Hypermobility Spectrum Disorder (HSD or hEDS) is attributed to a collagen abnormality associated with excessive joint flexibility. Approximately 90% of females with hip dysplasia have hypermobility. Manifestations of hypermobility in various body systems are unique to every patient, affecting different tissues of the body with varying degrees of severity. Our purposes were to identify the manifestations of hypermobility across multiple body systems and to study the recognition of hypermobility in the medical literature of multiple specialties over multiple decades. A literature search of the major medical disciplines for key words associated with HSD was performed. These specialties included gastroenterology, gynecology, neurology, psychiatry, oral-maxillofacial surgery, cardiology, and orthopaedic surgery. A specialty-specific impact factor (IF) score was calculated as the percentage of research articles that referenced hypermobility as a comorbidity over all articles within that specialty. Statistical differences were identified using single factor ANOVA with significance determined at p<0.05. We reviewed many published, specialty-specific manifestations of hypermobility, and describe them. All six non-orthopaedic specialties demonstrated a continually increasing relative IF ratio throughout the study period with a peak impact average of 0.22 (p<0.05 compared with other time ranges). There was a 93.3% overall increase in IF scores from the 1992–1998 period to the most recent period examined (p<0.05). Hypermobility is increasingly recognized as a significant health issue in multiple disciplines. Since dysplasia is associated with approximately 40% of all primary total hip arthroplasty cases, understanding the multi-system manifestations, and broad impact of hypermobility on patients, is relevant for every hip surgeon. We are expanding our research into other medical disciplines, including urology, ophthalmology, dermatology, clinical psychology, and others.
Periacetabular osteotomy (PAO) is a demanding procedure that puts patients at risk for potentially significant blood loss, and blood transfusions. Avoidance of transfusions in otherwise healthy young patients is important. This project was designed to study the effectiveness of our blood conservation efforts. 178 consecutive PAOs performed in one hospital by one surgeon (RFS) from 2008 to 2016 were reviewed retrospectively. PAO's were performed in other hospitals, too, but a majority were from the study group hospital. Data were collected from digitalized patient office charts and hospital electronic medical records. Collected data were analyzed for categorical associations between blood loss, demographic data, and transfusion risks. Over the past 27 months, the transfusion rate in 63 consecutive patients has been reduced to Zero. Discontinuation of drains, use of TXA, spinal anesthesia, reducing trigger for transfusion to Hgb of <7, cell saver use in all cases, and careful intraop coagulation, among others, have been incrementally incorporated. The overall transfusion rate was 10.7% for all patients. In the early years of this study, prior to adoption of all of these blood conservation measures, the transfusion rate was 12.5%. Over the past four years the transfusion rate was 1.5%. Over the last two years it has been zero. There is little data specifically regarding transfusion rates in PAOs but this study establishes that an aggressive approach to blood saving techniques and limitation of bleeding can reduce the risk of transfusion to virtually zero in this population of mostly young patients.