Purposes of the study and background. Smaller studies indicate that yoga may be an effective treatment for chronic low back pain. We conducted a randomised trial to evaluate if yoga compared to usual care improves back function in patients with chronic or recurrent low back pain. Summary of the methods used and the results. Outcomes were assessed by postal questionnaires. The setting was 13 non-National Health Service premises. We recruited 313 adults with chronic or recurrent low back pain from primary care. 157 were randomised to usual care. 156 were randomised to a 12-class, gradually-progressing programme of yoga delivered by 12 teachers over three months. All received The Back Book. Primary outcome was back function (Roland Morris Disability Score) at three months. Secondary outcomes: back function at six and 12 months, back pain, pain self-efficacy and general health. Back function improved more in the yoga group: mean difference in changes from baseline at three (−2.17, 95% CI −3.31 to −1.03, p<0.001), six (−1.48, 95% CI −2.62 to −0.33, p=0.011) and 12 months (−1.57, −2.71 to −0.42, p=0.007). Improvement in pain self-efficacy at three and six months in the yoga group. No differences in general health and pain reduction. Two adverse events were reported by controls and 12 by the yoga group – 8 out of 12 reported pain which may have been due to yoga. 63 (40%) were not fully compliant with treatment and 23 (15%) did not attend any yoga classes. Conclusion. At all time points Yoga was more effective than usual care at improving back function. Conflicts of Interest. AT, AS and JDA are self-employed yoga practitioners and may benefit if there is a demand for the yoga programme. AT, AS, the funders and the University of York would share any royalties from the future sale of the yoga manuals and CD.” AT, AS AND JDA had no involvement in the collection of data and in the analysis of the trial. Source of funding. Arthritis Research UK

The August 2012 Knee Roundup. 360. looks at: meniscal defects and a polyurethane scaffold; which is best between a single or double bundle; OA of the knee; how to resolve anterior knee pain; whether yoga can be bad for your menisci; metal ions in the serum; whether ACI is any good; the ACL; whether hyaluronic acid delays collagen degradation; and hyaluronan and patellar tendinopathy

The April 2012 Spine Roundup. 360. looks at yoga for lower back pain, spinal tuberculosis, complications of spinal surgery, fusing the subaxial cervical spine, minimally invasive surgery and osteoporotic vertebral fractures, spinal surgery in the over 65s, and pain relief after spinal surgery

The October 2012 Knee Roundup. 360. looks at: autologous chondrocytes and chondromalacia patellae; drilling the femoral tunnel at ACL reconstruction; whether we repair the radially torn lateral meniscus; factors associated with patellofemoral pain; mechanoreceptors and the allografted ACL; whether high tibial osteotomy can delay the need for knee replacement; return to sport after ACL reconstruction; tissue-engineered cartilage; and the benefits of yoga

Osteoarthritis of the knee is a global scourge. Treatment ranges from cumbersome conservative measures with too many drugs with undesirable side effects, to aggressive knee replacements which still remain elusive to an average Indian. Can we provide hope to these patients and offer them a dignified existence?. In a study conducted over 100 patients in my hospital since 1998, I have devised a very effective treatment option, a new integrated therapy incorporating Yoga and a few alternative systems. Apart from offering to combat associated problems like diabetes, hypertension, obesity, osteoporosis etc it has lessened the amount of medications used for their treatment

Patient History. This patient is a 59-year-old female who presents with right side hip pain which has gradually progressed over the last 2 years. She describes activity related pain in the right groin radiating down the anterior thigh to the knee. There is also a moderate amount of posterior pain in the ischial region. She is now having pain at night as well as occasional back pain. The patient works as a landscape designer and historically has been quite active participating in yoga, snow skiing, and hiking. These activities have become more limited over the last 12 months. She denies any significant right knee pain and has no radicular complaints. Prior treatment has consisted of physical therapy on two separate occasions over the last year both for 6-week periods without relief. She uses anti-inflammatories daily but otherwise has not had any injections or surgery on the right hip. A cane is used for long distances and her maximum ambulatory capacity is 2 blocks. She is unable to negotiate stairs easily and has difficulty donning socks and shoes. Overall she describes her activity level as light labour. She has no significant past medical or surgical history and takes no medications. The patient is allergic to sulfa drugs. She denies tobacco use. By physical exam she stands 5 feet 4 inches and weighs 150 pounds. Lumbar spine exam shows no tenderness to palpation with negative straight leg raise bilaterally. Right hip exam is consistent with 95 degrees of flexion and 10 degrees extension. Abduction and adduction are 20 degrees and 10 degrees, respectively with 5 degrees of both internal and external rotation. Groin pain is reproduced with passive hip range of motion. Hip flexion and abduction strength are 5/5 with mild tenderness along the greater trochanteric region. Leg lengths are symmetrical. Right knee exam shoes full range of motion with neutral alignment and stability in both the coronal and sagittal planes. Right foot and ankle exam is consistent with normal sensory motor function and palpable dosalis pedis and posterior tibial pulses. X-ray examination demonstrates advanced degenerative changes in the right hip with complete joint space obliteration and early erosive changes in the femoral head. Bone quality shows mild osteoporosis. Impression: Osteoarthritis Right Hip. Plan: Anterior Approach Right Total Hip Arthroplasty

Purpose of study. NICE recommends 8-9 sessions of non operative therapy for back pain that has lasted for 6 weeks but less than 12 months. NICE recommended exercises, manual therapy, acupuncture and suggested that Lumbar supports, TENS, Ultrasound and Traction should not be offered. Since multiple methods and disciplines were available a survey was conducted among the local General Practitioners to determine what non operative methods they preferred and how it matched with NICE's recommendation. Methods. An online survey was conducted on . www.surveymonkey.com. among the local GPs to determine their practice and preferences in investigating low back pain. The 5 questions in the survey were “rating scale questions” on a scale of 1 and 10, where 1 = DISAgree and 10 = Agree. A request to participate in the survey was sent to all the local General Practitioners by e-mail. Results. 25 General Practitioners participated in the survey. A sample of the scores obtained were as follows. Method of treatment. Mean Score. Mobilisation exercises. 8.20. Specific Core Stability Exercises. 8.13. Physiotherapy. 7.96. Pilates. 7.21. Attending a Gymnasium. 6.32. Medications. 6.20. Yoga. 6.18. TENS (Transcutaneous electrical nerve stimulation). 5.44. Acupuncture. 5.44. Chiropractory. 5.42. Osteopathy. 5.41. Massage. 4.73. Ultrasound. 3.43. Traction. 2.75. Lumbar support. 2.65. Conclusion. This limited study demonstrates that General Practitioners prefer patients to use active modalities of treatment like exercises which require participation of the patient rather than passive methods of treatment like lumbar support and massage. The choices of the GPs are nearly in tune with the recommendations of NICE with some exceptions. TENS (not recommended by NICE) obtained a better score than Acupuncture (recommended by NICE)

Aims

Fracture-related infections (FRIs) are a devastating complication of fracture management. However, the impact of FRIs on mental health remains understudied. The aim of this study was a longitudinal evaluation of patients’ psychological state, and expectations for recovery comparing patients with recurrent FRI to those with primary FRI.

Aims

People with severe, persistent low back pain (LBP) may be offered lumbar spine fusion surgery if they have had insufficient benefit from recommended non-surgical treatments. However, National Institute for Health and Care Excellence (NICE) 2016 guidelines recommended not offering spinal fusion surgery for adults with LBP, except as part of a randomized clinical trial. This survey aims to describe UK clinicians’ views about the suitability of patients for such a future trial, along with their views regarding equipoise for randomizing patients in a future clinical trial comparing lumbar spine fusion surgery to best conservative care (BCC; the FORENSIC-UK trial).

Aims

Physician burnout and its consequences have been recognized as increasingly prevalent and important issues for both organizations and individuals involved in healthcare delivery. The purpose of this study was to describe and compare the patterns of self-reported wellness in orthopaedic surgeons and trainees from multiple nations with varying health systems.

Objectives

Modern metal-on-metal (MoM) hip resurfacing arthroplasty (HRA), while achieving good results with well-orientated, well-designed components in ideal patients, is contraindicated in women, men with head size under 50 mm, or metal hypersensitivity. These patients currently have no access to the benefits of HRA. Highly crosslinked polyethylene (XLPE) has demonstrated clinical success in total hip arthroplasty (THA) and, when used in HRA, potentially reduces metal ion-related sequelae. We report the early performance of HRA using a direct-to-bone cementless mono-bloc XLPE component coupled with a cobalt-chrome femoral head, in the patient group for whom HRA is currently contraindicated.