Correlation between groin pain and cup design of hip-resurfacing implants: a prospective study

Purpose

Cup design has been incriminated as the source of groin pain after hip resurfacing but has not been well described; thus, it was assessed in a prospective study looking at three implant types.

Methods

A group-match was done between three groups of hip resurfacing devices according to age, sex, body mass index, activity level, osteoarthritis aetiology and pre-operative scores.

Results

The global groin pain rate was 5.7 % at six months and 2.7 % at last follow-up. Groin pain rate was significantly different between the three groups (p = 0.004) and had a strong influence on the subjective results (p = 0.04). No groin pain emerged between six months and last follow-up. No clinical differences were noted in Harris hip score and Merle d’Aubigné-Postel score at last follow-up. However, the Oxford hip score and Devane activity score were significantly lower for cups with macrostructures.

Conclusion

The low groin pain rate in this prospective cohort was probably secondary to the specific surgical technique used and seems to be correlated with cup design. Macrostructures on the external part of the cup could be significantly harmful.     

Osseointegration of polyethylene implants coated with titanium and biomimetically or electrochemically deposited hydroxyapatite in a rabbit model

Purpose

The aim of this study was to evaluate the osseointegration of a new coating directly deposited on PE at room temperature.

Methods

Thirty-six (36) male New Zealand rabbits were randomly assigned to receive one out of three types of implants: two tested implants, i.e. PE implant coated with TiPVD and biomimetic HA (biomimetic), PE implant coated with TiPVD and electrolytic HA (electrolytic), and positive control made of massive microrough titanium coated with plasma sprayed HA (TiHAPS). Osseointegration was evaluated by histomorphometry (bone tissue in contact [BIC]), mineralized bone area [MBA]) and mechanical testing (push-out test, interfacial shear strength [ISS]) at six and 12 weeks in the distal femurs.

Results

For BIC there were no differences between the groups at six (p = 0.98) and 12 weeks (p = 0.13). For MBA, no statistically significant difference was measured between groups at six (p = 0.52) and 12 weeks (p = 0.57). At six weeks, interfacial shear strength (ISS) was significantly higher (p = 0.01) for TiHAPs implants compared to biomimetic and electrolytic implants. This difference was not significant at 12 weeks (p = 0.92).

Conclusion

The osseointegration of biomimetic and electrolytic implants was equivalent to a positive control at 12 weeks.     

The natural history of a newly developed flexion contracture following primary total knee arthroplasty

Purpose

We investigated the incidence, natural history, and functional consequences of a newly developed flexion contracture after total knee arthroplasty (TKA).

Methods

Forty patients with full knee extension preoperatively who developed a postoperative flexion contracture were match-paired 1:2 with 80 patients who had full extension. The incidence of a newly developed flexion contracture, ROM, and Knee Society scores (KSS) at six weeks, four months, and one year were analysed.

Results

The incidence of a new flexion contracture at six weeks was 14 %, but diminished to 5 % and 0.3 % at four months and one year, respectively. One year after surgery, there was no difference in the KSS (p = 0.5).

Conclusions

This study showed that the majority of patients who developed a new flexion contracture after TKA have full knee extension one year postoperatively. Moreover, knee extension and KSS at one year are equivalent to those patients who did not developed a flexion contracture.     

Pre-operative arthritis severity as a predictor for total knee arthroplasty patients’ satisfaction

Purpose

Studies have shown that up to 25 % of TKA patients are dissatisfied with the implanted knee, even if registry data shows ten-year revision rates below 5 %. It has been the question of our study, if it would be possible to identify those patients at risk for dissatisfaction pre-operatively.

Methods

The data of 1,121 consecutive TKA patients with a follow-up between one and six years have been analysed retrospectively. Demographic, radiologic and perioperative variables have been recorded and all patients were asked by questionnaire for satisfaction with the implanted knee. Logistic regression models have been used to identify significant risk factors.

Results

The data of 996 patients (89 %) were complete, 849 (85.2 %) reported satisfaction and 147 (14.8 %) dissatisfaction. Patients’ satisfaction was independent of the time after operation (p = 0.285). The only factor which influenced patients’ satisfaction was the osteoarthritic severity. In comparison to severe arthritis Kellgren Lawrence IV°, the risk for dissatisfaction was 2.556-fold elevated for arthritis grade III° (p < 0.001) and 2.956-fold higher for grade II° (p = 0.001).

Conclusions

Patients suffering from mild or moderate osteoarthritis are at risk for dissatisfaction after TKA. The TKA indication in those patients should therefore be critically proven. Furthermore, to adjust patients’ expectations, the elevated dissatisfaction risk in case of mild or moderate osteoarthritis should be included into patients’ pre-operative information.     

Atypical femoral fractures after anti-osteoporotic medication: a Korean multicenter study

Purpose

Increasing numbers of atypical femoral fractures have been reported among long-term bisphosphonate users. We evaluated clinical characteristics of atypical femoral fractures throughout Korean multicenter studies.

Methods

We retrospectively analysed the bone mineral density, prodromal symptoms before femoral fracture, and medication history of osteoporosis in 76 cases of atypical femoral fracture.

Results

The mean age of cases was 71.4 ± 8.8 (range, 43–89) years old. The mean follow-up period after the fracture operation was 24.5 ± 12.9 (range, 12–79) months. BMI was 23.2 ± 3.0 on average. The mean BMD of femur was −1.9 ± 1.4 (range, −4.8 to 1.3). Prodromal symptoms including thigh pain before femoral fracture appeared in 22 (28.9 %) of 76 patients. All patients included in the study used bisphosphonate. The duration of taking bisphosphonate before fracture was 36.8 ± 50.8 (one–204 months) months. Fifty-seven (75 %) of 76 patients were taking the medication for more than three years. Delayed union occurred in 43 (56.5 %) of 76 patients. Delayed union was defined as a fractured bone that did not completely heal within six months of injury. The group of having taken anti-osteoporotic medication for more than three years showed relatively longer union period compared to that for a shorter period medication group (4.8 ± 2.5 months vs 9.3 ± 3.7 months, p = 0.017). The delayed union developed in 43 (56.5 %) of 76 patients and showed a significantly higher incidence in the group with long-term therapy (five/43 vs 38/43, p = 0.021). The bilateral femoral fractures developed in 23 (30.2 %) of 76 patients and showed a high incidence in the group medicated more than three years (two/23 vs 21/23, p = 0.039).

Conclusions

The longer bisphosphonates are used, the more the cases of delayed union and the more frequent the development of bilateral fractures following unilateral fractures. With regard to the delayed union, the methods of the acceleration of fracture healing may be beneficial in atypical femoral fracture patients who had been receiving long-term bisphosphonates therapy. Careful observation is required for contra-lateral femurs due to a high incidence of bilateral atypical femoral fractures.     

Is it worthwhile to screen the hip in infants born with clubfeet?

Purpose

There is some disagreement about whether idiopathic congenital talipes equinovarus (CTEV) increases the risk of neonatal developmental dysplasia of the hip (DDH). This study aimed to investigate the incidence of DDH in our infants with idiopathic CTEV.

Methods

We conducted an observational cohort study over a three-year period to assess the relationship between idiopathic CTEV and DDH. All neonates younger than six weeks with idiopathic CTEV who were treated in our medical centre were admitted to this study. Each subject underwent hip ultrasound examination using the Graf method at the age of six weeks. DDH was diagnosed when a hip was type IIa(−) or worse according to the Graf classification of sonographic hip type.

Results

A total of 184 patients were diagnosed with idiopathic CTEV and underwent hip sonography. In total, seven hips of five individuals underwent treatment (four girls and one boy). The results indicated that 2.7 % of babies (five of 184) with idiopathic CTEV had DDH. However, we did not find any statistically significant difference (p = 0.5776) in the Pirani scores between the DDH group and group with normal hips.

Conclusions

This study revealed that the idiopathic CTEV group had a greater incidence of DDH in comparison with the general population. It is recommended that hip sonography be undertaken particularly in patients with idiopathic CTEV.     

Factors predictive of positive response to steroid therapy in simple bone cysts: an old trick that still works

Purpose

The aim of the study was to identify clinical, demographic and radiological factors predicting a positive response to steroid treatment in simple bone cysts (SBCs).

Methods

A retrospective study was conducted on 62 patients. The mean follow-up period was 9.2 years after the final steroid injection. Recurrences were defined according to Neer’s scale as modified by Chang et al.. To identify predictive factors, the group of patients who positively responded to treatment (Neer stages I and II, n = 39, 62.9 %, group 1) were compared with the group in which recurrences occurred (Nerr stages III and IV, n = 23, 37.1 %, group 2).

Results

Recurrences were experienced by 37.1 % of the patients (n = 23). Cyst location, numbers of cavities (uni- or multilocular), the area of the cyst and its Enneking stage differed significantly between the groups (p < 0.05).

Conclusions

Steroid therapy may be of benefit in patients with unilocular, small-sized, humeral cysts, classified as Enneking stage IA.     

Indications for and results of arthroscopy in the arthritic knee: a European survey

Purpose

The place of arthroscopic treatment in osteoarthritis of the knee has generated much controversy. A survey was initiated to collect the opinion of experienced surgeons.

Methods

Of the 211 surgeons interviewed, 170 (80.6 %) replied to the electronic questionnaire. Respondents had at least ten years of experience in arthroscopy and currently perform more than 100 arthroscopies per year. Various indications and treatment modalities for arthroscopy in osteoarthritis of the knee had to be evaluated on a scale from “excellent” to “no indication”.

Results

The respondents generally believe that an improvement is more likely in low-grade osteoarthritis (p < 0.001) and in neutral leg axis (p < 0.001). The outcome was rated better if symptoms had persisted for less than six months (p < 0.001) and for patients that were younger than 60 years (p < 0.001). Partial meniscectomy and notchplasty in cases of extension deficit were considered as successful treatment options. Debridement was an accepted indication, with an outcome mainly rated as fair. A majority saw no indication for joint lavage, arthroscopic treatment of arthrofibrosis and removal of osteophytes. The outcome appears to be poor if a bone edema is diagnosed on magnetic resonance imaging prior to arthroscopy. Only 55.9 % of respondents were comfortable with the current definition of osteoarthritis.

Conclusions

Experienced arthroscopic surgeons all over Europe believe arthroscopy in osteoarthritis is appropriate, under certain conditions. The major task for surgeons is to select the right patients who are likely to benefit from this intervention.     

Rotational laxity and collateral ligament laxity following total knee arthroplasty with rotating platform

Purpose

The aim of this study was to evaluate laxity in knees with pre-operative (preop) valgus alignment compared to knees with pre-operative varus alignment after total knee arthroplasty (TKA).

Methods

This was a retrospective study including 81 patients, with six years follow-up, for pre-operative valgus- or varus alignment of the leg. All patients had been supplied with the same cruciate retaining (CR) TKA with rotating platform. Clinical findings were assessed by KSS, OKS and IKDC 2000 score. Rotational knee laxity was evaluated by a validated instrument (Laxitester®) with 2 Nm torque in 30° flexion. Collateral ligament laxity was tested manually in 30° flexion with a bending moment of approximately 5 Nm. Biomechanical results were compared to the contralateral side.

Results

Thirty-one patients had a preop valgus alignment of 8.96° and 50 patients a varus leg axis of 4.99° in the mean. In the preop valgus knees rotational analysis showed an increased laxity of 10.7° compared to preop varus knees (p = 0.001). There was no significant difference in medial (valgus 2.6 mm, varus 2.5 mm) and lateral (valgus 2.8 mm, varus 2.7 mm) laxity. KSS and OKS showed no significant differences in the follow-up results. In the IKDC 2000 objective score 50 % of the preop varus knees and 25.8 % of the preop valgus knees were classified as nearly normal. The difference in the IKDC objective was highly significant (p < 0.001).

Conclusion

Preop valgus knees show a significantly increased rotational laxity but no increased collateral ligament laxity compared to pre-operative varus knees six years after TKA with rotating platform. There is a significant difference in IKDC objective.     

Patellar resurfacing as a second stage procedure for persistent anterior knee pain after primary total knee arthroplasty

Purpose

Knee pain after total knee arthroplasty may be caused by an unresurfaced patella. Secondary isolated resurfacing of the previously unresurfaced patella in total knee arthroplasty remains controversial. The aim of this retrospective study was to evaluate the outcome after patellar resurfacing as a second stage procedure.

Methods

The study included 22 patients (13 female/nine male) who underwent resurfacing of the patella with a mean follow-up of 61.8 ± 39.2 months. The mean age of the patients was 60 ± 9.7 years at the time of operation. The average period between total knee arthroplasty and patellar resurfacing was 26.3 ± 15.2 months. The patient’s subjective satisfaction was assessed by a custom-made questionnaire.

Results

The mean Knee Society Score improved significantly from 60.1 ± 8.3 to 77.0 ± 6.3 (p = 0.0063). The mean functional score also improved significantly from 42.7 ± 2.3 to 60.2 ± 3.9 (p = 0.001). Three patients (13.6%) needed further operative revision.

Conclusions

Although clinical scores showed significant improvement some patients continued to have pain and remained dissatisfied without detecting a specific reason. Further studies are needed to better elucidate the benefit of patellar resurfacing as second stage procedure.     

Surgical treatment of lumbar spondylodiscitis: a comparison of two methods

Purpose

This study evaluates two basic hypotheses: (1) the risk of an isolated dorsal approach to ventral lumbar spondylodiscitis based on clinical and radiographic results and (2) the risk of anterior radical debridement due to using a titanium implant in the site of bone infection.

Methods

Group A consisting of 23 patients was treated only by a dorsal transmuscular approach and group B consisting of eight patients was treated by two-stage posteroanterior surgery. Both evaluated groups were assessed before surgery, six weeks and one year after surgery with the Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS) and Kirkaldy-Willis functional criteria. To evaluate the sagittal balance restoration, measurement by the Cobb modified angle of the affected segment was performed.

Results

Differences (p < 0.001) in group A were found between JOA values before surgery (average 9.30) and at six weeks after surgery (average 11.82) and 12 months after surgery (13.27) and VAS differences before surgery (average 7.39), six weeks after surgery (average 3.82) and 12 months after surgery (average 2.36) in group A. According to the Kirkaldy-Willis functional criteria, 11 patients were evaluated as excellent, nine patients as good and two patients as poor. The values of the JOA score in group B showed an improvement compared with the JOA values before surgery (average 9.38) at six weeks after surgery (average 11.75) and 12 months after surgery (average 13.63), and the VAS score before surgery (average 7.38) was found to have improved six weeks after surgery (average 4.63) and 12 months after surgery (average 2.25). The functional evaluation according to the Kirkaldy-Willis functional criteria assessed three patients as excellent, four patients as good and one patient as fair. Radiographic examinations of group A revealed the following findings before surgery (average 1.75), six months after surgery (average −3.73) and 12 months after surgery (average −0.79) and in group B before surgery (average 3.71), six weeks after surgery (average −8.21) and 12 months after surgery (average −6.45).

Conclusions

The results demonstrate the minimum serious surgical complications and greater loss of sagittal balance without clinical correlation in group A. We did not find any relapse or persistence of the infection in the post-operative period in group B.     

Does total hip arthroplasty restore native hip anatomy? Three-dimensional reconstruction analysis

Purpose

Component orientations and positions in total hip arthroplasty (THA) are important parameters in restoring hip function. However, measurements using plain radiographs and 2D computed tomography (CT) slices are affected by patient position during imaging. This study used 3D CT to determine whether contemporary THA restores native hip geometry.

Methods

Fourteen patients with unilateral THA underwent CT scan for 3D hip reconstruction. Hip models of the nonoperated side were mirrored with the implanted side to quantify the differences in hip geometry between sides.

Results

The study demonstrated that combined hip anteversion (sum of acetabular and femoral anteversion) and vertical hip offset significantly increased by 25.3° ± 29.3° (range, −25.7° to 55.9°, p = 0.003) and 4.1 ± 4.7 mm (range, −7.1 to 9.8 mm, p = 0.009) in THAs.

Conclusions

These data suggest that hip anatomy is not fully restored following THA compared with the contralateral native hip.     

Critical analysis of tibial fracture healing following unreamed nailing

Purpose

Unreamed nails have revolutionised the treatment of tibial shaft fractures. Many authors, however, have reported increasing bone healing complications with these implants. Unfortunately, few studies have addressed the factors affecting bone healing after unreamed tibial nailing.

Methods

One-hundred and sixty tibial fractures in 158 patients (mean age 39.5 years) fixed using unreamed nails were reviewed. There were 78 AO type-A, 65 type-B and 17 type-C fractures (115 closed and 45 open fractures). Twelve patient, injury and surgery variables were analysed for their influence on fracture healing.

Results

Union occurred in all fractures after a mean time of 24.3 weeks. Additional surgery to achieve union, apart from dynamisation, was done in nine (6%) cases. The most important variables affecting healing were the mechanism of trauma (p = 0.005), fracture site gap (p = 0.01), degree of comminution (p = 0.0003), associated soft tissue injuries (p = 0.02) and the time to dynamisation (p = 0.0001).

Conclusions

High-energy trauma and fracture comminution have a negative impact on bone union and require close follow-up. It is essential to avoid distraction over three millimetres with unreamed nailing. Dynamisation is advised within ten weeks in axially stable fractures to encourage bone healing and avoid failure of the locking screws.     

Cartilage repair of the knee with Hyalograft C:® Magnetic Resonance Imaging assessment of the glycosaminoglycan content at midterm

Purpose

The aim of this study was to assess the stability of the glycosaminoglycan (GAG) content in the long term after matrix-associated autologous chondrocyte transplantation (MACT) with Hyalograft C in the knee over a follow-up period of one year.

Methods

In this cross-sectional evaluation, 11 patients after MACT of the knee consented to delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) measurements. The mean post-operative interval before the first MR examination was 40.6 ± 22.0 months, and the second MR examination was carried out after another 12 months. The Lysholm score was assessed for clinical evaluation. Quantitative T1 measurements after intravenous negatively charged MR contrast agent administration were performed. Global post-contrast T1 of the reference cartilage and the repair tissue and a relative post-contrast T1 value were calculated.

Results

The Lysholm score improved significantly from 59.8 ± 12.9 at baseline to 86.1 ± 15.7 at the second visit (p < 0.01). The mean global T1 of the repair tissue (1st visit 581.3 ± 126.4 ms; 2nd visit 684.1 ± 169.9 ms; p = 0.104) and the mean relative T1 value showed stable results over one year (1st visit 0.81 ± 0.28; 2nd visit 0.76 ± 0.32; p = 0.4).

Conclusions

The study demonstrated stable glycosaminoglycan content of the repair tissue after MACT at midterm.     

Favourable results of a new intraoperative and postoperative filtered autologous blood re-transfusion system in total hip arthroplasty: a randomised controlled trial

Purpose

A new intraoperative filtered salvaged blood re-transfusion system has been developed for primary total hip arthroplasty (THA) that filters and re-transfuses the blood that is lost during THA. This system is intended to increase postoperative haemoglobin (Hb) levels, reduce perioperative net blood loss and reduce the need for allogeneic transfusions. It supposedly does not have the disadvantages of intraoperative cell-washing/separating re-transfusion systems, such as extensive procedure, high costs and need for specialised personnel. To re-transfuse as much as blood as possible, postoperatively drained blood was also re-transfused.

Methods

A randomised, controlled, blinded, single-centre trial was conducted in which 118 THA patients were randomised to an intraoperative autologous blood re-transfusion (ABT) filter system combined with a postoperative ABT filter unit or high-vacuum closed-suction drainage.

Results

On average, 577 ml of blood was re-transfused in the ABT group: 323 ml collected intraoperatively and 254 ml collected postoperatively. Hb level was higher in the ABT vs the high-vacuum drainage group: 11.4 vs. 10.8 g/dl, p = 0.02 on day one (primary endpoint) and 11.0 vs. 10.4 g/dl, p = 0.007 on day three. Total blood loss was less in the autotransfusion group: 1472 vs. 1678 ml, p = 0.03. Allogeneic transfusions were needed in 3.6 % of patients in the ABT group and 6.5 % in the drainage group, p = 0.68.

Conclusion

The use of a new intraoperative ABT filter system combined with a postoperative ABT unit resulted in higher postoperative Hb levels and less total blood loss compared with a high-vacuum drain following THA.     

Contralateral electrodiagnosis in patients with abnormal median distal sensory latency

Background

We hypothesized that electrodiagnostic evidence of carpal tunnel syndrome (CTS) on the contralateral, less-severe side correlates with disease severity.

Methods

We retrospectively reviewed 285 adults that had bilateral electrodiagnostic testing and a median distal sensory latency (DSL) greater than 3.6 ms on at least one side. Variables associated with abnormal contralateral median DSL were analyzed in bivariable and multivariable analysis.

Results

Patients with a nonrecordable median DSL on the worst side were significantly more likely to have electrodiagnostic evidence of contralateral CTS compared to patients with a prolonged DSL on the worst side (90 versus 65 %, respectively; p < 0.001). Bilateral symptoms were reported by 75 % of patients. The best logistic regression model for electrodiagnostic evidence of contralateral CTS included nonrecordable median DSL of the worst side and polyneuropathy (p < 0.001 and p = 0.14, respectively).

Conclusions

The finding that disease severity relates to the probability of contralateral abnormalities is consistent with the concept that CTS is typically bilateral. Patients with CTS on one side should be advised of the likelihood that it can be present or may develop on the other side.     

Endothelial nitric oxide synthase gene intron 4 polymorphism in non-traumatic osteonecrosis of the femoral head

Purpose

Nitric oxide (NO) synthesised by endothelial NO synthase (eNOS) is a potent regulator of internal haemodynamics. A polymorphism in intron 4 of the eNOS is associated with different vascular disorders. We investigated the potential involvement of this polymorphism in idiopathic and secondary osteonecrosis of the femoral head (ONFH) in Polish patients.

Methods

We performed a study involving 68 patients with ONFH (45 idiopathic and 23 secondary) and 100 healthy controls. All subjects were genotyped for the eNOS4 polymorphism by the polymerase chain reaction followed by agarose gel electrophoresis.

Results

The analysis revealed that the frequencies of eNOS4 genotypes were significantly different in ONFH patients (both idiopathic and secondary) than in controls. The frequencies of the 4a allele were significantly higher in the total group of patients versus controls [22.79 vs 9 %, p = 0.00039, odds ratio (OR) 2.98]. In subgroup analysis the 4a allele increased significantly in both idiopathic (20 vs 9 %, p = 0.0074, OR = 2.52) and secondary (28.26 vs 9 %, p = 0.00047, OR = 3.98) ONFH patients compared to control subjects. The frequency of the 4a/b genotype in the total group of patients (36.76 vs 16 %, p = 0.0011, OR = 3.24) as well as patients with idiopathic (35.56 vs 16 %, p = 0.0069, OR = 2.96) and secondary (39.13 vs 16 %, p = 0.0073, OR = 3.89) ONFH was higher than in the control group.

Conclusions

There was a significantly higher frequency of eNOS 4a allele carriers among the total group of patients as well as in idiopathic and secondary ONFH. This suggests that the eNOS gene polymorphism may be associated with increased risk of ONFH.     

A comparative and retrospective study of three hundred and twenty primary Charnley type hip replacements with a minimum follow up of ten years to assess wether a dual mobility cup has a decreased dislocation risk

Purpose

Mid- and long-term follow-up of Charnley total hip arthroplasty (THA) demonstrated good functional results with 85 % survivorship at 25-year follow-up. However, dislocation still remains an unsolved problem. Dislocation may occur throughout the patient’s and implant’s life. The aim of this study is to answer the question: does a dual mobility cup (DMC) decrease the dislocation risk?

Methods

We report comparative results at ten years of follow-up of two groups of primary cemented Charnley-type THA, one with a standard polyethylene cup (group 1, n = 215) and the other one with a DMC (group 2, n = 105).

Results

In group 1, 26 dislocations (12.9 %) occurred. In group 2 only one dislocation (0.9 %) occurred. This dislocation was successfully reduced by closed reduction, without any recurrence. This difference was statistically significant (p = 0.0018). In group 1, the reason for revision was recurrent dislocation in 21 cases. Five patients were revised for other reasons. The global revision rate was 12.9 %. In group 2, two patients needed revision surgery for aseptic loosening. The global revision rate was 2.1 %. This difference was statistically significant (p = 0.054). The goal was reached for the patients of group 2 who had more risks factors for dislocation (age, aetiology, American Society of Anesthesiologists and Devane scores) than those of group 1.

Conclusions

When using a DMC, we observed a low rate of dislocation in primary THA (0.9 %). This surgical choice seems to be a safe and effective technique in Charnley-type THA, especially in a high-risk population.     

Inappropriate requests for magnetic resonance scans of the shoulder

Purpose

Magnetic resonance imaging (MRI) scans are a useful investigation for some shoulder pathology. They are costly however and a significant burden on radiology departments. In most cases clinical examination, plain radiography or ultrasound scan (USS) are sufficient for a diagnosis. There are no current UK guidelines regarding MRI shoulder scan requests.

Methods

We reviewed 100 consecutive MRI shoulder scan requests and the associated formal reports; other investigations were also assessed.

Results

Overall, 56 % of MRI scans were ordered inappropriately. Shoulder consultant''s requests were more appropriate than other groups (70 % vs. 38 %. p = 0.04). Excluding shoulder consultants 63 % of scans were inappropriately ordered. Shoulder consultants were more likely to order a preceding X-ray (80 % vs. 53 % respectively, p = 0.03). Of those with a clinical diagnosis of cuff pathology only 29 % had an USS.

Conclusion

A high percentage of MRI shoulder scans are performed inappropriately. Shoulder consultants are more appropriate in their ordering than other groups. If all groups performed as well 50 % less MRI scans would need to be performed.     

Evaluation of content and accessibility of hand fellowship websites

Background

Graduates of general, orthopedic, and plastic surgery residencies utilize web-based resources when applying for hand fellowship training. The purpose of this study was to evaluate the accessibility and content of hand fellowship websites (HFWs).

Methods

Websites of accredited hand surgery fellowships were eligible for study inclusion. HFWs were evaluated for comprehensiveness in the domains of education and recruitment. Website content was correlated with program characteristics via Fisher exact tests.

Results

Fifteen plastic, 65 orthopedic, and 1 general surgery hand fellowships were analyzed. Seventy-four hand fellowships maintained an HFW (91 %). HFWs were not found for 3 plastic and 4 orthopedic hand programs (20 versus 6 %, p = 0.118). HFWs provided only half of all analyzed content (54 %—education and 49 %—recruitment). Orthopedic programs had more education content than plastic surgery programs (55 versus 44 %, p = 0.030). Programs in the South had more education content than programs in the Northeast (63 versus 47 %, p = 0.001), but not more than programs in the West (54 %) or Midwest (55 %). Larger programs with more fellows had greater education content than those with only one fellow (57 versus 49 %, p = 0.042). Programs affiliated with top-ranked medical schools had less education content than lower-ranked schools (48 versus 56 %, p = 0.045). No differences existed in recruitment content between programs.

Conclusions

Most hand surgery fellowships lack readily accessible and comprehensive websites. The paucity of online content suggests HFWs are underutilized as educational resources and future opportunity may exist to optimize these tools.