Chiropractic management of hip pain after conservative hip arthroplasty

Australian chiropractic sports medicine: half way there or living on a prayer?

Sports chiropractic within Australia has a chequered historical background of unorthodox individualistic displays of egocentric treatment approaches that emphasise specific technique preference and individual prowess rather than standardised evidence based management. This situation has changed in recent years with the acceptance of many within sports chiropractic to operate under an evidence informed banner and to embrace a research culture. Despite recent developments within the sports chiropractic movement, the profession is still plagued by a minority of practitioners continuing to espouse certain marginal and outlandish technique systems that beleaguer the mainstream core of sports chiropractic as a cohesive and homogeneous group. Modern chiropractic management is frequently multimodal in nature and incorporates components of passive and active care. Such management typically incorporates spinal and peripheral manipulation, mobilisation, soft tissue techniques, rehabilitation and therapeutic exercises. Externally, sports chiropractic has faced hurdles too, with a lack of recognition and acceptance by organized and orthodox sports medical groups. Whilst some arguments against the inclusion of chiropractic may be legitimate due to its historical baggage, much of the argument appears to be anti-competitive, insecure and driven by a closed-shop mentality.sequently, chiropractic as a profession still remains a pariah to the organised sports medicine world. Add to this an uncertain continuing education system, a lack of protection for the title 'sports chiropractor', a lack of a recognized specialist status and a lack of support from traditional chiropractic, the challenges for the growth and acceptance of the sports chiropractor are considerable. This article outlines the historical and current challenges, both internal and external, faced by sports chiropractic within Australia and proposes positive changes that will assist in recognition and inclusion of sports chiropractic in both chiropractic and multi-disciplinary sports medicine alike.

Chiropractic Treatment of Lower Extremity Conditions: A Literature Review

OBJECTIVE

The purpose of this study was to document the quantity and type of research conducted on the chiropractic management of lower extremity conditions.

METHODS

A review of the literature was conducted using the CINAHL, MEDLINE, MANTIS, and Science Direct databases (each from inception to December 15, 2005). Search terms included chiropractic, hip, knee, ankle, foot, with Medical Subject Heading terms for each region. Inclusion criteria included studies with a lower extremity diagnosis, and the treatment was performed by doctors of chiropractic. Articles were excluded if pain was referred from spinal sites and if there was a duplicate publication; articles published in non-peer-reviewed literature and abstracts in conference proceedings were also excluded. Of the articles identified, an analysis was conducted assessing those including peripheral and/or spinal treatment. Clinical trials were assessed for quality using the Physiotherapy Evidence Database scale.

RESULTS

There was a total of 1652 citations. Of these, 76 were deemed relevant; 24 were related to the foot, 10 to the ankle, 25 to the knee, and 17 to the hip. Twenty-nine citations included spinal treatment, 47 solely peripheral, and 2 solely spinal. Ten citations were clinical trials and scored on the Physiotherapy Evidence Database scale.

CONCLUSIONS

Literature on the chiropractic management of lower extremity conditions has a large number of case studies (level 4 evidence) and a smaller number of higher-level publications (level 1-3 evidence). The management available in the peer-reviewed literature is predominantly multimodal and contains combined spinal and peripheral components. Future chiropractic research should use higher-level research designs, such as randomized controlled trials.

Assessments of different kinds of stems by experiments and FEM analysis: appropriate stress distribution on a hip prosthesis

BACKGROUND

It is now recognized that initial stability is essential for avoidance of thigh pain in hip replacement. The initial stability corresponds to an optimal stress distribution of cementless orthopedic implants. Although the relationship between the contour and stress at the fixation site has been analyzed, guidelines on stem design have not been established.

METHODS

Finite element models of three currently-used stems were constructed for a computer simulation. Contact stress at the fixation site of a joint prosthesis was analyzed by an explicit three-dimensional finite element method. The stress immediately after applying load using a film or sensor which can measure contact stress was observed. The situation of the initial fixation about the specific part which becomes important clinically based on the results was clarified.

FINDINGS

We introduced fluctuation area as a measure to evaluate the primary fixation of femoral stems. It was found that the stress distribution on the PerFix SV stem fluctuated with a slight disturbance. On the Intra-Medullary Cruciate stem, the high stress areas were distributed on the proximal area and under the pin. The high stress area on the VerSys stem were spread on the medial side.

INTERPRETATION

This study highlights the mechanical instability of the fixation site of joint prostheses, and thus suggests that the general idea that unconditionally recommends a larger area for the fixation site of joint prostheses should be revised.