Modular neck femoral stems

Following the recall of modular neck hip stems in July 2012, research into femoral modularity will intensify over the next few years. This review aims to provide surgeons with an up-to-date summary of the clinically relevant evidence. The development of femoral modularity, and a classification system, is described. The theoretical rationale for modularity is summarised and the clinical outcomes are explored. The review also examines the clinically relevant problems reported following the use of femoral stems with a modular neck. Joint replacement registries in the United Kingdom and Australia have provided data on the failure rates of modular devices but cannot identify the mechanism of failure. This information is needed to determine whether modular neck femoral stems will be used in the future, and how we should monitor patients who already have them implanted.

A review of rapid prototyped surgical guides for patient-specific total knee replacement

Improvements in the surgical technique of total knee replacement (TKR) are continually being sought. There has recently been interest in three-dimensional (3D) pre-operative planning using magnetic resonance imaging (MRI) and CT. The 3D images are increasingly used for the production of patient-specific models, surgical guides and custom-made implants for TKR. The users of patient-specific instrumentation (PSI) claim that they allow the optimum balance of technology and conventional surgery by reducing the complexity of conventional alignment and sizing tools. In this way the advantages of accuracy and precision claimed by computer navigation techniques are achieved without the disadvantages of additional intra-operative inventory, new skills or surgical time. This review describes the terminology used in this area and debates the advantages and disadvantages of PSI.

Who is the ideal candidate for autologous chondrocyte implantation?

We investigated the prognostic indicators for collagen-covered autologous chondrocyte implantation (ACI-C) performed for symptomatic osteochondral defects of the knee. We analysed prospectively 199 patients for up to four years after surgery using the modified Cincinnati score. Arthroscopic assessment and biopsy of the neocartilage was also performed whenever possible. The favourable factors for ACI-C include younger patients with higher pre-operative modified Cincinnati scores, a less than two-year history of symptoms, a single defect, a defect on the trochlea or lateral femoral condyle and patients with fewer than two previous procedures on the index knee. Revision ACI-C in patients with previous ACI and mosaicplasties which had failed produced significantly inferior clinical results. Gender (p = 0.20) and the size of the defect (p = 0.97) did not significantly influence the outcome.

Collagen-covered autologous chondrocyte implantation for osteochondritis dissecans of the knee

We prospectively studied the clinical, arthroscopic and histological results of collagen-covered autologous chondrocyte implantation (ACI-C) in patients with symptomatic osteochondritis dissecans of the knee. The study included 37 patients who were evaluated at a mean follow-up of 4.08 years.

Clinical results showed a mean improvement in the modified Cincinnati score from 46.1 to 68.4. Excellent and good clinical results were seen in 82.1% of those with juvenile-onset osteochondritis dissecans but in only 44.4% of those with adult-onset disease.

Arthroscopy at one year revealed International Cartilage Repair Society grades of 1 or 2 in 21 of 24 patients (87.5%). Of 23 biopsies, 11 (47.8%) showed either a hyaline-like or a mixture of hyaline-like and fibrocartilage, 12 (52.2%) showed fibrocartilage.

The age at the time of ACI-C determined the clinical outcome for juvenile-onset disease (p = 0.05), whereas the size of the defect was the major determinant of outcome in adult-onset disease (p = 0.01).

Domestic violence and help-seeking behaviors among rural women: results from a shelter-based study

Research on domestic violence and help-seeking behaviors of women living in rural communities has been limited. This study adds to existing knowledge by examining this type of violence along with mental health characteristics and related help-seeking behaviors of a sample of predominantly Hispanic women seeking shelter at a rural domestic violence shelter. Study participants experienced physical, verbal, emotional, and sexual abuse, harassment, stalking, and abuse with a weapon in their current intimate relationship. Twenty-four percent of study participants of Hispanic backgrounds and 10% of participants from all other racial/ethnic groups reported experiencing all types of abuse listed above. When compared with other study participants, a greater percentage of Hispanic participants indicated that they had thought of and/or attempted suicide. Participants' help-seeking behaviors from formal support systems suggest a mismatch between the types of abuse experienced and the resultant help-seeking behaviors they used. These help-seeking behaviors also indicate the relevance of mental health characteristics (e.g., suicide ideation) in these behaviors. These and findings from other studies may provide the impetus for a systematic documentation of domestic violence and help-seeking behaviors of women living in rural communities.

An examination of intimate partner violence in rural communities: results from a hospital emergency department study from Southwest United States

Intimate partner violence (IPV) affects women disproportionately, women being 5-8 times more likely than men to be victimized by their intimates. Women in abusive relationships use a disproportionate share of health care services, including more visits to the emergency departments. Female clients from two hospital emergency departments in the rural Southwest were recruited and administered semistructured interviews. Study findings indicate the prevalence and pervasiveness of IPV among study participants and illustrate the significant effects of and predictive nature of three factors associated with abuse in the past to current IPV.

Barriers to condom use: results from a study in Mumbai (Bombay), India

The consistent and correct use of condoms coupled with risk reduction education strategies, continue to play an important role in the reduction and prevention of HIV/AIDS transmission. Therefore understanding and incorporating strategies to overcome barriers to condom use in such education and prevention efforts are critical. This is particularly necessary in countries such as India, where HIV/AIDS has become a serious public health crisis. The current study documents and provides preliminary data on the use of condoms, reasons for and barriers to condom use, and sources of information about safer sex practices among a sexually active adult sample of 49 women and 203 men in Mumbai, India. Despite limitations such as the use of a nonrandom sample of participants composed predominantly of young, English-speaking males, the study findings provide some insights into the importance of and the need to address issues of privacy regarding condom purchase and use in India. Most notably, the lack of privacy in stores and the social stigma associated with condom use were indicated as the most significant barriers. These and other study findings suggest the need to ease the social costs and constraints to safe behaviors through increased acceptance of condoms and promotion of their consistent use. This could serve as an important means to curb the epidemic of HIV/AIDS in India.

Addressing barriers to community care of battered women in rural environments: creating a policy of social inclusion

Given domestic violence continues to be a serious social problem, recently acknowledged as a national public health epidemic as well, the need to examine existing formal helping services and address the barriers to service utilization among battered women is warranted. Social exclusion is the process by which multi-dimensionally disadvantaged individuals are prohibited from obtaining formal helping services. Although not a policy per se, many community helpers and organizations inadvertently contribute to erecting barriers which exclude battered women from using such services, particularly in rural environments. Suggestions to transform a process of social exclusion to social inclusion for battered women is offered.

Acceptability of the female condom among STD clinic patients

This study examines the acceptability of the female condom among African American and Latino patients from two inner-city sexually transmitted disease (STD) clinics through focus group discussions. Prior to the initial focus group sessions, 90% (n = 90) had heard about the female condom, 8% (n = 8) had seen it, and 2% (n = 2) had used it. Among the 41 participants (22 males and 19 females) attending a second focus group session, 85.4% (n = 35) had used the female condom at least once. Female study participants who had previous experience inserting a barrier contraceptive device, such as a diaphragm, indicated that they felt more comfortable inserting the female condom than those who had never used such a device. Male participants indicated that they were more comfortable using the female condom with their steady partners than with casual partners, whereas female participants indicated no such distinctions. These and other study findings suggest that need to promote and expand the use of the female condom as a device that protects women from STD transmissions including HIV and AIDS.