Adhesive capsulitis is a common condition causing painful limitation of shoulder movements. Hydrodistension is one of the techniques, is well recognised and has shown good outcomes. However, the results of hydro distension release in secondary adhesive capsulitis are not clear. This is a retrospective study on patients undergoing hydro distension release. Patients who had any surgical intervention were classed as secondary whilst the rest were included in the primary group. The hydro distension is a standard technique where in the senior author locates the gleno humeral joint using radio opaque dye, followed by injection of 20 mls 0.5% L-bupivacaine and 80 mg of Triamcinolone, this is followed by use of 60 mls saline to perform the hydro distension.Introduction
Patients and Methods
The MHRA guidelines for metal on metal (MOM) suggest cobalt and chromium levels of more than 7ppb as potential for soft tissue reaction. However, in some patients soft tissue reaction is seen even in the presence of normal serum metal ions levels. A prospective review of all patients who had metal-on-metal hip arthroplasty was done. Patients who had both serum metal ion levels and MARS MRI scan were included in this study.Introduction
Methods
Revision surgery for a failed metal on metal (MoM) hip arthroplasty is often unpredictable and challenging due to associated massive soft tissue and bony lesions. We present the analysis and early outcomes of revision surgery in failed MoM hip arthroplasties at our institution. We have retrospectively analysed the findings and outcomes of revision surgery in 61 failed MoM hip arthroplasties performed between 2009 and 2014. These patients were identified in the special MoM hip surveillance pathway. All these patients underwent clinical assessment and relevant investigations. Intra-operative and histopathological findings were analysed.Background
Methods
To evaluate one-year mortality rate of hip fractures treated surgically and assess the influence of medical status and ASA grade on this parameter. 212 patients above 65 years (range 65–100, mean 82.7): There were 104 (49.1%) intertrochanteric and 108 (51.9%) femoral neck fractures. A number of surgical procedures, (sliding/compression screw 104 (49.1%), hemiarthroplasty 81 (38.2%), cannulated screws 18 (8.5%) and total hip replacement (4.2%) were used. The one - year mortality rate was obtained from computerised records, case notes and General Practitioners. One-year mortality rate for the whole group was 28.8% with an exponential increase corresponding to ASA grade. The relationship between ASA grade and mortality for the whole group (P<
0.001), younger age group of 65 – 84 years (P<
0.001), older age group of 85– 100 years (P=0.002), early operation group <
2 days (P=0.001), females (P=0.000), intertrochanteric fractures (P=0.007), femoral neck fractures (P=0.022) and sliding/compression screw (P=0.007) was highly significant. The type of operation per se and time of operation had no predictive value.
The extensive dominant influence of ASA grade is a highly significant predictive determinant and final arbiter of surgical risk and mortality in hip fracture.
