Purpose The aim of this study was investigate the relationship between version and torsional abnormalities of the acetabulum, femur and tibia in patients with symptomatic FAI. Methods A systematic review was performed according to PRISMA guidelines using the EMBASE, MEDLINE, PubMed and Cochrane databases. Original research articles evaluating the described version and torsional parameters in FAI were included. The MINORS criteria was used to appraise study quality and risk of bias. Mean version and torsion values were displayed using forest plot and the estimated proportion of hips displaying abnormalities in version/torsion were calculated. A total of 1206 articles were identified from the initial search, with 43 articles, involving 8,861 hips, meeting the inclusion criteria. All studies evaluating femoral or acetabular version in FAI reported ‘normal’ mean version values (100 to 250). However, distribution analysis revealed that an estimated 31% and 51% of patients with FAI displayed abnormal central acetabular and femoral version respectively. Up to 51% of patients presenting with symptomatic FAI show an abnormal femoral version, whilst up to 31% demonstrate abnormal acetabular version. This high percentage of version abnormalities highlights the importance of evaluating these parameters routinely during assessment of patients with FAI, in order to guide clinical decision making.Abstract
Results
Conclusion
Extracellular matrix (ECM) and its architecture have a vital role in articular cartilage (AC) structure and function. We hypothesized that a multi-layered chitosan-gelatin (CG) scaffold that resembles ECM, as well as native collagen architecture of AC, will achieve superior chondrogenesis and AC regeneration. We also compared its in vitro and in vivo outcomes with randomly aligned CG scaffold. Rabbit bone marrow mesenchymal stem cells (MSCs) were differentiated into the chondrogenic lineage on scaffolds. Quality of in vitro regenerated cartilage was assessed by cell viability, growth, matrix synthesis, and differentiation. Bilateral osteochondral defects were created in 15 four-month-old male New Zealand white rabbits and segregated into three treatment groups with five in each. The groups were: 1) untreated and allogeneic chondrocytes; 2) multi-layered scaffold with and without cells; and 3) randomly aligned scaffold with and without cells. After four months of follow-up, the outcome was assessed using histology and immunostaining.Aims
Methods
The aim of this study was to systematically review the literature on measurement of muscle strength in patients with femoroacetabular impingement (FAI) and other pathologies and to suggest guidelines to standardise protocols for future research in the field. The Cochrane and PubMed libraries were searched for any publications using the terms ‘hip’, ‘muscle’, ‘strength’, and ‘measurement’ in the ‘Title, Abstract, Keywords’ field. A further search was performed using the terms ‘femoroacetabular’ or ‘impingement’. The search was limited to recent literature only.Objectives
Methods
Elevated serum cobalt and chromium ion levels associated with carcinogenesis and chromosomal damage in animals have raised concerns that metal-on-metal (MOM) total hip replacement (THR) in humans may produce the same effects over time. Considering that the risks may be related to the level of these ions in the body, this study compared the serum cobalt and chromium ion levels in patients with unilateral versus bilateral 28 mm diameter MOM THR. All patients having THR at our institution were prospectively registered on a computerised database. From our database, we identified 108 patients with Ultima (Johnson and Johnson, Leeds) MOM THR with 28 mm bearing made of cobalt-chromium alloy. After patient review in clinic and before blood results were known, patient matching was performed by date after surgery at blood sampling, activity level and body mass. Using these stringent criteria, 11 unilateral THR could be adequately matched with 11 bilateral THR. Blood serum was taken with full anti-contamination protocols and serum analysed via inductively coupled plasma mass spectrometry. The serum cobalt ion level after unilateral MOM THR was 4.4 times normal (median 22 nmol/L, range 15 to 37 nmol/L) compared to 8.4 times normal (median 42 nmol/L, range 19 to 221 nmol/L) for bilateral MOM THR (p=0.001). The serum chromium ion level after unilateral MOM THR was 3.8 times normal (median 19 nmol/L, range 2 to 35 nmol/L) compared to 10.4 times normal (median 52 nmol/L, range 19 to 287 nmol/ L) for bilateral MOM THR (p=0.04). This study has shown that the serum cobalt and chromium ion levels in patients with bilateral MOM THR are significantly higher than those in patients with unilateral MOM THR. With levels of up to 50 times the upper limit of normal, this finding may be of relevance for the potential development of long-term side effects.
Metal-on-metal (MOM) bearings after total hip arthroplasty are known to elevate the serum concentrations of metal ions, raising concerns about the long-term effects. One potential modifier of ion release is the bearing diameter used. Resurfacing MOM bearings have a large surface area available for corrosion compared to the typical bearing size of 28 mm in total hip replacement (THR) but may benefit from improved lubrication and reduced production of corrodible wear debris. The net effect of these two variables on metal ion release is unknown. In this study, we compared the level of ion release in patients after large bearing MOM hip resurfacing arthroplasty with patient after small bearing MOM THR. We measured the serum cobalt and chromium levels from 22 patients with large bearing diameter MOM hip resurfacing arthroplasty (Cormet 2000 and Birmingham Hip Resurfacing) and compared them to the serum cobalt and chromium levels of 22 patients with small bearing diameter (28 mm) MOM THR (Ultima). Patients were prospectively matched for activity level, body mass and date after surgery at blood sampling. All were at least 6 months after surgery. We found the median cobalt and chromium levels after hip resurfacing arthroplasty to be 7.6 times normal (median 38 nmol/L, range 14 to 144 nmol/L) and 10.5 times normal (median 53 nmol/L, range 25 to 165 nmol/ L) respectively. This is compared to 4.4 times normal (median 22 nmol/L, range 15 to 87 nmol/L) for cobalt and 3.8 times normal (median 19 nmol/L, range 2 to 58 nmol/L) for chromium after 28 mm MOM THR (p=0.0021 and p<
0.0001).
Hip resurfacing arthroplasty (RS) is said to be an operation that is suitable for the younger osteoarthritic population, allowing them to rehabilitate more rapidly. We wished to establish whether this was true and compared 35 consecutive RS (33 patients) with 41 consecutive total hip replacements (THR) (40 patients) and looked specifically at post-operative pain, speed of rehabilitation and length of hospital stay. A rehabilitation score was used. RS patients were significantly younger than THR patients (mean 53.0 years for RS, 64.7 years for THR; p<
0.0001). However, no significant difference was found in the mean rehabilitation score at any stage after surgery or in the speed of rehabilitation between the two groups. The mean pain score for group RS was 1.98 and 2.18 for group THR. The mean length of hospital stay was 5.18 days for resurfacing arthroplasties and 5.45 days for total hip replacements. Neither of these differences was significant. The male-female ratio in the two groups was significantly different. However, when the subgroups of the same gender were compared, the results were essentially the same: no statistical difference was found for the post-operative pain, speed of rehabilitation or length of hospital stay. We conclude that resurfacing arthroplasty has no evidence of an advantage over total hip replacement in the speed of post-operative rehabilitation.
Statistical analysis used the Mann-Whitney U test.
We present a surgical technique through an axillary incision to perform scapular neck osteotomy and insertion of bone graft for recurrent anterior dislocation of shoulder. Fifty patients in the age group 09–40 years with the history of anterior dislocation of shoulder more than three times were operated during 1988–1998. The dominant shoulder was involved in all cases and there was no history of epilepsy, addiction to drugs and psychosomatic ailments. The surgery was performed through an axillary incision. The lateral border of the scapula was palpated and infraglenoid tubercle identified. The scapular neck was osteotomised parallel to the glenoid margin, from infraglenoid tubercle to the lateral border of the base of coracoid leaving the superior cortex intact. The osteotomy was prised open and a 3 cmx1.5 cmx1 cm corticocancellous bone graft was wedgedwhich projected 10 mm anteriorly and 6 mm inferiorly. The graft remained secure and compressed in the osteotomy without any need of metallic fixation.The shoulder was immobilised in arm chest bandage for 4 weeks followed by mobilisation aimed to regain full movements in 12 weeks. The bone graft got incorporated in all patients in 6 months.There were no recurrence at follow up of 2–10 years. All the patients returned to their previous occupation. Rowes shoulder evaluation revealed excellent result (85–100 units). This surgical technique is extra-capsular, requires no muscle cutting, blood transfusion or metallic fixation. The projecting bone block anteriorly increased the depth of glenoid resulting in glenohumeral stability in larger arc of shoulder movements.
