Femoroacetabular impingement syndrome (FAI) is a common cause of hip and groin pain in young adults. Physiotherapy and surgery have both been used to treat FAI syndrome, but there is no robust evidence of comparative effectiveness. UK FASHIoN compared the clinical and cost-effectiveness of arthroscopic hip surgery (HA) versus best conservative care in patients with FAI syndrome. UK FASHIoN was a pragmatic, multicentre, 2 parallel arm, superiority, randomised controlled trial in patients with FAI syndrome. Eligible patients were over 16 without radiographic signs of osteoarthritis, deemed suitable for arthroscopic FAI surgery. Participants were randomly allocated to HA or Personalised Hip Therapy (PHT - a physiotherapist-led programme comprising 6 to 10 sessions). The primary outcome measure was hip-related quality of life using the patient-reported International Hip Outcome Tool (iHOT-33) at 12 months. Secondary outcomes included EQ5D5L, SF12, adverse events, and cost-effectiveness. Primary analysis compared differences in iHOT-33 scores at 12 months by intention to treat.Purpose
Methods
Cortisone injection for radicular leg pain may be useful in treating patients with lumbar foraminal pathology based on accurate CT/MRI diagnosis and operator-controlled biplanar fluoroscopy in an angiography suite. Patient details were collected from operative records and angiography suite records. Demographic data, diagnosis and level of injection were recorded. Low Back Outcome Scores (LBOS) were collected prospectively for most patients. Patients were then posted a questionnaire, including the LBOS. Patients were excluded from further analysis if further injection or surgery was required. Fifty eight patients, all with CT or MRI diagnosis, underwent lumbar foraminal steroid injection. Thirty-seven had disc protrusion (64%) and twenty-one had stenosis (36%). Eighteen (31%) patients required further intervention, eleven with stenosis (52%) and seven with disc protrusion (19%). Thirty-two patients (80%) completed follow up questionnaires, one patient had died, one was lost to follow up, and six patients declined to complete the questionnaires. The average LBOS for the thirty-two patients who completed the questionnaires was 41.8+/−17.5. Twenty-three patients with pre-treatment LBOS improved on average from 25.1+/−13.5 to 45.9+/−16.1 following injection (p=0.050). Of this group, the eight patients with stenosis improved from 28.8+/−12.3 to 41.6+/−15.9 (average 12.9). The fifteen patients with disc protrusion improved from 23.2+/−14.1 to 48.1+16.3 (average 24.9). This difference in improvement between the two groups was significant (p=0.016). This study reports 81% of patients with disc protrusions not requiring further treatment, with improvement of the average LBOS to 48.1=/−16.3. However the results in patients with foraminal stenosis was less satisfactory.
Twenty four patients who had a Proximal Row Carpectomy (PRC) were reviewed 9 months to 9 years post surgery (average 5 yrs). The initial cohort of 14 patients was previously reported to the society in a review encompassing 12 months to five years follow-up post surgery. No patients were lost to follow-up. Primary pathology involved wrists with scapholunate advanced collapse, long-standing scaphoid non-unions and fragmented Kienbock’s disease. All patients had painful wrists limiting function preoperatively. Twenty wrists continue to function well with their PRC. They are comfortable and strong. Mass power grip was 77% of the non-injured side. A functional flexion/extension arc of 65 % of the non-injured side was obtained. No patients with functioning PRCs have had to change their work or recreational activities primarily because of their wrist. Rapid return to work and sport was achieved in the twenty patients with a well functioning PRC. Four wrists (from the first cohort) were converted to wrist fusion for unresolved pain all around a year post PRC. Three patients developed major reflex sympathy dystrophy requiring intensive therapy. Three patients developed carpal tunnel syndrome requiring decompression. PRC is appealing in its surgical simplicity as a motion preserving procedure for the painful wrist. In the majority of circumstances it is both reliable and durable providing a comfortable strong wrist with a functional range of movement. Rehabilitation is uncomplicated and function is rapidly recovered. Patients with ongoing pain can be salvaged with a wrist fusion.
