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.

Aims

We aimed to determine hip-related quality of life and clinical findings following treatment for neonatal hip instability (NHI) compared with age- and sex-matched controls. We hypothesized that NHI would predispose to hip discomfort in long-term follow-up.

Aims

In previous studies, we identified multiple factors influencing the survivorship of hip resurfacing arthroplasties (HRAs), such as initial anatomical conditions and surgical technique. In addition, the University of California, Los Angeles (UCLA) activity score presents a ceiling effect, so a better quantification of activity is important to determine which activities may be advisable or detrimental to the recovered patient. We aimed to determine the effect of specific groups of sporting activities on the survivorship free of aseptic failure of a large series of HRA.

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.

Aims

This study reports the mid-term results of total hip arthroplasty (THA) performed using a monoblock acetabular component with a large-diameter head (LDH) ceramic-on-ceramic (CoC) bearing.

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

The use of joint-preserving surgery of the hip has been largely abandoned since the introduction of total hip replacement. However, with the modification of such techniques as pelvic osteotomy, and the introduction of intracapsular procedures such as surgical hip dislocation and arthroscopy, previously unexpected options for the surgical treatment of sequelae of childhood conditions, including developmental dysplasia of the hip, slipped upper femoral epiphysis and Perthes’ disease, have become available. Moreover, femoroacetabular impingement has been identified as a significant aetiological factor in the development of osteoarthritis in many hips previously considered to suffer from primary osteoarthritis.

As mechanical causes of degenerative joint disease are now recognised earlier in the disease process, these techniques may be used to decelerate or even prevent progression to osteoarthritis. We review the recent development of these concepts and the associated surgical techniques.

Cite this article: Bone Joint J 2014;96-B:5–18.

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 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

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

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

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)

We conducted a longitudinal study including patients with the same type of primary hybrid total hip replacement and evaluated patient activity and femoral osteolysis at either five or ten years post-operatively. Activity was measured using the University of California, Los Angeles scale. The primary outcome was the radiological assessment of femoral osteolysis. Secondary outcomes were revision of the femoral component for aseptic loosening and the patients’ quality of life. Of 503 hip replacements in 433 patients with a mean age of 67.7 years (30 to 91), 241 (48%) were seen at five and 262 (52%) at ten years post-operatively. Osteolytic lesions were identified in nine of 166 total hip replacements (5.4%) in patients with low activity, 21 of 279 (7.5%) with moderate activity, and 14 of 58 (24.1%) patients with high activity. The risk of osteolysis increased with participation in a greater number of sporting activities. In multivariate logistic regression adjusting for age, gender, body mass index and the inclination angle of the acetabular component, the adjusted odds ratio for osteolysis comparing high vs moderate activity was 3.6 (95% confidence interval 1.6 to 8.3). Stratification for the cementing technique revealed that lower quality cementing increased the effect of high activity on osteolysis. Revision for aseptic loosening was most frequent with high activity. Patients with the highest activity had the best outcome and highest satisfaction.

In conclusion, of patients engaged in high activity, 24% had developed femoral osteolysis five to ten years post-operatively.

Dislocation is a common and well-studied complication after total hip replacement. However, subluxation, which we define as a clinically recognised episode of incomplete movement of the femoral head outside the acetabulum with spontaneous reduction, has not been studied previously. Out of a total of 2521 hip replacements performed over 12 years by one surgeon, 30 patients experienced subluxations which occurred in 31 arthroplasties. Data were collected prospectively with a minimum follow-up of two years. Subluxation occurred significantly more frequently after revision than after primary hip replacement, and resolved in 19 of 31 cases (61.3%). In six of the 31 hips (19.4%) the patient subsequently dislocated the affected hip, and in six hips (19.4%) intermittent subluxation continued. Four patients had a revision operation for instability, three for recurrent dislocation and one for recurrent subluxation. Clinical and radiological comparisons with a matched group of stable total hips showed no correlation with demographic or radiological parameters.

Patients with subluxing hips reported significantly more concern that their hip would dislocate, more often changed their behaviour to prevent instability and had lower postoperative Harris hip scores than patients with stable replacements.