Aim. This study aims to determine the value of MRI in children with hip pain which remained unexplained following routine investigations including ultrasound examination. Materials and methods. Retrospective review of clinical notes and MRI findings in all children who received and MRI scan for undiagnosed hip pain over three years. Results. Fifty five children underwent an MRI scan of their hips for unexplained hip pain. 29 were male and 26 were female. The mean age was 10.9 years. The MR study provided a diagnosis in 22 children (40%), and was normal in 33 children (60%). Five cases were considered to be due to transient synovitis. Three children were diagnosed as osteoid osteoma. Two children were were found to have trochanteric bursitis. Two children were shown to have muscle trauma (one child with adductor trauma and one child with piriformis trauma). Two children were diagnosed with non-specific bone oedema. The remaining eight children were diagnosed with Perthes' disease, haemarthrosis, sacro-iliac infection, synovitis secondary to juvenile idiopathic arthritis, ischio-pubic osteochondrosis, acetabular dysplasia, Klippel-Trenaunay syndrome and resolution of an eosinophilic granuloma. None of the children discharged following a normal scan has subsequently presented with hip disease. Conclusions. It is concluded that MRI is useful in the diagnosis of hip pain in children in whom routine investigation has not yielded an answer

Various reports confirm that elevations in serum markers associated with skeletal muscle injury exist and can occur after orthopaedic surgery in the absence of overt clinical manifestations of myocardial injury. The purpose of this study is to measure the influence surgical approach on these serum markers following primary Minimally Invasive THA. Consecutive enrollment of 30 patients into three different groups of 10 was performed. The MIS Modified Watson Jones THA is an approach using an inter-muscular plane, the Mini Posterior is a trans-muscular approach with some muscle detachment and repair, while the MIS II Incision THA is an inter-muscular approach anteriorly and a trans-muscular approach posteriorly. Blood samples for total creatine kinase (CK), creatine phospho-kinase (CPK), and serum myoglobin were obtained at screening and the morning before surgery as a baseline, immediately post-operatively in the recovery room and 8, 16, 24, 36, 48, and 72 hours post-operatively. Hemoglobin and hematocrit was obtained pre-operatively, 16, 36, and 72 hours (±6 hours) post-operatively. Cardiac troponin-I was measured the morning before surgery (pre-operatively) and 16 hours following surgery to monitor any contributory effect of myocardial injury. We report measurable and reproducible trends in serum enzyme levels consistent with skeletal muscle damage due to THA. Troponin-I remained normal in all but one case throughout the entire study indicating no myocardial contribution to measured serum enzyme levels. While these trends may have slight correlation with surgical approach, they were not statistically significant. We conclude that all three procedures do affect serum enzyme markers and are safe from this standpoint, but no surgical approach appears to affect the degree of muscle trauma more or less than another

Background and aim. Total hip replacements (THRs) are associated with significant blood loss which often requires high transfusion rates of allogeneic blood. Although safer than ever, allogeneic blood transfusion is still associated with risks to the recipients. This meta-analysis aims to investigate the efficacy and safety of tranexamic acid (TXA) in reducing blood loss and allogeneic blood transfusion after THR. Patients and Methods. A systematic review and meta-analysis of published randomised controlled trials which used TXA to reduce blood loss and transfusion in hip arthroplasty were conducted. The data were evaluated using the generic evaluation tool designed by the Cochrane Bone, Joint and Muscle Trauma Group. Results. We identified 11 clinical trials which were suitable for detailed data extraction. There were no trials which utilised TXA in revision THR. Seven studies (350 patients) were eligible for the blood loss outcome. Using TXA reduced intraoperative blood loss by an average of 104 ml (95% Confidence Interval (CI) -164 to -44, P-value 0.0006, Heterogeneity I. 2. 0%), post-operative blood loss by an average of 172 ml (95% CI -263 to -81, P-value 0.0002, Heterogeneity I. 2. 63%) and total blood loss by an average of 289 ml (95% CI -440 to -138, P-value < 0.0002, Heterogeneity I. 2. 54%). TXA led to a significant reduction in the proportion of patients requiring allogeneic blood transfusion (Risk Difference -0.20, 95% CI -0.29 to -0.11, P-value < 0.00001, I. 2. 15%). There were no significant differences in deep venous thrombosis, pulmonary embolisms, infection rates or other complications between the study groups. Conclusion. TXA appears effective and safe in reducing blood loss and allogeneic blood transfusion in primary THRs