechterberger

2015-06-01

Conclusion: Although the human GLP-1 analogue liraglutide moderately reduced post-operative blood glucose levels in non-diabetic and prediabetic obese patients undergoing elective hip surgery, no changes were observed with respect to coagulation activation.

Laser Resurfacing at the Time of Rhytidectomy.

Science.gov (United States)

Scheuer, Jack F; Costa, Christopher R; Dauwe, Phillip B; Ramanadham, Smita R; Rohrich, Rod J

2015-07-01

Laser resurfacing with simultaneous rhytidectomy has been used to augment aesthetic results and decrease overall patient recuperative time, yet presents a potential dual insult to the microvasculature supply of facial skin flaps. This study describes the authors' experience with rhytidectomy and simultaneous laser resurfacing. Between May of 1999 and January of 2013, 85 face lifts with concomitant erbium laser resurfacing were reviewed retrospectively. Seven procedures were excluded for incomplete charting. Patient demographics, treatment zone, concomitant procedures, and secondary/tertiary face lifts were analyzed for associations with postoperative complications attributable to laser resurfacing. No complications were reported in the perioral resurfacing group. There was one instance of delayed wound healing and prolonged erythema in the full face group, and one instance of moderate hyperpigmentation in the central face group. No instances of hypopigmentation or flap necrosis attributable to laser resurfacing were noted. The overall complication rate was 3.8 percent. There was a statistically significant difference when comparing the number of complications between the facial laser resurfacing zones (p = 0.037). When analyzing zone of laser resurfacing as an independent risk factor for complications, no significant association was derived, but full face zone resurfacing approached statistical significance (p = 0.063). Although a significant difference in the number of complications between treatment groups existed, the authors were not able to definitively attribute this solely to the extent of laser resurfacing. Simultaneous laser resurfacing and rhytidectomy can be performed safely in select patients using ablative mode only over the undermined flap. Therapeutic, IV.

Sepsis Within 30 Days of Geriatric Hip Fracture Surgery.

Science.gov (United States)

Bohl, Daniel D; Iantorno, Stephanie E; Saltzman, Bryan M; Tetreault, Matthew W; Darrith, Brian; Della Valle, Craig J

2017-10-01

Sepsis after hip fracture typically develops from one of the 3 potential infectious sources: urinary tract infection (UTI), pneumonia, and surgical site infection (SSI). The purpose of this investigation is to determine (1) the proportion of cases of sepsis that arises from each of these potential infectious sources; (2) baseline risk factors for developing each of the potential infectious sources; and (3) baseline risk factors for developing sepsis. The National Surgical Quality Improvement Program database was searched for geriatric patients (aged >65 years) who underwent surgery for hip fracture during 2005-2013. Patients subsequently diagnosed with sepsis were categorized according to concomitant diagnosis with UTI, SSI, and/or pneumonia. Multivariate regression was used to test for associations while adjusting for baseline characteristics. Among the 466 patients who developed sepsis (2.4% of all patients), 157 (33.7%) also had a UTI, 135 (29.0%) also had pneumonia, and 36 (7.7%) also had SSI. The rate of sepsis was elevated in patients who developed UTI (13.0% vs 1.7%; P sepsis (21.0% vs 3.8%; P Sepsis occurs in about 1 in 40 patients after geriatric hip fracture surgery. Of these septic cases, 1 in 3 is associated with UTI, 1 in 3 with pneumonia, and 1 in 15 with SSI. The cause of sepsis is often unknown on clinical diagnosis, and this distribution of potential infectious sources allows clinicians for direct identification and treatment. Copyright © 2017 Elsevier Inc. All rights reserved.

Current role of resurfacing lasers.

Science.gov (United States)

Hantash, B M; Gladstone, H B

2009-06-01

Resurfacing lasers have been the treatment of choice for diminishing rhytids and tightening skin. The carbon dioxide and erbium lasers have been the gold and silver standards. Despite their effectiveness, these resurfacing lasers have a very high risk profile including scarring, hyperpigmentation and hypopigmentation. Because of these side effects, various practitioners have tried alternative settings for these lasers as well as alternative wavelengths, particularly in the infrared spectrum. These devices have had less downtime, but their effectiveness has been limited to fine wrinkles. As with selective photothemolysis, a major advance in the field has been fractionated resurfacing which incorporates grids of microthermal zones that spares islands of skin. This concept permits less tissue damage and quicker tissue regeneration. Initially, fractionated resurfacing was limited to the nonablative mid-infrared spectrum. These resurfacing lasers is appropriate for those patients with acne scars, uneven skin tone, mild to moderate photodamage, and is somewhat effective for melasma. Importantly, because there is less overall tissue damage and stimulation of melanocytes, these lasers can be used in darker skin types. Downtime is 2-4 days of erythema and scaling. Yet, these nonablative fractionated devices required 5-6 treatments to achieve a moderate effect. Logically, the fractionated resurfacing has now been applied to the CO2 and the Erbium:Yag lasers. These devices can treat deeper wrinkles and tighten skin. Downtime appears to be 5-7 days. The long term effectiveness and the question of whether these fractionated devices will approach the efficacy of the standard resurfacing lasers is still in question. Ultimately either integrated devices which may use fractionated resurfacing, radiofrequency and a sensitizer, or combining different lasers in a single treatment may prove to be the most effective in reducing rhtyides, smoothing the skin topography and tightening the

Age and racial/ethnic disparities in arthritis-related hip and knee surgeries.

Science.gov (United States)

Dunlop, Dorothy D; Manheim, Larry M; Song, Jing; Sohn, Min-Woong; Feinglass, Joseph M; Chang, Huan J; Chang, Rowland W

2008-02-01

Nearly 18 million Americans experience limitations due to their arthritis. Documented disparities according to racial/ethnic groups in the use of surgical interventions such as knee and hip arthroplasty are largely based on data from Medicare beneficiaries age 65 or older. Whether there are disparities among younger adults has not been previously addressed. This study assesses age-specific racial/ethnic differences in arthritis-related knee and hip surgeries. Longitudinal (1998-2004) Health and Retirement Study. National probability sample of US community-dwelling adults. A total of 2262 black, 1292 Hispanic, and 13,159 white adults age 51 and older. The outcome is self-reported 2-year use of arthritis-related hip or knee surgery. Independent variables are demographic (race/ethnicity, age, gender), health needs (arthritis, chronic diseases, obesity, physical activity, and functional limitations), and medical access (income, wealth, education, and health insurance). Longitudinal data methods using discrete survival analysis are used to validly account for repeated (biennial) observations over time. Analyses use person-weights, stratum, and sampling error codes to provide valid inferences to the US population. Black adults under the age of 65 years report similar age/gender adjusted rates of hip/knee arthritis surgeries [hazard ratio (HR) = 1.43, 95% confidence interval (CI) = 0.87-2.38] whereas older blacks (age 65+) have significantly lower rates (HR = 0.38, CI = 0.16-0.55) compared with whites. These relationships hold controlling for health and economic differences. Both under age 65 years (HR = 0.64, CI = 0.12-1.44) and older (age 65+) Hispanic adults (HR = 0.60, CI = 0.32-1.10) report lower utilization rates, although not statistically different than whites. A large portion of the Hispanic disparity is explained by economic differences. These national data document lower rates of arthritis-related hip/knee surgeries for older black versus white adults age 65 or

The influence of optimism on functionality after total hip replacement surgery.

Science.gov (United States)

Balck, Friedrich; Lippmann, Maike; Jeszenszky, Csilla; Günther, Klaus-Peter; Kirschner, Stephan

2016-08-01

Among other factors, optimism has been shown to significantly influence the course of some diseases (cancer, HIV, coronary heart disease). This study investigated whether optimism of a patient before a total hip replacement can predict the functionality of the lower limbs 3 and 6 months after surgery. A total of 325 patients took part in the study (age: 58.7 years; w: 55%). The functionality was measured with the Western Ontario and McMaster Universities arthrosis index, and optimism with the Life Orientation Test. To analyse the influences of age, gender and optimism, general linear models were calculated. In optimistic patients, functionality improved significantly over time. The study showed a clear influence of dispositional optimism on the recovery after total hip replacement in the first 3 months after surgery. © The Author(s) 2015.

Ablative skin resurfacing.

Science.gov (United States)

Agrawal, Nidhi; Smith, Greg; Heffelfinger, Ryan

2014-02-01

Ablative laser resurfacing has evolved as a safe and effective treatment for skin rejuvenation. Although traditional lasers were associated with significant thermal damage and lengthy recovery, advances in laser technology have improved safety profiles and reduced social downtime. CO2 lasers remain the gold standard of treatment, and fractional ablative devices capable of achieving remarkable clinical improvement with fewer side effects and shorter recovery times have made it a more practical option for patients. Although ablative resurfacing has become safer, careful patient selection and choice of suitable laser parameters are essential to minimize complications and optimize outcomes. This article describes the current modalities used in ablative laser skin resurfacing and examines their efficacy, indications, and possible side effects. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Anesthesia Methods in Laser Resurfacing

OpenAIRE

Gaitan, Sergio; Markus, Ramsey

2012-01-01

Laser resurfacing technology offers the ability to treat skin changes that are the result of the aging process. One of the major drawbacks of laser resurfacing technologies is the pain associated with the procedure. The methods of anesthesia used in laser resurfacing to help minimize the pain include both noninvasive and invasive procedures. The noninvasive procedures can be divided into topical, cryoanesthesia, and a combination of both. The invasive methods of anesthesia include injected fo...

Facelift combined with simultaneous fractional laser resurfacing: Outcomes and complications.

Science.gov (United States)

Wright, Eric J; Struck, Steve K

2015-10-01

The combination of simultaneous surgical rhytidectomy with ablative resurfacing has been a controversial procedure due to the concern of postoperative wound healing. Traditional ablative resurfacing lasers are believed to have higher rates of complications, leading to delayed healing and skin flap loss when combined with face rhytidectomy surgeries. With the development of fractionated ablative laser therapy, there has been increased interest in combining these two procedures. The objective of this study is to evaluate the clinical outcomes of patients undergoing simultaneous full-face rhytidectomy in combination with fractionated ablative skin resurfacing. A retrospective chart analysis was performed for all patients who had a combined procedure of facelift and ablative fractional laser resurfacing from 2008 to 2013 by the senior author (SKS). Postoperative recovery and complications were recorded. The surgical technique used for performing the facelift was an extended supraplatysmal dissection with SMAS plication. Fraxel Re:Pair 10,600-nm fractional carbon dioxide laser was used to perform an ablative resurfacing including the elevated skin flaps. A total of 86 patients were included. Average age was 60.01 years (range of 45-78 years). Longest follow up was five years. The average size of the elevated skin flaps was 100 cm(2). Average skin type was a Fitzpatrick type 2. All patients had complete re-epithelialization by one week after their procedure. Four patients (4.6%) experienced acne outbreaks. Four patients (4.6%) had facial erythema that persisted greater than two weeks. Of these four patients, all resolved by five weeks postoperatively. There was no delayed wound healing or skin flap loss observed. Our results indicate that simultaneous rhytidectomy with fractionated ablative laser resurfacing does not cause an increase in wound healing or skin loss. Due to improved patient outcomes with combining these procedures, we believe that this can be increasingly

The treatment of hypopigmentation after skin resurfacing.

Science.gov (United States)

Fulton, James E; Rahimi, A David; Mansoor, Sohail; Helton, Peter; Shitabata, Paul

2004-01-01

Hypopigmentation has plagued all methods of skin resurfacing. Whether the physician uses chemical peels, dermabrasion or laser resurfacing hypopigmentation can develop. To examine the pathogenesis and treatment of hypopigmentation after resurfacing. Areas of hypopigmentation after skin resurfacing were blended in with laser-assisted chemabrasion (LACA). The process begins with preconditioning of the skin with vitamin A/glycolic skin conditioning lotions. Then the area is resurfaced with the LACA. This resurfacing usually requires three to four freeze-sand cycles to remove the areas of hypopigmentation associated with dermal fibrosis. The resurfaced skin is then occluded with a combination of polyethylene/silicone sheeting during the acute phase of wound healing. Ultraviolet photography and histologic examination were used to demonstrate the improvement in dermal fibrosis and hypopigmentation. The LACA improved areas of hypopigmentation in the 22 cases studied. Under occlusive wound dressings, the melanocytes migrated into the areas of hypopigmentation, and the wounds healed without extensive fibrosis. This produced a blending of skin color. It is possible with skin preconditioning, LACA, and occlusive wound healing to provide for a wound healing environment that blends in areas of hypopigmentation that have developed after previous skin resurfacing.

Anesthesia Methods in Laser Resurfacing

Science.gov (United States)

Gaitan, Sergio; Markus, Ramsey

2012-01-01

Laser resurfacing technology offers the ability to treat skin changes that are the result of the aging process. One of the major drawbacks of laser resurfacing technologies is the pain associated with the procedure. The methods of anesthesia used in laser resurfacing to help minimize the pain include both noninvasive and invasive procedures. The noninvasive procedures can be divided into topical, cryoanesthesia, and a combination of both. The invasive methods of anesthesia include injected forms (infiltrative, nerve blocks, and tumescent anesthesia) and supervised anesthesia (monitored anesthesia care and general anesthesia). In this review, the authors summarize the types of anesthesia used in laser resurfacing to aid the provider in offering the most appropriate method for the patient to have as painless a procedure as possible. PMID:23904819

Seasonality of service provision in hip and knee surgery: a possible contributor to waiting times? A time series analysis.

Science.gov (United States)

Upshur, Ross E G; Moineddin, Rahim; Crighton, Eric J; Mamdani, Muhammad

2006-03-01

The question of how best to reduce waiting times for health care, particularly surgical procedures such as hip and knee replacements is among the most pressing concern of the Canadian health care system. The objective of this study was to test the hypothesis that significant seasonal variation exists in the performance of hip and knee replacement surgery in the province of Ontario. We performed a retrospective, cross-sectional time series analysis examining all hip and knee replacement surgeries in people over the age of 65 in the province of Ontario, Canada between 1992 and 2002. The main outcome measure was monthly hospitalization rates per 100,000 population for all hip and knee replacements. There was a marked increase in the rate of hip and knee replacement surgery over the 10-year period as well as an increasing seasonal variation in surgeries. Highly significant (Fisher Kappa = 16.05, p Holidays and utilization caps appear to exert a significant influence on the rate of service provision. It is expected that waiting times for hip and knee replacement could be reduced by reducing seasonal fluctuations in service provision and benchmarking services to peak delivery. The results highlight the importance of system behaviour in seasonal fluctuation of service delivery.

The effects of liberal versus restrictive transfusion thresholds on ambulation after hip fracture surgery

DEFF Research Database (Denmark)

Foss, Nicolai B; Kristensen, Morten Tange; Jensen, Pia Søe

2009-01-01

BACKGROUND: Perioperative anemia leads to increased morbidity and mortality and potentially inhibits rehabilitation after hip fracture surgery. As such, the optimum transfusion threshold after hip fracture surgery is unknown. PATIENTS AND METHODS: A total of 120 elderly, cognitively intact hip...... fracture patients admitted from their own home were randomly assigned to receive transfusion at a hemoglobin threshold of 10.0 g per dL (liberal) versus 8.0 g per dL (restrictive) in the entire perioperative period. Patients were treated according to a well-defined multimodal rehabilitation program...... hospitalization (median, 2 units [interquartile range, 1-2] vs. 1 [1-2]; p rehabilitation scores (CAS: median, 9 [9-15] vs. 9 [9-13.5]; p = 0.46) or in length of stay (median, 18 days vs. 16 days, respectively; p = 0.46). There were fewer patients...

Hip joint replacement

Science.gov (United States)

Hip arthroplasty; Total hip replacement; Hip hemiarthroplasty; Arthritis - hip replacement; Osteoarthritis - hip replacement ... Your hip joint is made up of 2 major parts. One or both parts may be replaced during surgery: ...

Implant Optimisation for Primary Hip Replacement in Patients over 60 Years with Osteoarthritis: A Cohort Study of Clinical Outcomes and Implant Costs Using Data from England and Wales.

Directory of Open Access Journals (Sweden)

Simon S Jameson

Full Text Available Hip replacement is one of the most commonly performed surgical procedures worldwide; hundreds of implant configurations provide options for femoral head size, joint surface material and fixation method with dramatically varying costs. Robust comparative evidence to inform the choice of implant is needed. This retrospective cohort study uses linked national databases from England and Wales to determine the optimal type of replacement for patients over 60 years undergoing hip replacement for osteoarthritis.Implants included were the commonest brand from each of the four types of replacement (cemented, cementless, hybrid and resurfacing; the reference prosthesis was the cemented hip procedure. Patient reported outcome scores (PROMs, costs and risk of repeat (revision surgery were examined. Multivariable analyses included analysis of covariance to assess improvement in PROMs (Oxford hip score, OHS, and EQ5D index (9159 linked episodes and competing risks modelling of implant survival (79,775 procedures. Cost of implants and ancillary equipment were obtained from National Health Service procurement data.EQ5D score improvements (at 6 months were similar for all hip replacement types. In females, revision risk was significantly higher in cementless hip prostheses (hazard ratio, HR = 2.22, p<0.001, when compared to the reference hip. Although improvement in OHS was statistically higher (22.1 versus 20.5, p<0.001 for cementless implants, this small difference is unlikely to be clinically important. In males, revision risk was significantly higher in cementless (HR = 1.95, p = 0.003 and resurfacing implants, HR = 3.46, p<0.001, with no differences in OHS. Material costs were lowest with the reference implant (cemented, range £1103 to £1524 and highest with cementless implants (£1928 to £4285. Limitations include the design of the study, which is intrinsically vulnerable to omitted variables, a paucity of long-term implant survival data (reflecting the

Direct quantitative comparison of molecular responses in photodamaged human skin to fractionated and fully ablative carbon dioxide laser resurfacing.

Science.gov (United States)

Orringer, Jeffrey S; Sachs, Dana L; Shao, Yuan; Hammerberg, Craig; Cui, Yilei; Voorhees, John J; Fisher, Gary J

2012-10-01

Fractionated ablative laser resurfacing has become a widely used treatment modality. Its clinical results are often found to approach those of traditional fully ablative laser resurfacing. To directly compare the molecular changes that result from fractionated and fully ablative carbon dioxide (CO(2)) laser resurfacing in photodamaged human skin. Photodamaged skin of 34 adult volunteers was focally treated at distinct sites with a fully ablative CO(2) laser and a fractionated CO(2) laser. Serial skin samples were obtained at baseline and several time points after treatment. Real-time reverse transcriptase polymerase chain reaction technology and immunohistochemistry were used to quantify molecular responses to each type of laser treatment. Fully ablative and fractionated CO(2) laser resurfacing induced significant dermal remodeling and collagen induction. After a single treatment, fractionated ablative laser resurfacing resulted in collagen induction that was approximately 40% to 50% as pronounced as that induced by fully ablative laser resurfacing. The fundamental cutaneous responses that result from fully ablative and fractionated carbon dioxide laser resurfacing are similar but differ in magnitude and duration, with the fully ablative procedure inducing relatively greater changes including more pronounced collagen induction. However, the molecular data reported here provide substantial support for fractionated ablative resurfacing as an effective treatment modality for improving skin texture. © 2012 by the American Society for Dermatologic Surgery, Inc. Published by Wiley Periodicals, Inc.

High perceived caregiver burden for relatives of patients following hip fracture surgery

DEFF Research Database (Denmark)

Ariza-Vega, Patrocinio; Ortiz-Piña, Mariana; Kristensen, Morten Tange

2018-01-01

treatment strategies such as the support and training of the caregivers in patient handling during hospital stay could be carried out to reduce caregiver burden. Implications for rehabilitation The main caregiver of a hip fracture patient is usually a woman who is the daughter of the patient, and reducing...... her burden of care should be included as one of the objectives of rehabilitation treatment. The caregivers of hip fracture patients must be considered as part of the treatment during the patient's recovery period, and patient handling training should be provided to the caregivers of hip fracture......PURPOSE: To determine the profile of the main informal caregivers, the evolution of the caregiver burden, and the influencing factors of caregiver burden at 1-year after hip fracture surgery. METHODS: In this prospective cohort study, a total of 172 informal caregivers of patients were interviewed...

The Frequency of AVN Following Reconstructive Hip Surgery in Children With Cerebral Palsy: A Systematic Review.

Science.gov (United States)

Hesketh, Kim; Leveille, Lise; Mulpuri, Kishore

2016-03-01

Children with cerebral palsy (CP) undergoing reconstructive hip surgery are at risk for developing avascular necrosis (AVN). The purpose of this systematic review was to investigate the reported frequency of AVN, the amount and quality of literature available, and possibly identity risk factors for developing AVN following reconstructive surgery for hip displacement in children with CP. We performed a review of the literature using EMBASE and MEDLINE databases. Studies investigating the outcome of reconstructive hip surgery in patients with CP that identified the presence or absence of AVN were included. Study quality was assessed using the Methodological Index for Non-Randomized Studies and the Oxford Centre for Evidence-Based Medicine scale. Three hundred and ninety-nine articles were identified using our search strategy. Twenty-nine studies were included for data extraction after full-text review. The frequency of AVN ranged from 0% to 46% with an overall rate across studies of 7.5%. Presence of AVN was the primary outcome in 2 studies. The frequency of AVN in these studies was significantly higher than other studies at 37% and 46%. No statistically significant associations were found between age at surgery, severity of hip subluxation, length of follow-up, or type of surgery (combined varus derotation osteotomy and pelvic osteotomy vs. varus derotation osteotomy alone), and the rate of AVN. The majority of studies did not comment on methods used for determining diagnosis or severity of AVN and clinical significance was not well documented. Children with CP undergoing reconstructive hip surgery are at risk of developing AVN. Frequency and severity of this complication is poorly documented in the literature. On the basis of current evidence no significant risk factors were identified; however, it is not possible to draw firm conclusions about them. Incidence of AVN was higher in studies in which AVN was a primary outcome suggesting that the true frequency of AVN

A clinical, radiological and biomechanical study of the TARA hip prosthesis

NARCIS (Netherlands)

Waal Malefijt, de M.C.; Huiskes, H.W.J.

1993-01-01

We reviewed 60 patients with 72 TARA (total articular replacement arthroplasty) resurfacing hip prostheses. To analyse the behaviour of the femoral component a radiographic study was done and a two-dimensional finite element model was constructed. The stem of the femoral component plays a role in

Seasonality of service provision in hip and knee surgery: A possible contributor to waiting times? A time series analysis

Directory of Open Access Journals (Sweden)

Upshur Ross EG

2006-03-01

Full Text Available Abstract Background The question of how best to reduce waiting times for health care, particularly surgical procedures such as hip and knee replacements is among the most pressing concern of the Canadian health care system. The objective of this study was to test the hypothesis that significant seasonal variation exists in the performance of hip and knee replacement surgery in the province of Ontario. Methods We performed a retrospective, cross-sectional time series analysis examining all hip and knee replacement surgeries in people over the age of 65 in the province of Ontario, Canada between 1992 and 2002. The main outcome measure was monthly hospitalization rates per 100 000 population for all hip and knee replacements. Results There was a marked increase in the rate of hip and knee replacement surgery over the 10-year period as well as an increasing seasonal variation in surgeries. Highly significant (Fisher Kappa = 16.05, p 2Autoreg = 0.85 seasonality was identified in the data. Conclusion Holidays and utilization caps appear to exert a significant influence on the rate of service provision. It is expected that waiting times for hip and knee replacement could be reduced by reducing seasonal fluctuations in service provision and benchmarking services to peak delivery. The results highlight the importance of system behaviour in seasonal fluctuation of service delivery.

Hip fracture - discharge

Science.gov (United States)

... neck fracture repair - discharge; Trochanteric fracture repair - discharge; Hip pinning surgery - discharge ... in the hospital for surgery to repair a hip fracture, a break in the upper part of ...

Surgery-induced changes and early recovery of hip-muscle strength, leg-press power, and functional performance after fast-track total hip arthroplasty: a prospective cohort study.

Directory of Open Access Journals (Sweden)

Bente Holm

Full Text Available By measuring very early changes in muscle strength and functional performance after fast-track total hip arthroplasty (THA, post-operative rehabilitation, introduced soon after surgery, can be designed to specifically target identified deficits.Firstly, to quantify changes (compared to pre-operative values in hip muscle strength, leg-press power, and functional performance in the first week after THA, and secondly, to explore relationships between the muscle strength changes, and changes in hip pain, systemic inflammation, and thigh swelling.Prospective, cohort study.Convenience sample of patients receiving a THA at Copenhagen University Hospital, Hvidovre, Denmark, between March and December 2011.Thirty-five patients (65.9 ± 7.2 years undergoing THA.Hip muscle strength, leg-press power, performance-based function, and self-reported disability were determined prior to, and 2 and 8 days after, THA (Day 2 and 8, respectively. Hip pain, thigh swelling, and C-Reactive Protein were also determined.Five patients were lost to follow-up. Hip muscle strength and leg press power were substantially reduced at Day 2 (range of reductions: 41-58%, P<0.001, but less pronounced at Day 8 (range of reductions: 23-31%, P<0.017. Self-reported symptoms and function (HOOS: Pain, Symptoms, and ADL improved at Day 8 (P<0.014. Changes in hip pain, C-Reactive Protein, and thigh swelling were not related to the muscle strength and power losses.Hip muscle strength and leg-press power decreased substantially in the first week after THA - especially at Day 2 - with some recovery at Day 8. The muscle strength loss and power loss were not related to changes in hip pain, systemic inflammation, or thigh swelling. In contrast, self-reported symptoms and function improved. These data on surgery-induced changes in muscle strength may help design impairment-directed, post-operative rehabilitation to be introduced soon after surgery.ClinicalTrials.gov NCT01246674.

Municipality-based physical rehabilitation after acute hip fracture surgery in Denmark

DEFF Research Database (Denmark)

Kronborg, Lise; Bandholm, Thomas; Kehlet, Henrik

2015-01-01

INTRODUCTION: Patients who are surgically treated for an acute hip fracture in Denmark commence early in-hospital physical rehabilitation (PR) with more than 95% of patients referred to further PR following discharge. However, the specifics of the PR services after discharge are unknown. Thus......, the aim of the present paper was to describe the specifics of PR provided to patients following discharge after hip fracture (HF) surgery in Denmark to evaluate the need for future interventions or guidelines. METHODS: This was a national, cross-sectional questionnaire survey including 56 randomly...... of which only 14% provided specific information regarding the intensity and the progression of training. CONCLUSION: PR after hip fracture in Denmark is initiated shortly after referral, for a variable duration of time and with poorly described exercise intensity and progression. This calls for a national...

Post-operative rounds by anaesthesiologists after hip fracture surgery: a pilot study

DEFF Research Database (Denmark)

Foss, Nicolai Bang; Christensen, Dorte Stig; Krasheninnikoff, Michael

2006-01-01

BACKGROUND: Efforts to optimize the peri-operative care of hip fracture patients through multidisciplinary intervention have focused on orthopaedic-geriatric liaisons, which have not resulted in significant outcome changes. The early phase of rehabilitation could potentially be optimized through...... a multidisciplinary effort between anaesthesiologists and orthopaedic surgeons. METHODS: During the first 25 weeks of 2004, 98 consecutive community-residing patients admitted to a hip fracture unit received daily rounds by anaesthesiologists during the first four post-operative days, on weekdays only, focusing...... conditions. CONCLUSION: This pilot study, with insufficient power to show significant differences in outcome, supports further evaluation of the concept of intensified orthopaedic-anaesthesiological co-operation after hip fracture surgery. Such a randomized trial should evaluate economic and clinical outcome...

Skin resurfacing procedures: new and emerging options.

Science.gov (United States)

Loesch, Mathew M; Somani, Ally-Khan; Kingsley, Melanie M; Travers, Jeffrey B; Spandau, Dan F

2014-01-01

The demand for skin resurfacing and rejuvenating procedures has progressively increased in the last decade and has sparked several advances within the skin resurfacing field that promote faster healing while minimizing downtime and side effects for patients. Several technological and procedural skin resurfacing developments are being integrated into clinical practices today allowing clinicians to treat a broader range of patients' skin types and pathologies than in years past, with noteworthy outcomes. This article will discuss some emerging and developing resurfacing therapies and treatments that are present today and soon to be available.

Palliative surgery for acetabular metastasis with pathological central dislocation of the hip joint after radiation therapy. A case report

International Nuclear Information System (INIS)

Hoshi, Manabu; Takada, Jun; Oebisu, Naoto; Nakamura, Hiroaki; Taguchi, Susumu; Takami, Masatsugu

2012-01-01

Orthopedic surgery for bone metastases is mainly a palliative treatment. Pathological central dislocation of the hip joint secondary to osteonecrosis of acetabular metastasis after radiation therapy brings severe suffering to cancer patients. We performed minimally invasive palliative surgery for an elderly woman, and excellent pain relief was achieved. An 80-year-old female suffering from right hip pain was referred to our hospital. She had undergone surgery for lung cancer 5 years previously and her right acetabulum was subsequently affected by metastasis. With the aim of controlling the metastasis, radiation therapy was performed. Two years later, pathological central dislocation of the hip joint occurred with sudden onset of severe pain, and she was unable to maintain a sitting position and became bedridden. After she was referred to our hospital, we created an intentional pseudarthrosis in the femoral neck for palliation. After the surgery, excellent pain relief and remarkably improved mobility were achieved during her limited remaining lifetime. In this report, we introduce a novel method of producing a pseudarthrosis in the femoral neck for pathological dislocation. This procedure is a minimally invasive treatment and an alternative option for palliative surgery for pathological dislocation of the hip joint due to osteonecrosis after radiation therapy. (author)

Increasing Severity of Malnutrition Is Associated With Poorer 30-Day Outcomes in Patients Undergoing Hip Fracture Surgery.

Science.gov (United States)

Chung, Andrew S; Hustedt, Joshua W; Walker, Robert; Jones, Clifford; Lowe, Jason; Russell, George V

2018-04-01

Low serum albumin levels (hypoalbuminemia) have classically been used to identify malnutrition. The effect of increasing severity of malnutrition on postoperative outcomes in patients undergoing hip fracture surgery has not been well delineated on a large scale. Retrospective. Multicenter. A total of 12,373 patients undergoing hip fracture surgery from 2006 to 2013 National Surgery Quality Improvement Project data were identified. Patient demographic, comorbidity, and preoperative laboratory data and complication, reoperation, and readmission data were collected. Multivariate logistic regression was used to determine the effect of increasing severity of malnutrition on rates of 30-day postoperative complications, readmissions, and reoperations. A total of 12,373 hip fractures met inclusion criteria. A total of 6506 (52.6%) patients had normal albumin levels (albumin ≥3.5 g/dL), 3205 (25.9%) patients were mildly malnourished (albumin 3.1-3.49 g/dL), 2265 (18.3%) were moderately malnourished (albumin 2.4-3.1 g/dL), and 397 (3.2%) patients were severely malnourished (albumin malnutrition was associated with a 2-fold increase in the odds of postoperative complications and mortality when compared with mild malnutrition (P malnutrition was associated with significantly longer lengths of stay and higher odds of experiencing a related readmission (P hip fracture surgery. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

The Hip Fracture Surgery in Elderly Patients (HIPELD study: protocol for a randomized, multicenter controlled trial evaluating the effect of xenon on postoperative delirium in older patients undergoing hip fracture surgery

Directory of Open Access Journals (Sweden)

Coburn Mark

2012-09-01

Full Text Available Abstract Background Strategies to protect the brain from postoperative delirium (POD after hip fracture are urgently needed. The development of delirium often is associated with the loss of independence, poor functional recovery, and increased morbidity, as well as increases in length of hospital stay, discharges to nursing facilities, and healthcare costs. We hypothesize that xenon may reduce the burden of POD, (i by avoiding the need to provide anesthesia with a drug that targets the γ-amino-butyric acid (GABAA receptor and (ii through beneficial anesthetic and organ-protective effects. Methods and design An international, multicenter, phase 2, prospective, randomized, blinded, parallel group and controlled trial to evaluate the incidence of POD, diagnosed with the Confusion Assessment Method (CAM, in older patients undergoing hip fracture surgery under general anesthesia with xenon or sevoflurane, for a period of 4 days post surgery (primary outcome is planned. Secondary objectives are to compare the incidence of POD between xenon and sevoflurane, to evaluate the incidence of POD from day 5 post surgery until discharge from hospital, to determine the time to first POD diagnosis, to evaluate the duration of POD, to evaluate the evolution of the physiological status of the patients in the postoperative period, to evaluate the recovery parameters, to collect preliminary data to evaluate the economical impact of POD in the postoperative period and to collect safety data. Patients are eligible if they are older aged (≥ 75 years and assigned to a planned hip fracture surgery within 48 h after the hip fracture. Furthermore, patients need to be willing and able to complete the requirements of this study including the signature of the written informed consent. A total of 256 randomized patients in the 10 participating centers will be recruited, that is, 128 randomized patients in each of the 2 study groups (receiving either xenon or sevoflurane

Routine patellar resurfacing using an inset patellar technique.

LENUS (Irish Health Repository)

Hurson, Conor

2012-02-01

The management of the patella in total knee arthroplasty still causes controversy. Whether or not to resurface the patella in primary total knee arthroplasty remains unclear. In this study we examined 220 consecutive total knee replacements, by a single surgeon, where the patella was routinely resurfaced using the inset technique. All patellae were suitable for resurfacing. Patellar thickness was not altered in 54.5% of patellae. In 97.2% the patella was within 2 mm of the original thickness. There were no significant complications. In this study we have found that the inset technique of patella resurfacing in total knee replacement is a simple and safe resurfacing procedure.

Two-stage revision surgery with preformed spacers and cementless implants for septic hip arthritis: a prospective, non-randomized cohort study

Directory of Open Access Journals (Sweden)

Logoluso Nicola

2011-05-01

Full Text Available Abstract Background Outcome data on two-stage revision surgery for deep infection after septic hip arthritis are limited and inconsistent. This study presents the medium-term results of a new, standardized two-stage arthroplasty with preformed hip spacers and cementless implants in a consecutive series of adult patients with septic arthritis of the hip treated according to a same protocol. Methods Nineteen patients (20 hips were enrolled in this prospective, non-randomized cohort study between 2000 and 2008. The first stage comprised femoral head resection, debridement, and insertion of a preformed, commercially available, antibiotic-loaded cement hip spacer. After eradication of infection, a cementless total hip arthroplasty was implanted in the second stage. Patients were assessed for infection recurrence, pain (visual analog scale [VAS] and hip joint function (Harris Hip score. Results The mean time between first diagnosis of infection and revision surgery was 5.8 ± 9.0 months; the average duration of follow up was 56.6 (range, 24 - 104 months; all 20 hips were successfully converted to prosthesis an average 22 ± 5.1 weeks after spacer implantation. Reinfection after total hip joint replacement occurred in 1 patient. The mean VAS pain score improved from 48 (range, 35 - 84 pre-operatively to 18 (range, 0 - 38 prior to spacer removal and to 8 (range, 0 - 15 at the last follow-up assessment after prosthesis implantation. The average Harris Hip score improved from 27.5 before surgery to 61.8 between the two stages to 92.3 at the final follow-up assessment. Conclusions Satisfactory outcomes can be obtained with two-stage revision hip arthroplasty using preformed spacers and cementless implants for prosthetic hip joint infections of various etiologies.

A qualitative study of Functioning, Disability, and Rehabilitation of patients after hip fracture surgery

DEFF Research Database (Denmark)

Ehlers, Monica Milter

2013-01-01

A qualitative study of functioning, disability, and rehabilitation of patients after hip fracture surgery Monica Milter Ehlers PhD student, MSc in Nursing Merete Bender Bjerrum* PhD, MA, Associate Professor Claus Vinther Nielsen* Professor, PhD, MD, Specialist in Clinical Social Medicine...... *Department of Public Health, Aarhus University Introduction Hip fractures cause the greatest consumption of bed days in Danish hospitals. The need for rehabilitation of hip fracture patients older than 65 years is increasing because of a growing number of elderly people in Denmark. Rehabilitation of hip...... fracture patients consists primarily of muscle training and daily mobilisation. Patients' functioning, disability, and involvement in their rehabilitation process have not been investigated in scientific studies. Aims To establish a specific research-based knowledge for functioning, disability...

Clinical and radiological evolution of Intervened patients of total arthroplasty of hip with prostheses of resuperficialization metal-metal - Preliminary report

International Nuclear Information System (INIS)

Galvan Villamarin, Fernando; Bernal Torres, Fabio A; Paez, Jose Mauricio and others

2006-01-01

The articular degeneration of the hip in young patients requires including therapeutical alternatives for the management of this population. The resurfacing prostheses with metal-metal surfaces is an alternative for this type of patients. Reports with short and medium follow up are very promising, besides the different studies of laboratory that bear, the theoretical bases for their success. In this descriptive study, observational cases series type is described the radiological and clinical evolution of patients intervened of total arthroplasty of hip with resurfacing prostheses metal-metal in the hospital el Tunal of Bogota. The results of 31 hips are presented (27 patients) with an age average of 50 years old and a medium follow up of 16 months, with a good post surgical functional result with a median of 96 in the Harris Scores. The complications presented in the patient series are described and their relation with the different factors analyzed

Patellar resurfacing versus nonresurfacing in total knee arthroplasty for osteoarthritis: experience at a tertiary care institution in Pakistan

Directory of Open Access Journals (Sweden)

Lakdawala RH

2012-02-01

Full Text Available Akil Fazal1, Riaz H Lakdawala21Clinical Fellow, NYU Hospital for Joint Disease, New York, US; 2Associate Professor and Chief, Section of Orthopedics, Department of Surgery, The Aga Khan University Hospital, Karachi, PakistanObjective: To determine the effect of patellar resurfacing in patients offered total knee arthroplasty for osteoarthritis.Design: Randomized control study.Place and duration of study: The Aga Khan University Hospital, Karachi, Pakistan from January 3, 2005 to January 9, 2010.Patients and methods: Patients undergoing primary total knee arthroplasty for osteoarthritis were assigned to either the patellar resurfacing or nonresurfacing arm using systematic sampling. This consisted of patients undergoing unilateral and bilateral knee arthroplasty. Preoperatively, Knee Society Knee and Function Scores were calculated. After a minimum of 3 years postoperatively Knee Society Knee and Function Scores as well as the Clinical Anterior Knee Pain Rating were calculated and analysis done to check for differences.Results: Seventy-five patients were recruited in each arm; 135 patients had bilateral and 15 had unilateral knee arthroplasty. The mean preoperative knee score was 40.4 for the resurfacing group and 40.60 for the nonresurfacing group (P = 0.45. This improved postoperatively to 93.67 and 94.23 respectively, with no difference between the two groups (P = 0.67. The mean preoperative function score was 45.50 for resurfaced patellae and 45.83 for nonresurfaced. This improved to 89.67 and 90.50, respectively, again with no difference (P = 0.51. Postoperative Clinical Anterior Knee Pain Rating was a mean of 0.1 for resurfaced and 0.13 for nonresurfaced patellas, with no difference on analysis (P = 0.06. However, patients who had bilateral knee arthroplasty had a slightly higher Clinical Anterior Knee Pain Rating than those who had single knee surgery (P = 0.046 irrespective of whether the patellar was resurfaced or not.Conclusion: In

Postoperative Delirium in Elderly Patients Undergoing Hip Fracture Surgery in the Sugammadex Era: A Retrospective Study

Science.gov (United States)

Oh, Chung-Sik; Rhee, Ka Young; Yoon, Tae-Gyoon; Woo, Nam-Sik; Hong, Seung Wan; Kim, Seong-Hyop

2016-01-01

Background. Residual neuromuscular block (NMB) after general anesthesia has been associated with pulmonary dysfunction and hypoxia, which are both associated with postoperative delirium (POD). We evaluated the effects of sugammadex on POD in elderly patients who underwent hip fracture surgery. Methods. Medical records of 174 consecutive patients who underwent hip fracture surgery with general anesthesia were reviewed retrospectively to compare the perioperative incidence of POD, pulmonary complications, time to extubation, incidence of hypoxia, and laboratory findings between patients treated with sugammadex and those treated with a conventional cholinesterase inhibitor. Results. The incidence of POD was not significantly different between the two groups (33.3% versus 36.5%, resp.; P = 0.750). Postoperative pulmonary complications and laboratory findings did not showed significant intergroup difference. However, time to extubation (6 ± 3 versus 8 ± 3 min; P sugammadex group than in the conventional cholinesterase inhibitor group. Conclusion. Sugammadex did not reduce POD or pulmonary complications compared to conventional cholinesterase inhibitors, despite reducing time to extubation and postoperative hypoxia in elderly patients who underwent hip fracture surgery under general anesthesia. PMID:26998480

Erythema after laser skin resurfacing.

Science.gov (United States)

Ruiz-Esparza, J; Barba Gomez, J M; Gomez de la Torre, O L; David, L

1998-01-01

Erythema after laser skin resurfacing is seen by many as a necessary evil in order to get good results from the procedure. A critical review of widely accepted concepts may lead to diminishing the length of postoperative erythema in patients undergoing laser resurfacing. The authors report on two previously unrecognized factors in the causation of this problem.

Early symptoms in the prodromal phase of delirium: a prospective cohort study in elderly patients undergoing hip surgery

NARCIS (Netherlands)

de Jonghe, Jos F. M.; Kalisvaart, Kees J.; Dijkstra, Marty; van Dis, Huib; Vreeswijk, Ralph; Kat, Martin G.; Eikelenboom, Piet; van der Ploeg, Tjeerd; van Goo, Willem A.

2007-01-01

OBJECTIVES: The authors investigated prodromal delirium symptoms in elderly patients undergoing hip surgery. METHODS: This was a prospective cohort study in the setting of a large medical school-affiliated general hospital in Alkmaar, The Netherlands. Participants were patients undergoing hip

[Effects of surgery on muscles on clinical and radiographic findings in the hip joint region in cerebral palsy patients].

Science.gov (United States)

Schejbalová, A; Havlas, V

2008-10-01

PURPOSE OF THE STUDY Isolated or combined surgical procedures on muscles around the hip joint are currently indicated by many authors. In cerebral palsy patients they are regarded as essential intervention. MATERIAL In the years 2005-2007, surgery in the hip joint region was essential for 150 children between 3 and 18 years of age. At the time of surgery, the patients' locomotion ranged from stage 1 to stage 7 of the Vojta system. METHODS The outcome was evaluated by clinical and radiographic examination at 2 and 6 months post-operatively and hip migration percentage and Wiberg's CE angle were measured. RESULTS The best clinical and radiographic outcomes were achieved in children younger than 6 years of age. On the other hand, isolated transfer of the distal rectus femoris muscle significantly affected pelvis anteflexion in adolescent patients. The most marked decrease in migration percentage was found after adductor tenotomy combined with surgery on the iliopsoas muscle (55.6 %) or when the two procedures were combined with distal rectus femoris transfer. DISCUSSION Combined surigical procedures, i.e., adductor tenotomy, surgery on the iliopsoas muscle or rectus femoris muscle and medial hamstrings, with fixation using an abduction modified Atlanta brace, are effective in patients with marked lateral hip migration who are younger that 6 years. Isolated adductor tenotomy and distal transfer of the rectus femoris muscle markedly improve standing position in walking patients. CONCLUSION An appropriate combination of surgical procedures on muscles in the hip region and on medial hamstrings can significantly improve the patient's locomotion and, if lateral migration is present, help to avoid surgery on bones.

Heated wire humidification circuit attenuates the decrease of core temperature during general anesthesia in patients undergoing arthroscopic hip surgery.

Science.gov (United States)

Park, Sooyong; Yoon, Seok-Hwa; Youn, Ann Misun; Song, Seung Hyun; Hwang, Ja Gyung

2017-12-01

Intraoperative hypothermia is common in patients undergoing general anesthesia during arthroscopic hip surgery. In the present study, we assessed the effect of heating and humidifying the airway with a heated wire humidification circuit (HHC) to attenuate the decrease of core temperature and prevent hypothermia in patients undergoing arthroscopic hip surgery under general anesthesia. Fifty-six patients scheduled for arthroscopic hip surgery were randomly assigned to either a control group using a breathing circuit connected with a heat and moisture exchanger (HME) (n = 28) or an HHC group using a heated wire humidification circuit (n = 28). The decrease in core temperature was measured from anesthetic induction and every 15 minutes thereafter using an esophageal stethoscope. Decrease in core temperature from anesthetic induction to 120 minutes after induction was lower in the HHC group (-0.60 ± 0.27℃) compared to the control group (-0.86 ± 0.29℃) (P = 0.001). However, there was no statistically significant difference in the incidence of intraoperative hypothermia or the incidence of shivering in the postanesthetic care unit. The use of HHC may be considered as a method to attenuate intraoperative decrease in core temperature during arthroscopic hip surgery performed under general anesthesia and exceeding 2 hours in duration.

Perioral Rejuvenation With Ablative Erbium Resurfacing.

Science.gov (United States)

Cohen, Joel L

2015-11-01

Since the introduction of the scanning full-field erbium laser, misconceptions regarding ablative erbium resurfacing have resulted in its being largely overshadowed by ablative fractional resurfacing. This case report illustrates the appropriateness of full-field erbium ablation for perioral resurfacing. A patient with profoundly severe perioral photodamage etched-in lines underwent full-field ablative perioral resurfacing with an erbium laser (Contour TRL, Sciton Inc., Palo Alto, CA) that allows separate control of ablation and coagulation. The pre-procedure consultations included evaluation of the severity of etched-in lines, and discussion of patient goals, expectations, and appropriate treatment options, as well as a review of patient photos and post-treatment care required. The author generally avoids full-field erbium ablation in patients with Fitzpatrick type IV and above. For each of 2 treatment sessions (separated by approximately 4 months), the patient received (12 cc plain 2% lidodaine) sulcus blocks before undergoing 4 passes with the erbium laser at 150 μ ablation, no coagulation, and then some very focal 30 μ ablation to areas of residual lines still visualized through the pinpoint bleeding. Similarly, full-field ablative resurfacing can be very reliable for significant wrinkles and creping in the lower eyelid skin--where often a single treatment of 80 μ ablation, 50 μ coagulation can lead to a nice improvement. Standardized digital imaging revealed significant improvement in deeply etched rhytides without significant adverse events. For appropriately selected patients requiring perioral (or periorbital) rejuvenation, full-field ablative erbium resurfacing is safe, efficacious and merits consideration.

Feasibility of using administrative data for identifying medical reasons to delay hip fracture surgery: a Canadian database study.

Science.gov (United States)

Guy, Pierre; Sheehan, Katie J; Morin, Suzanne N; Waddell, James; Dunbar, Michael; Harvey, Edward; Sirett, Susan; Sobolev, Boris; Kuramoto, Lisa; Tang, Michael

2017-10-05

Failure to account for medically necessary delays may lead to an underestimation of early surgery benefits. This study investigated the feasibility of using administrative data to identify the National Institute for Health and Care Excellence (NICE) 124 guideline list of conditions that appropriately delay hip fracture surgery. We assembled a list of diagnosis and procedure codes to reflect the NICE 124 conditions. The list was reviewed and updated by an advanced clinical coder. The list was refined by five clinical experts. We then screened Canadian Institute for Health Information discharge abstracts for 153 918 patients surgically treated for a non-pathological first hip fracture between 1 January 2004 and 31 December 2012 for diagnosis codes present on admission and procedure codes that antedated hip fracture surgery. We classified abstracts as having medical reasons for delaying surgery based on the presence of these codes. In total, 10 237 (6.7%; 95% CI 6.5% to 6.8%) patients had diagnostic and procedure codes indicating medical reasons for delay. The most common reasons for medical delay were exacerbation of a chronic chest condition (35.9%) and acute chest infection (23.2%). The proportion of patients with reasons for medical delays increased with time from admission to surgery: 3.9% (95% CI 3.6% to 4.1%) for same day surgery; 4.7% (95% CI 4.5% to 4.8%) for surgery 1 day after admission; 7.1% (95% CI 6.9% to 7.4%) for surgery 2 days after admission; and 15.5% (95% CI 15.1% to 16.0%) for surgery more than 2 days after admission. The trend was seen for admissions on weekday working hours, weekday after hours and on weekends. Administrative data can be considered to identify conditions that appropriately delay hip fracture surgery. Accounting for medically necessary delays can improve estimates of the effectiveness of early surgery. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights

Oral nutrition or water loading before hip replacement surgery; a randomized clinical trial.

Science.gov (United States)

Ljunggren, Stefan; Hahn, Robert G

2012-07-02

Surgery induces insulin resistance that might be alleviated by a nutritional drink given preoperatively. The authors hypothesized that some of the beneficial effects of the drink could be attributed to the volume component (approximately 1 L) rather than to the nutrients. Sixty patients scheduled for elective total hip replacement under spinal anesthesia were recruited to a clinical trial, and randomly allocated to preoperative fasting, to oral ingestion of tap water, or to oral ingestion of a carbohydrate drink. An intravenous glucose tolerance test calculated glucose clearance and insulin sensitivity on the day before surgery, in the postoperative ward, and on the day after surgery. Other parameters were stress (cortisol in plasma and urine), muscle catabolism (urinary 3-methylhistidine), and wellbeing. Fifty-seven patients completed the study. In the postoperative ward, the glucose clearance and the insulin response had decreased from the previous day by 23% and 36%, respectively. Insulin sensitivity did not decrease until the next morning (-48%) and was due to an increased insulin response (+51%). Cortisol excretion was highest on the day of surgery, while 3-methylhistidine increased 1 day later. Follow-up on the third postoperative day showed an average of 1.5 complications per patient. Wellbeing was better 2 weeks after than before the surgery. None of the measured parameters differed significantly between the study groups. Preoperative ingestion of tap water or a nutritional drink had no statistically significant effect on glucose clearance, insulin sensitivity, postoperative complications, or wellbeing in patients undergoing elective hip surgery.

Red blood cell transfusion for people undergoing hip fracture surgery.

Science.gov (United States)

Brunskill, Susan J; Millette, Sarah L; Shokoohi, Ali; Pulford, E C; Doree, Carolyn; Murphy, Michael F; Stanworth, Simon

2015-04-21

The incidence of hip fracture is increasing and it is more common with increasing age. Surgery is used for almost all hip fractures. Blood loss occurs as a consequence of both the fracture and the surgery and thus red blood cell transfusion is frequently used. However, red blood cell transfusion is not without risks. Therefore, it is important to identify the evidence for the effective and safe use of red blood cell transfusion in people with hip fracture. To assess the effects (benefits and harms) of red blood cell transfusion in people undergoing surgery for hip fracture. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (31 October 2014), the Cochrane Central Register of Controlled Trials (The Cochrane Library, 2014, Issue 10), MEDLINE (January 1946 to 20 November 2014), EMBASE (January 1974 to 20 November 2014), CINAHL (January 1982 to 20 November 2014), British Nursing Index Database (January 1992 to 20 November 2014), the Systematic Review Initiative's Transfusion Evidence Library, PubMed for e-publications, various other databases and ongoing trial registers. Randomised controlled trials comparing red blood cell transfusion versus no transfusion or an alternative to transfusion, different transfusion protocols or different transfusion thresholds in people undergoing surgery for hip fracture. Three review authors independently assessed each study's risk of bias and extracted data using a study-specific form. We pooled data where there was homogeneity in the trial comparisons and the timing of outcome measurement. We used GRADE criteria to assess the quality (low, moderate or high) of the evidence for each outcome. We included six trials (2722 participants): all compared two thresholds for red blood cell transfusion: a 'liberal' strategy to maintain a haemoglobin concentration of usually 10 g/dL versus a more 'restrictive' strategy based on symptoms of anaemia or a lower haemoglobin concentration, usually 8 g/dL. The exact

Molecular effects of fractional carbon dioxide laser resurfacing on photodamaged human skin.

Science.gov (United States)

Reilly, Michael J; Cohen, Marc; Hokugo, Akishige; Keller, Gregory S

2010-01-01

Objective To elucidate the sequential changes in protein expression that play a role in the clinically beneficial results seen with fractional carbon dioxide (CO(2)) laser resurfacing of the face and neck. Methods Nine healthy volunteers were recruited for participation from the senior author's facial plastic surgery practice. After informed consent was obtained, each volunteer underwent a 2-mm punch biopsy from a discrete area of infra-auricular neck skin prior to laser treatment. Patients then immediately underwent laser resurfacing of photodamaged face and neck skin at a minimal dose (30 W for 0.1 second) with the Pixel Perfect fractional CO(2) laser. On completion of the treatment, another biopsy specimen was taken adjacent to the first site. Additional biopsy specimens were subsequently taken from adjacent skin at 2 of 3 time points (day 7, day 14, or day 21). RNA was extracted from the specimens, and reverse transcriptase-polymerase chain reaction and protein microarray analysis were performed. Comparisons were then made between time points using pairwise comparison testing. Results We found statistically significant changes in the gene expression of several matrix metalloproteinases (MMPs). The data demonstrate a consistent up-regulation of MMPs 1, 3, 9, and 13, all of which have been previously reported for fully ablative CO(2) laser resurfacing. There was also a statistically significant increase in MMP-10 and MMP-11 levels in this data set. Conclusion This study suggests that the molecular mechanisms of action are similar for both fractional and fully ablative CO(2) laser resurfacing.

Social profile and cost analysis of deep infection following total hip replacement surgery

Directory of Open Access Journals (Sweden)

Vera Lucia Frazão

Full Text Available ABSTRACT OBJECTIVE: To characterize the socio-economic and demographic profile of patients undergoing surgery for revision total hip arthroplasty regarding the diagnosis of deep prosthetic infection. METHODS: Twenty patients were retrospectively studied, admitted in the period between 2009 and 2010 by the Hip Surgery Group with the diagnosis of deep prosthetic infection, whose proposed treatment was surgical. This study was carried out in the presence of the patient by completing two forms applied by the social worker of the Group. RESULTS: In a 20-patient sample, 40% were male, 45% were working age, 50% of patients originated from the capital, 85% depended on benefits, 70% were retired, 60% of patients were from this hospital, and 40% were from other services. The average cost of patients to the public system was R$ 55,821.62 per patient and the total spent on treatment of patients in the study exceeded one million Brazilian reals, totalling R$ 1,116,432.40. CONCLUSION: Infection from total hip arthroplasty generates a major expense to the social security system and to the public healthcare system. Physicians must always be alert to the possible risk factors and perioperative care, striving to minimize this complication.

The hip fracture best practice tariff: early surgery and the implications for MRSA screening and antibiotic prophylaxis.

Science.gov (United States)

Bryson, David J; Gulihar, Abhinav; Aujla, Randeep S; Taylor, Grahame J S

2015-01-01

In April 2010, the Department of Health introduced the hip fracture best practice. Among the clinical criteria required to earn remuneration is surgery within 36 h of admission. However, early surgery may mean that methicillin-resistant Staphylococcus aureus (MRSA) colonisation status is not known before surgery, and therefore, appropriate antibiotic prophylaxis may not be administered. In view of this, our department's policy is to administer an additional dose of teicoplanin to patients with unknown MRSA status along with routine antimicrobial prophylaxis. The purpose of this study was to provide a safe and effective antimicrobial prophylaxis for hip fracture patients. We prospectively collected details of demographics and antimicrobial prophylaxis for all patients admitted with a hip fracture in November 2011. This was repeated in February 2012 after an educational and advertising drive to improve compliance with departmental antimicrobial policy. Microbiology results were obtained from the hospital microbiology database. A cost-benefit analysis was undertaken to assess this regime. A total of 144 hip fracture patients were admitted during the 2 months. The average admission to surgery time was 32 h, and the average MRSA swab processing time was 35 h. 86 % of patients reached theatre with unknown MRSA status. Compliance with the departmental antimicrobial policy improved from 25 % in November 2011 to 76 % in February 2012. Potential savings of £ 40,000 were calculated. With best practice tariff resulting in 86 % of patients reaching theatre with unknown MRSA status, we advocate an additional single dose of teicoplanin to cover against possible MRSA colonisation.

Complications and their risk factors following hip fracture surgery.

Science.gov (United States)

Poh, Keng Soon; Lingaraj, K

2013-08-01

PURPOSE. To evaluate various postoperative complications and their risk factors in hip fracture patients. METHODS. 207 female and 87 male consecutive patients (mean age, 78.1 years) who underwent surgical (n=242) or conservative (n=52) treatment for closed fractures of the femoral neck (n=157) or peritrochanter (n=137) were prospectively studied. The types of complication and outcome were recorded. The comorbidity status of the patients was categorised based on the American Society of Anesthesiologists (ASA) classification. Complications and their associations with various risk factors and mortality were analysed. RESULTS. For all patients, the mean length of hospitalisation was 14.6 days. For the 242 patients who underwent surgical treatment after a mean of 3.6 days, 56.8% of them had at least one complication. Acute urinary retention (39.3%) and urinary tract infection (24.0%) were most common. Patients with ASA grade III or higher had 2.3 fold higher risk of developing complications than those with lower-grade comorbidity, whereas patients with delayed operation (>48 hours after presentation) had 1.8 fold higher risk of developing complications than those without delayed operation. Four patients died in hospital: 2 from myocardial infarction and 2 from upper gastrointestinal bleeding. CONCLUSION. Complications after hip fracture surgery were common. Advanced age, high ASA status, and delay in surgery were associated with higher complication rates. Operations should be performed on medically fit patients as early as possible.

Safety measures in hip arthroscopy and their efficacy in minimizing complications: a systematic review of the evidence.

Science.gov (United States)

Gupta, Asheesh; Redmond, John M; Hammarstedt, Jon E; Schwindel, Leslie; Domb, Benjamin G

2014-10-01

The purpose of this systematic review was to evaluate the literature to determine complications of hip arthroscopy, with a secondary focus on how to minimize complications and risks. Two independent reviewers performed a search of PubMed for articles that contained at least 1 of the following terms: complications and hip arthroscopy, hip impingement, femoral acetabular impingement and complications, or femoroacetabular impingement (FAI) and complications. The search was limited to articles published between 1999 and June 2013. An additional search was performed for articles evaluating techniques on how to minimize complications. We identified 81 studies (5,535 patients; 6,277 hips). The mean age was 35.48 years, and the mean body mass index was 25.20 kg/m(2). Of the participants, 52% were male and 48% were female. The majority of studies were Level IV Evidence (63%). A total of 285 complications were reported, for an overall rate of 4.5%. There were 26 major complications (0.41%) and a 4.1% minor complication rate. The overall reoperation rate was 4.03%. A total of 94 hips underwent revision arthroscopy. Regarding open procedures, 150 patients (93%) underwent either total hip arthroplasty or a hip resurfacing procedure. The conversion rate to total hip arthroplasty or a resurfacing procedure was 2.4%. Overall, primary hip arthroscopy is a successful procedure with low rates of major (0.41%) and minor (4.1%) complications. The reoperation rate was 4.03% in our review. There is admittedly a learning curve to performing hip arthroscopy, and we present a systematic review of the complications and how to minimize these complications with careful technique and planning. Level IV, systematic review of Level II to V studies. Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Fractionated laser skin resurfacing treatment complications: a review.

Science.gov (United States)

Metelitsa, Andrei I; Alster, Tina S

2010-03-01

Fractional photothermolysis represents a new modality of laser skin resurfacing that was developed to provide a successful clinical response while minimizing postoperative recovery and limiting treatment complications. To review all of the reported complications that develop as a result of fractional ablative and nonablative laser skin resurfacing. A literature review was based on a MEDLINE search (1998-2009) for English-language articles related to laser treatment complications and fractional skin resurfacing. Articles presenting the highest level of evidence and the most recent reports were preferentially selected. Complications with fractional laser skin resurfacing represent a full spectrum of severity and can be longlasting. In general, a greater likelihood of developing post-treatment complications is seen in sensitive cutaneous areas and in patients with intrinsically darker skin phototypes or predisposing medical risk factors. Although the overall rate of complications associated with fractional laser skin resurfacing is much lower than with traditional ablative techniques, recent reports suggest that serious complications can develop. An appreciation of all of the complications associated with fractional laser skin resurfacing is important, especially given that many of them can be potentially prevented. The authors have indicated no significant interest with commercial supporters.

Anterior greater trochanteric muscle pedicle bone grafting: a viable graft option adjunct to hip osteotomy or fracture surgery.

Science.gov (United States)

Limpaphayom, Noppachart; Osateerakun, Phatcharapa; Wilairatana, Vajara; Prasongchin, Pairatch

2017-05-12

The objectives were to evaluate a technique, outcome and complications following anterior greater trochanteric with gluteus medius muscle pedicle bone graft (AMG) procedure in the treatment of adolescent and active adult hip disorders. 20 patients (20 hips) with a mean age of 22.7 ± 15.6 (range 10.0-63.5) years who had undergone AMG and been followed up more than 12 months postoperative were retrospectively enrolled in our study. The AMG procedure was performed in conjunction with subcapital osteotomy for slipped capital femoral epiphysis in 12 and open reduction for fracture/dislocation in 8 hips. At the most recent evaluation, patient functional status was rated by the Harris Hip Score (HHS) and radiographic changes were graded according to Tönnis criteria. Complications were defined as Tönnis grade >2 or hip requiring further surgery. Univariate analysis was used to explore factors associated with complications. Spearman's rank correlation coefficient was calculated between HHS and Tönnis grading. At mean follow-up of 4.4 ± 2.6 (range 1.1-9.5) years, mean HHS was 87.4. Tönnis grading was rated as 0 in 10 hips, 1 in 5 hips, 2 in 2 hips, and 3 in 3 hips. Avascular necrosis of the femoral head as a complication developed in 3 hips (15%). Clinical parameters including age at surgery, duration of follow-up and diagnosis were not significantly associated with postoperative complications. A negative correlation between HHS and Tönnis grade was shown by Spearman's rank correlation (rs = -0.49, p = 0.03). The AMG can be safely recommended as an adjunct bone graft procedure when performing anterior open reduction of adolescent and active adult hip disorders.

Oral nutrition or water loading before hip replacement surgery; a randomized clinical trial

Directory of Open Access Journals (Sweden)

Ljunggren Stefan

2012-07-01

Full Text Available Abstract Background Surgery induces insulin resistance that might be alleviated by a nutritional drink given preoperatively. The authors hypothesized that some of the beneficial effects of the drink could be attributed to the volume component (approximately 1 L rather than to the nutrients. Methods Sixty patients scheduled for elective total hip replacement under spinal anesthesia were recruited to a clinical trial, and randomly allocated to preoperative fasting, to oral ingestion of tap water, or to oral ingestion of a carbohydrate drink. An intravenous glucose tolerance test calculated glucose clearance and insulin sensitivity on the day before surgery, in the postoperative ward, and on the day after surgery. Other parameters were stress (cortisol in plasma and urine, muscle catabolism (urinary 3-methylhistidine, and wellbeing. Results Fifty-seven patients completed the study. In the postoperative ward, the glucose clearance and the insulin response had decreased from the previous day by 23% and 36%, respectively. Insulin sensitivity did not decrease until the next morning (−48% and was due to an increased insulin response (+51%. Cortisol excretion was highest on the day of surgery, while 3-methylhistidine increased 1 day later. Follow-up on the third postoperative day showed an average of 1.5 complications per patient. Wellbeing was better 2 weeks after than before the surgery. None of the measured parameters differed significantly between the study groups. Conclusions Preoperative ingestion of tap water or a nutritional drink had no statistically significant effect on glucose clearance, insulin sensitivity, postoperative complications, or wellbeing in patients undergoing elective hip surgery. Trial registration Registration number: NCT 01211184 (http://www.clinicaltrials.gov

Association of Hospital-level Neuraxial Anesthesia Use for Hip Fracture Surgery with Outcomes: A Population-based Cohort Study.

Science.gov (United States)

McIsaac, Daniel I; Wijeysundera, Duminda N; Huang, Allen; Bryson, Gregory L; van Walraven, Carl

2018-03-01

There is consistent and significant variation in neuraxial anesthesia use for hip fracture surgery across jurisdictions. We measured the association of hospital-level utilization of neuraxial anesthesia, independent of patient-level use, with 30-day survival (primary outcome) and length of stay and costs (secondary outcomes). We conducted a population-based cohort study using linked administrative data in Ontario, Canada. We identified all hip fracture patients more than 65 yr of age from 2002 to 2014. For each patient, we measured the proportion of hip fracture patients at their hospital who received neuraxial anesthesia in the year before their surgery. Multilevel, multivariable regression was used to measure the association of log-transformed hospital-level neuraxial anesthetic-use proportion with outcomes, controlling for patient-level anesthesia type and confounders. Of 107,317 patients, 57,080 (53.2%) had a neuraxial anesthetic; utilization varied from 0 to 100% between hospitals. In total, 9,122 (8.5%) of patients died within 30 days of surgery. Survival independently improved as hospital-level neuraxial use increased (P = 0.009). Primary and sensitivity analyses demonstrated that most of the survival benefit was realized with increase in hospital-level neuraxial use above 20 to 25%; there did not appear to be a substantial increase in survival above this point. No significant associations between hospital neuraxial anesthesia-use and other outcomes existed. Hip fracture surgery patients at hospitals that use more than 20 to 25% neuraxial anesthesia have improved survival independent of patient-level anesthesia type and other confounders. The underlying causal mechanism for this association requires a prospective study to guide improvements in perioperative care and outcomes of hip fracture patients. An online visual overview is available for this article at http://links.lww.com/ALN/B634.

Postoperative Delirium in Elderly Patients Undergoing Hip Fracture Surgery in the Sugammadex Era: A Retrospective Study

Directory of Open Access Journals (Sweden)

Chung-Sik Oh

2016-01-01

Full Text Available Background. Residual neuromuscular block (NMB after general anesthesia has been associated with pulmonary dysfunction and hypoxia, which are both associated with postoperative delirium (POD. We evaluated the effects of sugammadex on POD in elderly patients who underwent hip fracture surgery. Methods. Medical records of 174 consecutive patients who underwent hip fracture surgery with general anesthesia were reviewed retrospectively to compare the perioperative incidence of POD, pulmonary complications, time to extubation, incidence of hypoxia, and laboratory findings between patients treated with sugammadex and those treated with a conventional cholinesterase inhibitor. Results. The incidence of POD was not significantly different between the two groups (33.3% versus 36.5%, resp.; P=0.750. Postoperative pulmonary complications and laboratory findings did not showed significant intergroup difference. However, time to extubation (6 ± 3 versus 8 ± 3 min; P<0.001 and the frequency of postoperative hypoxia were significantly lower (23% versus 43%; P=0.010 in the sugammadex group than in the conventional cholinesterase inhibitor group. Conclusion. Sugammadex did not reduce POD or pulmonary complications compared to conventional cholinesterase inhibitors, despite reducing time to extubation and postoperative hypoxia in elderly patients who underwent hip fracture surgery under general anesthesia.

Face resurfacing using a cervicothoracic skin flap prefabricated by lateral thigh fascial flap and tissue expander.

Science.gov (United States)

Li, Qingfeng; Zan, Tao; Gu, Bin; Liu, Kai; Shen, Guoxiong; Xie, Yun; Weng, Rui

2009-01-01

Resurfacing of facial massive soft tissue defect is a formidable challenge because of the unique character of the region and the limitation of well-matched donor site. In this report, we introduce a technique for using the prefabricated cervicothoracic skin flap for facial resurfacing, in an attempt to meet the principle of flap selection in face reconstructive surgery for matching the color and texture, large dimension, and thinner thickness (MLT) of the recipient. Eleven patients with massive facial scars underwent resurfacing procedures with prefabricated cervicothoracic flaps. The vasculature of the lateral thigh fascial flap, including the descending branch of the lateral femoral circumflex vessels and the surrounding muscle fascia, was used as the vascular carrier, and the pedicles of the fascial flap were anastomosed to either the superior thyroid or facial vessels in flap prefabrication. A tissue expander was placed beneath the fascial flap to enlarge the size and reduce the thickness of the flap. The average size of the harvested fascia flap was 6.5 x 11.7 cm. After a mean interval of 21.5 weeks, the expanders were filled to a mean volume of 1,685 ml. The sizes of the prefabricated skin flaps ranged from 12 x 15 cm to 15 x 32 cm. The prefabricated skin flaps were then transferred to the recipient site as pedicled flaps for facial resurfacing. All facial soft tissue defects were successfully covered by the flaps. The donor sites were primarily closed and healed without complications. Although varied degrees of venous congestion were developed after flap transfers, the marginal necrosis only occurred in two cases. The results in follow-up showed most resurfaced faces restored natural contour and regained emotional expression. MLT is the principle for flap selection in resurfacing of the massive facial soft tissue defect. Our experience in this series of patients demonstrated that the prefabricated cervicothoracic skin flap could be a reliable alternative

Timing of antibiotic prophylaxis in surgery for adult hip fracture.

Science.gov (United States)

Thonse, Raghuram; Sreenivas, Muthyala; Sherman, Kevin P.

2004-01-01

BACKGROUND: Antibiotic prophylaxis is widely used in surgery for hip fractures. METHODS AND RESULTS: In a retrospective study of case notes of 100 patients, frequent inaccuracies in dose administration were observed. This was applicable to both the pre-operative and the postoperative doses. Longer time intervals between the doses, failure to administer the prescribed doses, and failure of proper documentation were observed. CONCLUSIONS: Improvement in the awareness of staff and timely administration of prophylactic antibiotic has resulted from this study. PMID:15239868

Revision total hip arthoplasty: factors associated with re-revision surgery.

Science.gov (United States)

Khatod, Monti; Cafri, Guy; Inacio, Maria C S; Schepps, Alan L; Paxton, Elizabeth W; Bini, Stefano A

2015-03-04

highly cross-linked polyethylene bearing articulation decreases the hazard relative to metal on highly cross-linked polyethylene by a factor of 0.32 (95% confidence interval, 0.11 to 0.95). Metal on constrained bearing increases the hazard relative to metal on highly cross-linked polyethylene by a factor of 3.32 (95% confidence interval, 1.16 to 9.48). When evaluating patient, implant, and surgical factors at the time of revision total hip arthroplasty, age, surgeon experience, implant fixation, and bearing surfaces had significant impacts on the risk of re-revision. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

Most patients regain prefracture basic mobility after hip fracture surgery in a fast-track programme

DEFF Research Database (Denmark)

Kristensen, Morten Tange; Kehlet, Henrik

2012-01-01

Treatment of patients with hip fracture has improved over the past decade. Still, some patients do not regain independent mobility within their primary hospital stay even if they follow a multimodal fast-track surgical programme. The aim of the present article was to examine the validity of the p......Treatment of patients with hip fracture has improved over the past decade. Still, some patients do not regain independent mobility within their primary hospital stay even if they follow a multimodal fast-track surgical programme. The aim of the present article was to examine the validity...... of the preliminary prefracture New Mobility Score (NMS), age and fracture type as independent predictors of in-hospital outcome after hip fracture surgery....

Correlation of ABO and Rh blood groups with transfusion administration and fever onset after hip surgery in children.

Science.gov (United States)

Brdar, Radivoj; Petronic, Ivana; Nikolic, Dejan; Golubovic, Zoran; Bukva, Bojan; Radlovic, Vladimir; Abramovic, Dusan; Ducic, Sinisa; Colovic, Hristina

2012-01-01

Aim of our study was to evaluate distribution of ABO and Rh blood type groups in children after hip surgery regarding transfusion administration and fever presence. Four types of ABO blood groups (A; B; AB; O) and 2 types of Rh blood groups (Rh+; Rh-) were evaluated in group with administered transfusion (tr+) and without given transfusion (tr-); and in group with fever (fev+) and without fever (fev-), in 146 children after hip surgery. Tr+ and fev+ groups were divided into 3 groups (0-24h; 25-48h; 49-72h): for tr+ group (Group 1, Group 2, Group 3), and for fev+ group (Group A, Group B, Group C). AB blood group significantly decreased in Group 1 (χ2= 6.44; pblood group in Group 3 in tr+ group (χ2= 7.68; pblood group significantly increased in Group 3 in tr+ group (χ2= 9.96; pblood group significantly decreased in Groups B (χ2= 12.2; pblood group significantly increased in Group C (χ2= 34.4; pgroup. Administration of transfusion and fever onset in pediatric patients undergoing surgical correction of the hip is not influenced by the ABO and Rh blood groups system in humans. There is correlation between distribution of ABO blood groups with the time of transfusion administration and fever onset in children after hip surgery.

Pre-operative indicators for mortality following hip fracture surgery: a systematic review and meta-analysis.

Science.gov (United States)

Smith, Toby; Pelpola, Kelum; Ball, Martin; Ong, Alice; Myint, Phyo Kyaw

2014-07-01

hip fracture is a common and serious condition associated with high mortality. This study aimed to identify pre-operative characteristics which are associated with an increased risk of mortality after hip fracture surgery. systematic search of published and unpublished literature databases, including EMBASE, MEDLINE, AMED, CINAHL, PubMed and the Cochrane Library, was undertaken to identify all clinical studies on pre-operative predictors of mortality after surgery in hip fracture with at least 3-month follow-up. Data pertaining to the study objectives was extracted by two reviewers independently. Where study homogeneity was evidence, a meta-analysis of pooled relative risk and 95% confidence intervals was performed for mortality against pre-admission characteristics. fifty-three studies including 544,733 participants were included. Thirteen characteristics were identified as possible pre-operative indicators for mortality. Following meta-analysis, the four key characteristics associated with the risk of mortality up to 12 months were abnormal ECG (RR: 2.00; 95% CI: 1.45, 2.76), cognitive impairment (RR: 1.91; 95% CI: 1.35, 2.70), age >85 years (RR: 0.42; 95% CI: 0.20, 0.90) and pre-fracture mobility (RR: 0.13; 95% CI: 0.05, 0.34). Other statistically significant pre-fracture predictors of increased mortality were male gender, being resident in a care institution, intra-capsular fracture type, high ASA grade and high Charlson comorbidity score on admission. this review has identified the characteristics of patients with a high risk of mortality after a hip fracture surgery beyond the peri-operative period who may benefit from comprehensive assessment and appropriate management. CRD42012002107. © The Author 2014. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Patellofemoral arthritis treated with resurfacing implant: Clinical outcome and complications at a minimum two-year follow-up.

Science.gov (United States)

Zicaro, Juan Pablo; Yacuzzi, Carlos; Astoul Bonorino, Juan; Carbo, Lisandro; Costa-Paz, Matias

2017-12-01

This study evaluated the clinical and radiographic outcomes of a series of patients treated with an anatomic inlay resurfacing implant, with a minimum two-year follow-up. Fifteen patients underwent patellofemoral-resurfacing procedures using a HemiCAP Wave Patellofemoral Inlay Resurfacing implant from 2010 to 2013. Clinical outcomes included: Visual Analog Scale (VAS), Lysholm score, Knee Society Score (KSS), and evaluation of Kujala, and Hospital for Special Surgery Patellofemoral score (HSS-PF). The postoperative complications were analyzed. Nineteen knees were evaluated; the average follow-up was 35.2months. Fourteen were women, with an average age of 54years. The pre-operative/postoperative clinical results presented a significant improvement: VAS 8/2.5, Lysholm 31.9/85.8, KSS 39.8/82.5, Kujala 32.1/79.3 and Hospital for Special Surgery Patellofemoral score (HSS-PF) 15.9/90.6. A total of 87% of patients were either satisfied or very satisfied with the overall outcome. There were no radiographic signs of loosening. Seven postoperative complications were recorded: two presented ongoing knee pain, one postoperative stiffness, one patellar bounce due to maltracking, two ilio-tibial band syndrome, and one tibial anterior tuberosity osteotomy nonunion. Two patients underwent a total knee arthroplasty conversion and were considered a failure. None of these complications were implant related. Patellofemoral inlay resurfacing for isolated patellofemoral arthritis was an effective and safe procedure with high levels of patient satisfaction. No mechanical implant failure was seen at a minimum two-year follow-up. This implant design appeared to be an alternative to the traditional patellofemoral prostheses. Concomitant osteochondral lesions, patellofemoral dysplasia or patellar maltracking might be poor prognostic factors for this type of implant. Copyright © 2017 Elsevier B.V. All rights reserved.

Skin resurfacing procedures: new and emerging options

Directory of Open Access Journals (Sweden)

Loesch MM

2014-08-01

Full Text Available Mathew M Loesch,1 Ally-Khan Somani,1 Melanie M Kingsley,1 Jeffrey B Travers,1–3 Dan F Spandau1,41Department of Dermatology, 2Department of Pharmacology and Toxicology, 3Department of Pediatrics, 4Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, IN, USAAbstract: The demand for skin resurfacing and rejuvenating procedures has progressively increased in the last decade and has sparked several advances within the skin resurfacing field that promote faster healing while minimizing downtime and side effects for patients. Several technological and procedural skin resurfacing developments are being integrated into clinical practices today allowing clinicians to treat a broader range of patients' skin types and pathologies than in years past, with noteworthy outcomes. This article will discuss some emerging and developing resurfacing therapies and treatments that are present today and soon to be available.Keywords: rejuvenation, wounding, non-melanoma skin cancer, therapy

Hip supporting device

DEFF Research Database (Denmark)

2011-01-01

The present invention relates to a device for limiting movements in one or more anatomical joints, such as a device for limiting movement in the human hip joint after hip replacement surgery. This is provided by a device for limiting movement in the human hip joint, said device comprising: at least...

The current status and future prospects of computer-assisted hip surgery.

Science.gov (United States)

Inaba, Yutaka; Kobayashi, Naomi; Ike, Hiroyuki; Kubota, So; Saito, Tomoyuki

2016-03-01

The advances in computer assistance technology have allowed detailed three-dimensional preoperative planning and simulation of preoperative plans. The use of a navigation system as an intraoperative assistance tool allows more accurate execution of the preoperative plan, compared to manual operation without assistance of the navigation system. In total hip arthroplasty using CT-based navigation, three-dimensional preoperative planning with computer software allows the surgeon to determine the optimal angle of implant placement at which implant impingement is unlikely to occur in the range of hip joint motion necessary for daily activities of living, and to determine the amount of three-dimensional correction for leg length and offset. With the use of computer navigation for intraoperative assistance, the preoperative plan can be precisely executed. In hip osteotomy using CT-based navigation, the navigation allows three-dimensional preoperative planning, intraoperative confirmation of osteotomy sites, safe performance of osteotomy even under poor visual conditions, and a reduction in exposure doses from intraoperative fluoroscopy. Positions of the tips of chisels can be displayed on the computer monitor during surgery in real time, and staff other than the operator can also be aware of the progress of surgery. Thus, computer navigation also has an educational value. On the other hand, its limitations include the need for placement of trackers, increased radiation exposure from preoperative CT scans, and prolonged operative time. Moreover, because the position of a bone fragment cannot be traced after osteotomy, methods to find its precise position after its movement need to be developed. Despite the need to develop methods for the postoperative evaluation of accuracy for osteotomy, further application and development of these systems are expected in the future. Copyright © 2016 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

Risk of acute renal failure and mortality after surgery for a fracture of the hip: a population-based cohort study.

Science.gov (United States)

Pedersen, A B; Christiansen, C F; Gammelager, H; Kahlert, J; Sørensen, H T

2016-08-01

We examined risk of developing acute renal failure and the associated mortality among patients aged > 65 years undergoing surgery for a fracture of the hip. We used medical databases to identify patients who underwent surgical treatment for a fracture of the hip in Northern Denmark between 2005 and 2011. Acute renal failure was classified as stage 1, 2 and 3 according to the Kidney Disease Improving Global Outcome criteria. We computed the risk of developing acute renal failure within five days after surgery with death as a competing risk, and the short-term (six to 30 days post-operatively) and long-term mortality (31 days to 365 days post-operatively). We calculated adjusted hazard ratios (HRs) for death with 95% confidence intervals (CIs). Among 13 529 patients who sustained a fracture of the hip, 1717 (12.7%) developed acute renal failure post-operatively, including 1218 (9.0%) with stage 1, 364 (2.7%) with stage 2, and 135 (1.0%) with stage 3 renal failure. The short-term mortality was 15.9% and 5.6% for patients with and without acute renal failure, respectively (HR 2.8, 95% CI 2.4 to 3.2). The long-term mortality was 25.0% and 18.3% for those with and without acute renal failure, respectively (HR 1.3, 95% CI 1.2 to 1.5). The mortality was higher in patients with an increased severity of renal failure. Acute renal failure is a common complication of surgery in elderly patients who sustain a fracture of the hip, and is associated with increased mortality up to one year after surgery despite adjustment for coexisting comorbidity and medication before surgery. Cite this article: Bone Joint J 2016;98-B:1112-18. ©2016 The British Editorial Society of Bone & Joint Surgery.

Risks of hip and knee replacement

Science.gov (United States)

... is normal to lose blood during and after hip or knee replacement surgery. Some people need a ... clot form are higher during and soon after hip or knee replacement surgery. Sitting or lying down ...

Impact of surgical complications on length of stay after hip fracture surgery

DEFF Research Database (Denmark)

Foss, Nicolai Bang; Palm, Henrik; Krasheninnikoff, Michael

2006-01-01

BACKGROUND: Rehabilitation after hip fracture may be lengthy, with bed-day consumption accounting for up to 85% of the total cost of admission to hospital. Data suggest that surgical complications requiring reoperation may lead to an excessively long in-patient stays. However, the overall impact...... of surgical complications has not been examined in detail. METHODS: All 600 consecutive patients included were admitted with primary hip fracture and received primary surgical intervention with multimodal rehabilitation. Surgical complications were audited and classified as being due to a patient fall......, infection or suboptimal surgery, stratified into either requiring reoperation or not allowing mobilisation because of instability. RESULTS: Of the 600, 116 (19.3, 95% CI 16-22%) patients underwent reoperation or immobilisation; 27.1% of bed-day consumption resulted from surgical complications. The audit...

Timing of surgery for hip fracture and in-hospital mortality: a retrospective population-based cohort study in the Spanish National Health System

Directory of Open Access Journals (Sweden)

Librero Julián

2012-01-01

Full Text Available Abstract Background While the benefits or otherwise of early hip fracture repair is a long-running controversy with studies showing contradictory results, this practice is being adopted as a quality indicator in several health care organizations. The aim of this study is to analyze the association between early hip fracture repair and in-hospital mortality in elderly people attending public hospitals in the Spanish National Health System and, additionally, to explore factors associated with the decision to perform early hip fracture repair. Methods A cohort of 56,500 patients of 60-years-old and over, hospitalized for hip fracture during the period 2002 to 2005 in all the public hospitals in 8 Spanish regions, were followed up using administrative databases to identify the time to surgical repair and in-hospital mortality. We used a multivariate logistic regression model to analyze the relationship between the timing of surgery ( Results Early surgery was performed on 25% of the patients. In the unadjusted analysis early surgery showed an absolute difference in risk of mortality of 0.57 (from 4.42% to 3.85%. However, patients undergoing delayed surgery were older and had higher comorbidity and severity of illness. Timeliness for surgery was not found to be related to in-hospital mortality once confounding factors such as age, sex, chronic comorbidities as well as the severity of illness were controlled for in the multivariate analysis. Conclusions Older age, male gender, higher chronic comorbidity and higher severity measured by the Risk Mortality Index were associated with higher mortality, but the time to surgery was not.

Early symptoms in the prodromal phase of delirium: a prospective cohort study in elderly patients undergoing hip surgery.

Science.gov (United States)

de Jonghe, Jos F M; Kalisvaart, Kees J; Dijkstra, Marty; van Dis, Huib; Vreeswijk, Ralph; Kat, Martin G; Eikelenboom, Piet; van der Ploeg, Tjeerd; van Gool, Willem A

2007-02-01

The authors investigated prodromal delirium symptoms in elderly patients undergoing hip surgery. This was a prospective cohort study in the setting of a large medical school-affiliated general hospital in Alkmaar, The Netherlands. Participants were patients undergoing hip surgery aged 70 and older at risk for delirium. Before surgery, patients were randomized to low-dose prophylactic haloperidol treatment or placebo. Daily assessments were based on patient interviews with the Mini-Mental State Examination and Digit Span test. The Delirium Rating Scale-Revised (DRS-R-98) was used to measure early symptoms during the prodromal phase before the onset of delirium. Data of 66 patients with delirium were compared with those of 35 at-risk patients who did not develop delirium: 14 of 66 patients (21%) had delirium on the day of surgery or early the day after, 32 of 66 (48%) on the second day, 14 of 66 on the third, and six of 66 (9%) on the fourth. The average DRS-R-98 total scores on day -4 to day -1 before delirium were 1.9 for the comparison group patients and 5.0, 4.3, 5.8, and 10.7 for patients with postoperative delirium. Multivariate analysis showed that the early symptoms memory impairments, incoherence, disorientation, and underlying somatic illness predict delirium. Most elderly patients undergoing hip surgery with postoperative delirium already have early symptoms in the prodromal phase of delirium. These findings are potentially useful for screening purposes and for optimizing prevention strategies targeted at reducing the incidence of postoperative delirium.

Exercise therapy may postpone total hip replacement surgery in patients with hip osteoarthritis

DEFF Research Database (Denmark)

Svege, Ida; Nordsletten, Lars; Fernandes, Linda

2015-01-01

Exercise treatment is recommended for all patients with hip osteoarthritis (OA), but its effect on the long-term need for total hip replacement (THR) is unknown.......Exercise treatment is recommended for all patients with hip osteoarthritis (OA), but its effect on the long-term need for total hip replacement (THR) is unknown....

Hip dislocations after 2,734 elective unilateral fast-track total hip arthroplasties

DEFF Research Database (Denmark)

Jørgensen, Christoffer Calov; Kjærsgaard-Andersen, Per; Kehlet, Henrik

2014-01-01

STUDY DESIGN: Retrospective review of prospectively collected data. OBJECTIVE: To investigate the incidence of hip dislocation 90 days after total hip arthroplasty in relation to time after surgery, mechanism of dislocation and predisposing factors. METHODS: Prospective data on preoperative patient.......31-3.40)] but not hospital stay of hip...

Managing hip fracture and lower limb surgery in the emergency setting: Potential role of non-vitamin K antagonist oral anticoagulants.

Science.gov (United States)

Fisher, William

2017-06-01

Trauma, immobilization, and subsequent surgery of the hip and lower limb are associated with a high risk of developing venous thrombo-embolism (VTE). Individuals undergoing hip fracture surgery (HFS) have the highest rates of VTE among orthopedic surgery and trauma patients. The risk of VTE depends on the type and location of the lower limb injury. Current international guidelines recommend routine pharmacological thromboprophylaxis based on treatment with heparins, fondaparinux, dose-adjusted vitamin K antagonists and acetylsalicylic acid for patients undergoing emergency HFS; however, not all guidelines recommend pharmacological prophylaxis for patients with lower limb injuries. Non-vitamin K antagonist oral anticoagulants (NOACs) are indicated for VTE prevention after elective hip or knee replacement surgery, but at present are not widely recommended for other orthopedic indications despite their advantages over conventional anticoagulants and promising real-world evidence. In patients undergoing HFS or lower limb surgery, decisions on whether to anticoagulate and the most appropriate anti-coagulation strategy can be guided by weighing the risk of thromboprophylaxis against the benefit in relation to each patient's medical history and age. In addition, the nature and location of the fracture, operating times and times before fracture fixation should be considered. The current review discusses the need for anticoagulation in patients undergoing emergency HFS or lower limb surgery together with the current guidelines and available evidence on the use of NOACs in this setting. Appropriate thromboprophylactic strategies and practical advice on the peri-operative management of patients who present to the Emergency Department on a NOAC before emergency surgery are further outlined.

Taking care of your new hip joint

Science.gov (United States)

Hip arthroplasty - precautions; Hip replacement - precautions; Osteoarthritis - hip; Osteoarthritis - knee ... After you have hip replacement surgery, you will need to be careful how you move your hip, especially for the first few months ...

Fractional nonablative laser resurfacing: is there a skin tightening effect?

Science.gov (United States)

Kauvar, Arielle N B

2014-12-01

Fractional photothermolysis, an approach to laser skin resurfacing that creates microscopic thermal wounds in skin separated by islands of spared tissue, was developed to overcome the high incidence of adverse events and prolonged healing times associated with full coverage ablative laser procedures. To examine whether fractional nonablative laser resurfacing induces skin tightening. A literature review was performed to evaluate the clinical and histologic effects of fractional nonablative laser resurfacing and full coverage ablative resurfacing procedures. Fractional nonablative lasers produce excellent outcomes with minimal risk and morbidity for a variety of clinical conditions, including photodamaged skin, atrophic scars, surgical and burn scars. Efforts to induce robust fibroplasia in histologic specimens and skin tightening in the clinical setting have yielded inconsistent results. A better understanding of the histology of fractional laser resurfacing will help to optimize clinical outcomes.

Evolution of laser skin resurfacing: from scanning to fractional technology.

Science.gov (United States)

Aslam, Arif; Alster, Tina S

2014-11-01

Laser skin resurfacing was popularized for photoaged and scarred skin 2 decades ago. Since then, several technologic advancements have led to a new generation of delivery systems that produce excellent clinical outcomes with reduced treatment risks and faster recovery times. To review the evolution of laser skin resurfacing from pulsed and scanned infrared laser technology to the latest techniques of nonablative and ablative fractional photothermolysis. All published literature regarding laser skin resurfacing was analyzed and collated. A comprehensive review of laser skin resurfacing was outlined and future developments in the field of fractionated laser skin treatment were introduced. Laser skin resurfacing has evolved such that excellent clinical outcomes in photodamaged and scarred skin are achieved with rapid wound healing. As newer devices are developed, the applications of this technology will have a dramatic effect on the delivery of medical and aesthetic dermatology.

The effects of the empowerment education program in older adults with total hip replacement surgery.

Science.gov (United States)

Huang, Tzu-Ting; Sung, Chia-Chun; Wang, Woan-Shyuan; Wang, Bi-Hwa

2017-08-01

To measure the effectiveness of an education empowerment program on primary (self-efficacy and self-care competence) and secondary outcomes (Activities of Daily Life, mobility, depressive mood and quality of life) for older adults with total hip replacement surgery. Degenerative arthritis is a common and serious chronic illness that impacts the quality of life of older adults. As joints continue to degenerate and the hip damaged by arthritis, activities of daily life will be difficult to perform due to severe hip pain and joint stiffness. Therefore, hip replacement surgery should be considered and effective nursing care should be provided to improve the recovery of older adults. A prospective randomized control trial. A trial was conducted from September 2013 - May 2014 in two hospitals in northern Taiwan. 108 participants were random assigned to either the education empowerment group or in the comparison group. The researchers collected baseline data at admission and outcomes on the day of discharge, one month after and three months after the discharge. After the interventions, the education empowerment group participants demonstrated significantly higher self-care competence and self-efficacy and lower depressive inclinations compared with those in the comparison group. Participants in both groups significantly improved on activities of daily life, mobility and quality of life over the course of the interventions. This education empowerment intervention was very effective in enhancing participants' outcomes. Moreover, involving both older adults and their caregivers for the participation this program is recommended for a greater impact. © 2017 John Wiley & Sons Ltd.

OUTCOMES OF PALLIATIVE ORTHOPEDIC SURGERY FOR HIP DISLOCATION IN PATIENTS WITH CEREBRAL PALSY

Directory of Open Access Journals (Sweden)

R. R. Bidyamshin

2016-01-01

Full Text Available Introduction. Hip dislocation is the key problem in patients with severe cerebral palsy (GMFCS IV, V older than 10 years that affects life quality and limits functional capabilities. In the present study the authors evaluated the efficiency of the proximal femoral resection arthroplasty (pfra and valgus proximal osteotomy of the femur (VPOF associated with femoral head resection for pain control, improvement of postural management, hygiene and verticalization with total weight-bearing and correction of accompanying orthopaedic deformities. Material and мethods. A retrospective study compared two groups of patients where PFRA (7 cases, 13 hips or VPOF (14 patients, 23 hips were performed. Level V of GMFCS was reported in 10 patients, and level IV of GMFCS – in 11 patients. The mean age at time of surgery was 15.3±3.9 y.o. PFRA was performed in 7 cases (13 joints and VPOF – in 14 patients (23 joints. Results. The authors did not observe any difference between the methods in respect of pain control, postural management, comfortable sitting position and hygiene. The verticalization with total weight-bearing and life quality improvement was achieved only after PVOF with femoral head resection associated with simultaneous knee and foot deformity correction performed according to the principles of Single-Event Multilevel Orthopedic Surgery. Conclusion. Both palliative methods allow to control pain syndrome, to achieve satisfactory postural management, comfortable sitting position and hygiene. But only VPOF with simultaneous knee and foot deformity correction provides possibility to verticalize the patient with weight-bearing using different orthopedic devices.

Lifetime risk of primary total hip replacement surgery for osteoarthritis from 2003-2013

DEFF Research Database (Denmark)

Ackerman, Ilana N; Bohensky, Megan A; de Steiger, Richard

2017-01-01

OBJECTIVE: To compare the lifetime risk of total hip replacement surgery (THR) for osteoarthritis (OA) between countries, and over time. METHODS: Data on primary THR procedures performed for OA in 2003 and 2013 were extracted from national arthroplasty registries in Australia, Denmark, Finland, N....... These multi-national risk estimates can inform resource planning for OA service delivery. This article is protected by copyright. All rights reserved....

Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: fast-track experience in 712 patients

DEFF Research Database (Denmark)

Husted, Henrik; Holm, Gitte; Jacobsen, Steffen

2008-01-01

BACKGROUND AND PURPOSE: Very few studies have focused on patient characteristics that influence length of stay (LOS) in fast-track total hip (THR) and knee arthroplasty (TKR). The aim of this prospective study was to identify patient characteristics associated with LOS and patient satisfaction...... after total hip and knee replacement surgery. PATIENTS AND METHODS: Between September 2003 and December 2005, 712 consecutive, unselected patients (440 women) with a mean age of 69 (31-91) years were admitted for hip and knee replacement surgery at our specialized fast-track joint replacement unit....... Epidemiological, physical, and perioperative parameters were registered and correlated to LOS and patient satisfaction. RESULTS: 92% of the patients were discharged directly to their homes within 5 days, and 41% were discharged within 3 days. Age, sex, marital status, co-morbidity, preoperative use of walking...

Resurfacing Graphics

Directory of Open Access Journals (Sweden)

Prof. Patty K. Wongpakdee

2013-06-01

Full Text Available “Resurfacing Graphics” deals with the subject of unconventional design, with the purpose of engaging the viewer to experience the graphics beyond paper’s passive surface. Unconventional designs serve to reinvigorate people, whose senses are dulled by the typical, printed graphics, which bombard them each day. Today’s cutting-edge designers, illustrators and artists utilize graphics in a unique manner that allows for tactile interaction. Such works serve as valuable teaching models and encourage students to do the following: 1 investigate the trans-disciplines of art and technology; 2 appreciate that this approach can have a positive effect on the environment; 3 examine and research other approaches of design communications and 4 utilize new mediums to stretch the boundaries of artistic endeavor. This paper examines how visuals communicators are “Resurfacing Graphics” by using atypical surfaces and materials such as textile, wood, ceramics and even water. Such non-traditional transmissions of visual language serve to demonstrate student’s overreliance on paper as an outdated medium. With this exposure, students can become forward-thinking, eco-friendly, creative leaders by expanding their creative breadth and continuing the perpetual exploration for new ways to make their mark.

Resurfacing Graphics

Directory of Open Access Journals (Sweden)

Prof. Patty K. Wongpakdee

2013-06-01

Full Text Available “Resurfacing Graphics” deals with the subject of unconventional design, with the purpose of engaging the viewer to experience the graphics beyond paper’s passive surface. Unconventional designs serve to reinvigorate people, whose senses are dulled by the typical, printed graphics, which bombard them each day. Today’s cutting-edge designers, illustrators and artists utilize graphics in a unique manner that allows for tactile interaction. Such works serve as valuable teaching models and encourage students to do the following: 1 investigate the trans-disciplines of art and technology; 2 appreciate that this approach can have a positive effect on the environment; 3 examine and research other approaches of design communications and 4 utilize new mediums to stretch the boundaries of artistic endeavor. This paper examines how visuals communicators are “Resurfacing Graphics” by using atypical surfaces and materials such as textile, wood, ceramics and even water. Such non-traditional transmissions of visual language serve to demonstrate student’s overreliance on paper as an outdated medium. With this exposure, students can become forward-thinking, eco-friendly, creative leaders by expanding their creative breadth and continuing the perpetual exploration for new ways to make their mark. 

Diagnosis and management of skin resurfacing-related complications.

Science.gov (United States)

Zhang, Alexandra Y; Obagi, Suzan

2009-02-01

The field of skin resurfacing is undergoing rapid evolution with many new technologies that have developed, providing more choices for physicians and patients. Knowing the potential adverse effects associated with each skin resurfacing modality is paramount in selecting the appropriate approach for each candidate, thereby minimizing complications and achieving optimal results.

Resurfacing the Penis of Complex Hypospadias Repair ("Hypospadias Cripples").

Science.gov (United States)

Fam, Mina M; Hanna, Moneer K

2017-03-01

After the creation of a neourethra in a "hypospadias cripple," resurfacing the penis with healthy skin is a significant challenge because local tissue is often scarred and unusable. We reviewed our experience with various strategies to resurface the penis of hypospadias cripples. We retrospectively reviewed the records of 215 patients referred after multiple unsuccessful hypospadias repairs from 1981 to 2014. In 130 of 215 patients we performed resurfacing using local penile flaps using various techniques, including Byars flaps, Z-plasty or double Z-plasty, or a dorsal relaxing incision. Of the 215 patients 85 did not have adequate healthy local penile skin to resurface the penis after urethroplasty. Scrotal skin was used to resurface the penis in 54 patients, 6 underwent tissue expansion of the dorsal penile skin during a 12 to 16-week period prior to penile resurfacing, 23 underwent full-thickness skin grafting and another 4 received a split-thickness skin graft. Of the 56 patients who underwent fasciomyocutaneous rotational flaps, tissue expansion or a combination of both approaches 54 (96.4%) finally had a successful outcome. All 6 patients who underwent tissue expansion had a successful outcome without complications and were reported on previously. All 23 full-thickness skin grafts took with excellent results. All 4 patients who underwent fenestrated split-thickness skin grafting had 100% graft take but secondary contraction and ulceration were associated with sexual activity. In our experience scrotal skin flaps, tissue expansion of the dorsal penile skin and full-thickness skin grafts serve as reliable approaches in resurfacing the penis in almost any hypospadias cripple lacking healthy local skin. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

A case of severe ankylosing spondylitis posted for hip replacement surgery

Directory of Open Access Journals (Sweden)

Nalini Kotekar

2007-01-01

Full Text Available A 50-year-old male patient with history of ankylosing spondylitis (AS for 30 years presented for hip replacement surgery. Airway management in ankylosing spondylitis patients presents the most serious array of intubation and airway hazards imagin-able, which is secondary to decrease in cervical spine mobility and possible temporo-mandibular joint disease. Literatures support definitive airway management and many authors consider regional anaesthesia to be contraindicated. The reasons cited include inability to gain neuraxial access and the need for urgent airway control in case of complication of regional anaesthesia.

Imaging evaluation of the hip after arthroscopic surgery for femoroacetabular impingement

Energy Technology Data Exchange (ETDEWEB)

Crim, Julia [University of Missouri at Columbia, Columbia, MO (United States)

2017-10-15

Arthroscopic surgery for femoroacetabular impingement (FAI) is increasingly frequently performed. Initial reports were that complications were very low, but as experience has increased, a number of long-term complications, in addition to factors related to poor clinical outcomes, have been identified. This review describes the normal and abnormal postoperative imaging appearance of the hip after arthroscopy for FAI. Abnormalities discussed include incomplete resection or over-resection of the impingement lesion, heterotopic ossification, cartilage damage, chondrolysis, instability and dislocation, recurrent labral tear, adhesions, psoas atrophy, infection, and avascular necrosis. (orig.)

Imaging evaluation of the hip after arthroscopic surgery for femoroacetabular impingement

International Nuclear Information System (INIS)

Crim, Julia

2017-01-01

Arthroscopic surgery for femoroacetabular impingement (FAI) is increasingly frequently performed. Initial reports were that complications were very low, but as experience has increased, a number of long-term complications, in addition to factors related to poor clinical outcomes, have been identified. This review describes the normal and abnormal postoperative imaging appearance of the hip after arthroscopy for FAI. Abnormalities discussed include incomplete resection or over-resection of the impingement lesion, heterotopic ossification, cartilage damage, chondrolysis, instability and dislocation, recurrent labral tear, adhesions, psoas atrophy, infection, and avascular necrosis. (orig.)

Usability Test of Exercise Games Designed for Rehabilitation of Elderly Patients After Hip Replacement Surgery: Pilot Study

NARCIS (Netherlands)

Y. Ling (Yun); L.P.D.M. ter Meer (Louis); Z. Yumak (Zerrin); R.C. Veltkamp (Remco)

2017-01-01

markdownabstractBACKGROUND: Patients who receive rehabilitation after hip replacement surgery are shown to have increased muscle strength and better functional performance. However, traditional physiotherapy is often tedious and leads to poor adherence. Exercise games, provide ways for increasing

Support for total hip replacement surgery: Structures modeling, Gait Data Analysis and Report system

Directory of Open Access Journals (Sweden)

Gianluca Mario Izzo

2012-03-01

Full Text Available For the treatment of advanced damages of hip joints, Total Hip Arthroplasty is well proven. Due to the different mechanical properties of the prosthesis material and the bone tissue, a partial unloading of the periprosthetic bone occurs. The bone cement causes reduction in bone density as a result of removal of normal stress from the bone, leading to weakening of the bone in that area and the fracture risk increases. Bone loss is identified as one of the main reasons for loosening of the stem. Otherwise, thanks to the press-fit of the non-cemented stem achieved by surgery, the bone layers immediately adjacent to the stem are preloaded, thus encouraged growing, and the bone getting stronger. The non-cemented stem would be the better choice for every patient, but the question remains if the femur can handle the press- fitting surgery. This studies aim to develop a monitoring techniques based on Gait analysis and bone density changes to assess patient recovery after Total Hip Arthroplasty. Furthermore, to validate computational processes based on 3D modeling and Finite Element Methods for optimizing decision making in the operation process and selecting the suited surgical procedure. A vision could be minimizing risk of periprosthetic fracture during and after surgery. Patients: The sample presents 11 patients receiving cemented implant and 13 for the uncemented. Patients are grouped by type of implant. Three checkpoints were considered: before, after operation and one year later. CT scans, gaitrite and kinepro measurements have been realized. Main outcome measures: Fracture risk probability is higher in bone with low bone mineral density; therefore bones are more fragile in elderly people. BMD is indeed one parameter considered among all the observations. Periprosthetic fracture of the femur is a rare but complex complication of THA, and requires demanding surgery. As such, they result in considerable morbidity and dysfunction. Thus, tests of

Physical Activity in the Acute Ward Following Hip Fracture Surgery is Associated With Less Fear of Falling

DEFF Research Database (Denmark)

Kronborg Poulsen, Lise; Bandholm, Thomas Quaade; Palm, Henrik

2016-01-01

Early mobilization following hip fracture surgery reduces medical complications and mortality, but may increase the risk of falling. The aim was to measure objectively the physical activity (time spent upright) the first week after hip fracture surgery, and relate it to functional performance...... and fear of falling at discharge. The 24-hour upright time was measured for a median of 6 days using a thigh-worn accelerometer in 37 patients (mean 80 years ± 8.4) and increased from median 13 (IQR 6-31) minutes to 46 (11-107) minutes at day 7. More upright time at discharge was associated with less fear...... of falling (r=-0.48, p=0.01, n=27), which also was associated with fast gait speed (r=-0.50, p=0.02, n=23) and a faster Timed Up and Go test time (r=0.54, p

Conditioning in laser skin resurfacing - betulin emulsion and skin recovery.

Science.gov (United States)

Metelmann, Hans-Robert; Podmelle, Fred; Waite, Peter D; Müller-Debus, Charlotte Friederieke; Hammes, Stefan; Funk, Wolfgang

2013-04-01

Laser skin resurfacing of the face by CO₂-laser ablation is causing superficial wounds that need rapid recovery to reduce the risk of infection, the risk of chronification and as a result the risk of unaesthetic scars. The question being addressed by this study is to demonstrate benefit of betulin emulsion skin care after CO₂-laser wounds. The outcome of this aesthetic comparison between betulin emulsion, moist wound dressing and gauze covering in promoting the recovery process in laser skin ablation is to demonstrate improved aesthetic benefit for the patient. Copyright © 2012 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Isolated scaphotrapeziotrapezoid osteoarthritis treatment using resurfacing arthroplasty with scaphoid anchorage.

Science.gov (United States)

Humada Álvarez, G; Simón Pérez, C; García Medrano, B; Faour Martín, O; Marcos Rodríguez, J J; Vega Castrillo, A; Martín Ferrero, M A

The aim of this study is to show the results of scaphotrapeziotrapezoid (STT) joint osteoarthritis treatment performing resurfacing arthroplasty with scaphoid anchorage. An observational, descriptive and retrospective study was performed. Ten patients with isolated STT joint osteoarthritis were studied between 2013 and 2015. The mean follow-up time was 26months. Clinical results, functional and subjective scores were reviewed. The patients were satisfied, achieving an average of 2.1 (0-3) on the VAS score and 16 (2 to 28) in the DASH questionnaire, and returning to work in the first three months post-surgery. Recovery of range of motion compared to the contralateral wrist was 96% in extension, 95% in flexion, 87% in ulnar deviation and 91% in radial deviation. The average handgrip strength of the wrist was 95% and pinch strength was 95% compared to the contralateral side. There were no intraoperative complications or alterations in postoperative carpal alignment. Resurfacing arthroplasty is proposed as a good and novel alternative in treating isolated SST joint arthritis. Achieving the correct balance between the strength and mobility of the wrist, without causing carpal destabilisation, is important to obtain satisfactory clinical and functional results. Copyright © 2017. Publicado por Elsevier España, S.L.U.

[Cartilage regeneration surgery on the hip : What is feasible?

Science.gov (United States)

Landgraeber, Stefan; Jäger, Marcus; Fickert, Stefan

2017-11-01

Localized cartilage defects at the hip are mainly caused by pre-arthritic deformities, particularly by cam-type femoroacetabular impingement (FAI). Timely elimination of symptomatic deformities can prevent further progression such as cartilage defects. As the defects mostly occur in the anterolateral part of the acetabulum, they can be easily treated either by open surgery or by arthroscopy. To date the most effective methods of treatment are bone marrow stimulation, with or without a covering of biomaterials, and autologous chondrocyte transplantation. In selected cases, readaptation of the damaged cartilage can be attempted by biological procedures. In the present article, the findings reported in current studies on these procedures are summarized and discussed in detail. An outlook is given regarding possible future treatment concepts.

Precipitants of Delirium in Older Inpatients Admitted in Surgery for Post-Fall Hip Fracture: An Observational Study.

Science.gov (United States)

Levinoff, E; Try, A; Chabot, J; Lee, L; Zukor, D; Beauchet, O

2018-01-01

Hip fractures precipitate several acute adverse outcomes in elderly people, thus leading to chronic adverse outcomes. The objective of our study was to examine the clinical characteristics associated with incident delirium in community dwelling elderly individuals who have a hip fracture. Retrospective observational cohort study. Data was collected from an academic tertiary hospital affiliated with McGill University. 114 elderly individuals who were above 65 years of age, who underwent surgery for a fractured hip. The main outcome variable was incident delirium, which was assessed by chart reviews of notes and observations recorded by nurses and physicians when patients were admitted post operatively to the surgical unit. Covariates included age, sex, length of stay, delay to surgery, number of medical comorbidities, number of medications and hip fracture location, and were extracted from medical records. Baseline mobility and functional status, preoperative cognitive impairment, postoperative complications, regular psychotropic medications, psychotropic medications in hospital, and location of discharge were also assessed through chart review. The results demonstrated that 17.5% of participants with a diagnosis of delirium had a longer length of hospitalization (p = 0.01), a lower baseline functional status (p = 0.03) and pre-operative cognitive impairment (p = 0.01). Patients receiving new psychotropic medications in hospital were more likely to have delirium (OR = 4.6, p = 0.01) which was independent of pre-operative cognitive impairment. We have shown that an association exists between psychotropic medication prescription and incident delirium in patients with hip fractures, even when adjusting for cognitive impairment. Hence, the prescription of psychotropic drugs should be judicious in these patients so as minimize the risk of adverse outcomes.

BLEPHAROPLASTY AND PERIOCULAR SKIN RESURFACING WITH NEW GENERATION ER:YAG LASER

Directory of Open Access Journals (Sweden)

Brigita Drnovšek-Olup

2002-12-01

Full Text Available Background. In this study, a new type of Er:YAG laser, emitting irradiation with variable pulse duration, has been used for blepharoplasty and skin resurfacing in periocular region.More than 40 patients have been treated with second generation Er:YAG laser (Fotona Fidelis for blepharoplasty and skin resurfacing. A focused laser beam (diameter 0.4 mm with very short pulse width (100 µs, that is significantly below the thermal relaxation time of skin, leads to a precise cut with no observable thermal effect on surrounding tissue. The depth of the cut is approximately 1–2 mm, precision comparable to a surgical scalpel. The high repetition rate of consecutive laser pulses (50 Hz at 120 mJ energy accounts for accumulation of thermal load in tissue, and thus leads to complete hemostasis of the cut tissue. Due to improved cutting abilities of the Er:YAG laser, excision of orbital fat is also performed with one pass of the laser beam. By changing the laser parameters to short pulses (300 µs, energy 500 mJ, spot diameter 5 mm and repetition rate 12–15 Hz, skin resurfacing was performed. No special pretreatment therapy was used. Anesthesia: 2% Xylocain inj. subcutaneously. Non adhesive dressing for 24 hours was applied after surgery.Epithelisation was complete after ten days. Redness persists up to 5 weeks. Discomfort of patients was mild. Cosmetic results are satisfying.Conclusions. New generation of Er:YAG laser offers a possibility to cut and coagulate the tissue simultaneously, and by changing the parameters to ablate the tissue with heating influence on skin collagen.

Effect of preoperative education of patients before hip or knee replacement surgery: A systematic review

DEFF Research Database (Denmark)

Aydin, Dogu; Klit, Jakob; Husted, Henrik

2013-01-01

Background Total hip (THA) and knee arthroplasty (TKA) are standard procedures for treatment of end stage osteoarthritis, and much is done to optimize results. It is usually hypothesized that education of patients before surgery reduces anxiety, secures more realistic patient expectations...... and enhances postoperative outcomes. Objectives To determine whether results reported in the literature proves an effect of preoperative education on postoperative outcomes in replacement surgery patients regarding anxiety, pain, length of hospital stay, patient satisfaction, postoperative complications...... visual) given by health professionals to patients were included. Results Seven studies involving 677 participants met the inclusion criteria. Two studies involved patients undergoing THA replacement, while five studies involved patients undergoing both THA and TKA replacement surgery. Mean number...

Plasma skin resurfacing: personal experience and long-term results.

Science.gov (United States)

Bentkover, Stuart H

2012-05-01

This article presents a comprehensive clinical approach to plasma resurfacing for skin regeneration. Plasma technology, preoperative protocols, resurfacing technique, postoperative care, clinical outcomes, evidence-based results, and appropriate candidates for this procedure are discussed. Specific penetration depth and specific laser energy measurements are provided. Nitrogen plasma skin regeneration is a skin-resurfacing technique that offers excellent improvement of mild to moderate skin wrinkles and overall skin rejuvenation. It also provides excellent improvement in uniformity of skin color and texture in patients with hyperpigmentation with Fitzpatrick skin types 1 through 4. Copyright © 2012 Elsevier Inc. All rights reserved.

Analysis of erythema after Er:YAG laser skin resurfacing.

Science.gov (United States)

Ko, Na Young; Ahn, Hyo-Hyun; Kim, Soo-Nam; Kye, Young-Chul

2007-11-01

Postoperative erythema can be expected to occur in every patient after laser resurfacing, and pigmentary disturbances may be related to the intensity and the duration of erythema. This study was undertaken to assess the clinical features of erythema, the factors that influence its duration, and the relation between the duration of erythema and the incidence of hyperpigmentation and hypopigmentation in skin of Asian persons after Er:YAG laser resurfacing. A total of 218 patients (skin phototypes III to V) were recruited and treated with a short-pulsed Er:YAG laser, a variable-pulsed Er:YAG laser, or a dual-mode Er:YAG laser for skin resurfacing. Clinical assessments were performed retrospectively using medical charts and serial photographs. Postoperative erythema was observed in all patients after Er:YAG laser resurfacing with a mean duration of 4.72 months. In 98.2% of patients, erythema faded completely within 12 months. Postinflammatory hyperpigmentation was observed in 38.1% of patients after Er:YAG laser resurfacing. Skin phototype, level of ablation, and depth of thermal damage caused by a long-pulsed laser appear to be important factors that affect the duration of erythema. Moreover, prolonged erythema was related to the risk of postinflammatory hyperpigmentation.

The use of ceramic in prosthetic hip surgery. The state of the art.

Science.gov (United States)

Toni, A; Terzi, S; Sudanese, A; Tabarroni, M; Zappoli, F A; Stea, S; Giunti, A

1995-01-01

The authors review current knowledge regarding the use of ceramic materials in prosthetic hip surgery, both as constituents of prosthetic components, and as materials used to coat metallic surfaces. A review of the literature defines the advantages and disadvantages to using ceramic-polyethylene or ceramic-ceramic combinations, based on the possibility that alumina coating may favor localized bone demineralization, and on the first promising clinical results of the use of hydroxyapatite coating.

Skin resurfacing procedures: new and emerging options

OpenAIRE

Loesch MM; Somani AK; Kingsley MM; Travers JB; Spandau DF

2014-01-01

Mathew M Loesch,1 Ally-Khan Somani,1 Melanie M Kingsley,1 Jeffrey B Travers,1–3 Dan F Spandau1,41Department of Dermatology, 2Department of Pharmacology and Toxicology, 3Department of Pediatrics, 4Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, IN, USAAbstract: The demand for skin resurfacing and rejuvenating procedures has progressively increased in the last decade and has sparked several advances within the skin resurfacing fie...

THE COMPARISON OF HYPERBARIC BUPIVACAINE AND ROPIVACAINE USAGE IN SPINAL ANESTHESIA AT HIP AND LOWER EXTREMITY SURGERY

Directory of Open Access Journals (Sweden)

Aynur sahin

2013-03-01

Conclusion: Ropivacaine and bupivacaine usage in hip and lower extremity surgery may provide hemodynamic stability, therefore we suggest that ropivacaine and bupivacaine are safe to use in spinal anesthesia for this kind of processes. [J Contemp Med 2013; 3(1.000: 36-41

A new algorithm for hip fracture surgery

DEFF Research Database (Denmark)

Palm, Henrik; Krasheninnikoff, Michael; Holck, Kim

2012-01-01

Background and purpose Treatment of hip fracture patients is controversial. We implemented a new operative and supervision algorithm (the Hvidovre algorithm) for surgical treatment of all hip fractures, primarily based on own previously published results. Methods 2,000 consecutive patients over 50...... years of age who were admitted and operated on because of a hip fracture were prospectively included. 1,000 of these patients were included after implementation of the algorithm. Demographic parameters, hospital treatment, and reoperations within the first postoperative year were assessed from patient...... by reoperations was reduced from 24% of total hospitalization before the algorithm was introduced to 18% after it was introduced. Interpretation It is possible to implement an algorithm for treatment of all hip fracture patients in a large teaching hospital. In our case, the Hvidovre algorithm both raised...

Detection of incorrect manufacturer labelling of hip components

Energy Technology Data Exchange (ETDEWEB)

Durand-Hill, Matthieu; Henckel, Johann; Skinner, John; Hart, Alister [University College London, Institute of Orthopaedics, London (United Kingdom); Burwell, Matthew [Royal United Hospital, Bath (United Kingdom)

2017-01-15

We describe the case of a 53-year-old man who underwent a left metal-on-metal hip resurfacing in 2015. Component size mismatch (CSM) was suspected because of the patient's immediate post-operative mechanical symptoms and high metal ion levels. Surgical notes indicated the appropriate combinations of implants were used. However, we detected a mismatch using computed tomography. Revision was performed and subsequent measurements of explanted components confirmed the mismatch. To our knowledge, this case is the first report of a CT method being used in a patient to pre-operatively identify CSM. (orig.)

Total hip replacement for Mseleni Joint Disease undertaken in a ...

African Journals Online (AJOL)

found that hip surgery in this setting is of great benefit to Mseleni Joint Disease ... Conclusions: Hip surgery in this setting is of great benefit to the Mseleni Joint Disease patients but further attention .... The total hip score was divided into pain.

Metal ion levels and lymphocyte counts

DEFF Research Database (Denmark)

Penny, Jeannette Ø; Varmarken, Jens-Erik; Ovesen, Ole

2013-01-01

BACKGROUND AND PURPOSE: Wear particles from metal-on-metal arthroplasties are under suspicion for adverse effects both locally and systemically, and the DePuy ASR Hip Resurfacing System (RHA) has above-average failure rates. We compared lymphocyte counts in RHA and total hip arthroplasty (THA) an....../ppb. INTERPRETATION: Circulating T-lymphocyte levels may decline after surgery, regardless of implant type. Metal ions-particularly cobalt-may have a general depressive effect on T- and B-lymphocyte levels. Registered with ClinicalTrials.gov under # NCT01113762.......BACKGROUND AND PURPOSE: Wear particles from metal-on-metal arthroplasties are under suspicion for adverse effects both locally and systemically, and the DePuy ASR Hip Resurfacing System (RHA) has above-average failure rates. We compared lymphocyte counts in RHA and total hip arthroplasty (THA....... RESULTS: The T-lymphocyte counts for both implant types declined over the 2-year period. This decline was statistically significant for CD3(+)CD8(+) in the THA group, with a regression coefficient of -0.04 × 10(9)cells/year (95% CI: -0.08 to -0.01). Regression analysis indicated a depressive effect...

The High Value Healthcare Collaborative: Observational Analyses of Care Episodes for Hip and Knee Arthroplasty Surgery.

Science.gov (United States)

Weeks, William B; Schoellkopf, William J; Sorensen, Lyle S; Masica, Andrew L; Nesse, Robert E; Weinstein, James N

2017-03-01

Broader use of value-based reimbursement models will require providers to transparently demonstrate health care value. We sought to determine and report cost and quality data for episodes of hip and knee arthroplasty surgery among 13 members of the High Value Healthcare Collaborative (HVHC), a consortium of health care systems interested in improving health care value. We conducted a retrospective, cross-sectional observational cohort study of 30-day episodes of care for hip and knee arthroplasty in fee-for-service Medicare beneficiaries aged 65 or older who had hip or knee osteoarthritis and used 1 of 13 HVHC member systems for uncomplicated primary hip arthroplasty (N = 8853) or knee arthroplasty (N = 16,434), respectively, in 2012 or 2013. At the system level, we calculated: per-capita utilization rates; postoperative complication rates; standardized total, acute, and postacute care Medicare expenditures for 30-day episodes of care; and the modeled impact of reducing episode expenditures or per-capita utilization rates. Adjusted per-capita utilization rates varied across HVHC systems and postacute care reimbursements varied more than 3-fold for both types of arthroplasty in both years. Regression analysis confirmed that total episode and postacute care reimbursements significantly differed across HVHC members after considering patient demographic differences. Potential Medicare cost savings were greatest for knee arthroplasty surgery and when lower total reimbursement targets were achieved. The substantial variation that we found offers opportunities for learning and collaboration to collectively improve outcomes, reduce costs, and enhance value. Ceteris paribus, reducing per-episode reimbursements would achieve greater Medicare cost savings than reducing per-capita rates. Copyright © 2016 Elsevier Inc. All rights reserved.

Fractionated laser resurfacing corrects the inappropriate UVB response in geriatric skin.

Science.gov (United States)

Spandau, Dan F; Lewis, Davina A; Somani, Ally-Khan; Travers, Jeffrey B

2012-06-01

Non-melanoma skin cancer is a disease primarily afflicting geriatric patients as evidenced by the fact that 80% of all non-melanoma skin cancers are diagnosed in patients over the age of 60 years. As such, geriatric skin responds to cancer-inducing UVB irradiation in a manner that allows the establishment of tumor cells. Currently, the only effective treatment for non-melanoma skin cancer is the removal of the tumors after they appear, indicating the need for a more cost-effective prophylactic therapy. Geriatric volunteers were treated with fractionated laser resurfacing therapy on either sun-protected (upper buttocks) or chronically sun-exposed (dorsal forearm) skin. Fractionated laser resurfacing therapy was shown to decrease the occurrence of senescent fibroblasts in geriatric dermis, increase the dermal expression of IGF-1, and correct the inappropriate UVB response observed in untreated geriatric skin. These responses to fractionated laser resurfacing were equal to the effects seen previously using the more aggressive wounding following dermabrasion. Furthermore, fractionated laser resurfacing was equally effective in both sun-protected and sun-exposed skin. The ability of fractionated laser resurfacing treatment to protect against the occurrence of UVB-damaged proliferating keratinocytes indicates the potential of fractionated laser resurfacing to reduce or prevent aging-associated non-melanoma skin cancer.

The radiation like preventive methods of the ectopic development after hip surgery

International Nuclear Information System (INIS)

Menendez Garcia, J.C.; Delgado Macias, M.T.

1995-01-01

In view of the prevalence of ectopic bone development after hip surgery, a review has been done on the reports appearing in the literature dealing with the use of irradiation, at different doses and postoperative intervals, as a method to prevent this complication. The results demonstrate the efficacy of radiotherapy in preventing ectopic bone formation, the need to begin its application within the first four days of surgical treatment and the fact that satisfactory results can be obtained with relatively low and, thus, theoretically innocuous doses. 17 refs

Isolated patellofemoral arthroplasty reproduces natural patellofemoral joint kinematics when the patella is resurfaced.

Science.gov (United States)

Vandenneucker, Hilde; Labey, Luc; Vander Sloten, Jos; Desloovere, Kaat; Bellemans, Johan

2016-11-01

The objectives of this in vitro project were to compare the dynamic three-dimensional patellofemoral kinematics, contact forces, contact areas and contact pressures of a contemporary patellofemoral prosthetic implant with those of the native knee and to measure the influence of patellar resurfacing and patellar thickness. The hypothesis was that these designs are capable to reproduce the natural kinematics but result in higher contact pressures. Six fresh-frozen specimens were tested on a custom-made mechanical knee rig before and after prosthetic trochlear resurfacing, without and with patellar resurfacing in three different patellar thicknesses. Full three-dimensional kinematics were analysed during three different motor tasks, using infrared motion capture cameras and retroflective markers. Patellar contact characteristics were registered using a pressure measuring device. The patellofemoral kinematic behaviour of the patellofemoral arthroplasty was similar to that of the normal knee when the patella was resurfaced, showing only significant (p patellofemoral kinematics acceptable well when the patella was resurfaced. From a kinematic point of view, patellar resurfacing may be advisable. However, the substantially elevated patellar contact pressures remain a point of concern in the decision whether or not to resurface the patella. This study therefore not only adds a new point in the discussion whether or not to resurface the patella, but also supports the claimed advantage that a patellofemoral arthroplasty is capable to reproduce the natural knee kinematics.

21 CFR 888.3590 - Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Knee joint tibial (hemi-knee) metallic resurfacing... Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis. (a) Identification. A knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis is a device intended to be implanted...

Osteochondritis Dissecans of the Hip

International Nuclear Information System (INIS)

Linden, B.; Jonsson, K.; Redlund-Johnell, I.

2003-01-01

Purpose: To investigate the clinical and radiological characteristics of osteochondritis dissecans (OD) of the hip and the outcome of this condition after treatment. Material and Methods: Twelve male and 3 female patients with OD were retrospectively studied. Six patients had a history of Legg-Calve-Perthes disease (LCPD) and among them 2 also had had a trauma to the hip. A further 5 had had trauma and 1 a developmental dislocation of the hip (DDH). The remaining 3 patients had no history of previous hip disease or trauma. All patients were examined with plain radiography, 7 with MR, 3 with CT and 2 with hip arthrography. Results: All OD lesions were detected at plain radiography, and most of them were located near the fovea. At MR the lesions had low signal intensity at T1-weighted sequences, and 6/7 had edema or fluid collection in or adjacent to the lesion on T2-weighted sequences. The early treatment in 7 patients was surgery, 2 had had conservative treatment and 6 no treatment. At follow-up 12 years after radiological diagnosis, 5 patients had hip arthrosis, 4 of whom were treated with arthroplasty. All but 3 had reduced hip rotation and all but 2 (with arthroplasty) had load pain. Three of the patients with earlier surgery had not developed arthrosis. Conclusions: OD lesions are usually well seen with plain radiography. There is a great risk of developing early arthrosis and it seems that early surgery is connected with arthrosis development. Thus only symptomatic treatment is recommended

Osteochondritis Dissecans of the Hip

Energy Technology Data Exchange (ETDEWEB)

Linden, B. [Hoeglands Hospital, Eksjoe (Sweden). Dept. of Orthopedic Surgery; Jonsson, K. [Univ. Hospital, Lund (Sweden). Center for Medical Imaging and Physiology; Redlund-Johnell, I. [Univ. Hospital, Malmoe (Sweden). Dept. of Diagnostic Radiology

2003-03-01

Purpose: To investigate the clinical and radiological characteristics of osteochondritis dissecans (OD) of the hip and the outcome of this condition after treatment. Material and Methods: Twelve male and 3 female patients with OD were retrospectively studied. Six patients had a history of Legg-Calve-Perthes disease (LCPD) and among them 2 also had had a trauma to the hip. A further 5 had had trauma and 1 a developmental dislocation of the hip (DDH). The remaining 3 patients had no history of previous hip disease or trauma. All patients were examined with plain radiography, 7 with MR, 3 with CT and 2 with hip arthrography. Results: All OD lesions were detected at plain radiography, and most of them were located near the fovea. At MR the lesions had low signal intensity at T1-weighted sequences, and 6/7 had edema or fluid collection in or adjacent to the lesion on T2-weighted sequences. The early treatment in 7 patients was surgery, 2 had had conservative treatment and 6 no treatment. At follow-up 12 years after radiological diagnosis, 5 patients had hip arthrosis, 4 of whom were treated with arthroplasty. All but 3 had reduced hip rotation and all but 2 (with arthroplasty) had load pain. Three of the patients with earlier surgery had not developed arthrosis. Conclusions: OD lesions are usually well seen with plain radiography. There is a great risk of developing early arthrosis and it seems that early surgery is connected with arthrosis development. Thus only symptomatic treatment is recommended.

The Timing of Hip Arthroscopy After Intra-articular Hip Injection Affects Postoperative Infection Risk.

Science.gov (United States)

Wang, Dean; Camp, Christopher L; Ranawat, Anil S; Coleman, Struan H; Kelly, Bryan T; Werner, Brian C

2017-11-01

To evaluate the association of preoperative intra-articular hip injection with surgical site infection after hip arthroscopy. A large administrative database was used to identify all patients undergoing hip arthroscopy from 2007 to 2015 within a single private insurer and from 2005 to 2012 within Medicare in the United States. Those that received an ipsilateral preoperative intra-articular hip injection were identified. The patients were then divided into the following groups based on the interval between preoperative injection and ipsilateral hip arthroscopy: (1) 12 months) of preoperative hip injection. Patients developing a surgical site infection within 6 months following hip arthroscopy were identified using International Classification of Diseases, Ninth Revision, and Current Procedural Terminology codes associated with infection. Groups were compared using a multivariate logistic regression analysis to control for age, gender, body mass index, smoking status, alcohol usage, and multiple medical comorbidities including diabetes mellitus, hemodialysis use, inflammatory arthritis, and peripheral vascular disease. In total, 19% of privately insured and 6% of Medicare patients received a hip injection within 12 months of hip arthroscopy. The overall infection rate in privately insured and Medicare patients was 1.19% and 1.10%, respectively. Preoperative hip injection within 3 months of surgery was associated with a significantly higher risk of postoperative infection versus controls (2.16%, odds ratio [OR] 6.1, P arthroscopy increased when preoperative intra-articular hip injections were given within 3 months of surgery. Level III, retrospective comparative study. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Assessment of Patients with a DePuy ASR Metal-on-Metal Hip Replacement: Results of Applying the Guidelines of the Spanish Society of Hip Surgery in a Tertiary Referral Hospital

Directory of Open Access Journals (Sweden)

Jenaro Fernández-Valencia

2014-01-01

Full Text Available The prognosis associated with the DePuy ASR hip cup is poor and varies according to the series. This implant was withdrawn from use in 2010 and all patients needed to be assessed. We present the results of the assessment of our patients treated with this device, according to the Spanish Society of Hip Surgery (SECCA algorithm published in 2011. This retrospective study evaluates 83 consecutive ASR cups, followed up at a mean of 2.9 years. Serum levels of chromium and cobalt, as well as the acetabular abduction angle, were determined in order to assess their possible correlation with failure, defined as the need for revision surgery. The mean Harris Hip Score was 83.2 (range 42–97. Eight arthroplasties (13.3% required revision due to persistent pain and/or elevated serum levels of chromium/cobalt. All the cups had a correct abduction angle, and there was no correlation between elevated serum levels of metal ions and implant failure. Since two previous ASR implants were exchanged previously to the recall, the revision rate for ASR cups in our centre is 18.2% at 2.9 years.

Time series trends of the safety effects of pavement resurfacing.

Science.gov (United States)

Park, Juneyoung; Abdel-Aty, Mohamed; Wang, Jung-Han

2017-04-01

This study evaluated the safety performance of pavement resurfacing projects on urban arterials in Florida using the observational before and after approaches. The safety effects of pavement resurfacing were quantified in the crash modification factors (CMFs) and estimated based on different ranges of heavy vehicle traffic volume and time changes for different severity levels. In order to evaluate the variation of CMFs over time, crash modification functions (CMFunctions) were developed using nonlinear regression and time series models. The results showed that pavement resurfacing projects decrease crash frequency and are found to be more safety effective to reduce severe crashes in general. Moreover, the results of the general relationship between the safety effects and time changes indicated that the CMFs increase over time after the resurfacing treatment. It was also found that pavement resurfacing projects for the urban roadways with higher heavy vehicle volume rate are more safety effective than the roadways with lower heavy vehicle volume rate. Based on the exploration and comparison of the developed CMFucntions, the seasonal autoregressive integrated moving average (SARIMA) and exponential functional form of the nonlinear regression models can be utilized to identify the trend of CMFs over time. Copyright © 2017 Elsevier Ltd. All rights reserved.

Protocol for a multi-centre randomised controlled trial comparing arthroscopic hip surgery to physiotherapy-led care for femoroacetabular impingement (FAI): the Australian FASHIoN trial.

Science.gov (United States)

Murphy, Nicholas J; Eyles, Jillian; Bennell, Kim L; Bohensky, Megan; Burns, Alexander; Callaghan, Fraser M; Dickenson, Edward; Fary, Camdon; Grieve, Stuart M; Griffin, Damian R; Hall, Michelle; Hobson, Rachel; Kim, Young Jo; Linklater, James M; Lloyd, David G; Molnar, Robert; O'Connell, Rachel L; O'Donnell, John; O'Sullivan, Michael; Randhawa, Sunny; Reichenbach, Stephan; Saxby, David J; Singh, Parminder; Spiers, Libby; Tran, Phong; Wrigley, Tim V; Hunter, David J

2017-09-26

Femoroacetabular impingement syndrome (FAI), a hip disorder affecting active young adults, is believed to be a leading cause of hip osteoarthritis (OA). Current management approaches for FAI include arthroscopic hip surgery and physiotherapy-led non-surgical care; however, there is a paucity of clinical trial evidence comparing these approaches. In particular, it is unknown whether these management approaches modify the future risk of developing hip OA. The primary objective of this randomised controlled trial is to determine if participants with FAI who undergo hip arthroscopy have greater improvements in hip cartilage health, as demonstrated by changes in delayed gadolinium-enhanced magnetic resonance imaging (MRI) of cartilage (dGEMRIC) index between baseline and 12 months, compared to those who undergo physiotherapy-led non-surgical management. This is a pragmatic, multi-centre, two-arm superiority randomised controlled trial comparing hip arthroscopy to physiotherapy-led management for FAI. A total of 140 participants with FAI will be recruited from the clinics of participating orthopaedic surgeons, and randomly allocated to receive either surgery or physiotherapy-led non-surgical care. The surgical intervention involves arthroscopic FAI surgery from one of eight orthopaedic surgeons specialising in this field, located in three different Australian cities. The physiotherapy-led non-surgical management is an individualised physiotherapy program, named Personalised Hip Therapy (PHT), developed by a panel to represent the best non-operative care for FAI. It entails at least six individual physiotherapy sessions over 12 weeks, and up to ten sessions over six months, provided by experienced musculoskeletal physiotherapists trained to deliver the PHT program. The primary outcome measure is the change in dGEMRIC score of a ROI containing both acetabular and femoral head cartilages at the chondrolabral transitional zone of the mid-sagittal plane between baseline and

An Empirical Comparison of Discrete Choice Experiment and Best-Worst Scaling to Estimate Stakeholders' Risk Tolerance for Hip Replacement Surgery.

Science.gov (United States)

van Dijk, Joris D; Groothuis-Oudshoorn, Catharina G M; Marshall, Deborah A; IJzerman, Maarten J

2016-06-01

Previous studies have been inconclusive regarding the validity and reliability of preference elicitation methods. The aim of this study was to compare the metrics obtained from a discrete choice experiment (DCE) and profile-case best-worst scaling (BWS) with respect to hip replacement. We surveyed the general US population of men aged 45 to 65 years, and potentially eligible for hip replacement surgery. The survey included sociodemographic questions, eight DCE questions, and twelve BWS questions. Attributes were the probability of a first and second revision, pain relief, ability to participate in sports and perform daily activities, and length of hospital stay. Conditional logit analysis was used to estimate attribute weights, level preferences, and the maximum acceptable risk (MAR) for undergoing revision surgery in six hypothetical treatment scenarios with different attribute levels. A total of 429 (96%) respondents were included. Comparable attribute weights and level preferences were found for both BWS and DCE. Preferences were greatest for hip replacement surgery with high pain relief and the ability to participate in sports and perform daily activities. Although the estimated MARs for revision surgery followed the same trend, the MARs were systematically higher in five of the six scenarios using DCE. This study confirms previous findings that BWS or DCEs are comparable in estimating attribute weights and level preferences. However, the risk tolerance threshold based on the estimation of MAR differs between these methods, possibly leading to inconsistency in comparing treatment scenarios. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Carbon dioxide laser resurfacing of rhytides and photodamaged skin

OpenAIRE

Kelly, KM; Nelson, JS

1998-01-01

Carbon dioxide (CO 2 ) laser resurfacing has been used as a method to treat rhytides and photodamaged skin. This laser offers several advantages over previously utilised modalities but its use has several inherent risks. This article will review important aspects of CO 2 laser resurfacing including laser-skin interactions, patient selection, effective pre- and post-operative regimens and potential complications.

Experiences of young women living with developmental dysplasia of the hip: insight into their experiences of surgery and recovery.

Science.gov (United States)

Gambling, Tina S; Long, Andrew F

2013-03-01

To explore the experiences of young women with developmental dysplasia of the hip explicating the impact of peri-acetabular osteotomy surgery and recovery in the short and longer term. Postings of five, selected women on an online active message board aimed at women with developmental dysplasia of the hip were analysed. Interest lay on their postings after they had had peri-acetabular osteotomy surgery. Data analysis was performed through the approach of interpretive phenomenological analysis. The time length of the postings for the cases ranged from 1 year to 6 years, and the number of postings varied substantially, from 48 to 591. Two major concepts were prominent across participants' accounts. The first concept, 'body image', centred on affects on the women's self-esteem and body image. The second, 'the long road to recovery', highlighted 'the emotional and physical battle of learning to walk' and concerns with 'saving my joints'. Developmental dysplasia of the hip potentially provides a critical case for exploration of the process of how a disability can affect confidence, self-esteem and body image. Recovery from this condition requires enormous effort, resilience and commitment from the women.

[Evaluation of selected parameters of blood coagulation and fibrinolysis system in patients undergoing total hip replacement surgery with normovolemic hemodilution procedure and standard enoxaparine prophylaxis].

Science.gov (United States)

Piecuch, Wiesław; Sokołowska, Bozena; Dmoszyńska, Anna; Furmanik, Franciszek

2003-01-01

The aim of the study was to evaluate selected blood coagulation and fibrinolysis parameters in patients undergoing total hip replacement surgery with normovolemic hemodilution and standard enoksaparine profilaxis. The study included 66 patients undergoing hip replacement surgery. The group consisted of 51 women and 15 men, within the age range of 47-78, the mean age was 64. In 32 (subgroup II) patients the surgery was performed with the use of normovolemic hemodilution, in 34 (subgroup I) the hemodilution procedure was not applied. The enoksaparine as prophylaxis started 12 hours prior to surgery and continued during hospitalisation. The examination of the coagulation system was performed: on the day of the operation in the morning, on the day of the operation in the evening and on the first day after operation. We determined the concentrations of TAT and PAP complexes, prothrombin fragments 1 + 2 (F1 + 2) and d-dimers (DD). 1) during total hip replacement surgery and particularly in the period of the first 12 hours after the procedure marked activation of coagulation and fibrinolysis occurRed; 2) the application of the hemodilution procedure does not influence significantly the degree of coagulation and fibrinolysis disorders in the perioperative period, but could reduced incidence of thromboembolic complications in the postoperative period.

Quality of life following hip fractures: results from the Norwegian hip fracture register.

Science.gov (United States)

Gjertsen, Jan-Erik; Baste, Valborg; Fevang, Jonas M; Furnes, Ove; Engesæter, Lars Birger

2016-07-07

Patient-reported health-related quality of life is an important outcome measure when assessing the quality of hip fracture surgery. The frequently used EQ-5D index score has unfortunately important limitations. One alternative can be to assess the distribution of each of the five dimensions of the patients' descriptive health profile. The objective of this paper was to investigate health-related quality of life (HRQoL) after hip fractures. Data from hip fracture operations from 2005 through 2012 were obtained from The Norwegian Hip Fracture Register. Patient reported HRQoL, (EQ-5D-3L) was collected from patients preoperatively and at four and twelve months postoperatively n = 10325. At each follow-up the distribution of the EQ-5D-3L and mean pain VAS was calculated. Generally, a higher proportion of patients reported problems in all 5 dimensions of the EQ-5D-3L at all follow-ups compared to preoperative. Also a high proportion of patients with no preoperative problems reported problems after surgery; At 4 and 12 months follow-ups 71 % and 58 % of the patients reported walking problems, and 65 % and 59 % of the patients reported pain respectively. Patients with femoral neck fractures and the youngest patients (age < 70 years) reported least problems both preoperatively and at all follow-ups. A hip fracture has a dramatic impact on the patients' HRQoL, and the deterioration in HRQoL sustained also one year after the fracture. Separate use of the descriptive profile of the EQ-5D is informative when assessing quality of life after hip fracture surgery.

Early rehabilitation in Resurfacing, standard and large head THA patients

DEFF Research Database (Denmark)

Penny, Jeannette Østergaard; Varmarken, Jens-Erik; Ovesen, Ole

2009-01-01

in the resurfacing patient may impair the early rehabilitation. We aimed to investigate early differences in rehabilitation parameters amongst the different groups. Materials and methods We randomized to resurfacing (n=20), standard 28 mm THA (n=19) and large head MoM THA (n=12). We recorded operation time, blood...

Modern radiological postoperative diagnostics of the hip joint in children and adults

International Nuclear Information System (INIS)

Weber, M.A.; Thierjung, H.; Kloth, J.K.; Egermann, M.

2015-01-01

The assessment of bone healing and loosening of endoprosthesis material was long the primary indication for postoperative projection radiography and CT imaging of the hip joint following trauma and endoprosthesis implantation. With the increasing number of joint-preserving surgery, e. g. of surgical hip luxation and hip arthroscopy for the treatment of femoroacetabular impingement (FAI), high-resolution imaging of intra-articular pathologies before and after surgery has become increasingly important. In this review article, diagnostic imaging of the hip joint is presented following common trauma surgery and orthopedic surgery interventions. The imaging modalities of projection radiography, CT and MRI including direct MR-arthrography are discussed with regard to their diagnostic capability in the postoperative assessment of the hip joint. Among others topics, imaging is discussed following hip arthroplasty, following surgical hip luxation and arthroscopic interventions for the treatment of FAI, as well as following core decompression for avascular necrosis of the femoral head. Moreover, orthopedic interventions of the hip joint in children and adolescents are presented and the dedicated reporting of postoperative imaging is outlined.

Liberal or restrictive transfusion in high-risk patients after hip surgery.

Science.gov (United States)

Carson, Jeffrey L; Terrin, Michael L; Noveck, Helaine; Sanders, David W; Chaitman, Bernard R; Rhoads, George G; Nemo, George; Dragert, Karen; Beaupre, Lauren; Hildebrand, Kevin; Macaulay, William; Lewis, Courtland; Cook, Donald Richard; Dobbin, Gwendolyn; Zakriya, Khwaja J; Apple, Fred S; Horney, Rebecca A; Magaziner, Jay

2011-12-29

The hemoglobin threshold at which postoperative red-cell transfusion is warranted is controversial. We conducted a randomized trial to determine whether a higher threshold for blood transfusion would improve recovery in patients who had undergone surgery for hip fracture. We enrolled 2016 patients who were 50 years of age or older, who had either a history of or risk factors for cardiovascular disease, and whose hemoglobin level was below 10 g per deciliter after hip-fracture surgery. We randomly assigned patients to a liberal transfusion strategy (a hemoglobin threshold of 10 g per deciliter) or a restrictive transfusion strategy (symptoms of anemia or at physician discretion for a hemoglobin level of strategy group and none in the restrictive-strategy group. The rates of the primary outcome were 35.2% in the liberal-strategy group and 34.7% in the restrictive-strategy group (odds ratio in the liberal-strategy group, 1.01; 95% confidence interval [CI], 0.84 to 1.22), for an absolute risk difference of 0.5 percentage points (95% CI, -3.7 to 4.7). The rates of in-hospital acute coronary syndrome or death were 4.3% and 5.2%, respectively (absolute risk difference, -0.9%; 99% CI, -3.3 to 1.6), and rates of death on 60-day follow-up were 7.6% and 6.6%, respectively (absolute risk difference, 1.0%; 99% CI, -1.9 to 4.0). The rates of other complications were similar in the two groups. A liberal transfusion strategy, as compared with a restrictive strategy, did not reduce rates of death or inability to walk independently on 60-day follow-up or reduce in-hospital morbidity in elderly patients at high cardiovascular risk. (Funded by the National Heart, Lung, and Blood Institute; FOCUS ClinicalTrials.gov number, NCT00071032.).

Nonablative fractional laser resurfacing in Asian skin--a review.

Science.gov (United States)

Sachdeva, Silonie

2010-12-01

Skin resurfacing has been a part of cosmetic dermatology for more than two decades now, and most of it has been ablative with traditional aggressive lasers including the CO(2) and erbium. The last few years have seen a revolutionary change with the invention of nonablative lasers for skin tightening. Fractional resurfacing is a new concept of cutaneous remodeling whereby laser-induced zones of microthermal injury are surrounded by normal untreated tissue that helps in quicker healing. The various wavelengths used are 1320, 1440, and 2940 nm with depth of penetration ranging from 25 μ to 1.2 mm. This article reviews the history of nonablative fractional laser resurfacing, its indications, contraindications, and a review of use in Asian skin with Fitzpatrick type III-VI. © 2010 Wiley Periodicals, Inc.

Perioperative glucocorticoids in hip and knee surgery - benefit vs. harm?

DEFF Research Database (Denmark)

Lunn, T H; Kehlet, H

2013-01-01

with systemic glucocorticoid. Pain was reduced with high-dose systemic and local glucocorticoid, but not with low-dose systemic glucocorticoid. Systemic inflammatory markers were reduced with low-dose and high-dose systemic glucocorticoid, and with local glucocorticoid. Functional recovery was improved...... with local glucocorticoid. All studies were small-sized and none sufficiently powered to meaningfully evaluate uncommon adverse events. Most of the local administration studies had poor scientific quality (high risk of bias). Due to clinical heterogeneity and poor scientific quality, no meta......-analysis was performed. In conclusion, in addition to PONV reduction with low-dose systemic glucocorticoid, this review supports high-dose systemic glucocorticoid to ameliorate post-operative pain after hip and knee surgery. However, large-scale safety and dose-finding studies are warranted before final recommendations....

Our Approach to the Spastic Hip Subluxation and Dislocation in Children with Cerebral Palsy

Directory of Open Access Journals (Sweden)

Pavel Šponer

2006-01-01

Full Text Available The purpose of this study was to evaluate the effectiveness of our approach to the spastic hip subluxation and dislocation in children with cerebral palsy. We evaluated 56 hips in our consecutive patients who had been operated on at our department between January 2003 and December 2005. There were done soft-tissue release procedures in 42 hips, osseous reconstructive surgery in 11 hips and osseous palliative surgery in 3 hips. The duration of follow-ups was 1–3 years after surgery. We achieved good result in 15 hips after soft-tissue release, fifteen hips had a fair result, nine a poor result and three a failure. No redislocation was observed after osseous surgery in our patients. Two patients observed no pain after osseous palliative surgery, transient pain in the hip was in one case. In all hips the range of motion (abduction was increased. The personal hygiene and possibilities of rehabilitation were improved. Childhood is the optimal time to intervene to maximize the function of the patient with cerebral palsy. The musculoskeletal treatment of the child prevents future problems with pain and deformity.

Edge loading in metal-on-metal hips: low clearance is a new risk factor.

Science.gov (United States)

Underwood, Richard J; Zografos, Angelos; Sayles, Ritchie S; Hart, Alister; Cann, Philippa

2012-03-01

The revision rate of large head metal-on-metal and resurfacing hips are significantly higher than conventional total hip replacements. The revision of these components has been linked to high wear caused by edge loading; which occurs when the head-cup contact patch extends over the cup rim. There are two current explanations for this; first, there is loss of entrainment of synovial fluid resulting in breakdown of the lubricating film and second, edge loading results in a large local increase in contact pressure and consequent film thickness reduction at the cup rim, which causes an increase in wear. This paper develops a method to calculate the distance between the joint reaction force vector and the cup rim--the contact patch centre to rim (CPCR) distance. However, the critical distance for the risk of edge loading is the distance from the contact patch edge to rim (CPER) distance. An analysis of explanted hip components, divided into edge worn and non-edge-worn components showed that there was no statistical difference in CPCR values, but the CPER value was significantly lower for edge worn hips. Low clearance hips, which have a more conformal contact, have a larger diameter contact patch and thus are more at risk of edge loading for similarly positioned hips.

The impact of subsidence on straight and curved modular cementless revision stems in hip revision surgery.

Science.gov (United States)

Fraile Suari, A; Gil González, S; Pérez Prieto, D; León García, A; Mestre Cortadellas, C; Tey Pons, M; Marqués López, F

Subsidence is one of the potential complications in femoral stem revision total hip arthroplasty surgery, and can affect stability and osseointegration. A retrospective study was conducted on the outcomes at one year and 5 years (specifically subsidence and clinical relevance) of 40 consecutive femoral total hip arthroplasty revisions, comparing two modular cementless revision stems, Straight vs. Curved, with 20 patients in each group. No mechanical failure was observed, and there was an improvement in functional outcomes. Mean radiological subsidence was 9.9±4.9mm (straight=10.75mm vs. curved=9.03mm), with no statistically significant difference between groups (p=0,076). Fourteen patients (35%) had ≥10mm of subsidence, up to a maximum of 22mm. The subsidence found in this study is similar to published series, with no short-term clinical manifestations, or an increased number of complications or stem loosening in either the Straight or Curved group. No differences in subsidence were observed at one year and 5 years after surgery between the 2 types of stems. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

Refractory pain following hip arthroscopy: evaluation and management

Science.gov (United States)

de SA, Darren L; Burnham, Jeremy M; Mauro, Craig S

2018-01-01

ABSTRACT With increased knowledge and understanding of hip pathology, hip arthroscopy is rapidly becoming a popular treatment option for young patients with hip pain. Despite improved clinical and radiographic outcomes with arthroscopic treatment, some patients may have ongoing pain and less than satisfactory outcomes. While the reasons leading to failed hip arthroscopy are multifactorial, patient selection, surgical technique and rehabilitation all play a role. Patients with failed hip arthroscopy should undergo a thorough history and physical examination, as well as indicated imaging. A treatment plan should then be developed based on pertinent findings from the workup and in conjunction with the patient. Depending on the etiology of failed hip arthroscopy, management may be nonsurgical or surgical, which may include revision arthroscopic or open surgery, periacetabular osteotomy or joint arthroplasty. Revision surgery may be appropriate in settings including, but not limited to, incompletely treated femoroacetabular impingement, postoperative adhesions, heterotopic ossification, instability, hip dysplasia or advanced degeneration. PMID:29423245

The sensitization potential of sunscreen after ablative fractional skin resurfacing using modified human repeated insult patch test.

Science.gov (United States)

Boonchai, Waranya; Sathaworawong, Angkana; Wongpraparut, Chanisada; Wanitphakdeedecha, Rungsima

2015-10-01

Ablative fractional skin resurfacing has become popular and proven to be useful in treating scars, photoaging and wrinkles. Although post-inflammatory hyperpigmentation (PIH) is the most common complication especially in dark-skinned patients like Asian. Several modalities have been used to overcome the PIH. To determine the sensitization potential of sunscreen applied immediately after ablative fractional skin resurfacing. Sixty volunteers were recruited. Of these 30 subjects were from previous ablative fractional skin resurfacing study who applied broad-spectrum sunscreen containing anti-inflammatory agent starting on the first day after resurfacing and another 30 non-resurfacing subjects had applied the same sunscreen on the intact skin. All subjects were patch/photopatch tested for sensitization study by using modified human repeated insult patch test (HRIPT). There were significantly higher sensitization rate of UV-filter, octocrylene and the sunscreen in resurfacing group than in non-resurfacing group. Early application of sunscreen after ablative fractional skin resurfacing has increased the incidence of sensitization potential of sunscreen. The sunscreen is recommended to start using from D3 after fractional ablative skin resurfacing to ensure the complete recovery of skin barrier and minimize the risk of sensitization.

Danish Hip Arthroscopy Registry

DEFF Research Database (Denmark)

Mygind-Klavsen, Bjarne; Lund, Bent; Nielsen, Torsten Grønbech

2018-01-01

PURPOSE: Predictors of outcome after femoroacetabular impingement (FAI) surgery are not well-documented. This study presents data from the Danish Hip Arthroscopy Registry (DHAR) for such analyses. The purpose of this study was to identify predictors of poor outcome after FAI surgery in a Danish FAI...

Breast milk metal ion levels in a young and active patient with a metal-on-metal hip prosthesis.

Science.gov (United States)

Nelis, Raymond; de Waal Malefijt, Jan; Gosens, Taco

2013-01-01

Metal-on-metal resurfacing arthroplasty of the hip has been used increasingly over the last 10 years in younger active patients. The dissolution of the metal wear particles results in measurable increases in cobalt and chromium ions in the serum and urine of patients with a metal-on-metal bearing. We measured the cobalt, chromium, and molybdenum ion levels in urine; serum; and breast milk in a young and active patient with a metal-on-metal hip prosthesis after a pathologic fracture of the femoral neck. Metal-on-metal hip prosthesis leads to increasing levels of molybdenum in breast milk in the short-term follow-up. There are no increasing levels of chromium and cobalt ions in breast milk. Besides the already known elevated concentrations in serum of chromium and cobalt after implantation of a metal-on-metal hip prosthesis, we found no increasing levels of chromium and cobalt in urine. Copyright © 2013 Elsevier Inc. All rights reserved.

Evolution of the hip and pelvis.

Science.gov (United States)

Hogervorst, Tom; Bouma, Heinse W; de Vos, John

2009-08-01

Man's evolution features two unique developments: growing a huge brain and upright gait. Their combination makes the pelvis the most defining skeletal element to read human evolution. Recent revival in joint preserving hip surgery have brought to attention morphological variations of the human hip that appear similar to hips of extant mammals. In man, such variations can produce hip osteoarthrosis through motion. We reviewed the evolution of the hip and pelvis with special interest in morphology that can lead to motion induced osteoarthrosis in man. The combination of giving birth to big brained babies and walking upright has produced marked differences between the sexes in pelvis and hip morphology, each having their characteristic mode of hip impingement and osteoarthrosis.

Alexandros Zaoussis, MD, PhD (1923-2005): An Orthopedic Surgeon and Historian and His Contribution to the Establishment of Hip Surgery.

Science.gov (United States)

Markatos, Konstantinos; Korres, Demetrios

2016-10-01

The purpose of our study was to summarize all the knowledge concerning the innovative pioneer in the field of orthopedic surgery and especially hip replacement, Alexandros Zaoussis (1923-2005). He was a pioneer in hip replacement, and he contributed to several fields of orthopedic surgery with his clinical work and his international publications. He was also an eminent historian of World War II and of the Greek Resistance to the Nazi occupation in which he played a significant part. A thorough study of texts, medical books, and reports in the field of history of medicine, together with a review of the available literature in PubMed, was undertaken. He was an eminent clinical director of orthopedics who had significant contribution in teaching, practicing, and expanding the horizons of orthopedic surgery in the 20th century. A thorough review of medical texts, books, and publications in the Greek academic press was undertaken to summarize his contributions and his turbulent life to commemorate the 10th anniversary of his death. © The Author(s) 2016.

Hip joint centre position estimation using a dual unscented Kalman filter for computer-assisted orthopaedic surgery.

Science.gov (United States)

Beretta, Elisa; De Momi, Elena; Camomilla, Valentina; Cereatti, Andrea; Cappozzo, Aurelio; Ferrigno, Giancarlo

2014-09-01

In computer-assisted knee surgery, the accuracy of the localization of the femur centre of rotation relative to the hip-bone (hip joint centre) is affected by the unavoidable and untracked pelvic movements because only the femoral pose is acquired during passive pivoting manoeuvres. We present a dual unscented Kalman filter algorithm that allows the estimation of the hip joint centre also using as input the position of a pelvic reference point that can be acquired with a skin marker placed on the hip, without increasing the invasiveness of the surgical procedure. A comparative assessment of the algorithm was carried out using data provided by in vitro experiments mimicking in vivo surgical conditions. Soft tissue artefacts were simulated and superimposed onto the position of a pelvic landmark. Femoral pivoting made of a sequence of star-like quasi-planar movements followed by a circumduction was performed. The dual unscented Kalman filter method proved to be less sensitive to pelvic displacements, which were shown to be larger during the manoeuvres in which the femur was more adducted. Comparable accuracy between all the analysed methods resulted for hip joint centre displacements smaller than 1 mm (error: 2.2 ± [0.2; 0.3] mm, median ± [inter-quartile range 25%; inter-quartile range 75%]) and between 1 and 6 mm (error: 4.8 ± [0.5; 0.8] mm) during planar movements. When the hip joint centre displacement exceeded 6 mm, the dual unscented Kalman filter proved to be more accurate than the other methods by 30% during multi-planar movements (error: 5.2 ± [1.2; 1] mm). © IMechE 2014.

Predictors for Long-Term Hip Survivorship Following Acetabular Fracture Surgery: Importance of Gap Compared with Step Displacement.

Science.gov (United States)

Verbeek, Diederik O; van der List, Jelle P; Tissue, Camden M; Helfet, David L

2018-06-06

Historically, the greatest residual (gap or step) displacement is used to predict clinical outcome following acetabular fracture surgery. Gap and step displacement may, however, impact the outcome to different degrees. We assessed the individual relationship between gap or step displacement and hip survivorship and determined their independent association with conversion to total hip arthroplasty. Patients who had acetabular fracture fixation (from 1992 through 2014), follow-up of ≥2 years (or early conversion to total hip arthroplasty), and postoperative computed tomography (CT) scans were included. Of 227 patients, 55 (24.2%) had conversion to total hip arthroplasty at a mean follow-up (and standard deviation) of 8.7 ± 5.6 years. Residual gap and step displacement were measured using a standardized CT-based method, and assessors were blinded to the outcome. Kaplan-Meier survivorship curves for the hips were plotted and compared (log-rank test) using critical cutoff values for gap and step displacement. These values were identified using receiver operating characteristic curves. Multivariate analysis was performed to identify independent variables associated with conversion to total hip arthroplasty. Subgroup analysis was performed in younger patients (step displacement. Hip survivorship at 10 years was 82.0% for patients with a gap of step of step of ≥1.0 mm (p = 0.012). A gap of ≥5 mm (hazard ratio [HR], 2.3; p = 0.012) and an age of ≥50 years (HR, 4.2; p step of ≥1 mm (HR, 6.4; p = 0.017) was an independent factor for conversion to total hip arthroplasty. Residual gap and step displacement as measured on CT scans are both related to long-term hip survivorship, but step displacement (1 mm) is tolerated less than gap displacement (5 mm). Of the 2 types of displacement, only a large gap displacement (≥5 mm) was independently associated with conversion to total hip arthroplasty. In younger patients who had less articular impaction with smaller residual

Acute cognitive dysfunction after hip fracture

DEFF Research Database (Denmark)

Bitsch, M S; Foss, N B; Kristensen, B B

2006-01-01

hip fracture surgery in an optimized, multimodal, peri-operative rehabilitation regimen. METHODS: One hundred unselected hip fracture patients treated in a well-defined, optimized, multimodal, peri-operative rehabilitation regimen were included. Patients were tested upon admission and on the second......BACKGROUND: Patients undergoing hip fracture surgery often experience acute post-operative cognitive dysfunction (APOCD). The pathogenesis of APOCD is probably multifactorial, and no single intervention has been successful in its prevention. No studies have investigated the incidence of APOCD after......, fourth and seventh post-operative days with the Mini Mental State Examination (MMSE) score. RESULTS: Thirty-two per cent of patients developed a significant post-operative cognitive decline, which was associated with several pre-fracture patient characteristics, including age and cognitive function...

Inter-observer and intra-observer reliability in the radiographic diagnosis of avascular necrosis of the femoral head following reconstructive hip surgery in children with cerebral palsy.

Science.gov (United States)

Hesketh, Kim; Sankar, Wudbhav; Joseph, Benjamin; Narayanan, Unni; Mulpuri, Kishore

2016-04-01

The incidence of avascular necrosis (AVN) following reconstructive hip surgery in cerebral palsy (CP) ranges from 0 to 69 % in the current literature. The purpose of this study was to determine the inter- and intra-observer reliability of radiographically diagnosing AVN in children with CP after hip surgery. A retrospective review of 65 children with CP who had reconstructive hip surgery between 2009 and 2012 at BC Children's Hospital was completed. Anterior-posterior and lateral radiographs were presented to four pediatric orthopaedic surgeons over two rounds. Surgeons were asked to review the set of unidentified radiographs and comment 'yes' or 'no' for the presence of AVN. Two weeks later the same set of radiographs was sent in a different order and the surgeons were again asked to comment on AVN. Inter- and intra-observer reliability was determined using kappa statistics. The intra-observer reliability ranged from 0.65 to 0.88 with an average score of 0.76. Inter-observer reliability showed greater variability, ranging from 0.41 to 0.77 with an average score of 0.56 across all surgeons. Although the intra-rater reliability produced a strength of "good" and the inter-rater reliability a strength of "moderate" agreement, the variability within these scores is clinically important as it demonstrates the difficulty in identifying AVN. This may explain the variability in AVN that is reported in the literature. The need for further education and research in the diagnosis of AVN in children with CP who have undergone reconstructive hip surgery is clinically necessary.

Predictive factors of hospital stay, mortality and functional recovery after surgery for hip fracture in elderly patients.

Science.gov (United States)

Pareja Sierra, T; Bartolomé Martín, I; Rodríguez Solís, J; Bárcena Goitiandia, L; Torralba González de Suso, M; Morales Sanz, M D; Hornillos Calvo, M

Due to its high prevalence and serious consequences it is very important to be well aware of factors that might be related to medical complications, mortality, hospital stay and functional recovery in elderly patients with hip fracture. A prospective study of a group of 130 patients aged over 75 years admitted for osteoporotic hip fracture. Their medical records, physical and cognitive status prior to the fall, fracture type and surgical treatment, medical complications and functional and social evolution after hospitalization were evaluated. Patients with greater physical disability, more severe cognitive impairment and those who lived in a nursing home before the fracture had worse functional recovery after surgery. Treatment with intravenous iron to reduce transfusions reduced hospital stay and improved walking ability. Infections and heart failure were the most frequent medical complications and were related to a longer hospital stay. The prescription of nutritional supplements for the patients with real indication improved their physical recovery after the hip fracture CONCLUSIONS: Evaluation of physical, cognitive and social status prior to hip fracture should be the basis of an individual treatment plan because of its great prognostic value. Multidisciplinary teams with continuous monitoring of medical problems should prevent and treat complications as soon as possible. Intravenous iron and specific nutritional supplements can improve functional recovery six months after hip fracture. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

Treatment of athletes with symptomatic intra-articular hip pathology and athletic pubalgia/sports hernia: a case series.

Science.gov (United States)

Larson, Christopher M; Pierce, Bradley R; Giveans, M Russell

2011-06-01

The purpose of the study was to evaluate the results of surgical treatment in athletes with associated intra-articular hip pathology and extra-articular sports pubalgia. Between December 2003 and September 2009, 37 hips (mean patient age, 25 years) were diagnosed with both symptomatic athletic pubalgia and symptomatic intra-articular hip joint pathology. There were 8 professional athletes, 15 collegiate athletes, 5 elite high school athletes, and 9 competitive club athletes. Outcomes included an evaluation regarding return to sports and modified Harris Hip Score, Short Form 12 score, and visual analog scale score. We evaluated 37 hips at a mean of 29 months (range, 12 to 78 months) after the index surgery. Thirty-one hips underwent thirty-five athletic pubalgia surgeries. Hip arthroscopy was performed in 32 hips (30 cases of femoroacetabular impingement treatment, 1 traumatic labral tear, and 1 borderline dysplasia). Of 16 hips that had athletic pubalgia surgery as the index procedure, 4 (25%) returned to sports without limitations, and 11 (69%) subsequently had hip arthroscopy at a mean of 20 months after pubalgia surgery. Of 8 hips managed initially with hip arthroscopy alone, 4 (50%) returned to sports without limitations, and 3 (43%) had subsequent pubalgia surgery at a mean of 6 months after hip arthroscopy. Thirteen hips had athletic pubalgia surgery and hip arthroscopy at one setting. Concurrent or eventual surgical treatment of both disorders led to improved postoperative outcomes scores (P pubalgia or intra-articular hip pathology in this patient population, outcomes were suboptimal. Surgical management of both disorders concurrently or in a staged manner led to improved postoperative outcomes scoring and an unrestricted return to sporting activity in 89% of hips. Level IV, therapeutic case series. Copyright © 2011 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Resurfacing hemiarthroplasty compared to stemmed hemiarthroplasty for glenohumeral osteoarthritis

DEFF Research Database (Denmark)

Rasmussen, Jeppe V; Olsen, Bo S; Sorensen, Anne Kathrine

2015-01-01

PURPOSE: The aim of this study was to conduct a randomised, clinical trial comparing stemmed hemiarthroplasty and resurfacing hemiarthroplasty in the treatment of glenohumeral osteoarthritis. METHODS: A total of 40 shoulders (35 patients) were randomised to stemmed hemiarthroplasty or resurfacing...... hemiarthroplasty and evaluated three and 12 months postoperatively using the Constant-Murley score (CMS) and Western Ontario Osteoarthritis of the Shoulder (WOOS) index. RESULTS: There were no statistically significant differences in age, gender or pre-operative scores except for WOOS at baseline. Two patients...

Regional variation in acute care length of stay after orthopaedic surgery total joint replacement surgery and hip fracture surgery.

Science.gov (United States)

Fitzgerald, John D; Weng, Haoling H; Soohoo, Nelson F; Ettner, Susan L

2013-01-01

To examine change in regional variations in acute care length of stay (LOS) after orthopedic surgery following expiration of the New York (NY) State exemption to the Prospective Payment System and implementation of the Medicare Short Stay Transfer Policy. Time series analyses were conducted to evaluate change in LOS across regions after policy implementations. Small area analyses were conducted to examine residual variation in LOS. The dataset included A 100% sample of fee-for-service Medicare patients undergoing surgical repair for hip fracture or elective joint replacement surgery between 1996 and 2001. Data files from Centers for Medicare and Medicaid Services 1996-2001 Medicare Provider Analysis and Review file, 1999 Provider of Service file, and data from the 2000 United States Census were used for analysis. In 1996, LOS in NY after orthopedic procedures was much longer than the remainder of the country. After policy changes, LOS fell. However, significant residual variation in LOS persisted. This residual variation was likely partly explained by differences variation in regional managed care market penetration, patient management practices and unmeasured characteristics associated with the hospital location. NY hospitals responded to changes in reimbursement policy, reducing variation in LOS. However, even after 5 years of financial pressure to constrain costs, other factors still have a strong impact on delivery of patient care.

The influence of NSAIDs on coumarin sensitivity in patients with CYP2C9 polymorphism after total hip replacement surgery.

NARCIS (Netherlands)

Beinema, M.J.; Jong, P.H. de; Salden, H.J.; Wijnen, M.H.W.A.; Meer, J.W.M. van der; Brouwers, J.R.B.J.

2007-01-01

OBJECTIVE: To determine the influence of NSAIDs on the international normalized ratio (INR) in patients with cytochrome P450 (CYP)-2C9 enzyme variants starting acenocoumarol (an oral coumarin) therapy during the first 7 days after total hip replacement surgery. METHODS: In this prospective study, an

The influence of NSAIDs on coumarin sensitivity in patients with CYP2C9 polymorphism after total hip replacement surgery

NARCIS (Netherlands)

Beinema, Maarten J.; de Jong, Petra H.; Salden, Har J. M.; van Wijnen, Merel; van der Meer, Jan; Brouwers, Jacobus R. B. J.

2007-01-01

Objective: To determine the influence of NSAIDs on the international normalized ratio (INR) in patients with cytochrome P450 (CYP)-2C9 enzyme variants starting acenocoumarol (an oral coumarin) therapy during the first 7 days after total hip replacement surgery. Methods: In this prospective study, an

Predictors of excellent early outcome after total hip arthroplasty

Directory of Open Access Journals (Sweden)

Smith George H

2012-03-01

Full Text Available Abstract Background Not all patients gain the same degree of improvement from total hip replacement and the reasons for this are not clear. Many investigators have assessed predictors of general outcome after hip surgery. This study is unique in its quest for the predictors of the best possible early outcome. Methods We prospectively collected data on 1318 total hip replacements. Prior to surgery patient characteristics, demographics and co-morbidities were documented. Hip function and general health was assessed using the Harris Hip score (HHS and the Short-Form 36 respectively. The HHS was repeated at three years. We took a maximal HHS of 100 to represent an excellent outcome (102 patients. Multiple logistic regression analysis was used to identify independent predictors of excellent outcome. Results The two strongest predictive factors in achieving an excellent result were young age and a high pre-operative HHS (p = 0.001. Conclusions It was the young and those less disabled from their arthritis that excelled at three years. When making a decision about the timing of hip arthroplasty surgery it is important to take into account the age and pre-operative function of the patient. Whether these patients continue to excel however will be the basis of future research.

Hip disarticulation - case series analysis and literature review

Directory of Open Access Journals (Sweden)

Diogo Lino Moura

Full Text Available ABSTRACT OBJECTIVE: To present a retrospective study of 16 patients submitted to hip disarticulation. METHODS: During the period of 16 years, 16 patients who underwent hip disarticulation were identified. All of them were studied based on clinical records regarding the gender, age at surgery, disarticulation cause, postoperative complications, mortality rates and functional status after hip disarticulation. RESULTS: Hip disarticulation was performed electively in most cases and urgently in only three cases. The indications had the following origins: infection (n = 6, tumor (n = 6, trauma (n = 3, and ischemia (n = 2. The mean post-surgery survival was 200.5 days. The survival rates were 6875% after six months, 5625% after one year, and 50% after three years. The mortality rates were higher in disarticulations with traumatic (66.7% and tumoral (60% causes. Regarding the eight patients who survived, half of them ambulate with crutches and without prosthesis, 25% walk with limb prosthesis, and 25% are bedridden. Complications and mortality were higher in the cases of urgent surgery, and in those with traumatic and tumoral causes. CONCLUSION: Hip disarticulation is a major ablative surgery with obvious implications for limb functionality, as well as high rates of complications and mortality. However, when performed at the correct time and with proper indication, this procedure can be life-saving and can ensure the return to the home environment with a certain degree of quality of life.

The unipolar ASR : Viable option in unsalvageable femoral head conditions in the young patient

Directory of Open Access Journals (Sweden)

Marya SKS

2006-01-01

Full Text Available Background: The management of unsalvageable femoral head conditions in the young patient has remained an unresolved dilemma. Articular surface replacement of the hip has recently made some headway in terms of providing near-normal hip joint mechanics and function. However, this surgery has been limited to early stages of arthritis only with reasonable maintenance of head-neck congruity and morphology. Femoral neck fractures, osteonecrosis with large segment collapse, advanced arthritis with femoral incongruity, etc are traditional contraindications to the resurfacing technique. Methods: We present here a report on our series of 20 cases of unsalvageable femoral heads in young patients (age range, 27 to 52yrs, over a twelve month period (Aug 2004 to Jul 2005, treated with the unipolar ASR prosthesis. Fifteen patients (two had bilateral hip pathology had primary or secondary arthritis (degenerative, post-traumatic, ankylosing spondylitis and post-avascular necrosis while three had old operated femoral neck fractures. All patients underwent hip replacement surgery using the Unipolar ASR prosthesis. Results: Clinical and radiological results at 6-month follow up have been very encouraging and warrant further study. At an average of 4 months post-operatively, patients were able to squat, sit on the ground and perform light sporting activities. Conclusions: The Unipolar ASR prosthesis is an extension of the articular resurfacing technique employing similar principles (large size bearings, metal-on-metal interfaces, and has incorporated the advantages of the uncemented technique. We propose that this technique be more frequently used so as to brighten the prognosis of the young active patient with unsalvageable hip conditions, especially in the Asian scenario.

Non-weight-bearing status compromises the functional level up to 1 yr after hip fracture surgery

DEFF Research Database (Denmark)

Ariza-Vega, Patrocinio; Jiménez-Moleón, José Juan; Kristensen, Morten Tange

2014-01-01

, age, health status, and cognitive impairment of the patient were associated negatively with the 1-yr functional outcome (P ≤ 0.03). Prefracture functional level and non-WB status were the strongest determinants of functional level (β = 0.599 and -0.204, respectively; P ... after surgery, in addition to prefracture function, cognitive status, health status, age and fracture type, was found to be an independent predictor of the 1-yr functional outcome in hip fracture patients....

Fractional laser skin resurfacing.

Science.gov (United States)

Alexiades-Armenakas, Macrene R; Dover, Jeffrey S; Arndt, Kenneth A

2012-11-01

Laser skin resurfacing (LSR) has evolved over the past 2 decades from traditional ablative to fractional nonablative and fractional ablative resurfacing. Traditional ablative LSR was highly effective in reducing rhytides, photoaging, and acne scarring but was associated with significant side effects and complications. In contrast, nonablative LSR was very safe but failed to deliver consistent clinical improvement. Fractional LSR has achieved the middle ground; it combined the efficacy of traditional LSR with the safety of nonablative modalities. The first fractional laser was a nonablative erbium-doped yttrium aluminum garnet (Er:YAG) laser that produced microscopic columns of thermal injury in the epidermis and upper dermis. Heralding an entirely new concept of laser energy delivery, it delivered the laser beam in microarrays. It resulted in microscopic columns of treated tissue and intervening areas of untreated skin, which yielded rapid reepithelialization. Fractional delivery was quickly applied to ablative wavelengths such as carbon dioxide, Er:YAG, and yttrium scandium gallium garnet (2,790 nm), providing more significant clinical outcomes. Adjustable laser parameters, including power, pitch, dwell time, and spot density, allowed for precise determination of percent surface area, affected penetration depth, and clinical recovery time and efficacy. Fractional LSR has been a significant advance to the laser field, striking the balance between safety and efficacy.

A Water Rehabilitation Program in Patients with Hip Osteoarthritis Before and After Total Hip Replacement.

Science.gov (United States)

Łyp, Marek; Kaczor, Ryszard; Cabak, Anna; Tederko, Piotr; Włostowska, Ewa; Stanisławska, Iwona; Szypuła, Jan; Tomaszewski, Wiesław

2016-07-25

BACKGROUND Pain associated with coxarthrosis, typically occurring in middle-aged and elderly patients, very commonly causes considerable limitation of motor fitness and dependence on pharmacotherapy. This article provides an assessment of a rehabilitation program with tailored water exercises in patients with osteoarthritis before and after total hip replacement. MATERIAL AND METHODS A total of 192 patients (the mean age 61.03±10.89) suffering from hip osteoarthritis (OA) were evaluated before and after total hip replacement (THR). The clinical study covered measurements of hip active ranges of motion (HAROM) and the forces generated by pelvis stabilizer muscles. Pain intensity was assessed according to analogue-visual scale of pain (VAS) and according to the Modified Laitinen Questionnaire. The patients were divided into 6 groups (4 treatment and 2 control). We compared 2 rehabilitation programs using kinesitherapy and low-frequency magnetic field. One of them also had specially designed exercises in the water. Statistical analysis was carried out at the significance level α=0.05. This was a cross-sectional study. RESULTS A positive effect of water exercises on a number of parameters was found in patients with OA both before and after total hip replacement surgery. We noted a significant reduction of pain (pwater exercises most significantly reduced pain in patients with OA before and after total hip replacement surgery. 2. Inclusion of water exercises in a rehabilitation program can reduce the use of medicines in patient with OA and after THR.

[The hip joint in neuromuscular disorders].

Science.gov (United States)

Strobl, W M

2009-07-01

Physiologic motor and biomechanical parameters are prerequisites for normal hip development and hip function. Disorders of muscle activity and lack of weight bearing due to neuromuscular diseases may cause clinical symptoms such as an unstable hip or reduced range of motion. Disability and handicap because of pain, hip dislocation, osteoarthritis, gait disorders, or problems in seating and positioning are dependent on the severity of the disease, the time of occurrence, and the means of prevention and treatment. Preservation of pain-free and stable hip joints should be gained by balancing muscular forces and by preventing progressive dislocation. Most important is the exact indication of therapeutic options such as movement and standing therapy as well as drugs and surgery.

Arthroscopic Labral Base Repair in the Hip: 5-Year Minimum Clinical Outcomes.

Science.gov (United States)

Domb, Benjamin G; Yuen, Leslie C; Ortiz-Declet, Victor; Litrenta, Jody; Perets, Itay; Chen, Austin W

2017-10-01

Arthroscopic labral base repair (LBR) in the hip is a previously described technique designed to restore the native functional anatomy of the labrum by reproducing its seal against the femoral head. LBR has been shown to have good short-term outcomes. Hypothesis/Purpose: The purpose was to evaluate clinical outcomes of an LBR cohort with a minimum 5-year follow-up. It was hypothesized that patients who underwent LBR would continue to have significant improvement from their preoperative scores and maintain scores similar to their 2-year outcomes. Case series; Level of evidence, 4. Data for patients undergoing primary hip arthroscopic surgery with LBR from February 2008 to May 2011 with a minimum 5-year follow-up were prospectively collected and retrospectively reviewed. Patients with preoperative Tonnis osteoarthritis grade ≥2, previous hip conditions (slipped capital femoral epiphysis, avascular necrosis, Legg-Calv-Perthes disease), severe dysplasia (lateral center-edge angle hip surgery were excluded. Statistical equivalence tests evaluated patient-reported outcomes (PROs) including the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sport-Specific Subscale (HOS-SSS), visual analog scale (VAS) for pain, and patient satisfaction (0-10 scale; 10 = very satisfied). Of the 70 patients (74 hips) who met inclusion and exclusion criteria, 60 (85.7%) patients (64 hips) were available at a minimum 5-year follow-up. All PRO scores significantly improved from preoperative values with a mean follow-up of 67.8 ± 7.4 months (range, 60.0-89.7 months). The mean mHHS increased from 64.4 ±13.8 to 85.3 ± 17.7 ( P hip arthroscopic surgery has yet to be determined; however, these midterm results demonstrate the rates of additional procedures (both secondary arthroscopic surgery and conversion to total hip arthroplasty), that may be necessary after 2 years.

[Revision hip arthroplasty by Waldemar Link custom-made total hip prosthesis].

Science.gov (United States)

Medenica, Ivica; Luković, Milan; Radoicić, Dragan

2010-02-01

The number of patients undergoing hip arthroplasty revision is constantly growing. Especially, complex problem is extensive loss of bone stock and pelvic discontinuity that requires reconstruction. The paper presented a 50-year old patient, who ten years ago underwent a total cement artrhroplasty of the left hip. A year after the primary operation the patient had difficulties in walking without crutches. Problems intensified in the last five years, the patient had severe pain, totally limited movement in the left hip and could not walk at all. Radiographically, we found loose femoral component, massive loss of bone stock of proximal femur, acetabular protrusion and a consequent pelvic discontinuity. Clinically, a completely disfunctional left hip joint was registered (Harris hip score--7.1). We performed total rearthroplasty by a custom-made Waldemar Link total hip prosthesis with acetabular antiprotrusio cage and compensation of bone defects with a graft from the bone bank. A year after the operation, we found clinically an extreme improvement in Harris hip score--87.8. Radiographically, we found stability of implanted components, a complete graft integration and bone bridging across the site of pelvic discontinuity. Pelvic discontinuity and massive loss of proximal femoral bone stock is a challenging and complex entity. Conventional prostheses cannot provide an adequate fixation and stability of the hip. Application of custom-made prosthesis (measured specificaly for a patient) and additional alografting bone defects is a good method in revision surgery after unsuccessful hip arthroplasty with extensive bone defects.

21 CFR 888.3580 - Knee joint patellar (hemi-knee) metallic resurfacing uncemented prosthesis.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Knee joint patellar (hemi-knee) metallic... § 888.3580 Knee joint patellar (hemi-knee) metallic resurfacing uncemented prosthesis. (a) Identification. A knee joint patellar (hemi-knee) metallic resurfacing uncemented prosthesis is a device made of...

Complications of hip fractures: A review

Science.gov (United States)

Carpintero, Pedro; Caeiro, Jose Ramón; Carpintero, Rocío; Morales, Angela; Silva, Samuel; Mesa, Manuel

2014-01-01

Nowadays, fracture surgery represents a big part of the orthopedic surgeon workload, and usually has associated major clinical and social cost implications. These fractures have several complications. Some of these are medical, and other related to the surgical treatment itself. Medical complications may affect around 20% of patients with hip fracture. Cognitive and neurological alterations, cardiopulmonary affections (alone or combined), venous thromboembolism, gastrointestinal tract bleeding, urinary tract complications, perioperative anemia, electrolytic and metabolic disorders, and pressure scars are the most important medical complications after hip surgery in terms of frequency, increase of length of stay and perioperative mortality. Complications arising from hip fracture surgery are fairly common, and vary depending on whether the fracture is intracapsular or extracapsular. The main problems in intracapsular fractures are biological: vascularization of the femoral head, and lack of periosteum -a major contributor to fracture healing- in the femoral neck. In extracapsular fractures, by contrast, the problem is mechanical, and relates to load-bearing. Early surgical fixation, the role of anti-thromboembolic and anti-infective prophylaxis, good pain control at the perioperative, detection and management of delirium, correct urinary tract management, avoidance of malnutrition, vitamin D supplementation, osteoporosis treatment and advancement of early mobilization to improve functional recovery and falls prevention are basic recommendations for an optimal maintenance of hip fractured patients. PMID:25232517

Safety and efficacy of 2,790-nm laser resurfacing for chest photoaging.

Science.gov (United States)

Grunebaum, Lisa D; Murdock, Jennifer; Cofnas, Paul; Kaufman, Joely

2015-01-01

Chest photodamage is a common cosmetic complaint. Laser treatment of the chest may be higher risk than other areas. The objective of this study was to assess the safety and efficacy of 2,790-nm chest resurfacing for photodamage. Twelve patients with Fitzpatrick skin types I-III were enrolled in this university IRB-approved study. Photo documentation was obtained at baseline and each visit. A test spot with the 2,790-nm resurfacing laser was performed on the chest. Patients who did not have adverse effects from the test spot went on to have a full chest resurfacing procedure. Patients were instructed on standardized aftercare, including sunscreen. A 5-point healing and photodamage improvement scale was used to rate improvement by both investigators and the patients and was obtained at 2 weeks, 1 month, 2 months, and 3 months. One pass chest treatment with the 2,790-nm resurfacing laser at fluences greater than or equal to 3.0 mJ with 10% overlap leads to unacceptable rates of hyperpigmentation. Double pass chest treatment at fluences less than or equal to 2.5 mJ with 10% overlap leads to mild improvement in chest photodamage parameters without significant or persistent adverse effects. Laser treatment of aging/photodamaged chest skin remains a challenge due to the delicacy of chest skin. Mild improvement may be obtained with double pass resurfacing with the 2,790-nm wavelength.

Hip fracture surgeries

Science.gov (United States)

... clearly. Sometimes, surgery can make this problem worse. Pressure sores ( pressure ulcers or bed sores) from being in bed or ... the hospital for 3 to 5 days. Full recovery will take from 3 to 4 months to ...

Hip or knee replacement - in the hospital after

Science.gov (United States)

Hip replacement surgery - after - self-care; Knee replacement surgery - after - self-care ... taking walks in the hallways with help. After knee replacement, some surgeons recommend using a continuous passive ...

The threshold force required for femoral impaction grafting in revision hip surgery.

LENUS (Irish Health Repository)

Flannery, Olivia M

2010-06-01

BACKGROUND AND PURPOSE: Femoral impaction grafting requires vigorous impaction to obtain adequate stability without risk of fracture, but the force of impaction has not been determined. We determined this threshold force in a preliminary study using animal femurs. METHODS: Adult sow femurs were used because of their morphological similarity to human femurs in revision hip arthroplasty. 35 sow femurs were impacted with morselized bone chips and an increasing force was applied until the femur fractured. This allowed a threshold force to be established. 5 other femurs were impacted to this force and an Exeter stem was cemented into the neomedullary canal. A 28-mm Exeter head was attached and loaded by direct contact with a hydraulic testing machine. Axial cyclic loading was performed and the position sensor of the hydraulic testing machine measured the prosthetic head subsidence. RESULTS: 29 tests were completed successfully. The threshold force was found to be 4 kN. There was no statistically significant correlation between the load at fracture and the cortex-to-canal ratio or the bone mineral density. Following impaction with a maximum force of 4 kN, the average axial subsidence was 0.28 mm. INTERPRETATION: We achieved a stable construct without fracture. Further studies using human cadaveric femurs should be done to determine the threshold force required for femoral impaction grafting in revision hip surgery.

Standard guidelines of care for acne surgery

Directory of Open Access Journals (Sweden)

Khunger Niti

2008-03-01

Full Text Available Acne surgery is the use of various surgical procedures for the treatment of postacne scarring and also, as adjuvant treatment for active acne. Surgery is indicated both in active acne and post-acne scars. Physicians′ qualifications: Any Dermatologist can perform most acne surgery techniques as these are usually taught during postgraduation. However, certain techniques such as dermabrasion, laser resurfacing, scar revisions need specific "hands-on" training in appropriate training centers. Facility: Most acne surgery procedures can be performed in a physician′s minor procedure room. However, full-face dermabrasion and laser resurfacing need an operation theatre in a hospital setting. Active acne: Surgical treatment is only an adjunct to medical therapy, which remains the mainstay of treatment. Comedone extraction is a process of applying simple mechanical pressure with a comedone extractor, to extract the contents of the blocked pilosebaceous follicle. Superficial chemical peel is a process of applying a chemical agent to the skin, so as to cause controlled destruction of the epidermis leading to exfoliation. Glycolic acid, salicylic acid and trichloroacetic acid are commonly used peeling agents for the treatment of active acne and superficial acne scars. Cryotherapy: Cryoslush and cryopeel are used for the treatment of nodulocystic acne. Intralesional corticosteroids are indicated for the treatment of nodules, cysts and keloidal acne scars. Nonablative lasers and light therapy using Blue light, non ablative radiofrequency, Nd:YAG laser, IPL (Intense Pulsed Light, PDT (Photodynamic Therapy, pulse dye laser and light and heat energy machines have been used in recent years for the treatment of active inflammatory acne and superficial acne scars. Proper counseling is very important in the treatment of acne scars. Treatment depends on the type of acne scars; a patient may need more than one type of treatment. Subcision is a treatment to break the

Fractional CO2 Laser Resurfacing as Monotherapy in the Treatment of Atrophic Facial Acne Scars.

Science.gov (United States)

Majid, Imran; Imran, Saher

2014-04-01

While laser resurfacing remains the most effective treatment option for atrophic acne scars, the high incidence of post-treatment adverse effects limits its use. Fractional laser photothermolysis attempts to overcome these limitations of laser resurfacing by creating microscopic zones of injury to the dermis with skip areas in between. The aim of the present study is to assess the efficacy and safety of fractional CO2 laser resurfacing in atrophic facial acne scars. Sixty patients with moderate to severe atrophic facial acne scars were treated with 3-4 sessions of fractional CO2 laser resurfacing at 6-week intervals. The therapeutic response to treatment was assessed at each follow up visit and then finally 6 months after the last laser session using a quartile grading scale. Response to treatment was labelled as 'excellent' if there was >50% improvement in scar appearance and texture of skin on the grading scale while 25-50% response and resurfacing as monotherapy is effective in treating acne scars especially rolling and superficial boxcar scars with minimal adverse effects.

Resource use and costs associated with opioid-induced constipation following total hip or total knee replacement surgery

Directory of Open Access Journals (Sweden)

Wittbrodt ET

2018-05-01

Full Text Available Eric T Wittbrodt,1 Tong J Gan,2 Catherine Datto,1 Charles McLeskey,1 Meenal Sinha3 1US Medical Affairs, AstraZeneca, Wilmington, DE, USA; 2Department of Anesthesiology, Stony Brook Medicine, Stony Brook, NY, USA; 3Premier Applied Sciences, Premier, Inc., Charlotte, NC, USA Purpose: Constipation is a well-known complication of surgery that can be exacerbated by opioid analgesics. This study evaluated resource utilization and costs associated with opioid-induced constipation (OIC. Patients and methods: This retrospective, observational, and propensity-matched cohort study utilized the Premier Healthcare Database. The study included adults ≥18 years of age undergoing total hip or total knee replacement as inpatients who received an opioid analgesic and were discharged between January 1, 2012, and June 30, 2015. Diagnosis codes identified patients with OIC who were then matched 1:1 to patients without OIC. Generalized linear and logistic regression models were used to compare inpatient resource utilization, total hospital costs, inpatient mortality, and 30-day all-cause readmissions and emergency department visits. Results: Of 788,448 eligible patients, 40,891 (5.2% had OIC. Covariates were well balanced between matched patients with and without OIC (n=40,890 each. In adjusted analyses, patients with OIC had longer hospital lengths of stay (3.6 versus 3.3 days; p<0.001, higher total hospital costs (US$17,479 versus US$16,265; p<0.001, greater risk of intensive care unit admission (odds ratio [OR]=1.12, 95% CI: 1.01–1.24, and increased likelihood of 30-day hospital readmissions (OR=1.16, 95% CI: 1.11–1.22 and emergency department visits (OR=1.38, 95% CI: 1.07–1.79 than patients without OIC. No statistically significant difference was found with inpatient mortality (OR=0.89, 95% CI: 0.59–1.35. Conclusion: OIC was associated with greater resource utilization and hospital costs for patients undergoing primarily elective total hip or total knee

Intramuscular psoas lengthening during single-event multi-level surgery fails to improve hip dynamics in children with spastic diplegia. Clinical and kinematic outcomes in the short- and medium-terms.

Science.gov (United States)

Mallet, C; Simon, A-L; Ilharreborde, B; Presedo, A; Mazda, K; Penneçot, G-F

2016-06-01

In children with spastic diplegia, hip extension in terminal stance is limited by retraction of the psoas muscle, which decreases stride propulsion and step length on the contralateral side. Whether intramuscular psoas lengthening (IMPL) is effective remains controversial. The objective of this study was to assess the impact of IMPL as a component of single-event multi-level surgery (SEMLS) on spatial and temporal gait parameters, clinical hip flexion deformity, and hip flexion kinematics. IMPL as part of SEMLS does not significantly improve hip flexion kinematics. A retrospective review was conducted of the medical charts of consecutive ambulatory children with cerebral palsy who had clinical hip flexion deformity (>10°) with more than 10° of excess hip flexion in terminal stance and who underwent SEMLS. The groups with and without IMPL were compared. Preoperative values of the clinical hip flexion contracture, hip flexion kinematics in terminal stance, and spatial and temporal gait parameters were compared to the values recorded after a mean postoperative follow-up of 2.4±2.0 years (range, 1.0-8.7 years). Follow-up was longer than 3 years in 6 patients. Of 47 lower limbs (in 34 patients) included in the analysis, 15 were managed with IMPL. There were no significant between-group differences at baseline. Surgery was followed in all limbs by significant decreases in kinematic hip flexion and in the Gillette Gait Index. In the IMPL group, significant improvements occurred in clinical hip flexion deformity, walking speed, and step length. The improvement in kinematic hip extension was not significantly different between the two groups. Crouch gait recurred in 3 (8%) patients. The improvement in kinematic hip extension in terminal stance was not significantly influenced by IMPL but was, instead, chiefly dependent on improved knee extension and on the position of the ground reaction vector after SEMLS. IMPL remains indicated only when the clinical hip flexion

Danish Hip Arthroscopy Registry

DEFF Research Database (Denmark)

Mygind-Klavsen, Bjarne; Grønbech Nielsen, Torsten; Maagaard, Niels

2016-01-01

Danish Hip Arthroscopy Registry (DHAR) was initiated in 2012 as a web-based prospective registry. The purpose of this study was to evaluate and report the epidemiologic and perioperative data of the first 2000 procedures in a Danish hip arthroscopy population and to describe the development of DHAR...... was 0.65 and HAGOS sub-scores were 51 (pain), 49 (symptoms), 53 (ADL), 35 (sport), 20 (physical activity) and 29, respectively. We conclude that patients undergoing hip arthroscopy report considerable pain, loss of function, reduced level of activity and reduced quality-of-life prior to surgery....... The problems with development and maintaining a large clinical registry are described and further studies are needed to validate data completeness. We consider the development of a national clinical registry for hip arthroscopy as a successful way of developing and maintaining a valuable clinical...

Don't forget the hip! Hip arthritis masquerading as knee pain

Directory of Open Access Journals (Sweden)

Florian F. Dibra, MD

2018-03-01

Full Text Available Background: Hip osteoarthritis typically manifests with groin or thigh pain. Other atypical pain patterns, including knee pain, have been described. Except for 2 case reports, there is no literature on this subject. Methods: From our institutional database, between 2011 and 2016, we identified 21 patients who were referred for treatment of knee pain but ultimately diagnosed with hip pathology as the cause of their pain. This group was evaluated for duration of symptoms prior to diagnosis, previous interventions, presence of walking aids, and symptom resolution after treatment of the hip pathology. Results: Fifteen of the 21 patients were referred from musculoskeletal providers (12 from orthopaedic surgeons. Prior to diagnosis of the hip etiology, 16 patients were reduced to major assistive devices including wheelchairs. Twelve of 21 patients had undergone surgical knee interventions, including total knee arthroplasty, with minimal to no relief of their pain. Seventeen of 21 referred patients underwent total hip arthroplasty at our institution. Fourteen patients had complete resolution of knee pain after total hip arthroplasty. Conclusions: Although knee pain referred from hip disease may be considered a basic and common knowledge, it continues to be an overlooked phenomenon. Most of the cases were misdiagnosed by musculoskeletal providers including orthopaedic surgeons and this highlights the need for continued education and awareness of this clinical scenario. Keywords: Hip pain, Knee pain, Referred pain, Delay in diagnosis, Unnecessary surgery

Revision hip arthroplasty by Waldemar Link custom-made total hip prosthesis

Directory of Open Access Journals (Sweden)

Medenica Ivica

2010-01-01

Full Text Available Background. The number of patients undergoing hip arthroplasty revision is constantly growing. Especially, complex problem is extensive loss of bone stock and pelvic discontinuity that requires reconstruction. Case report. The paper presented a 50-year old patient, who ten years ago underwent a total cement artrhroplasty of the left hip. A year after the primary operation the patient had difficulties in walking without crutches. Problems intensified in the last five years, the patient had severe pain, totally limited movement in the left hip and could not walk at all. Radiographically, we found loose femoral component, massive loss of bone stock of proximal femur, acetabular protrusion and a consequent pelvic discontinuity. Clinically, a completely disfunctional left hip joint was registered (Harris hip score - 7.1. We performed total rearthroplasty by a custom- made Waldemar Link total hip prosthesis with acetabular antiprotrusio cage and compensation of bone defects with a graft from the bone bank. A year after the operation, we found clinically an extreme improvement in Harris hip score - 87.8. Radiographically, we found stability of implanted components, a complete graft integration and bone bridging across the site of pelvic discontinuity. Conclusion. Pelvic discontinuity and massive loss of proximal femoral bone stock is a challenging and complex entity. Conventional prostheses cannot provide an adequate fixation and stability of the hip. Application of custom-made prosthesis (measured specifically for a patient and additional alografting bone defects is a good method in revision surgery after unsuccessful hip arthroplasty with extensive bone defects.

Timing matters in hip fracture surgery: patients operated within 48 hours have better outcomes. A meta-analysis and meta-regression of over 190,000 patients.

Directory of Open Access Journals (Sweden)

Lorenzo Moja

Full Text Available To assess the relationship between surgical delay and mortality in elderly patients with hip fracture. Systematic review and meta-analysis of retrospective and prospective studies published from 1948 to 2011. Medline (from 1948, Embase (from 1974 and CINAHL (from 1982, and the Cochrane Library. Odds ratios (OR and 95% confidence intervals for each study were extracted and pooled with a random effects model. Heterogeneity, publication bias, bayesian analysis, and meta-regression analyses were done. Criteria for inclusion were retro- and prospective elderly population studies, patients with operated hip fractures, indication of timing of surgery and survival status.There were 35 independent studies, with 191,873 participants and 34,448 deaths. The majority considered a cut-off between 24 and 48 hours. Early hip surgery was associated with a lower risk of death (pooled odds ratio (OR 0.74, 95% confidence interval (CI 0.67 to 0.81; P<0.000 and pressure sores (0.48, 95% CI 0.38 to 0.60; P<0.000. Meta-analysis of the adjusted prospective studies gave similar results. The bayesian probability predicted that about 20% of future studies might find that early surgery is not beneficial for decreasing mortality. None of the confounders (e.g. age, sex, data source, baseline risk, cut-off points, study location, quality and year explained the differences between studies.Surgical delay is associated with a significant increase in the risk of death and pressure sores. Conservative timing strategies should be avoided. Orthopaedic surgery services should ensure the majority of patients are operated within one or two days.

Fractional resurfacing in the Asian patient: Current state of the art.

Science.gov (United States)

Wat, Heidi; Wu, Douglas C; Chan, Henry Hin Lee

2017-01-01

Fractionated photothermolysis (FP) has revolutionized modern laser technology. By creating selective columns of microthermal damage, fractionated devices allows for greater treatment depths to be achieved without the prolonged downtime and risk of complications seen in traditional fully ablative laser resurfacing. Fractional resurfacing is a proven method to treat a variety of cutaneous conditions. In the Caucasian patient, a wide range of devices and treatment settings can be utilized safely and effectively. However, ethnic skin requires special consideration due to its unique pigmentary characteristics and clinical presentations. In this review article, we detail the current indications and strategies to optimize results and mitigate complications when utilizing fractional resurfacing for the Asian patient. A review of the MEDLINE English literature was conducted on fractionated laser devices studied in the Asian population. Articles included describe non-ablative devices including fractionated erbium glass, thulium fiber, diode, and radiofrequency devices; and ablative devices including fractionated carbon dioxide (CO 2 ) laser, erbium yttrium aluminum garnet and yttrium scandium gallium garnet (YSGG) laser. These data were integrated with the expert opinion of the authors. Taking into account the unique characteristics and cosmetic concerns of the Asian population, fractional resurfacing can be considered a safe and effective option for the treatment of atrophic and hypertrophic scarring, and photorejuvenation in ethnic skin types. Select cases of melasma may be treated with fractionated non-ablative devices, but utilized with caution. The predominant complication associated with fractional resurfacing for these conditions is post-inflammatory hyperpigmentation (PIH) and rebound worsening of melasma. A greater number of treatments at lower density settings and wider treatment intervals typically produce the lowest risks of PIH without compromising treatment

Bipolar hip arthroplasty as salvage treatment for loosening of the acetabular cup with significant bone defects

Directory of Open Access Journals (Sweden)

Ghanem, Mohamed

2016-04-01

Full Text Available Introduction: Revision arthroplasty of the hip is becoming increasingly important in recent years. Early primary arthroplasty and longer life expectancy of the patients increases the number of revision surgery. Revision surgery of hip arthroplasty is major surgery for the patients, especially the elderly, with significant risks concerning the general condition of the patient. The aim of this work is to evaluate the outcome of bipolar hip arthroplasty as a salvage procedure for treatment of loosening of the acetabular cup with significant acetabular bone defects after total hip replacement (THR in multi-morbid patients.Patients and methods: During the period from January 1 2007 to December 31 2011 19 revision hip surgeries were performed in , in which the loosened acetabular cup was replaced by a bipolar head. The examined patient group consisted exclusively of female patients with an average of 75 years. The predominant diagnosis was “aseptic loosening” (84.2%. All patients in our study were multi-morbid. We decided to resort to bipolar hip arthroplasty due to the compromised general condition of patients and the major acetabular bone defects, which were confirmed intraoperatively. The postoperative follow-up ranged from 0.5 to 67 months (average 19.1 months. Results: Evaluation of the modified Harris Hip Score showed an overall improvement of the function of the hip joint after surgery of approximately 45%.Surgery was less time consuming and thus adequate for patients with significantly poor general health condition. We noticed different complications in a significant amount of patients (68.4%. The most common complication encountered was the proximal migration of the bipolar head.The rate of revision following the use of bipolar hip arthroplasty in revision surgery of the hip in our patients was high (21%. Despite the high number of complications reported in our study, we have noticed significant improvement of hip joint function as well

A comparison of the fascia iliaca block to the lumbar plexus block in providing analgesia following arthroscopic hip surgery: A randomized controlled clinical trial.

Science.gov (United States)

Badiola, Ignacio; Liu, Jiabin; Huang, Stephanie; Kelly, John D; Elkassabany, Nabil

2018-05-31

This randomized controlled single blinded clinical trial compared the fascia iliaca block (FIB) and the lumbar plexus block (LPB) in patients with moderate to severe pain following hip arthroscopic surgery. Single blinded randomized trial. Postoperative recovery area, postoperative days 0 and 1. Fifty patients undergoing hip arthroscopy were approached in the Post Anesthesia Care Unit (PACU) if they had moderate to severe pain (defined as > or equal 4/10 on the numeric rating scale). Twenty-five patients were allocated to the FIB and twenty-five patients to the LPB. Fascia iliaca block or lumbar plexus block. A blinded observer recorded pain scores just prior to the block, 15 min following the block (primary endpoint), and then every 15 min for 2 h (or until the patient was discharged). Total PACU time and opioid use were recorded. Pain scores and analgesic use on postoperative day (POD) 0, and POD 1 were recorded. At 24 h post block the Quality of Recovery 9 questionnaire was administered. The mean pre-block pain scores were comparable between the two groups (P = 0.689). There was no difference in mean post block pain scores between the two groups at 15 min (P = 0.054). In the PACU patients who underwent a LPB consumed less opioids compared to FIB patients (P = 0.02), however no differences were noted between the two groups in PACU length of stay, or POD 0 or 1 opioid use. A fascia iliaca block is not inferior to a lumbar plexus block in reducing PACU pain scores in patients with moderate to severe pain following hip arthroscopic surgery and is a viable option to help manage postoperative pain following hip arthroscopic surgery. Copyright © 2018. Published by Elsevier Inc.

Upper Eyelid Fractional CO2 Laser Resurfacing With Incisional Blepharoplasty.

Science.gov (United States)

Kotlus, Brett S; Schwarcz, Robert M; Nakra, Tanuj

2016-01-01

Laser resurfacing, performed at the same time as blepharoplasty, has most commonly been applied to the lower eyelid skin but can effectively be used on the upper eyelid to reduce rhytidosis and improve skin quality. The authors evaluate the safety and efficacy of this procedure. Fractional CO2 laser resurfacing was performed in conjunction with incisional upper blepharoplasty. The ultrapulsed laser energy was applied to the sub-brow skin, the upper medial canthal skin, and the pretarsal skin in 30 patients. Photos were obtained preoperatively and at 3 months. All patients demonstrated reduction in upper eyelid rhytidosis without any serious complications. Independent rhytidosis grading (0-4) showed a mean improvement of 42%. One patient experienced wound dehiscence that satisfactorily resolved without intervention. Upper eyelid laser resurfacing is effective and can be safely performed at the same time as upper blepharoplasty. This approach reduces or eliminates the need for medial incisions to address medial canthal skin redundancy and rhytidosis and it directly treats upper eyelid wrinkles on residual eyelid and infra-brow skin during blepharoplasty.

Insulin sensitivity and beta-cell function after carbohydrate oral loading in hip replacement surgery: a double-blind, randomised controlled clinical trial.

Science.gov (United States)

Ljunggren, Stefan; Hahn, Robert G; Nyström, Thomas

2014-06-01

Surgery initiates a series of physiological stress processes in the body, inducing transient insulin resistance. Preoperative carbohydrate treatment can reduce the latter phenomenon. We investigated the effects of carbohydrate loading on insulin sensitivity and beta-cell function after elective hip replacement. Twenty-three nondiabetic patients (mean age of 68 years) who underwent elective hip replacement surgery participated in this double-blind controlled study. The patients were randomised to a nutrition group, which ingested a carbohydrate-rich fluid (50 kcal/100 ml) (Preop(®)), or a control group (tap water flavoured with lemon) 800 ml + 400 ml before the surgery. The insulin response (beta-cell function) and the insulin sensitivity were measured with an intravenous glucose tolerance test (IVGTT) and a hyperinsulinaemic euglycaemic glucose clamp, respectively, one day before and two days after the surgery. Insulin sensitivity decreased by 51% (median; 25-75th percentiles 35-61) after ingesting Preop(®) and by 39% (21-51) after ingesting in the control group (n.s.). The postoperative IVGTT in the nutrition group was followed by a significantly larger area under the curve (AUC) for plasma insulin (+54% versus the preoperative IVGTT) compared to the control group (+7%). This difference was already apparent during the first phase (0-10 min) of insulin secretion (+20 and -21%, respectively; P water prior to the surgery demonstrated a significant but similar decrease in insulin sensitivity. The carbohydrates increased the beta-cell function as a compensatory response to the disposition index, resulting in a smaller reduction in surgery-induced insulin resistance compared to the tap water. The study was registered at http://www.clinicaltrials.gov (NCT01774084). Copyright © 2013 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Management of anticoagulation in hip fractures: A pragmatic approach.

Science.gov (United States)

Yassa, Rafik; Khalfaoui, Mahdi Yacine; Hujazi, Ihab; Sevenoaks, Hannah; Dunkow, Paul

2017-09-01

Hip fractures are common and increasing with an ageing population. In the United Kingdom, the national guidelines recommend operative intervention within 36 hours of diagnosis. However, long-term anticoagulant treatment is frequently encountered in these patients which can delay surgical intervention. Despite this, there are no set national standards for management of drug-induced coagulopathy pre-operatively in the context of hip fractures.The aim of this study was to evaluate the management protocols available in the current literature for the commonly encountered coagulopathy-inducing agents.We reviewed the current literature, identified the reversal agents used in coagulopathy management and assessed the evidence to determine the optimal timing, doses and routes of administration.Warfarin and other vitamin K antagonists (VKA) can be reversed effectively using vitamin K with a dose in the range of 2 mg to 10 mg intravenously to correct coagulopathy.The role of fresh frozen plasma is not clear from the current evidence while prothrombin complex remains a reliable and safe method for immediate reversal of VKA-induced coagulopathy in hip fracture surgery or failed vitamin K treatment reversal.The literature suggests that surgery should not be delayed in patients on classical antiplatelet medications (aspirin or clopidogrel), but spinal or regional anaesthetic methods should be avoided for the latter. However, evidence regarding the use of more novel antiplatelet medications (e.g. ticagrelor) and direct oral anticoagulants remains a largely unexplored area in the context of hip fracture surgery. We suggest treatment protocols based on best available evidence and guidance from allied specialties.Hip fracture surgery presents a common management dilemma where semi-urgent surgery is required. In this article, we advocate an evidence-based algorithm as a guide for managing these anticoagulated patients. Cite this article: EFORT Open Rev 2017;2:394-402. DOI: 10.1302/2058-5241.2.160083.

Hip pathology in Majewski osteodysplastic primordial dwarfism type II.

Science.gov (United States)

Karatas, Ali F; Bober, Michael B; Rogers, Kenneth; Duker, Angela L; Ditro, Colleen P; Mackenzie, William G

2014-09-01

Majewski osteodysplastic primordial dwarfism type II (MOPDII) is characterized by severe prenatal and postnatal growth failure with microcephaly, characteristic skeletal dysplasia, an increased risk for cerebrovascular disease, and insulin resistance. MOPDII is caused by mutations in the pericentrin (PCNT) gene and is inherited in an autosomal-recessive manner. This study aimed to determine the incidence of hip pathology in patients with molecularly confirmed MOPDII and to describe the functional outcomes of surgical treatment. Thirty-three enrolled patients had a clinical diagnosis of MOPDII. Biallelic PCNT mutations or absent pericentrin protein was confirmed in 25 of these patients. Twelve patients (7 female) had appropriate clinical and radiographic records at this institution and were included in this study. The data collected included age at presentation, age at surgery, sex, body weight and height, weight-bearing status at diagnosis, and the clinical examination. Four patients (31%) had coxa vara: 3 unilateral and 1 bilateral. Three unilateral patients had in situ pinning at a mean age 4 years. The patient with bilateral coxa vara had valgus osteotomy at the age of 5 years. Two children had bilateral hip dysplasia and subluxation with no surgery. One patient had bilateral developmental hip dislocations. The patient was treated by open reduction-spica cast and 2 years after surgery, coxa valga was noted. Another patient was diagnosed at an age of 12 years with bilateral avascular necrosis of the hips. Four patients did not have hip pathology. Hip pathology is common among children with MOPDII; coxa vara is the most frequent diagnosis. Routine clinical and radiographic hip evaluation is important. The capital femoral epiphysis appears to slip down along the shaft, giving the appearance of a proximal femoral epiphysiolysis. A hip diagnosed with slipped capital femoral epiphysis in early life may progress to severe coxa vara. Level IV.

Improving older frail hip fracture patients’ experience and recovery:

DEFF Research Database (Denmark)

Bagger, Bettan; Taylor Kelly, Hélène; Kjøller varmarken, Tine

Background: An Interregional Project named Pro-hip aims at improving hip surgery patients’ outcomes based on best evidence in relation to rehabilitation; nutrition; urine retention; delirium and pressure ulcers. This presentation is an introduction to a new evidence based standard developed...

Association Between Preoperative Malnutrition and Postoperative Delirium After Hip Fracture Surgery in Older Adults.

Science.gov (United States)

Mazzola, Paolo; Ward, Libby; Zazzetta, Sara; Broggini, Valentina; Anzuini, Alessandra; Valcarcel, Breanna; Brathwaite, Justin S; Pasinetti, Giulio M; Bellelli, Giuseppe; Annoni, Giorgio

2017-06-01

To determine whether poor nutritional status can predict postoperative delirium in elderly adults undergoing hip fracture surgery. Prospective observational cohort study. Italian orthogeriatric unit. Individuals aged 70 and older (mean age 84.0 ± 6.6, 74.5% female) consecutively admitted for surgical repair of a proximal femur fracture between September 2012 and April 2016 (N = 415). Participants underwent a comprehensive geriatric assessment including nutritional status, which was evaluated using the Mini Nutritional Assessment Short Form (MNA-SF). The MNA-SF-based three-class stratification was tested using multivariable logistic regression to assess its role in predicting postoperative delirium (outcome). Seventy-eight malnourished individuals (MNA-SF score 0-7), 185 at risk of malnutrition (MNA-SF score 8-11), and 152 who were well nourished (MNA-SF score 12-14) were compared. On average, individuals with poor nutritional status were more disabled and more cognitively impaired than those who were well nourished and those at risk of malnutrition. Moreover, those who were malnourished were more likely to have postoperative delirium. Multivariate regression analysis adjusted for age, sex, comorbidity, functional impairment, preoperative cognitive status, and American Society of Anesthesiologists score showed that those who were at risk of malnutrition (odds ratio (OR) = 2.42, 95% confidence interval (CI) = 1.29-4.53) and those who were overtly malnourished (OR = 2.98, 95% CI = 1.43-6.19) were more likely to develop postoperative delirium. This is the first study in a Western population showing that risk of malnutrition and overt malnutrition, as assessed using the MNA-SF, are independent predictors of postoperative delirium. Accordingly, nutritional status should be assessed in individuals with hip fracture before surgery to determine risk of developing delirium. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

Structural-Geometric Functionalization of the Additively Manufactured Prototype of Biomimetic Multispiked Connecting Ti-Alloy Scaffold for Entirely Noncemented Resurfacing Arthroplasty Endoprostheses

Directory of Open Access Journals (Sweden)

Ryszard Uklejewski

2017-01-01

Full Text Available The multispiked connecting scaffold (MSC-Scaffold prototype, inspired by the biological system of anchorage of the articular cartilage in the periarticular trabecular bone by means of subchondral bone interdigitations, is the essential innovation in fixation of the bone in resurfacing arthroplasty (RA endoprostheses. The biomimetic MSC‐Scaffold, due to its complex geometric structure, can be manufactured only using additive technology, for example, selective laser melting (SLM. The major purpose of this work is determination of constructional possibilities for the structural-geometric functionalization of SLM‐manufactured MSC‐Scaffold prototype, compensating the reduced ability—due to the SLM technological limitations—to accommodate the ingrowing bone filling the interspike space of the prototype, which is important for the prototype bioengineering design. Confocal microscopy scanning of components of the SLM‐manufactured prototype of total hip resurfacing arthroplasty (THRA endoprosthesis with the MSC‐Scaffold was performed. It was followed by the geometric measurements of a variety of specimens designed as the fragments of the MSC-Scaffold of both THRA endoprosthesis components. The reduced ability to accommodate the ingrowing bone tissue in the SLM‐manufactured prototypes versus that in the corresponding CAD models has been quantitatively determined. Obtained results enabled to establish a way of compensatory structural‐geometric functionalization, allowing the MSC‐Scaffold adequate redesigning and manufacturing in additive SLM technology.

Preoperative Education for Hip and Knee Replacement: Never Stop Learning.

Science.gov (United States)

Edwards, Paul K; Mears, Simon C; Lowry Barnes, C

2017-09-01

Participation in alternative payment models has focused efforts to improve outcomes and patient satisfaction while also lowering cost for elective hip and knee replacement. The purpose of this review is to determine if preoperative education classes for elective hip and knee replacement achieve these goals. Recent literature demonstrates that patients who attend education classes prior to surgery have decreased anxiety, better post-operative pain control, more realistic expectations of surgery, and a better understanding of their surgery. As a result, comprehensive clinical pathways incorporating a preoperative education program for elective hip and knee replacement lead to lower hospital length of stay, higher home discharge, lower readmission, and improved cost. In summary, we report convincing evidence that preoperative education classes are an essential element to successful participation in alternative payment models such as the Bundle Payment Care Initiative.

[Randomised comparative study of early versus delayed surgery in hip-fracture patients on concomitant treatment with antiplatelet drugs. Determination of platelet aggregation, perioperative bleeding and a review of annual mortality].

Science.gov (United States)

Mas-Atance, J; Marzo-Alonso, C; Matute-Crespo, M; Trujillano-Cabello, J J; Català-Tello, N; de Miguel-Artal, M; Forcada-Calvet, P; Fernández-Martínez, J J

2013-01-01

A review of the perioperative management of patients with hip fractures and concomitant therapy with antiplatelet agents, and to analyse the differences in mortality and perioperative bleeding in early surgery (5 days). Platelet aggregation was measured on admission and immediately before surgery in all patients included in the study A total of 175 patients over 65 years old, with low energy hip fracture were randomised into 3 groups: Patients on antiplatelet therapy undergoing early surgery, patients on antiplatelet therapy undergoing delayed surgery, and patients not on antiplatelet therapy undergoing early surgery. The same clinical and laboratory data were collected prospectively up to 12 months for all the patients. The platelet aggregation was determined by a semi-quantitative computerised system based on impedance aggregometry in whole blood. Bleeding, transfusion requirements and analytical results showed no significant differences between groups. More than half (59.8%) of the patients not taking antiplatelet therapy had normal platelet aggregation on admission, while 13.5% of those taking antiplatelet agents did not. Multivariate analysis showed increased mortality at 12 months for the variables, low Barthel index before hip fracture (OR: 0.9-0.9) and number of transfusions (OR: 1.1-1.5). The average lenth of stay was 4.1 days greater in the delayed surgery group. Early surgery for patients receiving antiplatelet therapy has similar clinical outcomes to the delayed, but improves hospital efficiency by reducing the average length of stay. The antiplatelet drug reported by the patient showed low concordance with the determination of the platelet aggregation. Copyright © 2011 SECOT. Published by Elsevier Espana. All rights reserved.

Fractional ablative laser skin resurfacing: a review.

Science.gov (United States)

Tajirian, Ani L; Tarijian, Ani L; Goldberg, David J

2011-12-01

Ablative laser technology has been in use for many years now. The large side effect profile however has limited its use. Fractional ablative technology is a newer development which combines a lesser side effect profile along with similar efficacy. In this paper we review fractional ablative laser skin resurfacing.

Early results of patellofemoral inlay resurfacing arthroplasty using the HemiCap Wave prosthesis.

Science.gov (United States)

Patel, Akash; Haider, Zakir; Anand, Amarjit; Spicer, Dominic

2017-01-01

Common surgical treatment options for isolated patellofemoral osteoarthritis include arthroscopic procedures, total knee replacement and patellofemoral replacement. The HemiCap Wave patellofemoral resurfacing prosthesis is a novel inlay design introduced in 2009 with scarce published data on its functional outcomes. We aim to prospectively evaluate early functional outcomes and complications, for patients undergoing a novel inlay resurfacing arthroplasty for isolated patellofemoral arthrosis in an independent centre. From 2010 to 2013, 16 consecutive patients underwent patellofemoral resurfacing procedures using HemiCap Wave (Arthrosurface Inc., Franklin, Massachusetts, USA) for anterior knee pain with confirmed radiologically and/or arthroscopically isolated severe patellofemoral arthrosis. Standardized surgical technique, as recommended by the implant manufacturer, was followed. Outcome measures included range of movement, functional knee scores (Oxford Knee Score (OKS), Knee Injury and Osteoarthritis Outcome Score (KOOS) and Short Form-36 (SF-36)), radiographic disease progression, revision rates and complications. Eight men and eight women underwent patellofemoral HemiCap Wave resurfacing, with an average age of 63 years (range: 46-83). Average follow-up was 24.1 months (6-34). Overall, post-operative scores were excellent. There was a statistically significant improvement in the post-operative OKS, KOOS and SF-36 scores ( p patellofemoral resurfacing prosthesis has excellent early results in terms of functional outcomes, radiological outcomes and low complication rates. At the very least, early results show that the HemiCap Wave is comparable to more established onlay prostheses. The HemiCap Wave thus provides a safe and effective surgical option in the treatment of isolated patellofemoral osteoarthritis in selected patients.

Ablative skin resurfacing with a novel microablative CO2 laser.

Science.gov (United States)

Gotkin, Robert H; Sarnoff, Deborah S; Cannarozzo, Giovanni; Sadick, Neil S; Alexiades-Armenakas, Macrene

2009-02-01

Carbon dioxide (CO2) laser skin resurfacing has been a mainstay of facial rejuvenation since its introduction in the mid 1990s. Recently, a new generation of fractional or microablative CO2 lasers has been introduced to the marketplace. According to the concept of fractional photothermolysis, these lasers ablate only a fraction of the epidermal and dermal architecture in the treatment area. An array of microscopic thermal wounds is created that ablates the epidermis and dermis within very tiny zones; adjacent to these areas, the epidermis and dermis are spared. This microablative process of laser skin resurfacing has proven safe and effective not only for facial rejuvenation, but elsewhere on the body as well. It is capable of improving wrinkles, acne scars, and other types of atrophic scars and benign pigmented lesions associated with elastotic, sun-damaged skin. Because of the areas of spared epidermis and dermis inherent in a procedure that employs fractional photothermolysis, healing is more rapid compared to fully ablative CO2 laser skin resurfacing and downtime is proportionately reduced. A series of 32 consecutive patients underwent a single laser resurfacing procedure with the a new microablative CO2 laser. All patients were followed for a minimum of 6 months and were asked to complete patient satisfaction questionnaires; a 6 month postoperative photographic evaluation by an independent physician, not involved in the treatment, was also performed. Both sets of data were graded and reported on a quartile scale. Results demonstrated greater than 50% improvement in almost all patients with those undergoing treatment for wrinkles, epidermal pigment or solar elastosis deriving the greatest change for the better (>75%).

The effect of education and supervised exercise vs. education alone on the time to total hip replacement in patients with severe hip osteoarthritis. A randomized clinical trial protocol.

Science.gov (United States)

Jensen, Carsten; Roos, Ewa M; Kjærsgaard-Andersen, Per; Overgaard, Søren

2013-01-14

The age- and gender-specific incidence of total hip replacement surgery has increased over the last two decades in all age groups. Recent studies indicate that non-surgical interventions are effective in reducing pain and disability, even at later stages of the disease when joint replacement is considered. We hypothesize that the time to hip replacement can be postponed in patients with severe hip osteoarthritis following participation in a patient education and supervised exercise program when compared to patients receiving patient education alone. A prospective, blinded, parallel-group multi-center trial (2 sites), with balanced randomization [1:1]. Patients with hip osteoarthritis and an indication for hip replacement surgery, aged 40 years and above, will be consecutively recruited and randomized into two treatment groups. The active treatment group will receive 3 months of supervised exercise consisting of 12 sessions of individualized, goal-based neuromuscular training, and 12 sessions of intensive resistance training plus patient education (3 sessions). The control group will receive only patient education (3 sessions). The primary end-point for assessing the effectiveness of the intervention is 12 months after baseline. However, follow-ups will also be performed once a year for at least 5 years. The primary outcome measure is the time to hip replacement surgery measured on a Kaplain-Meier survival curve from time of inclusion. Secondary outcome measures are the five subscales of the Hip disability and Osteoarthritis Outcome Score, physical activity level (UCLA activity score), and patient's global perceived effect. Other measures include pain after exercise, joint-specific adverse events, exercise adherence, general health status (EQ-5D-5L), mechanical muscle strength and performance in physical tests. A cost-effectiveness analysis will also be performed. To our knowledge, this is the first randomized clinical trial comparing a patient education plus

Interventions for Hip Pain in the Maturing Athlete

Science.gov (United States)

Gomberawalla, M. Mustafa; Kelly, Bryan T.; Bedi, Asheesh

2014-01-01

Context: Femoroacetabular impingement (FAI) alters hip mechanics, results in hip pain, and may lead to secondary osteoarthritis (OA) in the maturing athlete. Hip impingement can be caused by osseous abnormalities in the proximal femur or acetabulum. These impingement lesions may cause altered loads within the hip joint, which result in repetitive collision damage or sheer forces to the chondral surfaces and acetabular labrum. These anatomic lesions and resultant abnormal mechanics may lead to early osteoarthritic changes. Evidence Acquisition: Relevant articles from the years 1995 to 2013 were identified using MEDLINE, EMBASE, and the bibliographies of reviewed publications. Level of Evidence: Level 4. Results: Improvements in hip arthroscopy have allowed FAI to be addressed utilizing the arthroscope. Adequately resecting the underlying osseous abnormalities is essential to improving hip symptomatology and preventing further chondral damage. Additionally, preserving the labrum by repairing the damaged tissue and restoring the suction seal may theoretically help normalize hip mechanics and prevent further arthritic changes. The outcomes of joint-preserving treatment options may be varied in the maturing athlete due to the degree of underlying OA. Irreversible damage to the hip joint may have already occurred in patients with moderate to advanced OA. In the presence of preexisting arthritis, these patients may only experience fair or even poor results after hip arthroscopy, with early conversion to hip replacement. For patients with advanced hip arthritis, total hip arthroplasty remains a treatment option to reliably improve symptoms with good to excellent outcomes and return to low-impact activities. Conclusion: Advances in the knowledge base and treatment techniques of intra-articular hip pain have allowed surgeons to address this complex clinical problem with promising outcomes. Traditionally, open surgical dislocations for hip preservation surgery have shown good

Clinical Outcomes and 90-Day Costs Following Hemiarthroplasty or Total Hip Arthroplasty for Hip Fracture.

Science.gov (United States)

Nichols, Christine I; Vose, Joshua G; Nunley, Ryan M

2017-09-01

In the era of bundled payments, many hospitals are responsible for costs from admission through 90 days postdischarge. Although bundled episodes for hip fracture will have a separate target price for the bundle, little is known about the 90-day resource use burden for this patient population. Using Medicare 100% Standard Analytic Files (2010-2014), we identified patients undergoing hemiarthroplasty or total hip arthroplasty (THA). Patients were aged 65 and older with admitting diagnosis of closed hip fracture, no concurrent fractures of the lower limb, and no history of hip surgery in the prior 12 months baseline. Continuous Medicare-only enrollment was required. Complications, resource use, and mortality from admission through 90 days following discharge (follow-up) were summarized. Four cohorts met selection criteria for analysis: (1) hemiarthroplasty diagnosis-related group (DRG) 469 (N = 19,634), (2) hemiarthroplasty DRG 470 (N = 77,744), (3) THA DRG 469 (N = 1686), and (4) THA DRG 470 (N = 9314). All-cause mortality during the study period was 51.6%, 29.5%, 48.1%, and 24.9% with mean 90-day costs of $28,952, $19,243, $29,763, and $18,561, respectively. Most of the patients waited 1 day from admission to surgery (41%-51%). Incidence of an all-cause complication was approximately 70% in each DRG 469 cohort and 14%-16% in each DRG 470 cohort. This study confirms patients with hip fracture are a costly subpopulation. Tailored care pathways to minimize post-acute care resource use are warranted for these patients. Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved.

Burden of blood transfusion in knee and hip surgery in the US and Belgium.

Science.gov (United States)

Blanchette, Christopher M; Joshi, Ashish V; Szpalski, Marek; Gunzburg, Robert; Du Bois, Mark; Donceel, Peter; Saunders, William B

2009-09-01

Transfusion services in orthopaedic surgery can lead to unnecessary complications and increased healthcare costs. The objective of this study was to assess treatments and costs associated with blood and blood product transfusions in a historical cohort of 189,457 inpatients in the US and 34,987 inpatients in Belgium undergoing knee or hip surgery. Descriptive analysis, logistic regression and ordinary least squares regression were used to describe the factors associated with the use and cost of allogeneic blood transfusion. Hospitalisation costs for joint replacement surgery totalled $12,718 (SD=6,356) and averaged 4.33 days in the US, while costs in Belgium were $6,526 (SD=3,192) and averaged 17.1 days. The use of low molecular weight heparin and tranexamic acid was much higher in Belgium than the US (36% and 99% compared to 0% and 40%, respectively). Patients in the US spent 12.7 (pcosts per hospitalisation than patients in Belgium. While hospital costs for patients were greater in the US, length of stay was shorter and patients were less likely to have transfusion services than those patients in Belgium. While this study is limited by factors inherent to observational studies, such as omitted variable bias, misclassification, and disease comorbidity, there are substantial differences in the use of blood products between Belgium and the US.

The effect of education of nurses on preventing catheter-associated urinary tract infections in patients who undergo hip fracture surgery.

Science.gov (United States)

Seyhan Ak, Ezgi; Özbaş, Ayfer

2018-03-01

The aim of the study was to investigate the effect of educating nurses on preventing catheter-associated urinary tract infections in patients who undergo hip fracture surgery. Urinary tract infections after hip fracture surgery are observed at a rate of 12% to 61%, and the most important risk factor associated with urinary tract infection is considered to be the presence of urinary catheters. Nurse education about the use and management of urinary catheters is important to decrease the risk of urinary tract infections. The study was semi-experimental. The study was conducted in an orthopedics and traumatology clinic of a training hospital between January 2014-December 2015. After a power analysis was performed, a total of 60 patients fulfilled the criteria to be included in the study, with n = 30 in the pre-education group and n = 30 in the posteducation group. Nurses who worked in the orthopedics and traumatology clinic of the military hospital were the target population, and 18 nurses who consented to join the study constituted the sample. The "Patient Monitoring Form," "Nurse Information Form" and "Daily Urinary Catheter Assessment Tool" were used as data collection tools. The mean pre-education knowledge score of the nurses was found to be 68.05 ± 10.69, while the mean posteducation score was 95.13 ± 6.27. The mean catheter duration decreased from 11.06 ± 6.34 days-3.83 ± 0.95 days after the education. The catheter-associated urinary tract infection rate decreased by 9.37 per thousand. Educating nurses on preventing catheter-associated urinary tract infections in patients who underwent hip fracture surgery significantly decreased the rate of catheter-associated urinary tract infections and the duration of catheterisation. The systematic and comprehensive education of all healthcare professionals and the development and practice of catheter removal protocols could contribute to the prevention of catheter-associated urinary tract infections. �

Bone Metabolism after Total Hip Revision Surgery with Impacted Grafting: Evaluation using H215O and [18F]fluoride PET; A Pilot Study

NARCIS (Netherlands)

Temmerman, Olivier; Raijmakers, Pieter; Heyligers, Ide; Comans, Emile; Lubberink, Mark; Teule, Gerrit; Lammertsma, Adriaan

2008-01-01

Purpose: To evaluate bone blood flow and bone formation in patients after total hip revision surgery with impacted bone grafting using H2 15O and [18F]fluoride positron emission tomography (PET). Procedures: To asses bone blood flow and bone metabolism in bone allograft after impaction grafting,

Viscous relaxation as a prerequisite for tectonic resurfacing on Ganymede: Insights from numerical models of lithospheric extension

Science.gov (United States)

Bland, Michael T.; McKinnon, William B.

2018-05-01

Ganymede's bright terrain formed during a near-global resurfacing event (or events) that produced both heavily tectonized and relatively smooth terrains. The mechanism(s) by which resurfacing occurred on Ganymede (e.g., cryovolcanic or tectonic), and the relationship between the older, dark and the younger, bright terrain are fundamental to understanding the geological evolution of the satellite. Using a two-dimensional numerical model of lithospheric extension that has previously been used to successfully simulate surface deformation consistent with grooved terrain morphologies, we investigate whether large-amplitude preexisting topography can be resurfaced (erased) by extension (i.e., tectonic resurfacing). Using synthetically produced initial topography, we show that when the total relief of the initial topography is larger than 25-50 m, periodic groove-like structures fail to form. Instead, extension is localized in a few individual, isolated troughs. These results pose a challenge to the tectonic resurfacing hypothesis. We further investigate the effects of preexisting topography by performing suites of simulations initialized with topography derived from digital terrain models of Ganymede's surface. These include dark terrain, fresh (relatively deep) impact craters, smooth bright terrain, and a viscously relaxed impact crater. The simulations using dark terrain and fresh impact craters are consistent with our simulations using synthetic topography: periodic groove-like deformation fails to form. In contrast, when simulations were initialized with bright smooth terrain topography, groove-like deformation results from a wide variety of heat flow and surface temperature conditions. Similarly, when a viscously relaxed impact crater was used, groove-like structures were able to form during extension. These results suggest that tectonic resurfacing may require that the amplitude of the initial topography be reduced before extension begins. We emphasize that viscous

Current Status of Fractional Laser Resurfacing.

Science.gov (United States)

Carniol, Paul J; Hamilton, Mark M; Carniol, Eric T

2015-01-01

Fractional lasers were first developed based on observations of lasers designed for hair transplantation. In 2007, ablative fractional laser resurfacing was introduced. The fractionation allowed deeper tissue penetration, leading to greater tissue contraction, collagen production and tissue remodeling. Since then, fractional erbium:YAG resurfacing lasers have also been introduced. These lasers have yielded excellent results in treating photoaging, acne scarring, and dyschromia. With the adjustment of microspot density, pulse duration, number of passes, and fluence, the surgeon can adjust the treatment effects. These lasers have allowed surgeons to treat patients with higher Fitzpatrick skin types (types IV to VI) and greater individualize treatments to various facial subunits. Immunohistochemical analysis has demonstrated remodeling effects of the tissues for several months, producing longer lasting results. Adjuvant treatments are also under investigation, including concomitant face-lift, product deposition, and platelet-rich plasma. Finally, there is a short recovery time from treatment with these lasers, allowing patients to resume regular activities more quickly. Although there is a relatively high safety profile for ablative fractionated lasers, surgeons should be aware of the limitations of specific treatments and the associated risks and complications.

Adverse Outcomes in Infantile Bilateral Developmental Dysplasia of the Hip.

Science.gov (United States)

Morbi, Abigail H M; Carsi, Belen; Gorianinov, Vitalli; Clarke, Nicholas M P

2015-01-01

It is believed that bilateral developmental dysplasia of the hip (DDH) has poorer outcomes with higher rates of avascular necrosis (AVN) and reintervention, compared with unilateral DDH. However, there is limited evidence in the literature, with few studies looking specifically at bilateral cases. A retrospective review of 36 patients (72 hips) with >4 years of follow-up. Patient population included surgically treated DDH including late presentations and failures of conservative treatment. The dislocated hips underwent either simultaneous closed or 1 open and 1 closed, or sequential open reduction. AVN and secondary procedures were used as endpoints for analysis as well as clinical and radiologic outcomes. At the last follow-up, 33% of hips had radiologic signs of AVN. Those hips that had no ossific nucleus (ON) at the time of surgery had an odds ratio of developing AVN of 3.05 and a statistically significant association between the 2 variables, whereas open/closed or simultaneous/sequential reduction did not increase the risk for AVN. In addition, 45.8% of those hips required further surgery. The estimated odds ratio of needing additional surgery after simultaneous reduction was 4.04. Clinically, 79.2% of the hips were graded as McKay I, whereas radiologically only 38.8% were Severin I. The AVN rate in bilateral DDH treated surgically is greater than the rate noted in unilateral cases from the same institution undergoing identical protocols. There was no difference in AVN rates between simultaneous and sequential or between the first and second hip to be sequentially reduced. Presence of ON decreases the risk for AVN, suggesting that in bilateral cases, awaiting the appearance of the ON is an important tool to reduce the incidence of AVN. IV.

Concomitant Hip Arthroscopy and Periacetabular Osteotomy.

Science.gov (United States)

Domb, Benjamin G; LaReau, Justin M; Hammarstedt, Jon E; Gupta, Asheesh; Stake, Christine E; Redmond, John M

2015-11-01

To detail our early experience using concomitant hip arthroscopy and periacetabular osteotomy (PAO) for the treatment of acetabular dysplasia. We prospectively collected and retrospectively reviewed the surgical and outcome data of 17 patients who underwent concomitant hip arthroscopy and PAO between October 2010 and July 2013. Preoperative and postoperative range of motion, outcome and pain scores, and radiographic data were collected. Intraoperative arthroscopic findings and postoperative complications were recorded. The group consisted of 3 male and 14 female patients with a mean follow-up period of 2.4 years. Three patients had undergone previous surgery on the affected hip. Chondrolabral pathology was identified in all 17 patients. Twelve patients underwent labral repair, and five patients underwent partial labral debridement. No patient was converted to total hip arthroplasty or required revision surgery at short-term follow-up. All 4 patient-reported outcome scores showed statistically significant changes from baseline to latest follow-up (P arthroscopy and PAO has been favorable. We noted that all our patients have evidence of chondrolabral damage at the time of PAO when the joint is distracted and evaluated. All patients in this series had intra-articular pathology treated arthroscopically and showed satisfactory mean clinical improvement. Hip arthroscopy with PAO did not appear to introduce complications beyond the PAO alone. Level IV, therapeutic case series. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Total hip and knee replacement surgery results in changes in leukocyte and endothelial markers

Directory of Open Access Journals (Sweden)

Maclean Kirsty M

2010-01-01

Full Text Available Abstract Background It is estimated that over 8 million people in the United Kingdom suffer from osteoarthritis. These patients may require orthopaedic surgical intervention to help alleviate their clinical condition. Investigations presented here was to test the hypothesis that total hip replacement (THR and total knee replacement (TKR orthopaedic surgery result in changes to leukocyte and endothelial markers thus increasing inflammatory reactions postoperatively. Methods During this 'pilot study', ten test subjects were all scheduled for THR or TKR elective surgery due to osteoarthritis. Leukocyte concentrations were measured using an automated full blood count analyser. Leukocyte CD11b (Mac-1 and CD62L cell surface expression, intracellular production of H2O2 and elastase were measured as markers of leukocyte function. Von Willebrand factor (vWF and soluble intercellular adhesion molecule-1 (sICAM-1 were measured as markers of endothelial activation. Results The results obtained during this study demonstrate that THR and TKR orthopaedic surgery result in similar changes of leukocyte and endothelial markers, suggestive of increased inflammatory reactions postoperatively. Specifically, THR and TKR surgery resulted in a leukocytosis, this being demonstrated by an increase in the total leukocyte concentration following surgery. Evidence of leukocyte activation was demonstrated by a decrease in CD62L expression and an increase in CD11b expression by neutrophils and monocytes respectively. An increase in the intracellular H2O2 production by neutrophils and monocytes and in the leukocyte elastase concentrations was also evident of leukocyte activation following orthopaedic surgery. With respect to endothelial activation, increases in vWF and sICAM-1 concentrations were demonstrated following surgery. Conclusion In general it appeared that most of the leukocyte and endothelial markers measured during these studies peaked between days 1

Fractional versus ablative erbium:yttrium-aluminum-garnet laser resurfacing for facial rejuvenation: an objective evaluation.

Science.gov (United States)

El-Domyati, Moetaz; Abd-El-Raheem, Talal; Abdel-Wahab, Hossam; Medhat, Walid; Hosam, Wael; El-Fakahany, Hasan; Al Anwer, Mustafa

2013-01-01

Laser is one of the main tools for skin resurfacing. Erbium:yttrium-aluminum-garnet (Er:YAG) was the second ablative laser, after carbon dioxide, emitting wavelength of 2940 nm. Fractional laser resurfacing has been developed to overcome the drawbacks of ablative lasers. We aimed to objectively evaluate the histopathological and immunohistochemical effects of Er:YAG 2940-nm laser for facial rejuvenation (multiple sessions of fractional vs single session of ablative Er:YAG laser). Facial resurfacing with single-session ablative Er:YAG laser was performed on 6 volunteers. Another 6 were resurfaced using fractional Er:YAG laser (4 sessions). Histopathological (hematoxylin-eosin, orcein, Masson trichrome, and picrosirius red stains) and immunohistochemical assessment for skin biopsy specimens were done before laser resurfacing and after 1 and 6 months. Histometry for epidermal thickness and quantitative assessment for neocollagen formation; collagen I, III, and VII; elastin; and tropoelastin were done for all skin biopsy specimens. Both lasers resulted in increased epidermal thickness. Dermal collagen showed increased neocollagen formation with increased concentration of collagen types I, III, and VII. Dermal elastic tissue studies revealed decreased elastin whereas tropoelastin concentration increased after laser resurfacing. Neither laser showed significant difference between their effects clinically and on dermal collagen. Changes in epidermal thickness, elastin, and tropoelastin were significantly more marked after ablative laser. The small number of patients is a limitation, yet the results show significant improvement. Multiple sessions of fractional laser have comparable effects to a single session of ablative Er:YAG laser on dermal collagen but ablative laser has more effect on elastic tissue and epidermis. Copyright © 2012 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

Transfusion practice in hip arthroplasty - a nationwide study

DEFF Research Database (Denmark)

Jans, Øivind; Kehlet, H; Hussain, Zubair Butt

2011-01-01

) in Denmark. Materials and Methods We performed a retrospective cohort study of all patients undergoing THA or RTHA in Denmark in 2008. Primary outcomes were intercentre variation in red blood cell (RBC) transfusion rates and the timing of transfusion related to surgery. Results Six thousand nine hundred......Background and Objectives The optimal transfusion strategy in hip arthroplasty remains controversial despite existing guidelines. The aim of this study was to evaluate the transfusion practice in patients undergoing primary total hip arthroplasty (THA) or revision total hip arthroplasty (RTHA...... thirty-two THA patients and 1132 RTHA patients were included for analysis of which 1674 (24%) THA and 689 (61%) RTHA patients received RBC transfusion. Of these, 47% of THA and 73% of RTHA patients received transfusion on the day of surgery. Transfusion rates between centres varied from 7 to 71...

Results of Lateral Retinacular Release Plus Circumpatellar Electrocautery in Total Knee Arthroplasty without Patellar Resurfacing.

Science.gov (United States)

Wang, Yong; Sun, Jun-Ying; Zha, Guo-Chun

2017-03-01

Anterior knee pain (AKP) is integral to the overall success of total knee arthroplasty (TKA) without patellar resurfacing. Numerous studies have evaluated various factors that may contribute to AKP, including patellofemoral design, surgical technique, characteristics of the patient, and degree of chondromalacia. This study aims to explore whether patients who received lateral retinacular release (LRR) plus circumpatellar electrocautery (CE) in TKA attain a low incidence of AKP and whether the LRR plus CE increases postoperative complications. Between February 2001 and February 2009, all patients undergoing TKA without patellar resurfacing and LRR plus CE were evaluated. In total, 286 TKAs in 259 (88.7%) patients were available for assessment, with a mean of 9.3 ± 2.5 years (range: 6-14 years) after the index TKA. The patients were evaluated with a VAS and the Kujala patellofemoral score (KPS) for AKP and the Knee Society's clinical scoring system (KSS) for the clinical function. Satisfaction and LRR-related complications were also assessed. The mean KPS and KSS improved from 45.2 ± 12.9 and 75.4 ± 26.8 points preoperatively to 82.8 ± 10.0 and 151.6 ± 17.3 points at the final follow-up ( p  < 0.001), respectively. Subjectively, 5.6% (16 of 286) of patients suffered from AKP and 88.1% (252 of 286) were satisfied or very satisfied. Postoperative complications occurred in 15 (5.2%) patients, but these complications were mild and did not require reoperation. None of patients exhibited aseptic and septic prosthesis loosening and required revision surgery in the final follow-up. LRR plus CE appears to be a reasonable option in TKA without patellar resurfacing. It may achieve adequate mid-term results, with a low incidence of AKP and postoperative complications.The level of evidence of the study is therapeutic level IV. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Is Anesthesia Technique Associated With a Higher Risk of Mortality or Complications Within 90 Days of Surgery for Geriatric Patients With Hip Fractures?

Science.gov (United States)

Desai, Vimal; Chan, Priscilla H; Prentice, Heather A; Zohman, Gary L; Diekmann, Glenn R; Maletis, Gregory B; Fasig, Brian H; Diaz, Diana; Chung, Elena; Qiu, Chunyuan

2018-06-01

Postoperative mortality and complications after geriatric hip fracture surgery remain high despite efforts to improve perioperative care for these patients. One factor of particular interest is anesthetic technique, but prior studies on this are limited by sample selection, competing risks, and incomplete followup. (1) Among older patients undergoing surgery for hip fracture, does 90-day mortality differ depending on the type of anesthesia received? (2) Do 90-day emergency department returns and hospital readmissions differ based on anesthetic technique after geriatric hip fracture repairs? (3) Do 90-day Agency for Healthcare Research and Quality (AHRQ) outcomes differ according to anesthetic techniques used during hip fracture surgery? We conducted a retrospective study on geriatric patients (65 years or older) with hip fractures between 2009 and 2014 using the Kaiser Permanente Hip Fracture Registry. A total of 1995 (11%) of the surgically treated patients with hip fracture were excluded as a result of missing anesthesia information. The final study sample consisted of 16,695 patients. Of these, 2027 (12%) died and 98 (< 1%) terminated membership during followup, which were handled as competing events and censoring events, respectively. Ninety-day mortality, emergency department returns, hospital readmission, deep vein thrombosis (DVT) or pulmonary embolism (PE), myocardial infarction (MI), and pneumonia were evaluated using multivariable competing risk proportional subdistribution hazard regression according to type of anesthesia technique: general anesthesia, regional anesthesia, or conversion from regional to general. Of the 16,695 patients, 58% (N = 9629) received general anesthesia, 40% (N = 6597) received regional anesthesia, and 2.8% (N = 469) patients were converted from regional to general. Compared with regional anesthesia, patients treated with general anesthesia had a higher likelihood of overall 90-day mortality (hazard ratio [HR], 1.22; 95

[Nutritional status in elderly patients with a hip fracture].

Science.gov (United States)

Pérez Durillo, F T; Ruiz López, M D; Bouzas, P R; Martín-Lagos, A

2010-01-01

Undernutrition is very common in elderly patients with a hip fracture. Malnutrition is associated with increased risk of complications after surgery. Few data exist about the presence of nutritional risk in these patients. The aim of this study was to evaluate the prevalence of undernutrition and the nutritional risk in elderly patients with a hip fracture admitted to a hospital. A cross sectional study assessing the nutritional status of 80 patients with hip fracture (mean age 80 years) was carried out. Functional capacity, anthropometric measurements, biochemical markers and dietary intake were evaluated. The Mini Nutritional Assessment test has been used to detect nutritional risk. 8.8% of patients were undernourished. 43.7% at risk of malnutrition and 47.5% well-nourished according to MNA test. If only BMI was considered the prevalence of malnutrition was 5%. Energy and micronutrient intake was low and could contribute to the development of complications after surgery. Our study shows a high prevalence of nutritional risk in elderly patients with a hip fracture. The inclusion of MNA in the preoperative evaluation could contribute to a better nutritional intervention during their stay in the hospital and to provide specific dietary advices to avoid malnutrition after surgery.

Preoperative irradiation for prevention of heterotopic ossification following prosthetic total hip replacement. Results of a prospective study in 462 hips

Energy Technology Data Exchange (ETDEWEB)

Koelbl, O.; Seufert, J.; Pohl, F.; Flentje, M. [Univ. Wuerzburg (Germany). Klinik and Poliklinik for Radiotherapy; Tauscher, A.; Springorum, H.W. [Caritas Hospital, Bad Mergentheim (Germany). Orthopedic Clinic; Lehmann, H. [Caritas Hospital, Bad Mergentheim (Germany). Inst. of Radiology

2003-11-01

Background: The effectiveness of pre- or postoperative radiotherapy for prevention of heterotopic ossification (HO) following total hip replacement (THR) has already been demonstrated in the past. Thereby, in most studies using preoperative radiotherapy patients were irradiated < 6 h before surgery. The purpose of this prospective study was to analyze the effectiveness of preoperative irradiation on the evening before surgery and to identify risk factors for HO in a homogeneous collective of patients. Patients and Methods: From July 1997 to July 2001, 416 patients (462 hips; 235 males, 227 females) received preoperative radiotherapy of the hip on the evening before surgery with a 7-Gy single fraction. The patients' median age was 67.1 years. The most frequent indication for radiotherapy was hypertrophic osteoarthritis (383 hips, 82.9%). Treatment results were assessed by comparison of pre- and postoperative hip X-rays (immediately and 6 months after surgery). The analysis of radiographs was performed according to the Brooker score. Results: The overall incidence of HO was 18.1% (n = 84), Brooker score 1 12.3% (n = 57), score 2 3.9% (n = 18), score 3 1.5% (n = 7), and score 4 0.4% (n = 2). Sex, body height, hypertrophic osteoarthritis of higher degree, size of the femoral component of the prosthesis, previous ipsi- or contralateral HO, and short course of nonsteroidal anti-inflammatory drug (diclofenac) therapy significantly influenced the HO rate in univariate analysis. In multivariate analysis, an interdependence of prosthesis size, sex and patient's height was found. From these three variables, only prosthesis size was statistically significant in multivariate analysis. The cumulative dose of diclofenac ({<=} 300 mg or > 300 mg) within the first 7 postoperative days and previous ipsi- or contralateral HO influenced the incidence of HO in multivariate analysis. Conclusion: Preoperative radiotherapy on the evening before surgery is an effective treatment

Total hip arthroplasty and perioperative oral carbohydrate treatment: a randomised, double-blind, controlled trial.

Science.gov (United States)

Harsten, Andreas; Hjartarson, Hjörtur; Toksvig-Larsen, Sören

2012-06-01

Perioperative oral carbohydrate intake is beneficial to general surgery patients. Total hip arthroplasty is a common surgical procedure, and even a moderate improvement in patient outcome could have a significant effect on the resources needed for these patients. However, few studies have focused on the effects of carbohydrate intake on orthopaedic patients. The purpose of this study was to investigate if perioperative oral carbohydrate intake alters the postoperative course for patients undergoing total hip arthroplasty. The primary hypothesis was that pain scores would be lower in patients treated with carbohydrate. A randomised, double-blind, controlled trial. This study was carried out between September 2009 and April 2011 at a district Swedish hospital that specialises in orthopaedic surgery. Sixty ASA physical status I-III patients scheduled for elective total hip arthroplasty were included. Exclusion criteria were obesity, diabetes, prior hip surgery to the same hip, ongoing infection, immunological deficiency or age less than 50 or more than 80 years. Patients were given 400 ml of either an oral 12.5% carbohydrate solution or a placebo beverage (flavoured water) 1.5 h before and 2 h after surgery. Visual analogue scales were used to score six discomfort parameters. Immediately prior to surgery, the carbohydrate-treated patients were less hungry (median score 9.5 vs. 22 mm) and experienced less nausea (0 vs. 1.5 mm) (Phip arthroplasty.

Physical activity of elderly patients after total hip arthroplasty.

Science.gov (United States)

Cukras, Zbigniew; Praczko, Katarzyna; Kostka, Tomasz; Jegier, Anna

2007-01-01

Total hip arthroplasty (THA) is the most common method of treatment of severe hip osteoarthritis. There is little data concerning the physical activity of total hip arthroplasty patients in Poland and investigations to explore this area are useful. The aim of the study was to describe the post-operative physical activity of total hip arthroplasty patients. A total of 146 adult people were examined, among which 28 men and 41 women had undergone total hip arthroplasty due to primary osteoarthritis of the hip, while another 32 men and 41 women matched for age who had not undergone hip surgery for osteoarthritis served as controls. The physical activity of study participants was assessed with the 7-Day Physical Activity Recall Questionnaire. All participants were also asked about the type and amount of physical activity they engaged in to maintain good health. Physical activity measured as the total amount of calories expended through physical activity per week was similar in the post-THA patients compared to the controls. The only differences were a smaller amount of calories expended during low-intensity physical activity by men after total hip arthroplasty compared to men who had not undergone surgery for osteoarthritis and a smaller amount of calories expended through high-intensity physical activity by women after total hip arthroplasty compared to female controls. The kinds of recreational physical activity most commonly practised by patients a mean of two years after total hip arthroplasty were marching, bicycling and general body conditioning exercises (usually the continuation of exercises recommended during post-operative rehabilitation). The percentage of post-THA patients undertaking physical activity for the prevention of non-communicable diseases was low. Physical activity should be more effectively encouraged in patients after total hip arthroplasty.

Commercialization of an electric propulsion unit for ecological ice resurfacers

Energy Technology Data Exchange (ETDEWEB)

Giroux, M. [MG Service, L' Assomption, PQ (Canada); Sylvestre, P. [Environment Canada, Montreal, PQ (Canada)

2000-03-01

Community health departments (CHD) and the general public are greatly concerned about the air quality at indoor skating rinks. A solution now exists whereby municipalities can convert their internal combustion resurfacers to electricity, using a system proposed by MG Service. This electric propulsion unit was developed and designed by MG Service, in conjunction with the Centre d'experimentation des vehicules electriques du Quebec (CEVEQ) and TPR Inc., an engineering firm. The main advantage of this technology is the ease of integration into the chassis of conventional resurfacers currently in use throughout the various municipalities. The propulsion unit is battery-powered and designed to replace the internal combustion engine. As a result, it eliminates carbon monoxide and nitrogen dioxide emissions, and more than meets the requirements set by health boards with regard to air quality at indoor skating rinks. Recyclable, maintenance-free and manufactured according to the standards set by the Underwriters Laboratories of Canada (ULC), the gel-sealed batteries display great advantages. The cost effectiveness of the electric propulsion unit is more impressive when considering that electricity is clean and costs five times less than conventional fuels currently in use. Regular verifications and calibrations are not required and the maintenance is minimal. The ventilation requirements are also reduced, leading to savings in energy costs required for the aeration of the indoor skating rink. Finally, the elimination of tank rental and fuel costs represent an added benefit. A detailed description of the components is provided. Following a series of trials, the operators were impressed by the surface gripability, traction and manoeuvrability. The resurfacers also gave an impression of greater raw power and were very quiet and easy to use, resulting in better overall operation when compared to conventional resurfacers. 1 fig.

The efficacy of autologous platelet rich plasma combined with ablative carbon dioxide fractional resurfacing for acne scars: a simultaneous split-face trial.

Science.gov (United States)

Lee, Jin Woong; Kim, Beom Joon; Kim, Myeung Nam; Mun, Seog Kyun

2011-07-01

.1 days on the experimental side (p=.04). No other adverse effects were observed in any participant. Four months after the final treatment, overall degree of clinical improvement was significantly better on the experimental side (2.7±0.7) than on the control side (2.3±0.5) (p=.03). Treatment with PRP after ablative CO(2) fractional resurfacing enhances recovery of laser-damaged skin and synergistically improves the clinical appearance of acne scarring. © 2011 by the American Society for Dermatologic Surgery, Inc.

Postoperative Recovery of Mechanical Muscle Function in Hip Replacement Patients

DEFF Research Database (Denmark)

Jensen, Carsten; Aagaard, Per; Overgaard, Søren

2011-01-01

the posterior-lateral approach. Prior to surgery no training program was initiated but the patients were encouraged to live as usual. Post surgery all patients were allowed fully weight-bearing and they were instructed to follow a conventional home-based rehabilitation, but were otherwise not engaged in any......-test for between group comparisons while ANOVA was used for repeated measures for comparisons over time (α=0.05)   RESULTS The results were calculated as deficits in percentages of the unaffected side (A-NA/NA)*100)) in order to evaluate degree of asymmetry. Our overall side-to-side deficits for peak torque ranged...... from 32.6 to 0.4% and hip flexion deficit being significantly more impacted then the other muscle groups (32.6%).  At baseline all muscle groups showed a significant torque deficit. At 8 weeks post surgery that asymmetry had increased for 4 out of 6 muscle groups. At 26 weeks the hip adduction and hip...

Mid-term results of the BIOLOX delta ceramic-on-ceramic total hip arthroplasty.

Science.gov (United States)

Lee, Y K; Ha, Y C; Yoo, J-I; Jo, W L; Kim, K-C; Koo, K H

2017-06-01

We conducted a prospective study of a delta ceramic total hip arthroplasty (THA) to determine the rate of ceramic fracture, to characterise post-operative noise, and to evaluate the mid-term results and survivorship. Between March 2009 and March 2011, 274 patients (310 hips) underwent cementless THA using a delta ceramic femoral head and liner. At each follow-up, clinical and radiological outcomes were recorded. A Kaplan-Meier analysis was undertaken to estimate survival. Four patients (four hips) died and 18 patients (20 hips) were lost to follow-up within five years. The remaining 252 patients (286 hips) were followed for a mean of 66.5 months (60 to 84). There were 144 men (166 hips) and 108 women (120 hips) with a mean age of 49.7 years (16 to 83) at surgery. The mean pre-operative Harris Hip Score of 47.1 points improved to 93.8 points at final follow-up. Six patients reported squeaking in seven hips; however, none were audible. Radiolucent lines involving Gruen zones one and/or seven were seen in 52 hips (18.2%). No hip had detectable wear, focal osteolysis or signs of loosening. One hip was revised because of fracture of the ceramic liner, which occurred due to an undetected malseating of the ceramic liner at the time of surgery. One hip was revised for a periprosthetic fracture of the femur, and one hip was treated for periprosthetic joint infection. The six-year survivorship with re-operation for any reason as the endpoint was 99.0% (95% confidence interval 97.8% to 100%). The rate of delta ceramic fracture was 0.3% (one of 286). While ceramic head fracture was dominant in previous ceramic-on-ceramic THA, fracture of the delta ceramic liner due to malseating is a concern. Cite this article: Bone Joint J 2017;99-B:741-8. ©2017 The British Editorial Society of Bone & Joint Surgery.

Radiation prophylaxis for heterotopic ossification about the hip joint - a multicenter study

International Nuclear Information System (INIS)

Seegenschmiedt, Michael Heinrich; Makoski, Hans-Bruno; Micke, Oliver

2001-01-01

Purpose: Prophylactic radiotherapy (RT) can prevent ectopic bone formation about the hip after total hip arthroplasty. The German Cooperative Group on Radiotherapy for Benign Diseases conducted a patterns of care study about this indication addressing the involved institutions, RT dose concepts, clinical handling, and treatment outcome of prophylactic RT about the hip joint. Methods and Materials: In 1999, a patterns of care study was conducted in all German institutions to analyze the accrual pattern, number of patients, and different indications for the use and performance of prophylactic RT about the hip. The applied RT concepts of prophylactic RT were evaluated with regard to the RT technique, timing of RT (pre- or postoperative), RT dose prescription (median, range of single and total doses), and treatment outcome. All institutions were asked about the radiologic and functional failure rates at least 1 year after the completion of RT using the established radiologic (Brooker) and functional (Harris) scores with objective and subjective evaluation components. Results: One hundred fourteen institutions reported their clinical experience with prophylactic RT for the prevention of heterotopic ossification about the hip joint: 70 community hospitals, 23 university hospitals, and 21 private RT practices. In 1999, 5677 patients (5989 hips) had received prophylactic RT. The median number per institution was 36 patients (range 8-240). The interdisciplinary referral included orthopedic surgery (89 institutions; 3763 patients), trauma surgery (82 institutions; 1611 patients), or other disciplines (8 institutions; 298 patients). Preoperative RT was applied in 53 institutions 0.5-24 h before surgery, and postoperative RT was applied in 54 institutions 1-120 h after surgery. Most patients received 1 x 7 Gy either pre- or postoperatively. The total dose range was 5-10 Gy (preoperative RT) or 5-16 Gy (postoperative RT); the median total RT dose of both RT concepts was 7 Gy

Structural differences between hip endoprostheses, and implications on a hip kinetics

Directory of Open Access Journals (Sweden)

Mirza Biščević

2005-11-01

Full Text Available We compared kinetic characteristic of unipolar, bipolar and total hip endoprostheses, implanted after dislocated femoral neck fracture. Ninety patients were divided into three groups (30 patients in each group; a group with unipolar partial hip endoprosthesis (UPEP, a group with bipolar partial hip endoprosthesis (BPEP and a group with total hip endoprosthesis (TEP. The patients from different groups were paired by parameters which could influence the long term functional result: follow up period, comorbidities, functional capabilities before injury, etc. After the average follow up 3.8 +/- 1.9 years, a measuring of range of hip motions (ROM was conducted. The largest mean amplitudes in flexion (104 degrees, extension (13 degrees, abduction (35 degrees and external rotation (38 degrees was achieved BPEP, the largest adduction (14 degrees was achieved UPEP, and internal rotation (34 degrees TEP. Differences in ROMs are partially related to the clinical parameters such as: level of the hip pain, gait pattern, age and rehabilitation period (P < 0.05. Measuring of ROMs is the most reliable part of the clinical exam and it does not depend on subjectivity of patient, as opposed to other clinical parameters (level of pain, walking distance, aids usage, etc. The results obtained are favorable for the bipolar hip endoprosthesis, and they can be related to the biomechanical differences between the three types of hip endoprostheses. Kinetic advantages of the BPEP as compared to the UPEP, can be explained by the BPEP's structure: two-level mobility and a thinner neck which delays impingement in the late motion phase. In comparison to the TEP, clinical advantages of the BPEP can be attributed to less extensive surgery and scarring.

Adult hip dysplasia and osteoarthritis. Studies in radiology and clinical epidemiology

DEFF Research Database (Denmark)

Jacobsen, Steffen

2006-01-01

studies. To develop a comprehensible and reproducible radiographic discriminator of hip OA with as close an association to self reported hip pain as possible. To identify prevalences of hip OA and HD in a Caucasian, urban background population and investigate the influence of sex, age, physical...... to be a significant risk factor for hip OA in men. However, only obesity was found to determine an event of hip replacement surgery. In a longitudinal study of 81 subjects and with mild or moderate hip dysplasia followed for a decade we did not document a tendency for radiological degeneration compared to 136 control...

Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: fast-track experience in 712 patients

DEFF Research Database (Denmark)

Husted, Henrik; Holm, Gitte; Jacobsen, Steffen

2008-01-01

BACKGROUND AND PURPOSE: Very few studies have focused on patient characteristics that influence length of stay (LOS) in fast-track total hip (THR) and knee arthroplasty (TKR). The aim of this prospective study was to identify patient characteristics associated with LOS and patient satisfaction...... aids, pre- and postoperative hemoglobin levels, the need for blood transfusion, ASA score, and time between surgery and mobilization, were all found to influence postoperative outcome in general, and LOS and patient satisfaction in particular. INTERPRETATION: We identified several patient...... characteristics that influence postoperative outcome, LOS, and patient satisfaction in our series of consecutive fast-track joint replacement patients, enabling further attention to be paid to certain aspects of surgery and rehabilitation....

Modern radiological postoperative diagnostics of the hip joint in children and adults; Moderne radiologische postoperative Diagnostik des Hueftgelenks im Kindes- und Erwachsenenalter

Energy Technology Data Exchange (ETDEWEB)

Weber, M.A.; Thierjung, H.; Kloth, J.K. [Heidelberg University Hospital (Germany). Diagnostic and Interventional Radiology; Egermann, M. [Heidelberg University Hospital (Germany). Center for Orthopedics

2015-07-15

The assessment of bone healing and loosening of endoprosthesis material was long the primary indication for postoperative projection radiography and CT imaging of the hip joint following trauma and endoprosthesis implantation. With the increasing number of joint-preserving surgery, e. g. of surgical hip luxation and hip arthroscopy for the treatment of femoroacetabular impingement (FAI), high-resolution imaging of intra-articular pathologies before and after surgery has become increasingly important. In this review article, diagnostic imaging of the hip joint is presented following common trauma surgery and orthopedic surgery interventions. The imaging modalities of projection radiography, CT and MRI including direct MR-arthrography are discussed with regard to their diagnostic capability in the postoperative assessment of the hip joint. Among others topics, imaging is discussed following hip arthroplasty, following surgical hip luxation and arthroscopic interventions for the treatment of FAI, as well as following core decompression for avascular necrosis of the femoral head. Moreover, orthopedic interventions of the hip joint in children and adolescents are presented and the dedicated reporting of postoperative imaging is outlined.

TOTAL HIP REPLACEMENT IN LEGG-CALVÉ-PERTHES DISEASE

DEFF Research Database (Denmark)

Froberg, Lonnie; Christensen, Finn; Pedersen, Niels Wisbech

2009-01-01

INTRODUCTION Poor long-time results in patients with Legg-Calvé-Perthes disease (LCP) are most often due to degenerative hip disease. The purpose of this study was to investigate if patients with LCP have an increased rate of total hip replacement (THR) compared to sex- and age-matched persons....... MATERIAL AND METHODS 167 LCP patients presented to our institution from 1941 to 1962. All patients were treated conservatively by a Thomas splint. Retrospectively medical records and radiographs were retrieved. Data from the Danish Hip Replacement Register and the Registries of the National Board of Health...... to follow-up and 3) patients with previous surgery to pelvis or lower limbs. 135 patients (156 hips) were enrolled in this study and 32 patients (35 hips) were excluded. RESULTS 20 hips out of 156 hips in patients with LCP have had a THR. Mean age at operation for the women was 50 years and 44 years...

Integra artificial skin dermal regeneration templates in burn scar surgery

International Nuclear Information System (INIS)

Rexon Ngim

1999-01-01

Integra artificial skin is a porous matrix used as a permanent dermal replacement. Developed in the 1970's, it has been used successfully in the treatment of acute bums requiring full or deep partial thickness skin replacement. Three patients with burn scars received Integra Artificial Skin to resurface various areas of burn scars and also contractures. The first was a 24-year-old woman who had two pieces of Integra to resurface a forearm/elbow/wrist defect. The second was a 28-year-old woman who had two pieces of Integra to resurface a neck contracture. The third was a 44 year-old woman who had two pieces to correct severe burn contractures/ scars of her hands. The results of these three patients, probably the first time Integra was used for bum scar and contracture revision, indicate that there is a place for Integra in Burn Scar surgery. However, the basic principle of its application must be adhered to. These include excision to remove the complete scar, recreation of original size of skin defect and meticulous application of the Artificial Skin and its care post-operatively. Details of its application will be highlighted

Influence of Minimally Invasive Total Hip Replacement on Hip Reaction Forces and Their Orientations

NARCIS (Netherlands)

Weber, Tim; Al-Munajjed, Amir A.; Verkerke, Gijsbertus Jacob; Dendorfer, Sebastian; Renkawitz, Tobias

2014-01-01

Minimally invasive surgery (MIS) is becoming increasingly popular. Supporters claim that the main advantages of MIS total hip replacement (THR) are less pain and a faster rehabilitation and recovery. Critics claim that safety and efficacy of MIS are yet to be determined. We focused on a

Rapidly destructive osteoarthritis of the hip joint: a case series

Directory of Open Access Journals (Sweden)

McMurtrie A

2008-01-01

Full Text Available Abstract Background Rapidly destructive arthrosis of the hip is a rare and incompletely understood disorder with scarce literature about variations in natural history within a population. Methods A series of cases from North Wales with rapid progressive joint destruction and extensive subchondral bone loss in the femoral head and acetabulum are presented. Radiographic findings mimicked those of other disorders such as septic arthritis, rheumatoid and seronegative arthritis, primary osteonecrosis with secondary osteoarthritis, or neuropathic osteoarthropathy, but none of the patients had clinical, pathologic, or laboratory evidence of these entities. Results Rapid progression of hip pain and disability was a consistent clinical feature. The average duration of symptoms was 1.4 years. Radiographs obtained at various intervals before surgery (average 14 months in 18 patients documented rapid hip destruction, involvement being unilateral in 13 cases. All patients underwent total hip arthroplasty, and osteoarthritis was confirmed at pathologic examination. Conclusion The authors postulate that these cases represent an uncommon subset of osteoarthritis and regular review, both clinically and radiologically, are required to assess speed of progression and prevent rapid loss of bone stock without the surgeon being aware. These cases are unsuitable for being placed on long waiting list due to technical difficulties in delayed surgery and compromised outcome following surgery.

Resurfacing asteroids from YORP spin-up and failure

Science.gov (United States)

Graves, Kevin J.; Minton, David A.; Hirabayashi, Masatoshi; DeMeo, Francesca E.; Carry, Benoit

2018-04-01

The spectral properties of S and Q-type asteroids can change over time due to interaction with the solar wind and micrometeorite impacts in a process known as 'space weathering.' Space weathering raises the spectral slope and decreases the 1 μm absorption band depth in the spectra of S and Q-type asteroids. Over time, Q-type asteroids, which have very similar spectra to ordinary chondrite meteorites, will change into S-type asteroids. Because there are a significant number of Q-type asteroids, there must be some process which is resurfacing S-type asteroids into Q-types. In this study, we use asteroid data from the Sloan Digital Sky Survey to show a trend between the slope through the g‧, r‧, and i‧ filters, called the gri-slope, and size that holds for all populations of S and Q-type asteroids in the inner solar system, regardless of orbit. We model the evolution of a suite of asteroids in a Monte Carlo YORP rotational evolution and space weathering model. We show that spin-up and failure from YORP is one of the key resurfacing mechanisms that creates the observed weathering trends with size. By varying the non-dimensional YORP coefficient and running time of the present model over the range 475-1425 Myr, we find a range of values for the space weathering timescale, τSW ≈ 19-80 Myr at 2.2 AU. We also estimate the time to weather a newly resurfaced Q-type asteroid into an S-complex asteroid at 1 AU, τQ → S(1AU) ≈ 2-7 Myr.

Metal ion concentrations in body fluids after implantation of hip replacements with metal-on-metal bearing--systematic review of clinical and epidemiological studies.

Directory of Open Access Journals (Sweden)

Albrecht Hartmann

Full Text Available INTRODUCTION: The use of metal-on-metal (MoM total hip arthroplasty (THA increased in the last decades. A release of metal products (i.e. particles, ions, metallo-organic compounds in these implants may cause local and/or systemic adverse reactions. Metal ion concentrations in body fluids are surrogate measures of metal exposure. OBJECTIVE: To systematically summarize and critically appraise published studies concerning metal ion concentrations after MoM THA. METHODS: Systematic review of clinical trials (RCTs and epidemiological studies with assessment of metal ion levels (cobalt, chromium, titanium, nickel, molybdenum in body fluids after implantation of metalliferous hip replacements. Systematic search in PubMed and Embase in January 2012 supplemented by hand search. Standardized abstraction of pre- and postoperative metal ion concentrations stratified by type of bearing (primary explanatory factor, patient characteristics as well as study quality characteristics (secondary explanatory factors. RESULTS: Overall, 104 studies (11 RCTs, 93 epidemiological studies totaling 9.957 patients with measurement of metal ions in body fluids were identified and analyzed. Consistently, median metal ion concentrations were persistently elevated after implantation of MoM-bearings in all investigated mediums (whole blood, serum, plasma, erythrocytes, urine irrespective of patient characteristics and study characteristics. In several studies very high serum cobalt concentrations above 50 µg/L were measured (detection limit typically 0.3 µg/L. Highest metal ion concentrations were observed after treatment with stemmed large-head MoM-implants and hip resurfacing arthroplasty. DISCUSSION: Due to the risk of local and systemic accumulation of metallic products after treatment with MoM-bearing, risk and benefits should be carefully balanced preoperatively. The authors support a proposed "time out" for stemmed large-head MoM-THA and recommend a restricted

Keloid Skin Flap Retention and Resurfacing in Facial Keloid Treatment.

Science.gov (United States)

Liu, Shu; Liang, Weizhong; Song, Kexin; Wang, Youbin

2018-02-01

Facial keloids commonly occur in young patients. Multiple keloid masses often converge into a large lesion on the face, representing a significant obstacle to keloid mass excision and reconstruction. We describe a new surgical method that excises the keloid mass and resurfaces the wound by saving the keloid skin as a skin flap during facial keloid treatment. Forty-five patients with facial keloids were treated in our department between January 2013 and January 2016. Multiple incisions were made along the facial esthetic line on the keloid mass. The keloid skin was dissected and elevated as a skin flap with one or two pedicles. The scar tissue in the keloid was then removed through the incision. The wound was covered with the preserved keloid skin flap and closed without tension. Radiotherapy and hyperbaric oxygen were applied after surgery. Patients underwent follow-up examinations 6 and 12 months after surgery. Of the 45 total patients, 32 patients were cured and seven patients were partially cured. The efficacy rate was 88.9%, and 38 patients (84.4%) were satisfied with the esthetic result. We describe an efficacious and esthetically satisfactory surgical method for managing facial keloids by preserving the keloid skin as a skin flap. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

CUSTOM TRIFLANGE ACETABULAR COMPONENTS IN REVISION HIP REPLACEMENT (EXPERIENCE REVIEW

Directory of Open Access Journals (Sweden)

A. A. Korytkin

2017-01-01

Full Text Available Extensive defects of acetabulum especially accompanied by pelvis discontinuity at the level of acetabulum pose a serious challenge in revision hip replacement and create additional complexity in fixing the acetabular component. One of the perspective options to solve the above issue is the use of custom triflange acetabular components (CTAC designed based on preoperative computer tomography given the specifics of bone defects of the patient. Purpose of the study — to evaluate the outcomes of CTAC use in revision hip replacement.Materials and methods. The authors analyzed treatment outcomes of 12 patients after revision hip replacement using additive techniques of computer simulation and 3D printing CTAC. Follow up period after the surgery averaged 7±3 months (from one to ten months. 7 out of 12 patients had acetabular defects of Paprosky 3B type, 4 patients had defects of Paprosky 3A and in one patient — of Paprosky 2C.Results. Two out of twelve patients had prosthesis dislocations that required revision hip surgery, one of those patients underwent open reduction of dislocation with wound debridement, another patient underwent replacement of articulating couple of acetabular component. Total scores under Harris Hip Score and paint VAS score prior to treatment was 28±7 and 7±1 points respectively, postoperative scores were 76±9 and 3±1 respectively.Conclusion. The application of additive techniques for revision hip replacement in patients with extensive acetabular and pelvic defects allows to make a precise preoperative planning, to restore joint rotation center, to reconstruct bone defects and to securely fix triflange acetabular component that altogether significantly improve treatment outcomes and patients satisfaction with the surgery.

Magnetic resonance imaging features of complications following hip replacement: A pictorial review

Directory of Open Access Journals (Sweden)

Khushboo Pilania

2016-01-01

Full Text Available Hip replacement surgery helps millions of people worldwide walk painlessly each year. With increasing life spans and decreased clinical threshold for surgery, this number will continue to rise. With the increase in the number of surgeries and the longevity of implants, the need for early and prompt diagnosis of complications is also rising. This essay underlines the fact that magnetic resonance imaging on a 1.5T scanner with specialized metal artefact reduction sequences is a viable technique to image the post-arthroplasty hip and has vast potential in the prompt and early diagnosis of complications in these patients.

Magnetic resonance imaging features of complications following hip replacement: A pictorial review

International Nuclear Information System (INIS)

Pilania, Khushboo; Jankharia, Bhavin

2016-01-01

Hip replacement surgery helps millions of people worldwide walk painlessly each year. With increasing life spans and decreased clinical threshold for surgery, this number will continue to rise. With the increase in the number of surgeries and the longevity of implants, the need for early and prompt diagnosis of complications is also rising. This essay underlines the fact that magnetic resonance imaging on a 1.5T scanner with specialized metal artefact reduction sequences is a viable technique to image the post-arthroplasty hip and has vast potential in the prompt and early diagnosis of complications in these patients

Postoperative pain after hip fracture is procedure specific

DEFF Research Database (Denmark)

Foss, Nicolai; Kristensen, Morten Tange; Palm, H

2009-01-01

BACKGROUND: Hip fracture patients experience high pain levels during postoperative rehabilitation. The role of surgical technique on postoperative pain has not been evaluated previously. METHODS: One hundred and seventeen hip fracture patients were included in a descriptive prospective study. All.......001) and walking (r=-0.36, P=0.004). CONCLUSIONS: Postoperative pain levels after surgery for hip fracture are dependent on the surgical procedure, which should be taken into account in future studies of analgesia and rehabilitation....... patients received continuous epidural analgesia and were treated according to a standardized perioperative rehabilitation programme. Resting pain, pain on hip flexion, and walking were measured during daily physiotherapy sessions on a verbal five-point rating scale during the first four postoperative days...

Revision Total Hip Arthoplasty: Factors Associated with Re-Revision Surgery

OpenAIRE

Khatod, M; Cafri, G; Inacio, MCS; Schepps, AL; Paxton, EW; Bini, SA

2015-01-01

The survivorship of implants after revision total hip arthroplasty and risk factors associated with re-revision are not well defined. We evaluated the re-revision rate with use of the institutional total joint replacement registry. The purpose of this study was to determine patient, implant, and surgeon factors associated with re-revision total hip arthroplasty.A retrospective cohort study was conducted. The total joint replacement registry was used to identify patients who had undergone revi...

The influence of heterotopic ossification on functional status of hip joint following total hip arthroplasty

Energy Technology Data Exchange (ETDEWEB)

Pohl, F.; Seufert, J.; Flentje, M.; Koelbl, O. [Wuerzburg Univ. (Germany). Dept. of Radiotherapy; Tauscher, A.; Springorum, H.W. [Caritas Krankenhaus Bad Mergentheim (Germany). Orthopedic Clinic; Lehmann, H. [Caritas Krankenhaus Bad Mergentheim (Germany). Inst. of Radiology

2005-08-01

Purpose: The functional failure induced by heterotopic ossification (HO) following total hip arthroplasty (THA) was analyzed and correlated to the radiologic failure. Patients and methods: From July 1997 to July 2001, 315 patients (345 hips) received THA indicated by a hypertrophic osteoarthritis of higher degree (Kellgren grade III, IV). All patients were irradiated prophylactically for prevention of HO on the evening before surgery with a 7-Gy single fraction. The patients' median age was 66.3 years. Radiologic failure was assessed by comparison of pre- and postoperative hip X-rays (immediately and 6 months after surgery). Analysis of radiographs was performed according to the Brooker Score. Clinical failure was appraised by measurement of passive range of motion (ROM) of the hip joint with a standard goniometer. The t-test was used for statistical analysis. Results: 281 patients (81.5%) did not develop HO. HO of Brooker grade I or II was found in 58 patients (16.8%). Six patients (1.7%) developed HO Brooker grade III or IV. There was a significant negative correlation between the degree of radiologic and clinical failure. ROM differed significantly between patients with HO Brooker grade 0, I, II and patients with HO Brooker grade III, IV. Comparing the pre- and postoperative ROM, all patients with Brooker grade 0, I and II showed a significant improvement of flexion, internal and external rotation, abduction and adduction movement. Patients with HO Brooker grade III and IV showed no improvement of ROM in the postoperative follow-up. Conclusion: The development of HO following THA influences the physical function of the hip joint dependent on the degree of ossification. HO of lower degree (Brooker I, II) does not influence the clinical outcome, whereas HO of higher degree (Brooker III, IV) reduces the function of hip arthroplasty. Therefore, the purpose of a prophylactic therapy must be to reduce HO of higher degree. (orig.)

Effects of impairment in activities of daily living on predicting mortality following hip fracture surgery in studies using administrative healthcare databases

Science.gov (United States)

2014-01-01

Background Impairment in activities of daily living (ADL) is an important predictor of outcomes although many administrative databases lack information on ADL function. We evaluated the impact of ADL function on predicting postoperative mortality among older adults with hip fractures in Ontario, Canada. Methods Sociodemographic and medical correlates of ADL impairment were first identified in a population of older adults with hip fractures who had ADL information available prior to hip fracture. A logistic regression model was developed to predict 360-day postoperative mortality and the predictive ability of this model were compared when ADL impairment was included or omitted from the model. Results The study sample (N = 1,329) had a mean age of 85.2 years, were 72.8% female and the majority resided in long-term care (78.5%). Overall, 36.4% of individuals died within 360 days of surgery. After controlling for age, sex, medical comorbidity and medical conditions correlated with ADL impairment, addition of ADL measures improved the logistic regression model for predicting 360 day mortality (AIC = 1706.9 vs. 1695.0; c -statistic = 0.65 vs 0.67; difference in - 2 log likelihood ratios: χ2 = 16.9, p = 0.002). Conclusions Direct measures of ADL impairment provides additional prognostic information on mortality for older adults with hip fractures even after controlling for medical comorbidity. Observational studies using administrative databases without measures of ADLs may be potentially prone to confounding and bias and case-mix adjustment for hip fracture outcomes should include ADL measures where these are available. PMID:24472282

The importance of patient expectations as a determinant of satisfaction with waiting times for hip and knee replacement surgery.

Science.gov (United States)

Conner-Spady, Barbara L; Sanmartin, Claudia; Johnston, Geoffrey H; McGurran, John J; Kehler, Melissa; Noseworthy, Tom W

2011-08-01

The disconfirmation model hypothesizes that satisfaction is a function of a perceived discrepancy from an initial expectation. Our objectives were: (1) to test the disconfirmation model as it applies to patient satisfaction with waiting time (WT) and (2) to build an explanatory model of the determinants of satisfaction with WT for hip and knee replacement. We mailed 1000 questionnaires to 2 random samples: patients waiting or those who had received a joint replacement within the preceding 3-12 months. We used ordinal logistic regression analysis to build an explanatory model of the determinants of satisfaction. Of the 1330 returned surveys, 1240 contained patient satisfaction data. The sample was 57% female; mean age was 70 years (SD 11). Consistent with the disconfirmation model, when their WTs were longer than expected, both waiting (OR 5.77, 95% CI 3.57-9.32) and post-surgery patients (OR 6.57, 95% CI 4.21-10.26) had greater odds of dissatisfaction, adjusting for the other variables in the model. Compared to those who waited 3 months or less, post-surgery patients who waited 6 to 12 months (OR 2.59, 95% CI 1.27-5.27) and over 12 months (OR 3.30, 95% CI 1.65-6.58) had greater odds of being dissatisfied with their waiting time. Patients who felt they were treated unfairly had greater odds of being dissatisfied (OR 4.74, 95% CI 2.60-8.62). In patients on waiting lists and post-surgery for hip and knee replacement, satisfaction with waiting times is related to fulfillment of expectations about waiting, as well as a perception of fairness. Measures to modify expectations and increase perceived fairness, such as informing patients of a realistic WT and communication during the waiting period, may increase satisfaction with WTs. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Metal Ion Concentrations in Body Fluids after Implantation of Hip Replacements with Metal-on-Metal Bearing – Systematic Review of Clinical and Epidemiological Studies

Science.gov (United States)

Hartmann, Albrecht; Hannemann, Franziska; Lützner, Jörg; Seidler, Andreas; Drexler, Hans; Günther, Klaus-Peter; Schmitt, Jochen

2013-01-01

Introduction The use of metal-on-metal (MoM) total hip arthroplasty (THA) increased in the last decades. A release of metal products (i.e. particles, ions, metallo-organic compounds) in these implants may cause local and/or systemic adverse reactions. Metal ion concentrations in body fluids are surrogate measures of metal exposure. Objective To systematically summarize and critically appraise published studies concerning metal ion concentrations after MoM THA. Methods Systematic review of clinical trials (RCTs) and epidemiological studies with assessment of metal ion levels (cobalt, chromium, titanium, nickel, molybdenum) in body fluids after implantation of metalliferous hip replacements. Systematic search in PubMed and Embase in January 2012 supplemented by hand search. Standardized abstraction of pre- and postoperative metal ion concentrations stratified by type of bearing (primary explanatory factor), patient characteristics as well as study quality characteristics (secondary explanatory factors). Results Overall, 104 studies (11 RCTs, 93 epidemiological studies) totaling 9.957 patients with measurement of metal ions in body fluids were identified and analyzed. Consistently, median metal ion concentrations were persistently elevated after implantation of MoM-bearings in all investigated mediums (whole blood, serum, plasma, erythrocytes, urine) irrespective of patient characteristics and study characteristics. In several studies very high serum cobalt concentrations above 50 µg/L were measured (detection limit typically 0.3 µg/L). Highest metal ion concentrations were observed after treatment with stemmed large-head MoM-implants and hip resurfacing arthroplasty. Discussion Due to the risk of local and systemic accumulation of metallic products after treatment with MoM-bearing, risk and benefits should be carefully balanced preoperatively. The authors support a proposed „time out“ for stemmed large-head MoM-THA and recommend a restricted indication for hip

Robotic hip arthroscopy in human anatomy.

Science.gov (United States)

Kather, Jens; Hagen, Monika E; Morel, Philippe; Fasel, Jean; Markar, Sheraz; Schueler, Michael

2010-09-01

Robotic technology offers technical advantages that might offer new solutions for hip arthroscopy. Two hip arthroscopies were performed in human cadavers using the da Vinci surgical system. During both surgeries, a robotic camera and 5 or 8 mm da Vinci trocars with instruments were inserted into the hip joint for manipulation. Introduction of cameras and working instruments, docking of the robotic system and instrument manipulation was successful in both cases. The long articulating area of 5 mm instruments limited movements inside the joint; an 8 mm instrument with a shorter area of articulation offered an improved range of motion. Hip arthroscopy using the da Vinci standard system appears a feasible alternative to standard arthroscopy. Instruments and method of application must be modified and improved before routine clinical application but further research in this area seems justified, considering the clinical value of such an approach. Copyright 2010 John Wiley & Sons, Ltd.

Risk-factors for surgical delay following hip fracture.

Science.gov (United States)

Sanz-Reig, J; Salvador Marín, J; Ferrández Martínez, J; Orozco Beltrán, D; Martínez López, J F

To identify pre-operative risk factors for surgical delay of more than 2 days after admission in patients older than 65 years with a hip fracture. A prospective observational study was conducted on 180 hip fractures in patients older than 65 years of age admitted to our hospital from January 2015 to April 2016. The data recorded included, patient demographics, day of admission, pre-fracture comorbidities, mental state, level of mobility and physical function, type of fracture, antiaggregant and anticoagulant medication, pre-operative haemoglobin value, type of treatment, and surgical delay. The mean age of the patients was 83.7 years. The mean Charlson Index was 2.8. The pre-fracture baseline co-morbidities were equal or greater than 2 in 70% of cases. Mean timing of surgery was 3.1 days. At the time of admission, 122 (67.7%) patients were fit for surgery, of which 80 (44.4%) underwent surgery within 2 days. A Charlson index greater than 2, anticoagulant therapy, and admission on Thursday to Saturday, were independently associated with a surgical delay greater than 2 days. The rate of hip fracture patients undergoing surgery within 2 days is low. Risk factors associated to surgical delay are non-modifiable. However, their knowledge should allow the development of protocols that can reduce surgical delay in this group of patients. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

[Characteristics in treatment of the hip in patients with Down syndrome].

Science.gov (United States)

Peterlein, C-D; Schiel, M; Timmesfeld, N; Schofer, M D; Eberhardt, O; Wirth, T; Fernandez, F F

2013-12-01

The treatment of hip instability in patients with Down syndrome is challenging. We have performed different pelvic osteotomies and corrections at the proximal femur for this indication. This retrospective study was conducted to evaluate the clinical and radiological outcome of each intervention. All in all, 166 patients with Down syndrome were treated at our orthopaedic department in the observation period. Problems related to the hip joint were diagnosed in 63 of those patients. Only patients who underwent surgery were included in this study. The charts and X-rays of these 31 patients were evaluated with respect to the following parameters: incidence of the hip problem, concomitant diseases, temporal progress, kind of operation method and date, duration of stay in the hospital, after-care, follow-on surgery related to complications, AC angle, CE angle, ACM angle, CCD angle, index of migration according to Reimers, classification of Bauer and Kerschbauer and general morphology of the femoral head. The group was compared with an age-matched group of 21 patients with hip dysplasia. Those patients underwent the same sort of operation in the same year. In the Morbus Down group, we performed surgery for preservation of the hip in 49 cases. This included 13 osteotomies according to Chiari, 11 triple osteotomies according to Tönnis, 10 corrections by femoral varus derotation osteotomy, 8 pelvic osteotomies according to Pemberton, 5 pelvic osteotomies according to Salter and 2 open reductions of the hip. With respect to the moment of surgery, we detected three peaks of age. There was no difference in course of disease and quantity of complications between the groups. Satisfactory results concerning clinical and radiological outcome were achieved predominantly by complete redirectional acetabular osteotomies. Half of the patients who were solely treated by femoral varus derotation osteotomy needed follow-on surgery in the form of pelvic osteotomy. Comparison of

Cystic lesion around the hip joint

Science.gov (United States)

Yukata, Kiminori; Nakai, Sho; Goto, Tomohiro; Ikeda, Yuichi; Shimaoka, Yasunori; Yamanaka, Issei; Sairyo, Koichi; Hamawaki, Jun-ichi

2015-01-01

This article presents a narrative review of cystic lesions around the hip and primarily consists of 5 sections: Radiological examination, prevalence, pathogenesis, symptoms, and treatment. Cystic lesions around the hip are usually asymptomatic but may be observed incidentally on imaging examinations, such as computed tomography and magnetic resonance imaging. Some cysts may enlarge because of various pathological factors, such as trauma, osteoarthritis, rheumatoid arthritis, or total hip arthroplasty (THA), and may become symptomatic because of compression of surrounding structures, including the femoral, obturator, or sciatic nerves, external iliac or common femoral artery, femoral or external iliac vein, sigmoid colon, cecum, small bowel, ureters, and bladder. Treatment for symptomatic cystic lesions around the hip joint includes rest, nonsteroidal anti-inflammatory drug administration, needle aspiration, and surgical excision. Furthermore, when these cysts are associated with osteoarthritis, rheumatoid arthritis, and THA, primary or revision THA surgery will be necessary concurrent with cyst excision. Knowledge of the characteristic clinical appearance of cystic masses around the hip will be useful for determining specific diagnoses and treatments. PMID:26495246

Focal femoral condyle resurfacing.

LENUS (Irish Health Repository)

Brennan, S A

2013-03-01

Focal femoral inlay resurfacing has been developed for the treatment of full-thickness chondral defects of the knee. This technique involves implanting a defect-sized metallic or ceramic cap that is anchored to the subchondral bone through a screw or pin. The use of these experimental caps has been advocated in middle-aged patients who have failed non-operative methods or biological repair techniques and are deemed unsuitable for conventional arthroplasty because of their age. This paper outlines the implant design, surgical technique and biomechanical principles underlying their use. Outcomes following implantation in both animal and human studies are also reviewed. Cite this article: Bone Joint J 2013;95-B:301-4.

Design of biped hip simulator using SolidWorks

Science.gov (United States)

Zainudin, M. R.; Yahya, A.; Fazli, M. I. M.; Syahrom, A.; Harun, F. K. C.; Nazarudin, M. S.

2017-10-01

The increasing number of people who underwent both hip implant surgery based on World Health Organization (WHO) has received massive attention from researchers lately to develop various types of hip simulators in order to test the hip implant. Various number of hip simulator have been developed with different functions and capabilities. This paper presents the design development of biped hip simulator using SolidWorks software by taking into consideration some improvement and modifications. The finite element method is used to test the design whether it is safe to be used or not. The biped hip simulator has been successfully designed and ready to be fabricated as the endurance testing shown a positive results. The von Mises stress induced in the material is an alloy steel which is 2,975,862.3 N/m2 lower than the yield strength. Thus, the design is safe to be used as it obey the safety criterion.

Geometry Modeling Program Implementation of Human Hip Tissue

Directory of Open Access Journals (Sweden)

WANG Mo-nan

2017-10-01

Full Text Available Abstract:Aiming to design a simulate software of human tissue modeling and analysis，Visual Studio 2010 is selected as a development tool to develop a 3 D reconstruction software of human tissue with language C++.It can be used alone. It also can be a module of the virtual surgery systems. The system includes medical image segmentation modules and 3 D reconstruction modules，and can realize the model visualization. This software system has been used to reconstruct hip muscles，femur and hip bone accurately. The results show these geometry models can simulate the structure of hip tissues.

Geometry Modeling Program Implementation of Human Hip Tissue

Directory of Open Access Journals (Sweden)

WANG Monan

2017-04-01

Full Text Available Aiming to design a simulate software of human tissue modeling and analysis，Visual Studio 2010 is selected as a development tool to develop a 3 D reconstruction software of human tissue with language C++.It can be used alone. It also can be a module of the virtual surgery systems. The system includes medical image segmentation modules and 3 D reconstruction modules，and can realize the model visualization. This software system has been used to reconstruct hip muscles，femur and hip bone accurately. The results show these geometry models can simulate the structure of hip tissues.

Total hip arthroplasty using a short-stem prosthesis: restoration of hip anatomy.

Science.gov (United States)

Amenabar, Tomas; Marimuthu, Kanniraj; Hawdon, Gabrielle; Gildone, Alessandro; McMahon, Stephen

2015-04-01

To evaluate hip parameters such as vertical centre of rotation (VCR), horizontal centre of rotation (HCR), femoral offset, and leg length after total hip arthroplasty (THA) using the Nanos short-stem prosthesis. Medical records of 73 men and 74 women aged 25 to 92 (mean, 63) years who underwent THA using the Nanos short-stem prosthesis by a single surgeon were reviewed. Prior to the surgery, the optimal cup and stem size, head length, and level of the neck osteotomy were determined using radiographs. Intra-operatively, the leg length and femoral offset were checked, and the level of neck resection and head length were adjusted. VCR, HCR, femoral offset, and leg length of the operated and contralateral sides were compared. Functional outcomes were assessed using the Harris Hip Score (HHS). Compared with the normal contralateral hips, the operated hips had a mean increase of 0.4 mm in VCR (p=0.032), a mean decrease of 1.4 mm in HCR (p=0.027), a mean increase of 0.6 mm in femoral offset (p=0.043), and a mean increase of 0.36 mm in leg length (p=0.035). For these respective parameters, the difference between the normal contralateral side and the operated side was within 5 mm in 89%, 80%, 71%, and 96% of patients. The HHS improved from a mean of 53 to 91 at one year (pNanos short-stem prosthesis enabled restoration of hip anatomy (VCR, HCR, femoral offset, and leg length).

Usefulness of Arthroscopic Treatment of Painful Hip after Acetabular Fracture or Hip Dislocation.

Science.gov (United States)

Hwang, Jung-Taek; Lee, Woo-Yong; Kang, Chan; Hwang, Deuk-Soo; Kim, Dong-Yeol; Zheng, Long

2015-12-01

Painful hip following hip dislocation or acetabular fracture can be an important signal for early degeneration and progression to osteoarthritis due to intraarticular pathology. However, there is limited literature discussing the use of arthroscopy for the treatment of painful hip. The purpose of this retrospective study was to analyze the effectiveness and benefit of arthroscopic treatment for patients with a painful hip after major trauma. From July 2003 to February 2013, we reviewed 13 patients who underwent arthroscopic treatment after acetabular fracture or hip dislocation and were followed up for a minimum of 2 postoperative years. The degree of osteoarthritis based on the Tonnis classification pre- and postoperatively at final follow-up was determined. Clinical outcomes were evaluated using visual analogue scale for pain (VAS) and modified Harris hip score (MHHS), and range of motion (ROM) of the hip pre- and postoperatively at final follow-up. There were nine male and four female patients with a mean age at surgery of 28 years (range, 20 to 50 years). The mean follow-up period of the patients was 59.8 months (range, 24 to 115 months), and the mean interval between initial trauma and arthroscopic treatment was 40.8 months (range, 1 to 144 months). At the final follow-up, VAS and MHHS improved significantly from 6.3 and 53.4 to 3.0 and 88.3, respectively (p = 0.002 and p hip flexion, abduction, adduction, external rotation, and internal rotation as minor improvements from 113.1°, 38.5°, 28.5°, 36.5°, and 22.7° to 118.5°, 39.0°, 29.2°, 38.9°, and 26.5° were observed, respectively (p = 0.070, p = 0.414, p = 0.317, p = 0.084, and p = 0.136, respectively). None of the patients exhibited progression of osteoarthritis of the hip at the final follow-up. Arthroscopic treatment after acetabular fracture or hip dislocation is effective and delays the progression of traumatic osteoarthritis.

The Effects of a Daily Skincare Regimen on Maintaining the Benefits Obtained from Previous Chemical Resurfacing Treatments.

Science.gov (United States)

Bruce, Suzanne; Roberts, Wendy; Teller, Craig; Colvan, Lora

2016-09-01

Chemical peels are versatile treatments that involve chemical exfoliation of the skin for cosmetic improvement. Deeper peels produce more significant results, but can be associated with longer healing time and potential complications. Novel chemical resurfacing treatments (AGE and MELA) were developed in Europe to produce skin resurfacing via controlled inflammation to promote cell regeneration with minimum negative effects associated with conventional peelings. The AGE Resurfacing regimen is indicated for the treatment of photoaging, and consists of multi-ingredient peeling solution with trichloroacetic acid, pyruvic acid, salicylic acid, mandelic acid, and lactobionic acid. The MELA Resurfacing regimen addresses hyperpigmentation concerns and contains mandelic acid, potassium azeloyl diglycinate, retinol, salicylic acid, phytic acid, lactobionic acid, and lactic acid. Results of previously conducted US clinical experience trial of AGE and MELA resurfacing protocols rated 81% of subjects with some level of improvement according to physician assessment. To evaluate whether a daily skin care regimen used for 12 weeks could maintain the benefits achieved with AGE and MELA chemical resurfacing treatments. Subjects who completed participation in the AGE and MELA skin resurfacing clinical trial were recruited to participate in a continuation trial and used a daily regimen of MDRejuvena facial products for 12 weeks. No other facial products were permitted. Physicians assessed the severity of individual skin parameters at baseline and week 12 and provided global assessment. Subjects assessed improvement of individual skin parameters at week 12 and provided an overall assessment. Thirteen subjects participated in the 12-week continuation trial. According to the physician's global assessment, all subjects demonstrated some level of improvement at week 12 compared to baseline. Physician assessment showed a decrease in severity of all skin parameters assessed at week 12

Chronic pain following total hip arthroplasty: a nationwide questionnaire study

DEFF Research Database (Denmark)

Nikolajsen, Lone; Brandsborg, Birgitte; Lucht, Ulf

2006-01-01

BACKGROUND: Chronic post-operative pain is a well-recognized problem after various types of surgery, but little is known about chronic pain after orthopedic surgery. Severe pre-operative pain is the primary indication for total hip arthroplasty (THA). Therefore, we examined the prevalence...... was 93.6%. Two hundred and ninety-four patients (28.1%) had chronic ipsilateral hip pain at the time of completion of the questionnaire, and pain limited daily activities to a moderate, severe or very severe degree in 12.1%. The chronic pain state was related to the recalled intensity of early post...

Proximal femoral resection and articulated hip distraction with an external fixator for the treatment of painful spastic hip dislocations in pediatric patients with spastic quadriplegia.

Science.gov (United States)

Lampropulos, Mario; Puigdevall, Miguel H; Zapozko, Daniel; Malvárez, Héctor R

2008-01-01

We describe the results obtained with an alternative method of treatment for spastic painful hip dislocations in nonambulatory patients, which consists of a proximal femoral resection with capsular interposition arthroplasty, and the addition of a hinged external fixator for postoperative articulated hip distraction to allow for an immediate upright position and the ability to sit in a wheelchair. We performed this technique in three patients (four hips) with a mean age at the time of surgery of 15 years. Postoperatively, clinical improvement was observed in all four hips, with respect to pain relief, sitting tolerance, perineal care and functional range of motion.

The migration of femoral components after total hip replacement surgery: accuracy and precision of software-aided measurements

International Nuclear Information System (INIS)

Decking, J.; Schuetz, U.; Decking, R.; Puhl, W.

2003-01-01

Objective: To assess the accuracy and precision of a software-aided system to measure migration of femoral components after total hip replacement (THR) on digitised radiographs. Design and patients: Subsidence and varus-valgus tilt of THR stems within the femur were measured on digitised anteroposterior pelvic radiographs. The measuring software (UMA, GEMED, Germany) relies on bony landmarks and comparability parameters of two consecutive radiographs. Its accuracy and precision were calculated by comparing it with the gold standard in migration measurements, radiostereometric analysis (RSA). Radiographs and corresponding RSA measurements were performed in 60 patients (38-69 years) following cementless THR surgery. Results and conclusions: The UMA software measured the subsidence of the stems with an accuracy of ±2.5 mm and varus-valgus tilt with an accuracy of ±1.8 (95% confidence interval). A good interobserver and intraobserver reliability was calculated with Cronbach's alpha ranging from 0.86 to 0.97. Measuring the subsidence of THR stems within the femur is an important parameter in the diagnosis of implant loosening. Software systems such as UMA improve the accuracy of migration measurements and are easy to use on routinely performed radiographs of operated hip joints. (orig.)

Utility of immediate postoperative hip MRI in developmental hip dysplasia: closed vs. open reduction.

Science.gov (United States)

Jadhav, Siddharth P; More, Snehal R; Shenava, Vinitha; Zhang, Wei; Kan, J Herman

2018-04-25

Magnetic resonance imaging (MRI) of the hips is being increasingly used to confirm hip reduction after surgery and spica cast placement for developmental dysplasia of the hip (DDH). To review a single institutional experience with post-spica MRI in children undergoing closed or open hip reduction and describe the utility of MRI in directing the need for re-intervention. Seventy-four patients (52 female, 22 male) who underwent post-spica hip MRI over a 6-year period were retrospectively reviewed. One hundred and seven hips were included. Data reviewed included age at intervention, gender, type of intervention performed, MRI findings, the need for re-intervention and the interval between interventions. Gender was compared between the closed and open reduction groups via the Fisher exact test. Age at the first procedure was compared via the Wilcoxon rank test. Rates of re-intervention after closed and open reduction were calculated and the reasons for re-intervention were reviewed. The mean age at the time of the first intervention was 16.4 months (range: 4 to 63 months). Mean age for the closed reduction group was 10.5 months (range: 4-24 months) and for the open reduction group was 23.7 months (range: 5-63 months), which was significant (P-value open reduction, MRI was useful in deciding re-intervention in only 1 (2%). This patient had prior multiple failed closed and open reductions at an outside institute. Post intervention hip spica MRI is useful in determining the need for re-intervention after closed hip reduction, but its role after open reduction is questionable.

The role of chair exercises for older adults following hip fracture

African Journals Online (AJOL)

for older adults following hip fracture. Claire M ... women temporarily disabled as a result of a fracture and ... recovering from hip fracture surgery are not very promising. ... investigation was to examine the influence of exercise on ..... from estimated energy expenditure relative to the reported ..... physical activity: A review. Jor.

A randomised, double-blinded clinical study on the efficacy of multimedia presentation using an iPad for patient education of postoperative hip surgery patients in a public hospital in Singapore.

Science.gov (United States)

Dallimore, Rachel-Kim; Asinas-Tan, Marxengel Leonin; Chan, Daryl; Hussain, Suharti; Willett, Catherine; Zainuldin, Rahizan

2017-09-01

This study compared patient satisfaction and recall of physiotherapy patient education among patients who had undergone hip surgery, with information presented via an iPad versus a standard paper booklet. Patients who had undergone hip surgery joined and completed this single-centre study, which utilised a randomised parallel group design. They were randomly allocated to either Group A (received information on hip surgery physiotherapy via an iPad) or Group B (received the same information via a paper booklet). The participants were blinded to the intervention received by the other group and the testers were blinded to the intervention received by the participants. The interventions were carried out during the patients' first four postoperative physiotherapy sessions. The outcome measures were recorded using pre-validated questionnaires. A total of 42 participants (mean age 70 ± 12 years) were recruited. After the intervention, patients in both groups had improved recall of the information presented during patient education. However, the patients in Group A had a significantly better recall score than those in Group B (4.0 points higher, p iPad and a paper booklet both had positive outcomes for patient recall and satisfaction, the use of an iPad was found to be more effective at improving patient satisfaction and recall of physiotherapy patient education in the present study. Copyright: © Singapore Medical Association

A simple technique to strengthen the initial and mid-term to long-term stability of the cup during total hip arthroplasty in developmental dysplasia of the hip.

Science.gov (United States)

Guan, Mingqiang; Zhou, Guanming; Li, Xue

2018-04-01

To assess the effects of a technique of cup blocking screws combined with impaction bone grafting during total hip arthroplasty (THA) for patients with developmental dysplasia of the hip (DDH). From August 2011 to July 2015, 53 patients (59 hips) with DDH in our hospital were treated with THA using the technique of cup blocking screws combined with impaction particulate bone grafting. These patients were prospectively followed, and the clinical and imaging results were collected. Harris hip score (HHS) was raised from 41.24 before surgery to 91.49 at the latest follow-up (p less than 0.001). Length discrepancy (LLD) was reduced from 28.97 mm before surgery to 6.08 mm after surgery (p less than 0.001). No loosening of the cup was detected at the last follow-up. The differences were insignificant in cup inclination and rate of cup coverage among the 3 groups of Crowe type II, type III, and type IV DDH (p greater than 0.05). The technique of cup blocking screws combined with impaction particulate bone grafting is simple and reliable, and it not only simplifies the attainment of initial stability, but also strengthens the mid-term to long-term stability during THA in DDH.

Imaging of hip joint arthroplasty

International Nuclear Information System (INIS)

Mayerhoefer, M.E.; Fruehwald-Pallamar, J.; Czerny, C.

2009-01-01

The hip joint is the largest joint in the human body and consequently, its evaluation by diagnostic imaging is highly important. This includes imaging of hip joint arthroplasty, which is used to avoid joint immobility following a wide spectrum of diseases, such as end-stage degenerative disease, avascular necrosis of the femoral head or post-traumatic fractures. Conventional radiography is still the standard imaging modality for the evaluation of hip arthroplasty both directly following surgery and for periodical follow-up. In the majority of cases conventional radiography enables adequate assessment of early and late complications that can arise following hip arthroplasty, such as loosening, prosthetic or periprosthetic fracture, luxation, infection and soft tissue calcification. If the diagnosis cannot be established by means of radiography, advanced imaging methods such as computed tomography (CT) and magnetic resonance imaging (MRI), with or without injection of contrast media, may provide additional information. This is particularly true for the depiction of inflammatory processes. Regardless of the imaging modality used patients' clinical symptoms must also be taken into account in order to establish the correct diagnosis. (orig.) [de

Bursae and abscess cavities communicating with the hip: diagnosis using arthrography and CT

International Nuclear Information System (INIS)

Steinbach, L.S.; Schneider, R.; Goldman, A.B.; Kazam, E.; Ranawat, C.S.; Ghelman, B.

1985-01-01

Bursae or abscess cavities communicating with the hip joint were demonstrated by hip arthrography or by computed tomography (CT) in 40 cases. The bursae or abscess cavities were associated with underlying abnormalities in the hip, including painful hip prostheses, infection, and inflammatory or degenerative arthritis. Symptoms may be produced directly as a result of infection or indirectly as a result of inflammation or pressure on adjacent structures. Hip arthrography can confirm a diagnosis of bursae and abscess cavities communicating with the hip joint in patients with hip pain or soft-tissue masses around the groin. Differentiation of enlarged bursae from other abnormalities is important to avoid unnecessary or incorrect surgery

[Radiographic appraisal between metal and bone interosculate backfill after total hip arthroplasty with trabecular metal cup].

Science.gov (United States)

Li, Wei; Zhou, Yi-Xin; Wu, Jian; Xu, Hui; Ji, Song-Jie

2009-02-15

To evaluate the bone refilling in the interface between the trabecular metal (TM) acetabular shell and the bone surface according to consecutive X film measuring after surgery. From July 2006 to July 2007, 35 patients (40 hips) accepted total hip replacement using trabecular metal monoblock acetabular cup system (TM). The cup was made of a ellipse shaped press fit Tantalum shell and high cross-linked PE liner (Longevity) with 28 mm inner diameter. The patients demography was: 16 male (20 hips), 19 female (20 hips), 5 bilateral hip replacements, age from 41 - 71 (mean 53), including 18 avascular necrosis hips, 16 osteoarthritis hips (including those secondary to a dysplasia hip), 4 avascular necrosis hips after femoral neck fracture, 2 Ankylosis Spondylitis. All the 40 total hip replacements used posterior approach, using hemispherical acetabular reamer and 2 mm press fit of final metal shell without screw fixation. The consecutive X film was taken at the end time of surgery and 2, 6, 12, 24 weeks, and 12 months. The clinical results was evaluate according to Harris scoring system, and the standard pelvis AP X film was measured at the interface between metal shell and the acetabular bone surface, witch was divided into five regions (A, B, C, D, E). Totally 32 patients (37 hips) were followed with average 8.7 months (7 - 12 months). The Harris before surgery was 50.5 (32 - 85), promoted to 91.0 (72 - 100), including 29 excellent, 6 good, 2 fair, and the total excellent and good rate was 94.6%. Complications include 4 patients leg length discrepancy from 1 - 2 cm, 3 patients moderate thigh pain and released after conservative therapy. No infection and dislocation was found. Twenty-one patients (23 hips) were found lucent line at the bone-metal interface from 1 - 5 mm, most common in B region and BC boundary than C, D, and CD boundary. All the patients followed was found the lucent line disappeared and refilled with bone at X film 24 weeks after surgery, however, no

One-stage or two-stage revision surgery for prosthetic hip joint infection--the INFORM trial: a study protocol for a randomised controlled trial.

Science.gov (United States)

Strange, Simon; Whitehouse, Michael R; Beswick, Andrew D; Board, Tim; Burston, Amanda; Burston, Ben; Carroll, Fran E; Dieppe, Paul; Garfield, Kirsty; Gooberman-Hill, Rachael; Jones, Stephen; Kunutsor, Setor; Lane, Athene; Lenguerrand, Erik; MacGowan, Alasdair; Moore, Andrew; Noble, Sian; Simon, Joanne; Stockley, Ian; Taylor, Adrian H; Toms, Andrew; Webb, Jason; Whittaker, John-Paul; Wilson, Matthew; Wylde, Vikki; Blom, Ashley W

2016-02-17

Periprosthetic joint infection (PJI) affects approximately 1% of patients following total hip replacement (THR) and often results in severe physical and emotional suffering. Current surgical treatment options are debridement, antibiotics and implant retention; revision THR; excision of the joint and amputation. Revision surgery can be done as either a one-stage or two-stage operation. Both types of surgery are well-established practice in the NHS and result in similar rates of re-infection, but little is known about the impact of these treatments from the patient's perspective. The main aim of this randomised controlled trial is to determine whether there is a difference in patient-reported outcome measures 18 months after randomisation for one-stage or two-stage revision surgery. INFORM (INFection ORthopaedic Management) is an open, two-arm, multi-centre, randomised, superiority trial. We aim to randomise 148 patients with eligible PJI of the hip from approximately seven secondary care NHS orthopaedic units from across England and Wales. Patients will be randomised via a web-based system to receive either a one-stage revision or a two-stage revision THR. Blinding is not possible due to the nature of the intervention. All patients will be followed up for 18 months. The primary outcome is the WOMAC Index, which assesses hip pain, function and stiffness, collected by questionnaire at 18 months. Secondary outcomes include the following: cost-effectiveness, complications, re-infection rates, objective hip function assessment and quality of life. A nested qualitative study will explore patients' and surgeons' experiences, including their views about trial participation and randomisation. INFORM is the first ever randomised trial to compare two widely accepted surgical interventions for the treatment of PJI: one-stage and two-stage revision THR. The results of the trial will benefit patients in the future as the main focus is on patient-reported outcomes: pain, function

Usability Test of Exercise Games Designed for Rehabilitation of Elderly Patients After Hip Replacement Surgery: Pilot Study

Science.gov (United States)

Ter Meer, Louis P; Yumak, Zerrin; Veltkamp, Remco C

2017-01-01

Background Patients who receive rehabilitation after hip replacement surgery are shown to have increased muscle strength and better functional performance. However, traditional physiotherapy is often tedious and leads to poor adherence. Exercise games, provide ways for increasing the engagement of elderly patients and increase the uptake of rehabilitation exercises. Objective The objective of this study was to evaluate Fietsgame (Dutch for cycling game), which translates existing rehabilitation exercises into fun exercise games. The system connects exercise games with a patient’s personal record and a therapist interface by an Internet of Things server. Thus, both the patient and physiotherapist can monitor the patient’s medical status. Methods This paper describes a pilot study that evaluates the usability of the Fietsgame. The study was conducted in a rehabilitation center with 9 participants, including 2 physiotherapists and 7 patients. The patients were asked to play 6 exercise games, each lasting about 5 min, under the guidance of a physiotherapist. The mean age of the patients was 74.57 years (standard deviation [SD] 8.28); all the patients were in the recovery process after hip surgery. Surveys were developed to quantitatively measure the usability factors, including presence, enjoyment, pain, exertion, and technology acceptance. Comments on advantages and suggested improvements of our game system provided by the physiotherapists and patients were summarized and their implications were discussed. Results The results showed that after successfully playing the games, 75% to 100% of the patients experienced high levels of enjoyment in all the games except the squats game. Patients reported the highest level of exertion in squats when compared with other exercise games. Lunges resulted in the highest dropout rate (43%) due to interference with the Kinect v2 from support chairs. All the patients (100%) found the game system useful and easy to use, felt that

Reliability and concurrent validity of the Dutch hip and knee replacement expectations surveys

NARCIS (Netherlands)

van den Akker-Scheek, Inge; van Raay, Jos J. A. M.; Reininga, Inge H. F.; Bulstra, Sjoerd K.; Zijlstra, Wiebren; Stevens, Martin

2010-01-01

Background: Preoperative expectations of outcome of total hip and knee arthroplasty are important determinants of patients' satisfaction and functional outcome. Aims of the study were (1) to translate the Hospital for Special Surgery Hip Replacement Expectations Survey and Knee Replacement

MRI Evaluation of Post Core Decompression Changes in Avascular Necrosis of Hip.

Science.gov (United States)

Nori, Madhavi; Marupaka, Sravan Kumar; Alluri, Swathi; Md, Naseeruddin; Irfan, Kazi Amir; Jampala, Venkateshwarlu; Apsingi, Sunil; Eachempati, Krishna Kiran

2015-12-01

Avascular necrosis of hip typically presents in young patients. Core decompression in precollapse stage provides pain relief and preservation of femoral head. The results of core decompression vary considerably despite early diagnosis. The role of MRI in monitoring patients post surgically has not been clearly defined. To study pre and post core decompression MRI changes in avascular necrosis of hip. This is a contiguous observational cohort of 40 hips treated by core decompression for precollapse avascular necrosis of femoral head, who had a baseline MRI performed before surgery. Core decompression of the femoral head was performed within 4 weeks. Follow up radiograph and MRI scans were done at six months. Harris hip score preoperatively, 1 month and 6 months after the surgery was noted. Success in this study was defined as postoperative increase in Harris hip score (HHS) by 20 points and no additional femoral collapse. End point of clinical adverse outcome as defined by fall in Harris hip score was conversion or intention to convert to total hip replacement (THR). MRI parameters in the follow up scan were compared to the preoperative MRI. Effect of core decompression on bone marrow oedema and femoral head collapse was noted. Results were analysed using SPSS software version. Harris hip score improved from 57 to 80 in all patients initially. Six hips had a fall in Harris hip score to mean value of 34.1 during follow up (9 to 12 months) and underwent total hip replacement. MRI predictors of positive outcome are lesions with grade A extent, Grade A & B location. Bone marrow oedema with lesions less than 50% involvement, medial and central location. Careful selection of patients by MR criteria for core decompression provides satisfactory outcome in precollapse stage of avascular necrosis of hip.

The use of LiDCO based fluid management in patients undergoing hip fracture surgery under spinal anaesthesia: Neck of femur optimisation therapy - targeted stroke volume (NOTTS: study protocol for a randomized controlled trial

Directory of Open Access Journals (Sweden)

Moran Chris G

2011-09-01

Full Text Available Abstract Background Approximately 70,000 patients/year undergo surgery for repair of a fractured hip in the United Kingdom. This is associated with 30-day mortality of 9% and survivors have a considerable length of acute hospital stay postoperatively (median 26 days. Use of oesophageal Doppler monitoring to guide intra-operative fluid administration in hip fracture repair has previously been associated with a reduction in hospital stay of 4-5 days. Most hip fracture surgery is now performed under spinal anaesthesia. Oesophageal Doppler monitoring may be unreliable in the presence of spinal anaesthesia and most patients would not tolerate the probes. An alternative method of guiding fluid administration (minimally-invasive arterial pulse contour analysis has been shown to reduce length of stay in high-risk surgical patients but has never been studied in hip fracture surgery. Methods Single-centre randomised controlled parallel group trial. Randomisation by website using computer generated concealed tables. Setting: University hospital in UK. Participants: 128 patients with acute primary hip fracture listed for operative repair under spinal anaesthesia and aged > 65 years. Intervention: Stroke volume guided intra-operative fluid management. Continuous measurement of SV recorded by a calibrated cardiac output monitor (LiDCOplus. Maintenance fluid and 250 ml colloid boluses given to achieve sustained 10% increases in stroke volume. Control group: fluid administration at the responsible (blinded anaesthetist's discretion. The intervention terminates at the end of the surgical procedure and post-operative fluid management is at the responsible anaesthetist's discretion. Primary outcome: length of acute hospital stay is determined by a blinded team of clinicians. Secondary outcomes include number of complications and total cost of care. Funding NIHR/RfPB: PB-PG-0407-13073. Trial registration number Trial registration: Current Controlled Trials ISRCTN

Nurses' responsibilities in postoperative pain management following total hip arthroplasty

OpenAIRE

Dumolard, Pierre; Gök, Mustafa; Le, Ngoc

2017-01-01

Total hip arthroplasty is the replacement of a hip joint that has been severely damaged. The operation is recommended if other treatments have not responded adequately. As the nurses are the professionals who spend the most time with patients after the surgery, they play an important role in the patient’s pain management. The aim of the thesis is to define the nurse’s responsibilities in the care of total hip arthroplasty. The purpose of the thesis is to analyze existing research, which may s...

Risk factors for renal dysfunction after total hip joint replacement

DEFF Research Database (Denmark)

Hassan, Basim Kamil; Sahlström, Arne; Dessau, Ram Benny Christian

2015-01-01

BACKGROUND AND PURPOSE OF THE STUDY: Renal injury and dysfunction are serious complications after major surgery, which may lead to increased morbidity and mortality. The objective of our study was to identify the possible risk factors for renal dysfunction after total hip joint replacement surger...... creatinine. Smoking, diabetes mellitus, high BMI, gender, and duration of surgery were not identified as significant risk factors........ METHODS: A retrospective study was conducted among 599 consecutive primary hip joint replacements performed between January 2011 and December 2013. According to the RIFLE criteria, increased postoperative serum creatinine was considered indicative of postoperative renal injury. The Welch two-sample test......, hypertension, general anesthesia, high ASA scores, low intra-operative systolic BP, and prophylactic dicloxacillin as significant risk factors. Low baseline systolic BP, low baseline diastolic blood pressure, and hip fracture diagnosis were independent risk factors for postoperative increase in serum...

Early treatment using fractional CO2 laser before skin suture during scar revision surgery in Asians.

Science.gov (United States)

Du, Feiya; Yu, Yusheng; Zhou, Zhiqin; Wang, Liujia; Zheng, Shusen

2018-04-01

Fractional CO 2 laser is one of the most effective treatment options used to resurface scars. However, most previous studies have been performed on mature scars at least 2 months after surgery. Recent studies have emphasized the importance of early treatment to reduce scar formation. In the present study, we described our experience with fractional CO 2 laser intervention before skin suture during scar revision surgery in Asians, and found the treatment was safe and effective.

High Rate of Return to Yoga for Athletes After Hip Arthroscopy for Femoroacetabular Impingement Syndrome.

Science.gov (United States)

Frank, Rachel M; Ukwuani, Gift; Allison, Bradley; Clapp, Ian; Nho, Shane J

2018-02-01

Femoroacetabular impingement syndrome (FAIS) is most commonly diagnosed in patients who perform activities that require repetitive hip flexion and rotational loading. Yoga is an activity growing in popularity that involves these motions. The purpose of this study was to evaluate patients' ability to return to yoga after hip arthroscopy for FAIS. There would be a high rate of return to yoga after hip arthroscopy. Retrospective analysis. Level 4. Consecutive patients with FAIS who had identified themselves as participating in yoga and had undergone hip arthroscopy for the treatment of FAIS between 2012 and 2015 were reviewed. Demographic data were collected and assessed for all patients, as well as preoperative physical examination, imaging, and patient-reported outcome (PRO) scores, including the modified Harris Hip Score (mHHS), Hip Outcome Score Activities of Daily Living (HOS-ADL) and Sports-Specific (HOS-SS) subscales, and visual analog scale (VAS) for pain. Postoperatively, examination and PRO data were collected at a minimum 1 year after surgery, including a yoga-specific questionnaire. A total of 42 patients (90% female; mean age, 35 ± 9 years; mean body mass index, 23.1 ± 3.2 kg/m 2 ) were included. Thirty patients (71%) had to discontinue their yoga routine preoperatively because of hip-related symptoms at a mean 9.5 ± 8.2 months before surgery. After surgery, 39 patients (93%) were able to return to yoga at a mean 5.3 ± 2.2 months after surgery. Two of the 3 patients who did not return to yoga noted loss of interest as their reason for stopping, while 1 patient was unable to return because of persistent hip pain. Nineteen patients (45%) returned to a higher level of yoga practice, 17 patients (40%) returned to the same level, and 3 patients (7%) returned to a lower level. There was no difference in the number of hours spent practicing yoga per week pre- and postoperatively (2.7 ± 1.9 vs 2.5 ± 1.3 hours; P = 0.44). All patients demonstrated

Room for improvement in the treatment of hip fractures in Denmark

DEFF Research Database (Denmark)

Egerod, Ingrid; Rud, Kirsten; Specht, Kirsten

2010-01-01

INTRODUCTION: Treatment of hip fractures has evolved since the introduction of fast-track surgical programs in the late 1990s. The aim of our study was to describe the quality of treatment and care related to fast-track hip fracture surgery in Denmark by external audit of patient records. MATERIAL......, nutritional screening, ambulation characteristics, training in activities of daily living, and rehabilitation planning were consistently inadequate. Length of stay was 7-11 days. CONCLUSION: Although the principles for fast-track surgery have been adapted to some extent at all departments in Denmark...... with an annual treatment of at least 50 patients with hip fractures, no single department has implemented the whole package. Hospital stay has been reduced since the introduction of fast-track regimes, and improvements were seen in many of the quality indicators. Implications for future practice include better...

Post-operative rounds by anaesthesiologists after hip fracture surgery

DEFF Research Database (Denmark)

Foss, N B; Christensen, D S; Krasheninnikoff, M

2006-01-01

Efforts to optimize the peri-operative care of hip fracture patients through multidisciplinary intervention have focused on orthopaedic-geriatric liaisons, which have not resulted in significant outcome changes. The early phase of rehabilitation could potentially be optimized through...

Nonablative Fractional Laser Resurfacing in Skin of Color: Evidence-based Review

OpenAIRE

Kaushik, Shivani B.; Alexis, Andrew F.

2017-01-01

Background: Nonablative laser resurfacing represents one of the major advances in procedural dermatology over the past decade. However, its use in darker skin types is limited by safety concerns and a relative lack of available data.

Cartilage status in FAI patients - results from the Danish Hip Arthroscopy Registry (DHAR)

DEFF Research Database (Denmark)

Lund, Bent; Nielsen, Torsten Grønbech; Lind, Martin

2017-01-01

management is not fully elucidated. This study from the Danish Hip Arthroscopy Registry (DHAR) will try to show data on the cartilage status from a large cohort. Data from a national registry potentially represent large amounts of population-based epidemiological information from multiple centres...... severe acetabular cartilage injury. DISCUSSION: The majority of patients with femoroacetabular impingement (FAI) undergoing hip arthroscopy have significant cartilage changes at the time of surgery primarily at the acetabulum and to a lesser degree at the femoral head. During FAI surgery the majority...

A longitudinal study of quality of life and functional status in total hip and total knee replacement patients.

Science.gov (United States)

Mandzuk, Lynda L; McMillan, Diana E; Bohm, Eric R

2015-05-01

Primary total hip and primary total knee surgeries are commonly performed to improve patients' quality of life and functional status. This longitudinal retrospective study (N = 851) examined self-reported quality of life and functional status over the preoperative and postoperative periods: 12 months prior to surgery, one month prior to surgery and 12 months following surgery. A linear mixed effects model was used to analyze the changes in quality of life and functional status over the sampling period. Patients in the convenience sample reported improvements in quality of life and functional status utilizing the SF-12 and Oxford Hip and Oxford Knee, although differences were noted by procedure and gender. Total hip patients tended to demonstrate greater improvement than total knee patients and males reported higher levels of physical and mental quality of life as well as functional status when compared to females. Of particular note was that mental health scores were consistently lower in both total hip and total knee replacement patients across the perioperative period and up to one year postoperative. This study identifies an opportunity for health care providers to proactively address the mental health of total hip and total knee replacement patients throughout their joint replacement trajectory. Copyright © 2014 Elsevier Ltd. All rights reserved.

Endoscopic resection of acetabular screw tip to decompress sciatic nerve following total hip arthroplasty.

Science.gov (United States)

Yoon, Sun-Jung; Park, Myung-Sik; Matsuda, Dean K; Choi, Yun Ho

2018-06-04

Sciatic nerve injuries following total hip arthroplasty are disabling complications. Although degrees of injury are variable from neuropraxia to neurotmesis, mechanical irritation of sciatic nerve might be occurred by protruding hardware. This case shows endoscopic decompression for protruded acetabular screw irritating sciatic nerve, the techniques described herein may permit broader arthroscopic/endoscopic applications for management of complications after reconstructive hip surgery. An 80-year-old man complained of severe pain and paresthesias following acetabular component revision surgery. Physical findings included right buttock pain with radiating pain to lower extremity. Radiographs and computed tomography imaging showed that the sharp end of protruded screw invaded greater sciatic foramen anterior to posterior and distal to proximal direction at sciatic notch level. A protruding tip of the acetabular screw at the sciatic notch was decompressed by use of techniques gained from experience performing endoscopic sciatic nerve decompression. The pre-operative pain and paresthesias resolved post-operatively after recovering from anesthesia. This case report describes the first documented endoscopic resection of the tip of the acetabular screw irritating sciatic nerve after total hip arthroplasty. If endoscopic resection of an offending acetabular screw can be performed in a safe and minimally invasive manner, one can envision a future expansion of the role of hip arthroscopic surgery in several complications management after total hip arthroplasty.

Analgesia after total hip replacement: epidural versus psoas ...

African Journals Online (AJOL)

tive analgesia following total hip replacement surgery. The research design was a ... matoma, intra-abdominal injury and pain due to spasm of the lumbar paravertebral ..... 2. Brown DL. Spinal, epidural, and caudal anesthesia In: Miller RD, ed.

Usability Test of Exercise Games Designed for Rehabilitation of Elderly Patients After Hip Replacement Surgery: Pilot Study.

Science.gov (United States)

Ling, Yun; Ter Meer, Louis P; Yumak, Zerrin; Veltkamp, Remco C

2017-10-12

Patients who receive rehabilitation after hip replacement surgery are shown to have increased muscle strength and better functional performance. However, traditional physiotherapy is often tedious and leads to poor adherence. Exercise games, provide ways for increasing the engagement of elderly patients and increase the uptake of rehabilitation exercises. The objective of this study was to evaluate Fietsgame (Dutch for cycling game), which translates existing rehabilitation exercises into fun exercise games. The system connects exercise games with a patient's personal record and a therapist interface by an Internet of Things server. Thus, both the patient and physiotherapist can monitor the patient's medical status. This paper describes a pilot study that evaluates the usability of the Fietsgame. The study was conducted in a rehabilitation center with 9 participants, including 2 physiotherapists and 7 patients. The patients were asked to play 6 exercise games, each lasting about 5 min, under the guidance of a physiotherapist. The mean age of the patients was 74.57 years (standard deviation [SD] 8.28); all the patients were in the recovery process after hip surgery. Surveys were developed to quantitatively measure the usability factors, including presence, enjoyment, pain, exertion, and technology acceptance. Comments on advantages and suggested improvements of our game system provided by the physiotherapists and patients were summarized and their implications were discussed. The results showed that after successfully playing the games, 75% to 100% of the patients experienced high levels of enjoyment in all the games except the squats game. Patients reported the highest level of exertion in squats when compared with other exercise games. Lunges resulted in the highest dropout rate (43%) due to interference with the Kinect v2 from support chairs. All the patients (100%) found the game system useful and easy to use, felt that it would be a useful tool in their further

Hip Arthroscopy in High-Level Baseball Players.

Science.gov (United States)

Byrd, J W Thomas; Jones, Kay S

2015-08-01

To report the results of hip arthroscopy among high-level baseball players as recorded by outcome scores and return to baseball. All patients undergoing hip arthroscopy were prospectively assessed with the modified Harris Hip Score. On review of all procedures performed over a 12-year period, 44 hips were identified among 41 intercollegiate or professional baseball players who had achieved 2-year follow-up. Among the 41 players, follow-up averaged 45 months (range, 24 to 120 months), with a mean age of 23 years (range, 18 to 34 years). There were 23 collegiate (1 bilateral) and 18 professional (2 bilateral) baseball players, including 10 Major League Baseball players. Of the 8 Major League Baseball pitchers, 6 (75%) also underwent ulnar collateral ligament elbow surgery. Improvement in the modified Harris Hip Score averaged 13 points (from 81 points preoperatively to 94 points postoperatively); a paired-samples t test determined that this mean improvement of 13 points was statistically significant (P arthroscopy. This study supports the idea that arthroscopic treatment for a variety of hip pathologies in high-level baseball players provides a successful return to sport and improvement in functional outcome scores. Level IV, therapeutic case series. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Standard guidelines of care: CO2 laser for removal of benign skin lesions and resurfacing.

Science.gov (United States)

Krupashankar, D S

2008-01-01

Resurfacing is a treatment to remove acne and chicken pox scars, and changes in the skin due to ageing. MACHINES: Both ablative and nonablative lasers are available for use. CO 2 laser is the gold standard in ablative lasers. Detailed knowledge of the machines is essential. INDICATIONS FOR CO 2 LASER: Therapeutic indications: Actinic and seborrheic keratosis, warts, moles, skin tags, epidermal and dermal nevi, vitiligo blister and punch grafting, rhinophyma, sebaceous hyperplasia, xanthelasma, syringomas, actinic cheilitis angiofibroma, scar treatment, keloid, skin cancer, neurofibroma and diffuse actinic keratoses. CO 2 laser is not recommended for the removal of tattoos. AESTHETIC INDICATIONS: Resurfacing for acne, chicken pox and surgical scars, periorbital and perioral wrinkles, photo ageing changes, facial resurfacing. PHYSICIANS' QUALIFICATIONS: Any qualified dermatologist (DVD or MD) may practice CO 2 laser. The dermatologist should possess postgraduate qualification in dermatology and should have had specific hands-on training in lasers either during postgraduation or later at a facility which routinely performs laser procedures under a competent dermatologist/plastic surgeon, who has experience and training in using lasers. For the use of CO 2 lasers for benign growths, a full day workshop is adequate. As parameters may vary in different machines, specific training with the available machine at either the manufacturer's facility or at another centre using the machine is recommended. CO 2 lasers can be used in the dermatologist's minor procedure room for the above indications. However, when used for full-face resurfacing, the hospital operation theatre or day care facility with immediate access to emergency medical care is essential. Smoke evacuator is mandatory. Detailed counseling with respect to the treatment, desired effects, possible postoperative complications, should be discussed with the patient. The patient should be provided brochures to study and

Standard guidelines of care: CO 2 laser for removal of benign skin lesions and resurfacing

Directory of Open Access Journals (Sweden)

Krupashankar D

2008-03-01

Full Text Available Resurfacing is a treatment to remove acne and chicken pox scars, and changes in the skin due to ageing. Machines : Both ablative and nonablative lasers are available for use. CO 2 laser is the gold standard in ablative lasers. Detailed knowledge of the machines is essential. Indications for CO 2 laser: Therapeutic indications: Actinic and seborrheic keratosis, warts, moles, skin tags, epidermal and dermal nevi, vitiligo blister and punch grafting, rhinophyma, sebaceous hyperplasia, xanthelasma, syringomas, actinic cheilitis angiofibroma, scar treatment, keloid, skin cancer, neurofibroma and diffuse actinic keratoses. CO 2 laser is not recommended for the removal of tattoos. Aesthetic indications: Resurfacing for acne, chicken pox and surgical scars, periorbital and perioral wrinkles, photo ageing changes, facial resurfacing. Physicians′ qualifications: Any qualified dermatologist (DVD or MD may practice CO 2 laser. The dermatologist should possess postgraduate qualification in dermatology and should have had specific hands-on training in lasers either during postgraduation or later at a facility which routinely performs laser procedures under a competent dermatologist/plastic surgeon, who has experience and training in using lasers. For the use of CO 2 lasers for benign growths, a full day workshop is adequate. As parameters may vary in different machines, specific training with the available machine at either the manufacturer′s facility or at another centre using the machine is recommended. Facility: CO 2 lasers can be used in the dermatologist′s minor procedure room for the above indications. However, when used for full-face resurfacing, the hospital operation theatre or day care facility with immediate access to emergency medical care is essential. Smoke evacuator is mandatory. Preoperative counseling and Informed consent Detailed counseling with respect to the treatment, desired effects, possible postoperative complications, should be

Relationship between flexible flat foot and developmental hip dysplasia.

Science.gov (United States)

Ponce de León Samper, M C; Herrera Ortiz, G; Castellanos Mendoza, C

2015-01-01

To evaluate the possible relationship between flexible flat foot and developmental hip dysplasia in children between six and 15 years of age. Cross-sectional study including 65 patients that had undergone surgery due to residual hip dysplasia or hip dislocation and compared against 75 healthy patients. Flexible flat foot prevalence was measured in each group, with the results showing that 61% of the group with residual hip dysplasia or hip dislocation had this condition, vs. 12% in the healthy group. The statistical analysis shows that the chances of suffering from flexible flat foot, are five times greater in the hip dysplasia or hip dislocation group, than in the healthy group. There is no evidence in the literature showing a relationship between these two conditions, even though they have a common etiology. This study shows a potential measurable relation between this two conditions. Patients with hip dysplasia or dislocation may have a higher chance of presenting flexible flat foot during late childhood, adolescence and adulthood, a fact that suggests a relationship between these two pathologies. Also, patients who seek assistance for the first time because of a flexible flat foot condition without having been evaluated during the first year of life for hip dysplasia, would be better off if evaluated for residual hip dysplasia. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

Functional Recovery Following Pertrochanteric Hip Fractures Fixated with the Dynamic Hip Screw vs. the Percutaneous Compression Plate

Directory of Open Access Journals (Sweden)

Yocheved Laufer

2005-01-01

Full Text Available The Dynamic Hip Screw (DHS is currently the most frequently used implant for the treatment of pertrochanteric hip fractures. The Percutaneous Compression Plate (PCCP is a recently developed, alternative device that involves minimal invasive surgery. The objective of the present study was to compare functional recovery following these two surgical procedures. A total of 76 consecutive elderly subjects (mean age and standard deviation, 80.6 ± 5.5 following pertrochanteric hip fracture fixation were evaluated prospectively. Functional recovery was assessed 3 and 12 weeks and 2 years following surgery. Differences between groups 3 weeks postsurgery were found only in pain level during ambulation and in the weight-bearing capability of the operated extremity, which were both in favor of the PCCP. By 3 months, both groups had improved in all measures, but did not reach their preinjury level of independence. However, the PCCP group ambulated with fewer assistive devices and demonstrated better recovery of basic activities of daily living (BADL. While the majority of the subjects from both groups ambulated independently 2 years postsurgery, the PCCP group exhibited less pain during ambulation, was more independent in ADL, and required fewer assistive devices for ambulation. To summarize, the PCCP presents enhanced short- and long-term recovery of functional abilities in comparison to DHS. However, given the limited number of patients, further studies are necessary to substantiate these results.

Comparison of total hip arthroplasty in osteoarthritis of mechanical and rheumatologic causes

Science.gov (United States)

Ejnisman, Leandro; Leonhardt, Nathalia Zalc; Fernandes, Laura Fillipini Lorimier; Leonhardt, Marcos de Camargo; Vicente, José Ricardo Negreiros; Croci, Alberto Tesconi

2014-01-01

Objective: To compare the use of uncemented implants in total hip arthroplasty in patients with rheumathologic diseases and mechanical osteoarthrosis. Methods: We retrospectively evaluated 196 patients who were operated by the Hip and Arthroplasty Surgery Group of the IOT-HCFMUSP between 2005 and 2009. Patients were divided into two groups: mechanical causes (165 patients) and rheumathologic causes (31 patients). Groups were compared between each other in age, gender and follow-up time. Osseointegration rate and percentage of failure in arthroplasty were evaluated. Results: No statistically significant difference was found in osseointegration rates (in both femoral and acetabular components) in both groups. The rates of revision surgery and implant survival also did not show statistically significant differences. Conclusion: The use of uncemented total hip arthroplasty did not show worse results in rheumathologic patients. Level of Evidence III, Retrospective Case Control Study. PMID:24644419

Pre-operative urinary tract infection: is it a risk factor for early surgical site infection with hip fracture surgery? A retrospective analysis

OpenAIRE

Yassa, Rafik RD; Khalfaoui, Mahdi Y; Veravalli, Karunakar; Evans, D Alun

2017-01-01

Objective The aims of the current study were to determine whether pre-operative urinary tract infections in patients presenting acutely with neck of femur fractures resulted in a delay to surgery and whether such patients were at increased risk of developing post-operative surgical site infections. Design A retrospective review of all patients presenting with a neck of femur fracture, at a single centre over a one-year period. The hospital hip fracture database was used as the main source of ...

Two or more impingement and/or instability deformities are often present in patients with hip pain.

Science.gov (United States)

Tibor, Lisa M; Liebert, Gunnar; Sutter, Reto; Impellizzeri, Franco M; Leunig, Michael

2013-12-01

Damage to the hip can occur due to impingement or instability caused by anatomic factors such as femoral and acetabular version, neck-shaft angle, alpha angle, and lateral center-edge angle (CEA). The associations between these anatomic factors and how often they occur in a painful hip are unclear but if unaddressed might explain failed hip preservation surgery. We determined (1) the influence of sex on the expression of impingement-related or instability-related factors, (2) the associations among these factors, and (3) how often both impingement and/or instability factors occur in the same hip. We retrospectively reviewed a cohort of 170 hips (145 patients) undergoing MR arthrography of the hip for any reason. We excluded 58 hips with high-grade dysplasia, Perthes' sequelae, previous surgery, or incomplete radiographic information, leaving 112 hips (96 patients). We measured femoral version and alpha angles on MR arthrograms. Acetabular anteversion, lateral CEA, and neck-shaft angle were measured on pelvic radiographs. We observed a correlation between sex and alpha angle. Weak or no correlations were observed between the other five parameters. In 66% of hips, two or more (of five) impingement parameters, and in 51% of hips, two or more (of five) instability parameters were found. Patients with hip pain frequently have several anatomic factors potentially contributing to chondrolabral damage. To address pathologic hip loading due to impingement and/or instability, all of the anatomic influences should be known. As we found no associations between anatomic factors, we recommend an individualized assessment of each painful hip.

Lumbar plexus block for post-operative analgesia following hip surgery: A comparison of "3 in 1" and psoas compartment block

Directory of Open Access Journals (Sweden)

Uma Srivastava

2007-01-01

Full Text Available We used a single shot lumbar plexus block by posterior approach (Psoas compartment block- PCB or anterior approach (′3in1′ block for postoperative analgesia in the patients of hip fractures operated under spinal anaesthesia. The blocks were given at the end of operation with 0.25% of bupivacaine and pain was assessed using Verbal Rating scale at 1,6,12 and 24 hours postoperatively both during rest and physiotherapy. We also noted time for first analgesic, need of supplemental analgesics and quality of analgesia during 24 hours. The mean time for first demand of analgesia was 12.4 ±7.9 and 10.7±6.4 hrs in groups PCB and ′3 in 1′ respectively (p>0.05. Requirement of supplemental analgesics was considerably reduced and more than 80% patients in both groups needed only single injection of diclofenac in 24 hrs. It was concluded that both approaches of lumbar plexus block were effective in providing post operative analgesia after hip surgery.

Lessons learned from study of congenital hip disease in adults

OpenAIRE

Hartofilakidis, George; Lampropoulou-Adamidou, Kalliopi

2016-01-01

Orthopaedic surgeons specialising in adult hip reconstruction surgery often face the problem of osteoarthritis secondary to congenital hip disease (CHD). To achieve better communication among physicians, better treatment planning and evaluation of the results of various treatment options, an agreed terminology is needed to describe the entire pathology. Furthermore, a generally accepted classification of the deformities is necessary. Herein, the authors propose the use of the term ?congenital...

Do large heads enhance stability and restore native anatomy in primary total hip arthroplasty?

Science.gov (United States)

Lombardi, Adolph V; Skeels, Michael D; Berend, Keith R; Adams, Joanne B; Franchi, Orlando J

2011-06-01

Dislocation remains a serious complication in hip arthroplasty. Resurfacing proponents tout anatomic femoral head restoration as an advantage over total hip arthroplasty. However, advances in bearings have expanded prosthetic head options from traditional sizes of 22, 26, 28, and 32 mm to diameters as large as 60 mm. Large heads reportedly enhance stability owing to increased range of motion before impingement and increased jump distance to subluxation. Available larger diameter material combinations include metal- or ceramic-on-highly crosslinked polyethylene and metal-on-metal, each with distinct advantages and disadvantages. We sought to determine (1) if using larger diameter heads has lowered our dislocation rate; and (2) how closely an anatomic metal-on-metal bearing with diameters to 60 mm replicates native femoral head size. We retrospectively reviewed 2020 primary arthroplasties performed with large heads (≥ 36 mm) in 1748 patients and noted dislocation incidence. In a prospective subset of 89 cases using anatomic heads, native femoral head diameter was measured intraoperatively with calipers by an independent observer and later compared with implanted size. One dislocation has occurred in 2020 hips for an incidence of 0.05%. The prosthetic head averaged 0.7 mm larger than the native head with 68 of 89 (76%) reconstructed to within ± 2 mm of native size. Larger diameter heads have contributed to lower dislocation rates and large-diameter metal-on-metal articulation can provide close anatomic restoration in primary THA.

Treatment of primary hip osteoarthritis for the primary care physician and the indications for total hip arthroplasty.

Science.gov (United States)

Levine, Mathew E; Nace, James; Kapadia, Bhaveen H; Issa, Kimona; Banerjee, Samik; Cherian, Jeffery J; Mont, Michael A

2013-01-01

Osteoarthritis is a degenerative condition that commonly affects knees and hips with an annual incidence of 88 in 100,000 people in the United States. The purpose of this study was to review the clinical presentation of osteoarthritis of the hip as well as the available management options. We reviewed the recent literature in regard to epidemiology, presentation, and treatment options available to patients. Nonoperative treatments include weight loss and low-impact, aerobic exercises. Along with weight loss and exercise, nonsteroidal anti-inflammatory drugs (NSAIDS), narcotics, and intra-articular steroid injections have been used to improve patient's symptoms. Surgical intervention is a viable option; however, indications such as severe pain that is refractory to nonsurgical management, osteophytes, or joint space narrowing on radiographic films, or impairment of function should be present. The most common surgical option, total hip arthroplasty, has been shown to improve a patient's physical and psychological well-being. However, inherent risks are present with surgery and these should be addressed with the patient so a sound decision can be made. Osteoarthritis of the hip can be bothersome to patients, but physicians can begin management with lifestyle changes or pharmaceuticals. In the event nonoperative measures fail to markedly improve quality of life, total hip arthroplasty remains a viable option.

Arthroscopic bursectomy for recalcitrant trochanteric bursitis after hip arthroplasty.

Science.gov (United States)

Van Hofwegen, Christopher; Baker, Champ L; Savory, Carlton G; Baker, Champ L

2013-01-01

This study evaluated the use of arthroscopic bursectomy for pain relief in patients with trochanteric bursitis after hip arthroplasty. In this retrospective case series of 12 patients undergoing arthroscopic treatment of recalcitrant trochanteric bursitis after hip arthroplasty, outcomes were assessed via phone interview with a numeric pain rating scale from 1 to 10 and were compared with preoperative pain ratings. Patients were asked the percentage of time they had painless hip function and whether they would have the surgery again. At an average 36-month follow-up (range, 4-85 months), the average numeric pain scale rating improved from 9.3 to 3.3. At an average of 62% of the time, patients had painless use of the hip. Ten of 12 patients in the study felt the pain relief gained was substantial enough to warrant having procedure again. In these patients, arthroscopic bursectomy was a viable option for patients with recalcitrant bursitis after hip arthroplasty.

Fractional CO 2 laser resurfacing as monotherapy in the treatment of atrophic facial acne scars

Directory of Open Access Journals (Sweden)

Imran Majid

2014-01-01

Full Text Available Background: While laser resurfacing remains the most effective treatment option for atrophic acne scars, the high incidence of post-treatment adverse effects limits its use. Fractional laser photothermolysis attempts to overcome these limitations of laser resurfacing by creating microscopic zones of injury to the dermis with skip areas in between. Aim: The aim of the present study is to assess the efficacy and safety of fractional CO 2 laser resurfacing in atrophic facial acne scars. Materials and Methods: Sixty patients with moderate to severe atrophic facial acne scars were treated with 3-4 sessions of fractional CO 2 laser resurfacing at 6-week intervals. The therapeutic response to treatment was assessed at each follow up visit and then finally 6 months after the last laser session using a quartile grading scale. Response to treatment was labelled as ′excellent′ if there was >50% improvement in scar appearance and texture of skin on the grading scale while 25-50% response and <25% improvement were labelled as ′good′ and ′poor′ response, respectively. The overall satisfaction of the patients and any adverse reactions to the treatment were also noted. Results: Most of the patients showed a combination of different morphological types of acne scars. At the time of final assessment 6 months after the last laser session, an excellent response was observed in 26 patients (43.3% while 15 (25% and 19 patients (31.7% demonstrated a good and poor response respectively. Rolling and superficial boxcar scars responded the best while pitted scars responded the least to fractional laser monotherapy. The commonest reported adverse effect was transient erythema and crusting lasting for an average of 3-4 and 4-6 days, respectively while three patients developed post-inflammatory pigmentation lasting for 8-12 weeks. Conclusions: Fractional laser resurfacing as monotherapy is effective in treating acne scars especially rolling and superficial boxcar

HIP FRACTURES IN THE ELDERLY PATIENT

Directory of Open Access Journals (Sweden)

Franci Koglot

2001-11-01

Full Text Available Background. Hip fractures are typical of the ageingpopulation. They represent a severe trauma for the elderlypatient due to significant impact on life quality and morbidity.We analyzed the characteristics of patients with hip fractures,the methods and success of treatment. In conclusion, theimportance of continuous team approach and surgical treatmentwithin 24 hours are stressed. Methods. We retrospectively evaluated patients admitted forfemoral neck and intertrochanteric fractures between 1994–1999. The incidence of these fractures, patient age and sex, comorbidity,methods of treatment, hospital stay and success oftreatment with regard to ambulatory status were established.Results. 662 patients were treated in the above mentioned period,yielding a 1‰ annual incidence for the choosen population.The mean patient age was 76 years; there were 426 female(64% and 236 male patients (36%. 336 patients (51%had a history of accompanying disease, in 73 patients (11%additional fractures were diagnosed. 30 patients (4.5% weretreated conservatively, 632 (95.5% underwent surgery. Themean hospital stay length was 17 days. Success of treatmentwas evaluated as good in 441 patients (67%, satisfactory in112 patients (17% and poor in 78 patients (12%. 31 patients(5% died during hospital admission. Conclusions. Patients with hip fractures represent 10% of allin-hospital trauma patients; with hospital stays twice as longas average trauma patients and considering the financial demandsof surgical treatment they are a challenge in traumawards organization and management in the Slovenian environment.Here as well as abroad the number of these patientsis increasing, along with their mean age and co-morbidity. Itis evident that hip fractures, regardless the way of treatment,implicate a partial or complete loss of ambulancy and henceloss of life-quality in one-third of patients. We advise early aspossible surgery –within 24 h– where not absolutely

Hip dislocation following the treatment of femoral neck fracture: Case report

Directory of Open Access Journals (Sweden)

Vukašinović Zoran

2010-01-01

Full Text Available Introduction. Femoral neck fractures are very rare in young patients and are frequently complicated by femoral head osteonecrosis and femoral neck nonunion. Case Outline. A 19-year-old girl with hip dislocation following the treatment of the femoral neck fracture is presented. The femoral neck fracture was initially treated by open reduction and three-screw fixation. After detecting the nonunion of femoral neck, valgus osteotomy was done. Secondary, iatrogenic, hip dislocation appeared. The patient had pains, and in clinical findings a shorter leg and limited range of motion in the hip - altogether 40 degrees. She was then successfully treated by open reduction, together with Chiari pelvic osteotomy and joint transfixation. Transfixation pin was removed three weeks following the operation. After that, the patient was put into the abduction device and physical therapy was started. The mentioned regimen lasted four months after the surgery, then the abduction device was removed and walking started. Full weight bearing was allowed eight months after surgery. Conclusion. As we have not found the literature data concerning the above mentioned problem, we solved it in the way that we usually do for the treatment of developmental dislocation of the hip in adolescence.

Manual resurfacing and trichloroacetic acid for the treatment of patients with widespread actinic damage. Clinical and histologic observations.

Science.gov (United States)

Cooley, J E; Casey, D L; Kauffman, C L

1997-05-01

A facial resurfacing regimen combining manual abrasion of the skin and 25% trichloroacetic acid has been reported to produce excellent results, but the histologic depth of injury produced by this technique has not been studied. To describe our experience with this technique treating patients with extensive actinic damage and to determine the histologic depth of injury produced. We treated 40 patients using manual resurfacing and trichloroacetic acid, primarily for widespread actinic keratoses. Resurfacing tools included silicone carbide sandpaper, drywall screen, electrocautery tip cleaners, abrasive pads, scalpel blades, and curettes. Four patients underwent sequential biopsies to evaluate the depth of wounding using this technique. Manual resurfacing combined with trichloroacetic acid consistently produced excellent cosmetic results and nearly complete eradication of actinic keratoses. Histologically, treated areas showed replacement of the dermal elastotic band by newly formed collagen, a significantly deeper level of wounding than the Jessner's/35% trichloroacetic acid peel. There was no evidence for foreign body granulomas clinically or histologically as a result of the abrasive materials. The deeper level of this peel explains the improved cosmetic outcome and greater eradication of actinic keratoses. This treatment is particularly well suited for patients with extensive photodamage and widespread actinic keratoses.

Time spent in primary care for hip osteoarthritis patients once the diagnosis is set : a prospective observational study

NARCIS (Netherlands)

Paans, Nienke; van der Veen, Willem Jan; van der Meer, Klaas; Bulstra, Sjoerd K.; van den Akker-Scheek, Inge; Stevens, Martin

2011-01-01

Background: Previous research on time to referral to orthopaedic surgery has predominantly used hip complaints as starting point instead of the moment the diagnosis of osteoarthritis (OA) of the hip is established, therefore little is known about the length of time a patient diagnosed with hip OA

Prefabricated neck expanded skin flap with the superficial temporal vessels for facial resurfacing.

Science.gov (United States)

Lazzeri, Davide; Su, Weijie; Qian, Yunliang; Messmer, Caroline; Agostini, Tommaso; Spinelli, Giuseppe; Marcus, Jeffrey R; Levin, L Scott; Zenn, Micheal R; Zhang, Yi Xin

2013-05-01

The achievement of a normal-appearing face after surgical resurfacing remains an elusive goal. This is due in part to insufficient color matching, restoration of contours, and the persistence of visible scars. Flap prefabrication is a staged procedure that provides an independent axial blood supply to local expanded tissues. We describe a new reconstructive alternative with superior reconstructive surgical options for facial resurfacing that better matches damaged or discarded facial tissues. A superficial temporal fascial flap was harvested as the vascular supply of the prefabricated neck flap and located in a subcutaneous neck pocket over a tissue expander. After a 5-month period for expansion and maturation, the prefabricated skin flap was raised, islanded, and rotated to resurface the facial defect. Four patients with hemifacial postburn contracture and two patients affected by hemifacial vascular malformations aged 17 to 42 years (mean 29 years) were successfully treated with no major complication after a mean period of 15 months. Prefabricated neck-expanded skin flap demonstrated an excellent color and texture match with facial skin that surrounded the repair sites, and optimal aesthetic results were obtained. Importantly, facial expression was completely maintained due to thinness and pliability of the rotated skin. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

BILATERAL PATHOLOGICAL HIP DISLOCATION IN CHILDREN

Directory of Open Access Journals (Sweden)

Yuriy E. Garkavenko

2017-03-01

Full Text Available Introduction. Pathological dislocation of the hip is one of the most severe complications of acute hematogenous osteomyelitis. The program of treatment for children with pathological hip dislocation is complex, but it has been sufficiently developed and implemented very successfully. At the same time, the available literature provides no cases of treating children with bilateral pathological hip dislocations after hematogenous osteomyelitis. There is no information on the incidence of such cases or in regards to remote functional results. Materials and methods. The results of the treatment of 18 children with bilateral pathological dislocation of the hip after hematogenous osteomyelitis are presented, which constituted 23.1% of the total number of patients (78 who underwent surgery in 2000–2016 for the diagnosis of pathological hip dislocation. Both hip joints were surgically operated on in 12 patients, while one hip joint was operated on in 6 patients. To assess the anatomical and functional state of hip joints, the clinical and roentgenological diagnostic techniques were used. Results and discussion. To stabilize and restore the function of the hip joints, 18 children underwent 30 surgical interventions: simple open hip reduction (19 and open hip reduction with hip arthroplasty with one (6 or two (5 demineralized osteochondral allogeneic grafts. The decision regarding the possibility of performing surgical intervention on the second hip joint was made only after a child's check-up examination was complete and after positive information about the anatomical and functional state of the operated hip joint was obtained. According to these criteria, 14 (77.8% children underwent surgical treatment of the second hip joint 1–1.5 years after the course of conservative measures to restore the range of motion in the previously operated hip joint. Over a period of 1–12 years, 17 patients were examined, 10 of which underwent an operation on both

Translation, Cross-cultural Adaptation, and Psychometric Properties of the German Version of the Hip Disability and Osteoarthritis Outcome Score

NARCIS (Netherlands)

Blasimann, A.; Dauphinee, S.W.; Staal, J.B.

2014-01-01

Study Design Clinical measurement. Objectives To translate and cross-culturally adapt the Hip disability and Osteoarthritis Outcome Score (HOOS) from English into German, and to study its psychometric properties in patients after hip surgery. Background There is no specific hip questionnaire in

The prevalence and risk factors of post-inflammatory hyperpigmentation after fractional resurfacing in Asians.

Science.gov (United States)

Chan, Henry H L; Manstein, D; Yu, C S; Shek, S; Kono, T; Wei, W I

2007-06-01

Ablative laser resurfacing is considered to be the main therapeutic option for the treatment of wrinkles and acne scarring. However, in Asians, post-inflammatory hyperpigmentation (PIH) is a common adverse effect of laser resurfacing. Fractional resurfacing is a new concept of skin rejuvenation whereby zones of micro thermal injury are generated in the skin with the use of a 1,540-nm laser. The risk and prevalence of hyperpigmentation in dark-skinned patients using this approach have not been studied. To assess the prevalence and risk factors of PIH that is associated with the use of fractional resurfacing in Asians. A retrospective study of 37 Chinese patients who were treated with fractional resurfacing for acne scarring, skin rejuvenation, and pigmentation was carried out. In all of the cases, pre- and post-treatment clinical photographs (from standardized and cross-polarized views) were taken using the Canfield CR system. Two independent observers assessed the photographs. A prospective study of treatments of nine different density and energy levels that were applied to the forearms of 18 volunteers was also performed. Clinical photographs were assessed pre- and post-treatment for evidence of PIH. In the retrospective study, 119 treatment sessions were performed. Sixty-eight treatment sessions were high energy, low density; 51 sessions were low energy, high density. Patients who underwent a high energy but low-density treatment (range of energy 7-20 mJ; average energy 16.3 mJ, 1,000 MTZ) were associated with a lower prevalence of generalized PIH (7.1% vs. 12.4%) than those who underwent a low energy but high-density (range of energy 6-12 mJ; average energy 8.2 mJ, 2,000 MTZ) treatment. However, the difference was not statistically significant. Localized PIH occurred in the peri-oral area among patients who did not receive air cooling as an adjunctive therapy. Both the density and energy of the treatment determines the risk of PIH in dark-skinned patients

Is Cup Positioning Challenged in Hips Previously Treated With Periacetabular Osteotomy?

DEFF Research Database (Denmark)

Hartig-Andreasen, Charlotte; Stilling, Maiken; Søballe, Kjeld

2014-01-01

After periacetabular osteotomy (PAO), some patients develop osteoarthritis with need of a total hip arthroplasty (THA). We evaluated the outcome of THA following PAO and explored factors associated with inferior cup position and increased polyethylene wear. Follow-up were performed 4 to 10years...... after THA in 34 patients (38 hips) with previous PAO. Computer analysis evaluated cup position and wear rates. No patient had dislocations or revision surgery. Median scores were: Harris hip 96, Oxford hip 38 and WOMAC 78. Mean cup anteversion and abduction angles were 22(o) (range 7°-43°) and 45......° (range 28°-65°). Outliers of cup abduction were associated with persisting dysplasia (CE...

Problems and complications of full-face carbon dioxide laser resurfacing for pathological lesions of the skin.

Science.gov (United States)

Read-Fuller, Andrew M; Yates, David M; Vu, David D; Hoopman, John E; Finn, Richard A

2017-01-01

Facial resurfacing with a CO 2 laser has been used for treatment of pathologic lesions and for cosmetic purposes. Postoperative complications and problems after laser resurfacing include infections, acneiform lesions, and pigment changes. This retrospective study describes the most common problems and complications in 105 patients and assesses postoperative pain in 38 patients. All patients received CO 2 laser resurfacing for treatment of malignant/premalignant lesions and had postoperative follow-up to assess problems and complications. Some had follow-up to assess postoperative pain. All patients had Fitzpatrick I-III skin types and underwent the same perioperative care regimen. There were 11 problems and 2 complications. Problems included infection, acneiform lesion/milia, and uncontrolled postoperative pain. Complications included hyperpigmentation. Among the postoperative pain group, 53% reported no pain and the rest had mild or moderate pain. Complications are rare. Infection and acneiform lesions/milia were the most common problems, as previously reported. Most patients do not experience postoperative pain. Copyright © 2016 Elsevier Inc. All rights reserved.

The use of a prosthetic inlay resurfacing as a salvage procedure for a failed cartilage repair.

Science.gov (United States)

Dhollander, Aad Alfons Maria; Almqvist, Karl Fredrik; Moens, Kris; Vandekerckhove, Pieter-Jan; Verdonk, René; Verdonk, Peter; Victor, Jan

2015-08-01

This study was designed to describe the clinical and radiographical outcome of the HemiCAP(®) resurfacing system as a salvage treatment for a failed index cartilage procedure. Fourteen patients were treated consecutively and clinically prospectively followed for a mean period of 26.1 ± 12.8 months. All patients were previously treated for their cartilage lesion. Radiographical data were analysed based on the Kellgren and Lawrence system. The patients involved in this study demonstrated a gradual clinical improvement in time. However, radiographically significant osteoarthritic changes were observed during the follow-up period. The position of the HemiCAP(®) resurfacing system was adequate in all cases, and no signs of loosening were observed during the follow-up period. The HemiCAP(®) resurfacing system is feasible as a salvage treatment for a failed index cartilage procedure and resulted in a gradual clinical improvement. However, the favourable clinical outcome was not confirmed by the radiographical findings. IV.

Iso-surface volume rendering for implant surgery

NARCIS (Netherlands)

van Foreest-Timp, Sheila; Lemke, H.U.; Inamura, K.; Doi, K.; Vannier, M.W.; Farman, A.G.

2001-01-01

Many clinical situations ask for the simultaneous visualization of anatomical surfaces and synthetic meshes. Common examples include hip replacement surgery, intra-operative visualization of surgical instruments or probes, visualization of planning information, or implant surgery. To be useful for

BIOMECHANICAL JUSTIFICATION OF THE THREADED ELEMENT’S FORM OF THE TOTAL HIP ENDOPROSTHESIS’ ACETABULAR COMPONENT

Directory of Open Access Journals (Sweden)

PANCHENKO S. P.

2017-03-01

Full Text Available Abstract. Formulation of the problem. Total hip replacement (THR remains to be responsible for the markable clinical achievements of contemporal orthopaedic surgery [1; 2; 4]. It should be noted, that numerous efforts to create an “ideal” uncemented hip endoprosthesis’ construction were failed, but led into wide diversity of implants. Such a diversity allowes to individualize implant type selection and to improve implant’s survival and total THR’s clinical outcomes [1; 4]. Outcomes mentioned above determine successful application of total hip replacement as a treatment method. Consequently, development of new and improvement of existing hip endoprosthesis’ constructions seems to be of current interest for contemporal orthopaedic surgery. Purpose. To determine optimal parametres of threaded element’s geometry of total hip endoprosthesis’ threaded acetabular component. Conclusion. There were revealed that threaded element model with right-angled triangle transverse section shape seems to be the most effective considering hardness, while the triangle is leaned on the bone massive with its cathetus. At the same time, results of calculations represent pelvic bone stress-strain state during THR quantitavely and stipulate further research.

Total hip and knee joint replacement: perioperative clinical aspects

Directory of Open Access Journals (Sweden)

Luciana Pereira Almeida de Piano

2010-09-01

Full Text Available Objective: To understand the profile of patients undergoing hip and knee replacement during two years, and to compare the data obtained with the literature. Methods: A total of 323 medical records were reviewed to analyze the perioperative data of patients submitted to hip and knee replacement. Results: Osteoarthritis was the main indication for both procedures and male patients were heavier than females (p < 0.05. Hypertension was the prevalent disease among patients. Blood loss was more frequent in knee surgery than in the hip. Conclusions: The profile of patients undergoing total arthroplasty improved substantially over the past decade due to shorter hospital stay, lower risk of thromboembolic events and no infection as compared to previous reports.

Postoperative plasma 8-iso-prostaglandin F2α levels are associated with delirium and cognitive dysfunction in elderly patients after hip fracture surgery.

Science.gov (United States)

Zheng, Yuan-Bo; Ruan, Guo-Mo; Fu, Jia-Xing; Su, Zhong-Liang; Cheng, Peng; Lu, Jian-Zuo

2016-04-01

Oxidative stress may be involved in occurrence of postoperative delirium (POD) and cognitive dysfunction (POCD). 8-iso-Prostaglandin F2α (8-iso-PGF2α), an isoprostane derived from arachidonic acid via lipid peroxidation, is considered a gold standard for measuring oxidative stress. The present study aimed to investigate the ability of postoperative plasma 8-iso-PGF2α levels to predict POD and POCD in elderly patients undergoing hip fracture surgery. Postoperative plasma 8-iso-PGF2α levels of 182 patients were measured by an enzyme-linked immunosorbent assay. We assessed the relationships between plasma 8-iso-PGF2α levels and the risk of POD and POCD using a multivariate analysis. Plasma 8-iso-PGF2α levels and age were identified as the independent predictors for POD and POCD. Based on areas under receiver operating characteristic curve, the predictive values of 8-iso-PGF2α were obviously higher than those of age for POD and POCD. In a combined logistic-regression model, 8-iso-PGF2α significantly enhanced the areas under curve of age for prediction of POD and POCD. Postoperative plasma 8-iso-PGF2α levels may have the potential to predict POD and POCD in elder patients undergoing hip fracture surgery. Copyright © 2016 Elsevier B.V. All rights reserved.

Emergency surgery

DEFF Research Database (Denmark)

Stoneham, M; Murray, D; Foss, N

2014-01-01

National reports recommended that peri-operative care should be improved for elderly patients undergoing emergency surgery. Postoperative mortality and morbidity rates remain high, and indicate that emergency ruptured aneurysm repair, laparotomy and hip fracture fixation are high-risk procedures...... undertaken on elderly patients with limited physiological reserve. National audits have reported variations in care quality, data that are increasingly being used to drive quality improvement through professional guidance. Given that the number of elderly patients presenting for emergency surgery is likely...

Hip fractures in elderly people : Surgery or no surgery? A systematic review and meta-analysis

NARCIS (Netherlands)

van de Ree, C.L.P.; de Jongh, M.A.C.; Peeters, Charles M M; de Munter, Leonie; Roukema, Jan A; Gosens, Taco

2017-01-01

Iintroduction: Increasing numbers of patients with hip fractures also have advanced comorbidities. A majority are treated surgically. However, a significantly increasing percentage of medically unfit patients with unacceptably high risk of perioperative death are treated nonoperatively. Important

Hip arthroscopy for femoroacetabular impingement

Science.gov (United States)

Nasser, Rima; Domb, Benjamin

2018-01-01

The purpose of this article is to give a general overview of femoroacetabular impingement (FAI) and how it could be treated arthroscopically, with some details about indications, the procedure itself and some of the complications associated with the surgery. FAI is a dynamic condition of the hip that can be a source of pain and disability and could potentially lead to arthritis. When symptomatic, and if conservative treatment fails, FAI can be addressed surgically. The goal of surgical treatment for FAI is to recreate the spherical contour of the femoral head, improve femoral offset, normalize coverage of the acetabulum, repair/reconstruct chondral damage and repair/reconstruct the labrum to restore normal mechanics and joint sealing. Advances in equipment and technique have contributed to an increase in the number of hip arthroscopy procedures performed worldwide and have made it one of the more common treatment options for symptomatic FAI. Hip arthroscopy is a procedure with an extremely steep and long learning curve. Cite this article: EFORT Open Rev 2018;3:121-129. DOI: 10.1302/2058-5241.3.170041 PMID:29780619

Use of Hip Arthroscopy and Risk of Conversion to Total Hip Arthroplasty: A Population-Based Analysis.

Science.gov (United States)

Schairer, William W; Nwachukwu, Benedict U; McCormick, Frank; Lyman, Stephen; Mayman, David

2016-04-01

To use population-level data to (1) evaluate the conversion rate of total hip arthroplasty (THA) within 2 years of hip arthroscopy and (2) assess the influence of age, arthritis, and obesity on the rate of conversion to THA. We used the State Ambulatory Surgery Databases and State Inpatient Databases for California and Florida from 2005 through 2012, which contain 100% of patient visits. Hip arthroscopy patients were tracked for subsequent primary THA within 2 years. Out-of-state patients and patients with less than 2 years follow-up were excluded. Multivariate analysis identified risks for subsequent hip arthroplasty after arthroscopy. We identified 7,351 patients who underwent hip arthroscopy with 2 years follow-up. The mean age was 43.9 ± 13.7 years, and 58.8% were female patients. Overall, 11.7% of patients underwent THA conversion within 2 years. The conversion rate was lowest in patients aged younger than 40 years (3.0%) and highest in the 60- to 69-year-old group (35.0%) (P arthroscopy. Patients treated at high-volume hip arthroscopy centers had a lower THA conversion rate than those treated at low-volume centers (15.1% v 9.7%, P arthroscopy is performed in patients of various ages, including middle-aged and elderly patients. Older patients have a higher rate of conversion to THA, as do patients with osteoarthritis or obesity. Level III, retrospective comparative study. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Evaluating healthcare resource utilization and outcomes for surgical hip dislocation and hip arthroscopy for femoroacetabular impingement.