Birmingham Metal-on-metal total hip resurfacing (BHR) is a bone-conserving option for patients with advanced articular damage. While the outcomes of Total Hip Replacement (THR) are well documented, there is a paucity of literature comparing the patient reported outcomes of BHR versus THR. This study aims to compare the patient reported outcomes for an impact on quality of life between patients who had a BHR vs. THR after correcting for selection bias. Patients who underwent a BHR or THR between July 2003 and December 2006 were included. Patient questionnaires included demographic details, co-morbidities, WOMAC, SF-36 Scores. In addition, a 4 point Likert scale was used to measure satisfaction post-operatively. The above data was collected pre-operatively and at 1, 2, 3 and 5 years post-operatively. Data was analysed with SPSS (version 19) software package. All analysis was adjusted for Age, gender, Co-morbidity and pre-operative score by using Multivariate regression analysis using a General Liner Model to rule out the effect of these predictors on outcomes between groups. 337 patients were included (205 for THR and 132 for BHR). BHR patients were younger than THR patients (49 vs. 67 years, p<0.01), were more likely to be male (68% vs. 42% of THR, p<0.01), reported fewer co-morbidities (1.06 vs. 1.59, p<0.01). BHR patients reported better WOMAC pain and function scores at 5 years (p<0.05). For SF-36 scores, BHR patients reported higher scores for all 8 domains at 1 year and 5 year follow up (p<0.05). BHR patients reported higher satisfaction than THR group for return to Activities of Daily Living and Recreational activities at 1 and 5 years (p<0.05) After correction for patient variability, BHR patients reported better improvement in pain and function and enjoyed a better quality of life in relation to return to ADL and recreational activities over to 5 years post-surgery.
The cause of elbow tendinosis is most likely a combination of mechanical overloading and abnormal microvascular responses. Numerous methods of treatment have been advocated. In this study, we evaluated the use of platelet-rich plasma (PRP) as a treatment for resistant epicondylitis. The rationale for using platelets is that they participate predominantly in the early inflammation phases and degranulation. They constitute a reservoir of critical growth factors and cytokines which when placed directly into the damaged tissue, may govern and regulate the tissue healing process. We looked at 25 patients (19 with lateral and 6 with medial) who failed to improve after physiotherapy, cortisone injections and application of epicondylar clasps and assessed the efficacy of platelet-rich plasma injections using Gravitational platelet separation system (GPS). The cohort of patients included over a period of three years had physiotherapy, stretches, epicondylar clasp and an average of 2.9steroid injections (1–6) before having a PRP injection. The mean patient age was 43 years ranging between 24 and 54. There were 11 men and 14 women. The study included 19 patients with lateral epicondylitis and 6 patients with symptoms on the medial side. The ratio between dominant and nondominant side was according to the literature: 76%. The quick DASH scores imroved by 14% on an average in the first 3 months and further 26% in the following 9 months. 4 patients needed reintervention, 3 lateral and 1 medial and had surgical release between 6 and 12 months. 2 of them had reinjections before surgery. No local infections except mild inflammation and no systemic effects were noted. Within the limitations of being a case series and limited follow-up PRP injections provided a safe and progressive benefit over a period of 1 year in refractory cases, providing a good nonoperative alternative.
