PEMF is currently approved by the FDA for adjunctive treatment of lumbar/cervical spine fusion and for treatment of long-bone non-unions. Soft tissues are a potential new therapeutic application for PEMF due to pre-clinical studies showing a reduction of inflammatory markers following PEMF exposure. The aim was therefore to investigate the structural/functional effects of PEMFs on tendon-to-bone and tendon-to-tendon healing in a rotator-cuff (RC) and Achilles tendon (AT) repair model, respectively. RC study: Adult male rats (n=280), underwent bi-lateral supraspinatus tendon transections with immediate repair followed by cage activity until sacrifice (4, 8, and 16 weeks). Non-controls received PEMF for 1, 3, or 6 hours daily. AT study: Male rats underwent acute, complete transection and repair of the Achilles tendon (FULL, n=144) or full thickness, partial width injury (PART, n=160) followed by immobilization for 1 week. Sacrifice was at 1, 3, and 6 weeks. Outcome measures included passive joint mechanics, gait analysis, biomechanical assessments, histological analysis of the repair site and mCT (humerus) assessment (FULL only). RC study: Significant increases in modulus, stiffness, bone mineral content and improved collagen organization was observed for the PEMF groups. No differences in joint mechanics and ambulation were observed. AT study: A decrease in stiffness and limb-loading rate was observed for the PEMF groups for the FULL groups, whereas an increase in stiffness with no change in range-of-motion was seen for the PART groups. The combined studies show that PEMF can be effective for soft tissue repair but is dependent on the location of application.

INTRODUCTION

Rotator cuff tears are common injuries which often require surgical repair. Unfortunately, repairs often fail [1] and improved repair strength is essential. P2 Porous titanium (DJO Surgical, Austin TX) has been shown to promote osseointegration [2,3] and subdermal integration [4]. However, the ability of P2Porous titanium to aid in supraspinatus tendon-to-bone repair has not been evaluated. Therefore, the purpose of this study was to investigate P2 implants used to augment supraspinatus tendon-to-bone repair in a rat model [5]. We hypothesized that supraspinatus tendon-to-bone repairs with P2 implants would allow for ingrowth and increased repair strength when compared to standard repair alone.

We aimed to assess whether using long stem femoral components, with cemented distal fixation and proximal impaction grafting allows early patient mobilisation, reconstitution of the proximal femur and long term stability of fixation in patients with aseptic loosening and proximal femoral analysis.

Over the past ten years 239 patients have been treated with an Elite Plus cemented long stem femoral implant, 33% with concomitant proximal impaction bone grafting. Many of the patients had co-morbidities. The average age at revision was 72 years (range 48 to 91). There was a slight female predominance. Fourteen percent of hips had been previously revised. Forty-eight patients were deceased and 22 were not available for follow-up; this left a cohort of 169 patients who were available for radiological and questionnaire review at an average of 4.5 years.

According to the Paprosky grading for pre-operative bone loss 40% had moderate to severe bone loss (grade IIIb or IV). The Barrack grading was used to assess the cement mantle post-operatively with 65% showing good cementation. The Harris and O'Neill grades were used at final review to assess probability of loosening with only 8% being probably or definitely loose. The average Oxford Hip Score was 29. Mesh ± cables were required in a third of cases to allow adequate containment and pressurisation. It was generally felt that the long stem needed to be at least one third longer than the initial component. The re-revision rate was 1.2 with a 10 year survivorship analysis of 94%. The complication rate of almost 6% included periprosthetic fractures, dislocations, infection and mesh breakage.

A long stem cemented femoral implant can be useful in bypassing proximal femoral deficiency in the appropriate patient.

There is an increasing body of evidence that allogenic blood transfusion is harmful and blood itself is a valuable resource not to be dispensed lightly. Therefore, a review was undertaken into the need for allogenic blood transfusion following primary unilateral hip arthroplasty in our unit. An initial audit was performed retrospectively on 191 consecutive patients, revealing that 73 of the 191 (38%) received allogenic blood either intra-operatively or postoperatively. Guidelines were drawn up, then implemented, with the assisistance of the anaesthetic and haematology departments. The threshold for transfusion was a post-operative haemoglobin of less than 8g/dL. A trial period of 2 months was used to study the impact of these guidelines. No patients were excluded at the outset due to age or co-morbidity. During this period 96 patients were identified for inclusion in the study, of which only 19 (20%) required blood transfusion. In order to ensure these guidelines were not unsafe we compared the length of hospital stay following surgery in both groups of patients as a surrogate measure of postoperative complications. There was no significant difference between the lengths of stay in each groups. The conclusion was drawn that these new guidelines are not detrimental to the patient, and roughly halve the need for allogenic blood transfusion.

There are very few reports on apophysitis of the iliac crest although similar afflictions of the knee, heel, and elbow are well recognised conditions. Excesive forefoot pronation has been suggested as a contributory factor in the development of iliac apophysitis. We present our experience of this not so well known problem.

Method: This is a prospective review of 8 patients (2- males, 6- females) between 12–16 years of age, who presented with pain in the hip of at least 3 months duration. They were prospectively reviewed over an average of 6 months (6–24 months). 7 of them were involved in some sort of sporting activity. 3 patients had to miss school due to pain. All of them had tenderness over the iliac crest, normal range of hip movements with pain on resisted hip abduction. None of them had any deformities in the lower limbs. Blood counts, ESR, CRP and radiographs were normal. 3 patients had persistent pain over 12 months hence had a bone scan which was normal. All patients had full symptomatic relief following rest, activity modification and anti-inflammatory medication.

Conclusions: Unlike previous reports, our patients did not have characteristic radiographic changes thus the diagnosis of this condition seems to be mainly clinical. All pediatric patients with hip pain should be thoroughly investigated to rule out other sinister causes. None of our patients had any foot deformities questioning the hypothesis that iliac apophysitis develops secondary to excessive forefoot pronation. It is important to be aware of this condition, which causes considerable distress and can be relieved easily by conservative means.