Birmingham hip resurfacing: a systematic review of outcomes at minimum 10-years follow-up

Although controversy surrounding the use of metal-on-metal (MoM) arthroplasty implants continues to exist, satisfactory clinical and radiological outcomes have been reported following Birmingham Hip Resurfacing (BHR) at long-term follow-up, leading to an Orthopaedic Data Evaluation Panel (ODEP) rating of 13A. The purpose of this study was to systematically review the literature to evaluate the functional outcomes, radiological outcomes and revision rates following BHR at a minimum of 10 years follow-up. Using the PRISMA guidelines, two independent reviewers performed a literature search using Pubmed, Embase and Scopus databases. Only studies reporting on outcomes of BHR with a minimum of 10 years' follow-up were considered for inclusion. A total of 12 studies including 7132 hips (64.8% males), with mean follow-up of 11.5 years (10-15.3), met our inclusion criteria. Of included patients, 94.3% of patient underwent BHR for osteoarthritis at a mean age was 52.0 years (48-52). At final follow-up, 96% of patients reported being satisfied with their BHR, with mean Harris Hip Scores of 93.6 and Oxford Hip Scores of 16.5. Rates of radiological femoral neck narrowing of greater than 10% and non-progressive radiological loosening were reported as 2.0% and 3.8% respectively. At final follow-up, the overall revision rate was 4.9% (334/7132), deep infection rate was 0.4%, metal allergy/insensitivity rate was 1.6%, metal reaction rate was 0.3%, rate of peri-prosthetic fracture was 0.9% and aseptic loosening rates were 1.6%. This systematic review demonstrates that BHR results in satisfactory clinical outcomes, acceptable implant survivorship, low complication rates and modest surgical revision rates in the long-term at minimum 10-year follow-up.

Trends in fractures and fatalities of farmyard injuries in Ireland: a 10 year analysis

The farming and agricultural sector remains one of Ireland's primary industries. Fatality rates remain higher than the European average. The aim of this study was to analyze the national trend in hospital in-patient admissions for farmyard related fractures and related fatalities in Ireland from 2005 to 2014. Relevant socioeconomic trends were used for comparison. There were 2,064 farm-related fractures and 187 fatalities recorded over the same period. Despite a decrease in incidence of farmyard fractures over 2005-2014, fatality rates have increased indicating the alarming continued occupational hazards and severity of sustained injuries.

Diathermy versus scalpel incisions for hemiarthroplasty for hip fracture: a randomised prospective trial

As the age profile of our population expands, we can expect subsequent increase in patients presenting with intracapsular fracture. The onus remains on the surgeon to make all reasonable efforts to find new and innovative means of reducing associated morbidity and mortality of the treatment of these injuries. This challenge is particularly relevant in the elderly and in patients with multiple co-morbidities. In this study, 100 patients were randomly allocated into two groups. One group had dissection to the level of the hip joint under direct diathermy control; the other group had dissection using a scalpel with supplementary electrocautery. Intraoperative total blood loss prior to dissection of the abductors was measured by collecting blood using wound swabs using a local protocol and results were statistically analysed using PROC GLM SAS. We demonstrate a clear advantage in the use of diathermy to create a hip incision showing a significant reduction in wound-related blood loss and a reduction, whilst not statistically significant, in total operative blood loss using diathermy incision. Larger randomised prospective trials are necessary to study the effects of this intervention in a larger patient population so that these end-points can be adequately assessed.

Coracoid impingement syndrome: a treatable cause of anterior shoulder pain

BACKGROUND

Coracoid Impingement Syndrome is a relatively uncommon but generally treatable cause of anterior shoulder pain that can be easily overlooked. It typically presents with anterior shoulder joint pain in activities involving forward flexion, adduction and internal rotation.

AIMS

To assess the outcome of a cohort of patients diagnosed with Coracoid Impingement Syndrome.

METHODS

Patients were investigated clinically and radiologically. They received appropriate therapeutic measures and were followed-up in an orthopaedic outpatient setting.

RESULTS

Twelve patients were identified over a four-year period. All patients have made good progress. Thus far, none have needed operative intervention for symptom relief.

CONCLUSION

Coracoid impingement syndrome is an uncommon cause of anterior shoulder pain but diagnosed patients can expect good symptomatic relief following referral to a dedicated shoulder unit. An increase in clinical awareness of the condition may prevent undue diagnostic delay in such cases.

Strain on the human sciatic nerve in vivo during movement of the hip and knee

Injuries to the sciatic nerve are an occasional complication of surgery to the hip and acetabulum, and traction is frequently the causative mechanism. In vitro and animal experiments have shown that increased tensile strain on peripheral nerves, when applied for prolonged periods, impairs nerve function. We have used video-extensometry to measure strain on the human sciatic nerve during total hip replacement (THR). Ten consecutive patients with a mean age of 72 years undergoing primary THR by the posterior approach were recruited, and strains in the sciatic nerve were measured in different combinations of flexion and extension of the hip and knee, before dislocation of the hip. Significant increases (p = 0.02) in strain in the sciatic nerve were observed in flexion of the hip and extension of the knee. The mean increase was 26% (19% to 30%). In animal studies increases of this magnitude have been shown to impair electrophysiological function in peripheral nerves. Our results suggest that excessive flexion of the hip and extension of the knee should be avoided during THR.

Tibial shaft fractures in amateur footballers

BACKGROUND

Footballers constitute a unique group of patients with tibial shaft fractures. They tend to have excellent general health and well developed musculature in the leg, and their fractures are generally closed injuries caused by low velocity trauma. However, little has been reported on the outcome after tibial shaft fractures in this group.

OBJECTIVE

To identify patterns of injury, response to treatment, and functional outcome in such a group.

METHOD

Fifty consecutive tibial shaft fractures in adult footballers treated at Merlin Park Regional Hospital over a five year period were analysed.

RESULTS

Most of the fractures were type A injuries (AO/ASIF classification). The incidence of complications was low. All patients reported good or excellent satisfaction with their outcome. However, only 54% of patients returned to playing competitive football.

CONCLUSION

Tibial shaft fractures in amateur footballers are associated with good results when traditional outcome criteria are used, but many patients do not regain their previous level of function.

The role of bone scintigraphy with pinhole collimation in the evaluation of symptomatic paediatric hips

Sixty-two children with signs and symptoms of hip pathology underwent bone scintigraphy with pinhole collimation of the hip joints. Three distinct patterns of isotope uptake were observed: a normal uptake of isotope, a focal increase or decrease of isotope uptake and a mild diffuse increase of isotope uptake. Forty-four children had normal isotope scans, an average hospital stay of 6.8 days and no significant pathology on follow-up. Ten children had a focal increase or decrease of isotope uptake, an average hospital stay of 21 days and on follow-up all had significant pathology. Eight children had a mild diffuse increase of isotope uptake, an average hospital stay of 8.75 days and no significant pathology on follow-up. We conclude: (1) Normal isotope hip scintigrams with pinhole collimation indicate an excellent prognosis in symptomatic paediatric hips; (2) Focal scintigraphic abnormalities are indicative of significant pathology; (3) A mild diffuse increase in isotope uptake on both sides of the joint is not associated with significant pathology; (4) There is a good correlation between scintigrams and the length of hospital stay; (5) Scintigraphy is at least twice as sensitive at the time of presentation as plain radiographs in the detection of pathology.

The surgical treatment of hyperparathyroidism: a regional hospital experience

Parathyroidectomy is an established surgical treatment for symptomatic hyperparathyroidism. In this regional hospital experience, 50 patients who had undergone a parathyroidectomy were looked at. We examined clinical indications and noted trends for hypertension, neuromuscular symptomatology and psychiatric complaints to occur commonly as presenting symptoms. Operative results and histology results are examined and correlated. Particular note is made of any postoperative complications.

Colposuspension and transvaginal bladder neck suspension in the treatment of stress incontinence

The present work was performed to evaluate the clinical usefulness of colposuspension in stress urinary incontinence without uterovaginal descent and bladder neck suspension in cases with uterovaginal descent. Modified Burch colposuspension was performed in 29 patients and modified Raz bladder neck suspension in 19 patients. The patients were examined clinically and urodynamically before and 8-12 months after operation. All patients in the colposuspension group regarded themselves as being totally continent postoperatively. In the bladder neck suspension group the respective figure was 58%, plus 21% showing improvement and 21% failures. Urodynamically, the cure rates (positive urethral closure pressure at stress) were 100% for colposuspension and 79% for bladder neck suspension. After colposuspension the urethral closure pressure at stress and the pressure transmission ratio were significantly increased whereas successful bladder neck suspension increased only urethral closure pressure at stress. The failed bladder neck suspensions did not induce any urodynamic changes. The present data confirms that Burch colposuspension is effective in stress urinary incontinence in women without simultaneous uterovaginal descent, whereas bladder neck suspension by the modified Raz technique did not appear to be optimal for the treatment of stress incontinence in patients with uterovaginal descent.