Femoroacetabular impingement treatment using the arthroscopic extracapsular outside-in approach: Does capsular suture affect functional outcome?

BACKGROUND

Over the last decades, the arthroscopic treatment of hip pathology has highly grown thanks to the evolution of surgical techniques and instrumentation development. An alternative approach consisting in making a first outside-in longitudinal capsulotomy was described by Laude at the end of the 2000s and is experiencing significant development in France. The clinical results of this technique have rarely been reported and in particular the influence of the repair of the capsule is unknown. Therefore we performed a retrospective case control study aiming to asses: (1) the clinical outcomes and complication rates of the outside-in extracapsular approach for the treatment of FemoroAcetabular Impingement (FAI) and (2) the effect of capsular closure on the functional outcome.

HYPOTHESIS

We hypothesize that the outside-in extracapsular approach is a safe and efficient technique and the capsular closure at the end of the procedure positively affects the functional outcome.

METHODS

A retrospective study was conducted on prospectively collected data of a consecutive series of hip arthroscopies performed for surgical treatment of FAI using the outside-in extracapsular approach. Any complications during follow-up were identified and recorded. Linear regression models were used to estimate the influence of capsular closure on the functional outcome. Functional outcome was assessed using modified Harris Hip Score (mHHS) and Non-arthritic Hip Score (NAHS).

RESULTS

Sixty-four hips in 57 patients operated by a single surgeon between October 2013 and December 2016 were analyzed at the time of final follow-up of 34.17 months (range 24 to 53). As the surgical technique evolved over time, a side-to-side capsular closure was performed at the end of the procedure for 25 hips and the capsule was left open for the remaining 39 patients. Functional outcome measurements showed an improvement from the preoperative to the last follow-up: 63.5±11.0 to 88.1±11.2 for mHHS, 63.1±13.8 to 86.4±13.4 for NAHS. Capsular closure leads to a significantly improved clinical outcome: gain in mHHS: 25.8±2.3 vs. 20.6±1.9 (p≤0.044), gain in NAHS: 26.1±2.5 vs. 19.6±2.1, (p=0.023). No major complications occurred. One case of postoperative tensor fascia latae atrophy was documented in the group "capsule left open".

CONCLUSION

Hip arthroscopy in the management of FAI with an extraarticular starting point (outside-in) is a safe technique with functional results and postoperative morbidity comparable to previously reported techniques. Side-to-side capsular closure at the end of the procedure might positively affect the final functional outcome.

LEVELS OF EVIDENCE

III, case control retrospective study.

Quantitation of hepatitis C virus RNA by third generation branched DNA-based signal amplification assay

Quantitation of hepatitis C virus (HCV) RNA has become an important tool in different clinical settings and is used extensively for pretreatment evaluation of patients infected chronically with HCV. In this study, the performance characteristics of the third generation branched DNA-based signal amplification assay (bDNA 3.0) for HCV RNA quantitation were established. The new assay version showed an analytical specificity of 98%. Mean intra- and between-run imprecisions were 6.8 and 11.2%, respectively. The assay was linear over its entire dynamic range. Quantitation appeared to be unaffected by the genotypic variability of HCV. A comparison of bDNA 3.0 with the second generation bDNA assay calibrated against the international WHO HCV RNA standard, and the PCR-based Cobas Amplicor HCV Monitor 2.0 revealed a fairly good correlation among the assays. Twenty-nine and 11% of the paired quantitative results differed by more than log(10)0.5 (i.e. three-fold). All three assays after calibration against the WHO standard also yielded clinically comparable results with regard to the tailoring of interferon alpha/ribavirin treatment duration in patients infected by HCV genotypes 1, 4, and 5.

GB virus C infection in patients who underwent liver transplantation

To elucidate the impact of an infection with the recently discovered GB virus C (GBV-C) on the clinical course after orthotopic liver transplantation (OLT), we studied eight patients who were GBV-C RNA positive after transplantation. Five individuals had been viraemic before transplantation, three became GBV-C RNA positive thereafter. A control group comprised eight patients without pre- or post-transplant GBV-C infection. GBV-C RNA was detected by reverse-transcription followed by nested polymerase-chain-reaction (PCR) with primers corresponding to the NS5 genome region. Nested PCR products were sequenced directly. The five patients infected with GBV-C before transplantation remained GBV-C RNA positive throughout the time of observation. Pre- and post-transplant GBV-C RNA titres were almost identical. Phylogenetic analysis revealed a very close relationship between the pre- and post-transplant viral nucleotide sequences indicating persistent GBV-C infection. No signs of hepatitis could be detected after transplantation in all GBV-C infected patients. However, four out of eight GBV-C RNA positive patients had a clinical course complicated by severe cholestasis, which was not observed in the control group. Although GBV-C infection does not lead to an increase in the rate of post-transplant hepatitis, it might be associated with severe unexplained cholestatic courses after OLT.

Transmission of GBV-C/HGV from drug-addicted mothers to their babies

BACKGROUND/AIMS

In 1995, a new flavivirus, GBV-C/HGV was identified. Little information is available on the clinical manifestations and epidemiology of GBV-C/HGV infection. We investigated the risk of mother-to-infant transmission in a group of GBV-C/HGV RNA positive women and followed up the GBV-C/HGV infected babies.

METHODS

Twenty-eight anti-HCV positive women, of whom 25 have been intravenous drug users, and their children were included in the study. RNA was extracted from serum, reverse transcribed and amplified with primers from the NS5 region of GBV-C/HGV and 5'-UTR of HCV in a nested polymerase chain reaction. Amplified DNA fragments were gel purified and sequenced; the sequences obtained were subjected to a phylogenetic analysis.

RESULTS

Transmission of GBV-C/HGV occurred in 10 (56%) of 18 infants born to GBV-C/HGV positive mothers; all these women were drug abusers. Only one (5%) of 19 babies whose mothers were HCV RNA positive by polymerase chain reaction, was infected with HCV during the follow up. High sequence homology in the NS5 region of GBV-C/HGV isolates in 10 mother-child pairs suggested mother-to-infant transmission. All 10 babies remained GBV-C/HGV RNA positive during follow up (2-12 months). None of the GBV-C/HGV infected infants became icteric or demonstrated any clinical or biochemical signs of liver disease.

CONCLUSIONS

Mother-to-infant transmission of GBV-C/HGV may be high, at least in HCV-infected, drug-addicted women. In GBV-C/HGV RNA positive infants the rate of GBV-C/HGV persistent infection is high, but the infection is not accompanied by any symptoms of liver disease.

Field trials to control schistosome intermediate hosts by the plant molluscicide Ambrosia maritima L. in the Senegal River Basin

Several field experiments were carried out in Senegal to evaluate the molluscicidal activity of Ambrosia maritima L. Applications of 400 mg L-1 of dry leaves of the plant in creeks of the Lampsar river did result in a reduction of Bulinus spp of 54-56% 2 weeks after treatment. Treatment of a closed irrigation canal caused a reduction of the density of Biomphalaria pfeifferi up to 77% 2 weeks after the application of 150 mg L-1 and 300 mg L-1. In both trials, however, a quick increase in the snail density was observed after treatment. It is concluded that the large amounts of crude plant material required to achieve snail reductions of less than 80% compromise the use of A. maritima in schistosomiasis control programmes.

Outbreak of intestinal schistosomiasis in the Senegal River Basin

Intestinal schistosomiasis has never been reported in the delta of the Senegal River Basin. A year and a half after the Diama dam became operational, a first case of Schistosoma mansoni infection was detected at Richard-Toll. In 1988 and 1989, 1,935 stool examinations out of a sample of 3,926 were found positive for S. mansoni. The progression of positive stool samples is rapid in all neighbourhoods of Richard-Toll: 1.9% positive examinations in 1988 compared to 71.5% in the last quarter of 1989. One thousand nine hundred and sixty nine Biomphalaria pfeifferi were collected during several malacological surveys carried out from February 1989 to December 1989 at three observation points. An emission of S. mansoni furcocercariae was determined in 44 out of 926 B. pfeifferi (4.75%) examined during this same period. Intestinal schistosomiasis is new in this area and spreading quickly. Rapid intervention measures are required immediately.