INTRODUCTION. Interest in tissue-preserving or minimally invasive total hip arthroplasty (THA) is increasing with focus toward decreased hospital stay, enhanced rehabilitation, and quicker recovery for patients. Two tissue-preserving techniques, the anterior and superior approaches to THA, have excellent clinical results, but little is known about their relative impact on soft tissue. The purpose of this study was to evaluate the type and extent of tissue damage after THA with each approach, focusing on abductors, short external rotators, and the hip capsule. METHODS. Total hip arthroplasty was performed on bilateral hips of eleven fresh-frozen cadavers (22 hips). They were randomized to anterior THA performed on one side and superior THA performed on the other, in the senior authors' standard technique. Two independent examiners graded the location and extent of
During two sequential deployments to Afghanistan, it was noticed that an inordinately high number of patients with bilateral lower limb injuries that resulted in amputations at Camp Bastion itself, had associated upper limb injuries. It was decided to study the incidence and distribution of the same. Permission was granted to conduct this study as it would throw a light on the pattern of injuries and allow a further study of the impact of this on rehabilitation. This was both a retrospective as well as a prospective study. Of the 221 cases, 68 were recorded and data collected prospectively whereas the data for the rest was gathered using the patients' scanned records from Camp Bastion, their radiology reports and clinical photographs (from the Joint Theatre Trauma Registry). A total of 221 patients were studied as described above. They included UK, NATO, US, ANA, ANP, EF and Afghan civilians (June 2009 - January 2011). There were 59 fatalities from these 221 cases. That data pertaining to these cases was discarded. Of the surviving 162 cases, 31 cases had no upper limb involvement. A number of these individuals were subjected to an IED attack when mounted, although dismounted injuries still accounted for the vast majority. 131 individuals had upper limb involvement of some sort or the other. The injuries were classified into anatomical distribution as well and the type of trauma (amputations, composite soft tissue, fractures, vascular, nerves etc). The predominance of the injuries was on the distal portion of the upper limb (i.e involving the digits, hands and forearm (digits and hands – 66 patients, wrist and forearm in 69 patients, elbow and arm in 42 patients). The most common form of involvement was a composite
Introduction. Numerous studies have been conducted to investigate the kinematics of the lumbar spine, and while many have documented its intricacies, few have analyzed the complex coupled out-of-plane rotations inherent in the low back. Some studies have suggested a possible relationship between patients having low back pain (LBP) or degenerative conditions in the lumbar region and various degrees of restricted, excessive, or poorly-controlled lumbar motion. Conversely, others in the orthopedic community maintain there has been no distinct correlation found between spinal mobility and clinical symptoms. The objective of this study was to evaluate both the in-plane and coupled out-of-plane rotational magnitudes about all three motion axes in both symptomatic and asymptomatic patients. Methods. Ten healthy, 10 LBP, and 10 degenerative patients were CT scanned and evaluated under fluoroscopic surveillance while performing flexion/extension of the lumbar spine. Three-dimensional, patient-specific bone models were created and registered to fluoroscopic images using a 3D-to-2D model fitting algorithm. In vivo kinematics were derived at specified increments and the overall in-plane flexion/extension and coupled out-of-plane rotations were analyzed using two techniques. The first method derived the maximal absolute rotational magnitude (MARM) at each level by subtracting the rotational motion in the increment exhibiting the most negative or least amount of rotation from the increment having the greatest amount of rotation. The second method was designed to isolate the path of rotation (POR) of the vertebrae at each level while performing the prescribed flexion/extension activity. By tracking the rotational path of the cephaled vertebrae as it articulated upon the more caudal vertebrae and summing the absolute rotation between each increment about each axis the POR was calculated over the entire flexion/extension activity. Results. Using both the MARM and POR methods, the average overall in-plane rotations between L1 and L5 were not significantly different among any of the groups, although the degenerative group did exhibit less in-plane range-of-motion compared to the healthy and LBP patients. At the L4–L5 level, patients in the healthy and LBP groups achieved 13.1° and 14.4° of rotation, respectively, compared to only 10.7° in the degenerative group. In addition, both of the symptomatic patient groups experienced less rotation during the extension phase of the activity. The coupled out-of-plane motions in both the LBP and degenerative subjects were significantly greater than those observed in healthy subjects (p=0.0199 and p<0.001, respectively). On average, LBP and degenerative patients achieved 5.5° and 7.1° more out-of plane rotational motion per level, respectively, compared to healthy subjects. Conclusions. These findings correlate with previous studies documenting paradoxical motions in the lumbar spine during an overall gross motion and support the idea of pain being a biological response to
