To quantify the prevalence of Generalized Joint
Greater trochanteric pain syndrome (GTPS) is a common and disabling hip condition.
We have studied patients with Joint
Introduction:
Background.
Background.
This study was performed to assess the incidence of generalised ligament laxity in patients presented with recurrent shoulder dislocations. Prospective data was collected for 38 patients with recurrent shoulder dislocations and 43 patients with clavicle fractures as a control group between May 2007 and July 2009, including demographic details, mechanism of injury, number of dislocations and hyperlaxity. Clinical examination was used to assess the ligament laxity using the Beighton score. The mean age was 29 years with a range from 14-40 years. There were 36 males and 2 females. The left shoulder was involved in 21 patients; right in 13 patients and 4 patients had bilateral shoulder dislocations. The average number of dislocations was 3 with a range from 2-17, while the average number of subluxations was 4.5 with a range from 0-35. The average Beighton score for the patients with recurrent shoulder dislocations was 2.8 with a range from 0-8. 17 patients (45%) in this group had a Beighton score of 4 or more as compared to the control group that had only 12 patients (27%) There was a statistically significant difference between the 2 groups with a P value of < 0.05. 8 patients (21%) fulfilled the Brighton criteria for BJHS. The most common cause of recurrent shoulder dislocation was sports related injuries in 26 patients (68%). The most common sport was football in 14 patients (37%) followed by rugby in 10 (26%) patients. We looked at the incidence of generalised ligament laxity in patients with recurrent shoulder dislocations and found a statistically significant difference as compared with the control group. 21% of the patients fulfilled the Brighton criteria for BJHS but 45% had a Beighton score of 4 or more. Appropriate advice should be given to these patients with hyperlaxity and the timing of shoulder stabilisation should be carefully decided.
The mechanisms of how spinal arthrodesis (SA) affects patient function after total hip replacement (THA) remain unclear. The objectives of this study were to a) Determine how outcome post-THA compares between patients with- and without-SA, b) Characterize sagittal pelvic changes that occur when moving between different functional positions, and test for differences between patients with- and without-SA, and c) Assess whether differences in sagittal pelvic dynamics are associated with outcome post-THA. Forty-two patients with THA-SA (60 hips) were case-control matched for age, gender, BMI with 42 THA-only patients (60 hips). All presented for review where outcome, PROMs [including Oxford-Hip-Score(OHS)] and 4 radiographs of the pelvis and spino-pelvic complex in 3 positions (supine, standing, deep-seated) were obtained. Cup orientation and various spino-pelvic parameters [including pelvic tilt (PT) and Pelvic-Femoral-Angle (PFA)] were measured. The difference in PT between standing and seated allowed for patient classification based on spino-pelvic mobility into normal (±10–30°), stiff (<±10°) or hypermobile (>±30°).Introduction
Patients/Materials & Methods
Two individuals with generalised articular hypermobility are described. There are many affected members in both kindreds, and the pedigrees indicate that the disorder is transmitted as an autosomal dominant trait. Orthopaedic complications and deformities are common in one family but absent in the other. It is suggested therefore that the two disorders are distinct and separate genetic entities.
Unidirectional instability with or without hyperlaxity can be adressed as such; mostly traumatic changes like Bankart or capsule lesions are seen and they can be treated with the standard arthroscopic suture techniques. Multidirectional instability (MDI) with or without hyperlaxity is quite rare. In the literature MDI is often mentioned, but most of the time it refers to multidirectional laxity with unidirectional instability. During arthroscopy often capsular redundancy is seen without obvious pathological changes. Several series have been described where arthroscopic capsulorraphy has shown to be reasonably succesfull Since the introduction of thermal shrinkage several series have been published, with poorer results compared to capsular shift: failure rates vary between 11 to 36%. The possible reason of this high failure rate is that 1) many patients with multi-directional laxity are included, 2) as well as the fact that after time the effect of the shrinkage disappears due to regeneration of the capsule. Posterior instability. In posterior subluxation, often posttraumatic, with hyperlaxity frequently as accompanying phenomenon, arthroscopic capsulorraphy has been rather successful. My personal series of 10 patients showed a failure rate of 50%. Shrinkage has been applied for this indication as well, with varying results. Since 1998 13 patients with posterior subluxations were treated in our hospital with shrinkage after the failure of extensive physical therapy. After 1 yr follow-up most of them were stable; after 18–24 months follow-up all showed recurrence of the posterior instability. The pain, often accompanying the subluxation, was however still absent at the latest follow-up. Multidirectional instability with or without hyperlaxity is a not well defined clinical entity; for this reason the results of several treatment modalities are often not comparable. Posterior instability, especially subluxations are often posttraumatic, with some accompanying hyperlaxity. In both pathological conditions arthroscopic capsulorraphy seems to be more effective than shrinkage
Spinopelvic mobility plays an important role in functional acetabular component position following total hip arthroplasty (THA). The primary aim of this study was to determine if spinopelvic hypermobility persists or resolves following THA. Our second aim was to identify patient demographic or radiological factors associated with hypermobility and resolution of hypermobility after THA. This study investigated patients with preoperative posterior hypermobility, defined as a change in sacral slope (SS) from standing to sitting (ΔSSstand-sit) ≥ 30°. Radiological spinopelvic parameters, including SS, pelvic incidence (PI), lumbar lordosis (LL), PI-LL mismatch, anterior pelvic plane tilt (APPt), and spinopelvic tilt (SPT), were measured on preoperative imaging, and at
six weeks and a minimum of
one year postoperatively. The severity of bilateral hip osteoarthritis (OA) was graded using Kellgren-Lawrence criteria.Aims
Methods
As it remains unproven that hypermobility of
the first tarsometatarsal joint (TMTJ-1) is a significant factor
in hallux valgus deformity, the necessity for including arthrodesis
of TMTJ-1 as part of a surgical correction of a hallux valgus is
questionable. In order to evaluate the role of this arthrodesis
on the long-term outcome of hallux valgus surgery, a prospective,
blinded, randomised study with long-term follow-up was performed,
comparing the Lapidus procedure (which includes such an arthrodesis)
with a simple Hohmann distal closing wedge metatarsal osteotomy. The
study cohort comprised 101 feet in 87 patients: 50 feet were treated
with a Hohmann procedure and 51 with a Lapidus procedure. Hypermobility
of TMTJ-1 was assessed pre-operatively by clinical examination.
After a mean of 9.25 years (7.25 to 11.42), 91 feet in 77 patients
were available for follow-up. There was no difference in clinical
or radiological outcome between the two procedures. Also, there
was no difference in outcome between the two procedures in the subgroup
clinically assessed as hypermobile. This study does not support
the theory that a hallux valgus deformity in a patient with a clinically
assessed hypermobile TMTJ-1 joint requires fusion of the first tarso-metatarsal
joint. Cite this article:
Introduction: The increasing use of Arthroscopic surgery for recurrent anterior shoulder dislocations (RASD) has questioned the indications and contraindications for this procedure. The ideal candidate for this kind of surgery is an overhead athlete, who participates in a noncontact sport, with traumatic unidirectional anterior instability with a well-defined Bankart lesion. Purpose of the paper: To demonstrate that complementing the Arthroscopic Bankart Repair (ABR) with an Arthroscopic Rotator Interval Closure (ARIC) the indication for Arthroscopic management of Anterior shoulder instability can be broaden for patients who has a less defined Bankart lesion and has additional multidirectional hyperlaxity. Patients and Methods: Between January 1, 1999 and December 31, 2002, 166 patients (175 shoulders) suffering from recurrent anterior dislocations were treated by ABR. In the first two years, only patients who had unidirectional instability with no
Aims. Periacetabular osteotomy is an effective way of treating symptomatic
hip dysplasia. We describe a new minimally invasive technique using
a modification of the Smith-Peterson approach. We performed a prospective, longitudinal cohort study to assess
for any compromise in acetabular correction when using this approach,
and to see if the procedure would have a higher complication rate
than that quoted in the literature for other approaches. We also
assessed for any improvement in functional outcome. Patients and Methods. From 168 consecutive patients (189 hips) who underwent acetabular
correction between March 2010 and March 2013 we excluded those who
had undergone previous pelvic surgery for DDH and those being treated
for acetabular retroversion. The remaining 151 patients (15 men,
136 women) (166 hips) had a mean age of 32 years (15 to 56) and the
mean duration of follow-up was 2.8 years (1.2 to 4.5). In all 90%
of cases were Tönnis grade 0 or 1. Functional outcomes were assessed
using the Non Arthritic Hip Score (NAHS), University of California,
Los Angeles (UCLA) and Tegner activity scores. Results. The mean pre-operative lateral centre-edge angle was 14.2° (-5°
to 30°) and the mean acetabular index was 18.4° (4° to 40°). Post-operatively
these were 31° (18° to 46°) and 3° (-7° to 29°), respectively, a
significant improvement in both (p <
0.001). Allogenic blood
transfusion was required in two patients (1.2%). There were no major
nerve or vascular complications, and no wound infections. At the
time of last follow-up, we noted a significant improvement in functional
outcome scores: UCLA improved by 2.31 points, Tegner improved by
1.08 points, and the NAHS improved by 25.4 points (p <
0.001
for each).