Comparison of fully porous-coated and hybrid hip resurfacing: a minimum 2-year follow-up study

The purpose of this study was to compare clinical and radiological outcomes of the first 191 fully porous-coated hip resurfacing arthroplasties with 96 hybrid hip resurfacing arthroplasties performed during the same period at a minimum 2-year follow-up to evaluate the initial fixation of uncemented femoral resurfacing components. The results of this study indicate that fully porous-coated femoral resurfacing components can routinely achieve reliable fixation and provide similar initial results as have been achieved with cemented fixation. Long-term results are needed to determine which type of fixation is superior for the femoral hip resurfacing component.     

Failure modes of 433 metal-on-metal hip implants: how, why, and wear

Metal-on-metal total hip replacements (THRs) and hip resurfacings are coming under increasing scrutiny in light of concerns that they fail because of high wear and elevated metal ions. The aim of this study was to investigate the modes of failure in a collection of 433 metal-on-metal THRs and hip resurfacings and to examine the correlations between the reasons for revision and a range of patient and implant variables considered relevant to implant wear.     

Imaging of adductor-related groin pain

Groin pain is a common condition in athletes and results from various causes. Osteitis pubis, adductor dysfunction, inguinal hernia, or a combination of all three entities, generally explains the onset of symptoms. Adductor longus tendinopathy is the main cause of adductor-related groin pain. It leads to a significant reduction of sports participation and can require surgical management. Diagnosis is based on ultrasonography and magnetic resonance imaging. Asymptomatic findings (tendinosis, calcifications, cortical erosions) are common in athletes and care should be taken when assessing groin pain. The most specific sign of tendinopathy is an intratendinous tear of the adductor longus.     

金属对金属全髋关节表面置换术早中期临床报告

目的探讨金属对金属全髋关节表面置换术治疗髋关节疾病的早中期临床效果,分析影响疗效的相关因素。方法回顾性分析我科全髋关节表面置换术患者54例60髋,男28例32髋,女26例28髋,年龄22～62岁,平均（42.3±12.5）岁。术后患者均进行定期临床与影像学随访16～45个月,平均随访32个月。采用Harris,UCLA,VAS评分对患者术前术后的髋关节功能进行评估。结果 Harris评分由术前38.3分增加到术后95.4分;UCLA评分由术前3.6分增加到术后7.9分;VAS评分由术前8.8分降低到术后1.8分。患者假体位置良好,无假体松动、关节脱位、股骨颈骨折及明显骨溶解等并发症。结论全髋关节表面置换术能有效改善髋关节疾病患者的关节功能、减轻疼痛,早中期随访结果满意。     

Evaluating postherniorrhaphy groin pain: Visual Analogue or Verbal Rating Scale?

Introduction Several tools for pain measurement including a Visual Analogue Scale (VAS) and a Verbal Rating Scale (VRS) are currently used in patients with chronic pain. The aim of the present study was to determine which of these two pain tests performs optimally in patients following groin hernia repair. Patients and methods A questionnaire identified pain level in a cohort of patients that had previously undergone corrective groin hernia surgery. Current pain intensity was graded on a four-point VRS scale (no pain, mild, moderate or severe pain) and on a 100-mm VAS scale (0 = no pain, 100 = unbearable). “Scale failure” (one or both tests not completed correctly) was determined, and cut-off points for the VAS test were calculated by creating the optimum kappa coefficient between both tools. Results The response rate was 78.2% (706/903). Scale failure was present in VAS tests more than VRS (VAS: 12.5%, 88/706 vs. VRS: 2.8%, 20/706; P < 0.001). Advanced age was a risk factor for scale failure (P < 0.001). The four categories of VRS corresponded to mean VAS scores of 1, 20, 42, and 78 mm, respectively. VAS categories associated with the highest kappa coefficient (k = 0.78) were as follows: 0–8 = no pain, 9–32 = mild, 33–71 = moderate, >71 = severe pain. VAS scores grouped per VRS category showed considerable overlap. Age and sex did not significantly influence cut-off points. Conclusions Because of lower scale failure rates and overlapping VAS scores per VRS category, the VRS should be favored over the VAS in future postherniorrhaphy pain assessment. If VAS is preferred, the presented cut-off points should be utilized. This study was unfunded.     

Metal sensitivity as a cause of groin pain in metal-on-metal hip resurfacing

We describe 4 patients pooled from our patient populations who presented with groin pain at different periods postoperatively after implantation of a metal-on-metal hip resurfacing. Each patient underwent exploratory surgery after radiographic imaging, hematologic testing, and microbiological assessment of joint aspirations failed to explain their symptoms. Samples of periprosthetic tissues revealed extensive amounts of lymphocytic infiltrates that were suggestive of an immunologic reaction. The patients obtained complete resolution of symptoms subsequent to revision surgery. The incidence of implant failures resulting from metal sensitivity is unknown owing to the difficulty in making a confirmed diagnosis. The possibility that this is the source of groin pain should be considered when other reasons for symptoms of pain and/or joint effusion in hips with metal-on-metal resurfacing arthroplasties have been discounted.     

Hip resurfacing: mid-term results of the last-generation metal-on-metal devices

Total hip resurfacing has long been conceptually attractive to both surgeons and patients. However, historically it has been plagued by limited durability and marked acetabular bone loss. The recent development of wear-resistant bearings such as metal-on-metal has led to renewed interest in hip resurfacing in the orthopaedic community. We report the clinical and radiological results of 350 consecutive surface arthroplasties performed in 325 patients (mean follow-up 20 months). Harris Hip Score increased over time from 57 pre-operatively to 98 at 2 years follow-up. Complication’s rate was low. Four patients required revision surgery. The overall survival rate was 98.8%. Considering the positive results of more than 350 implants of our series, we now believe that there is evidence showing that this surgical concept deserves consideration, particularly when treating young patients with hip diseases.     

Total extra-peritoneal repair of groin hernia: prospective evaluation at a tertiary care center

Background The laparoscopic repair of groin hernia is increasingly being used. However, the relative merits and demerits of laparoscopic repair are debatable. The present study was undertaken to evaluate the total extra-peritoneal (TEP) repair of groin hernia. Methods This prospective study was undertaken at a single surgical unit between January 2004 and June 2006. Consecutive patients with elective groin hernias were offered laparoscopic TEP repair. Indigenous balloon or telescopic dissection was used to create extra-peritoneal space. Polypropylene mesh was used in all of the patients and mesh fixation was performed with tackers. Results A total of 185 patients with age range 18–92 years were included; 180 were males. TEP repair was attempted in 298 groin hernias in 185 patients with a success rate of 89.5%. Indigenous balloon or telescopic dissection was used to create extra-peritoneal space. Thirty-one (31, 10.5%) TEP repairs were converted to transabdominal pre-peritoneal or open repair. Two patients developed recurrence during follow-up. Conclusion TEP is an excellent technique for laparoscopic groin hernia repair, with acceptable rates of complication.     

Effects of cobalt and chromium ions at clinically equivalent concentrations after metal-on-metal hip replacement on human osteoblasts and osteoclasts: implications for skeletal health

Metal-on-metal hip replacement (MOMHR) using large diameter bearings has become a popular alternative to conventional total hip arthroplasty, but is associated with elevated local tissue and circulating levels of chromium (Cr) and cobalt (Co) ions that may affect bone health. We examined the effects of acute and chronic exposure to these metals on human osteoblast and osteoclast formation and function over a clinically relevant concentration range previously reported in serum and within hip synovial fluid in patients after MOMHR. SaOS-2 cells were cultured with Co²⁺, Cr³⁺ and Cr⁶⁺ for 3 days after which an MTS assay was used to assess cell viability, for 13 days after which alkaline phosphatase and cell viability were assessed and for 21 days after which nodule formation was assessed. Monocytes were isolated from human peripheral blood and settled onto dentine disks then cultured with M-CSF and RANKL plus either Co²⁺, Cr³⁺ or Cr⁶⁺ ions for 21 days from day 0 or between days 14 and 21. Cells were fixed and stained for TRAP and osteoclast number and amount of resorption per dentine disk determined. Co²⁺ and Cr³⁺ did not affect osteoblast survival or function over the clinically equivalent concentration range, whilst Cr⁶⁺ reduced osteoblast survival and function at concentrations within the clinically equivalent serum range after MOMHR (IC₅₀ = 2.2 μM). In contrast, osteoclasts were more sensitive to metal ions exposure. At serum levels a mild stimulatory effect on resorption in forming osteoclasts was found for Co²⁺ and Cr³⁺, whilst at higher serum and synovial equivalent concentrations, and with Cr⁶⁺, a reduction in cell number and resorption was observed. Co²⁺ and Cr⁶⁺ within the clinical range reduced cell number and resorption in mature osteoclasts. Our data suggest that metal ions at equivalent concentrations to those found in MOMHR affect bone cell health and may contribute to the observed bone-related complications of these prostheses.     

Stress fracture of femoral stem of hip resurfacing a cause of sudden onset hip pain- A case report and review of literature

Resurfacing arthroplasty of the hip has had a difficult last decade.Fracture of the femoral neck has been a known complication of resurfaced hip replacement; however, fracture of the metal peg within the femoral component has only been reported twice. We encountered and treated a patient with a unique type of metal failure.A 45 year old lady had advanced arthritis of her left hip secondary to rheumatoid disease.In 2006, an ASR resurfacing arthroplasty was performed and excellent function of the hip was achieved. After 9 years, she experienced an acute pain in the hip without trauma.Serial radiographs before & after the onset of symptoms did not reveal any significant abnormality. MRI scan did not suggest any adverse features too. No evidence emerged in favour of adverse reactions to metal debris (ARMD). Decision to revise the hip was taken with suspicion of an occult fracture.At surgery, the stem of the femoral component was found fractured at its junction with the dome, the dome being still well fixed with the femoral neck. The acetabular component was well fixed. Till date she is very satisfied with the revised hip.Fracture of the femoral peg at its junction to the dome is a complication of hip resurfacing that has not been previously reported in the literature. On the retrieved specimen, instead of ‘beach lines’ indicative of failure of the material over a prolonged period, we observed only a notched area of bending on the medial side of the implant. This is indicative of an acute event.We wish to make surgeons aware of this particular complication when investigating a similar Case presentation. There is unlikely any standard investigation that diagnoses the fractured implant accurately.     

Groin pain in the absence of hernia: a new syndrome

Abstract Abstract. Groin pain may be produced by a true hernia, trauma to the groin structures or peripheral nerve, or root compression at various levels. Approximately 4,000 patients underwent inguinal herniorrhaphy (group A). An additional 134 patients complaining of groin pain and exhibiting no evidence of primary or recurrent hernia fell into two categories: 30 patients who had a previous herniorrhaphy (group B) and 104 patients without previous surgery (group C). Group B patients underwent a diagnostic nerve block which, when positive, suggested ilioinguinal nerve compromise at the wound. Those who failed conservative measures underwent nerve division. Group C patients were advised to decrease recreational and occupational activities; if that failed, they underwent lumbosacral spine imaging. There were no neuralgias in group A. Eight group B patients responded to conservative measures; the 22 others required ilioinguinal nerve division which relieved their pain. In group C, 42 patients responded to physical activity restriction plus NSAIDs; the remaining 62 underwent imaging which revealed lumbosacral bone pathology producing root compression and were referred to orthopedists. Lumbosacral spine pathology should be suspected in patients who complain of groin pain in the absence of hernia or previous herniorrhaphy. Recognition of this syndrome may avoid negative exploratory herniorrhaphies. Electronic Publication     

Post-thoracotomy pain after thoracic epidural analgesia: a prospective follow-up study

BACKGROUND: Pain becomes chronic in 22-67% of patients who undergo a thoracotomy. Thoracic epidural analgesia (TEA) has replaced less invasive methods to manage postoperative pain. We wanted to find out if active use of TEA, combined with extended pain management at home, reduces the incidence of chronic post-thoracotomy pain. METHODS: All consecutive thoracotomy patients during a 16-month period were included. On the ward, pain was measured daily by VAS during rest and coughing and the consumption of analgesics was registered. The patients were interviewed one week after discharge by telephone and by a questionnaire after 3 and 6 months to find out how much pain they had. RESULTS: A total of 114 patients were recruited. The data were analysed from 89 patients who had had TEA and 22 who had had other methods. TEA was effective in alleviating pain at rest and during coughing. In the TEA patients the incidence of chronic pain of at least moderate severity was 11% and 12% at 3 and 6 months, respectively. One week after discharge 92% of all patients needed daily pain medication. CONCLUSIONS: TEA seems effective in controlling evoked postoperative pain, but technical problems occurred in 24% of the epidural catheters. The incidence of chronic pain was lower compared with previous studies where TEA was not used. The patients had significant pain and needed regular pain medication and instructions during the first week after discharge. Extended postoperative analgesia up to the first week at home is warranted.     

Prolene hernia system compared with mesh plug technique: a prospective study of short- to mid-term outcomes in primary groin hernia repair

Two types of anterior tension-free hernioplasty, prolene hernia system (PHS) repair and mesh plug technique (MPT), were introduced to Taiwan in 2001. This study compared the short- to mid-term outcomes following primary groin hernia repair with PHS and MPT. From January 2001 to December 2003, 393 patients with 426 primary groin hernias were operated on by a single surgeon using MPT (n=192) and PHS (n=234). Baseline perioperative details and follow-up information were compared. Demographic characteristics of both groups were similar. The laterality, types of anesthesia, postoperative stay, postoperative wound pain scores, wound complications and days to return to activities of daily life were equally distributed between the two groups. However, the distribution of Gilbert types in the PHS group was shifted a little to the right compared with that of the MPT group. PHS repair had longer operative time (34±17 vs 25±9 minutes, p<0.01). No recurrence was noted in both groups during the follow-up from 5 to 41 months. Chronic non-disabling groin pains were noted in 2.8% (6/218) of patients in the PHS group and 8.9% (14/175) in the MPT group (p=0.01). Our results show that both PHS and MPT repairs can be performed with short operation time, minor wound pain and quick return to activities of daily life without short- to mid-term recurrences, but postoperatively the MPT group had higher incidence of chronic non-disabling groin pain. Although the MPT is less invasive, the additional protective patch in the preperitoneal space of the PHS may provide a further safeguard against recurrences, especially for those patients with attenuated inguinal floor. Long-term follow-up is needed.     

Use of groin flap in the closure of through and through defect of a forearm: A case report

The groin flap is a vascularized axial flap based on the superficial circumflex iliac artery arising from the femoral artery just below the inguinal ligament. It is used regularly by many reconstructive surgeons for covering soft tissue defects of the hand. Although the development of various fasciocutaneous free flaps during the 1980s decreased the attractiveness of the groin flap, these flaps can be used in reconstructing significant defects of the forearm and hand where free tissue transfer is not feasible.     

Laparoscopic surgery for chronic groin pain in the general population: a prospective study

BACKGROUND: Chronic groin pain is a challenging problem among not only athletes but also the general population. The aim of this study was to evaluate the role of laparoscopic surgery in the management of these patients. PATIENTS AND METHODS: Prospective data including the outcomes were collected and analyzed for 43 patients who had groin pain without clinical or radiologic evidence of hernia. All patients had magnetic resonance imaging scan and had consulted an orthopedic surgeon when appropriate. All patients were followed in clinic 2 weeks after operation and 6 months after the operation by phone call, and all were asked to call our unit in case of partial or no improvement. RESULTS: From September 1999 to August 2006, we performed 1617 laparoscopic groin hernia repairs in 1209 patients using the transabdominal preperitoneal approach. Forty-three patients (3 women and 40 men) with variable life activities and employment were included in this study. Only five patients played football at a professional level. The mean age of these patients was 38 years (range, 17-74 years), and the mean follow-up was 43 months (range, 14-72 months).The clinical invagination test showed wide external inguinal ring in 27 (62.7%) patients and tender inguinal canal in another 6 (13.95%) patients. Negative laparoscopy was reported in 7 (16.27%) patients. All patients had mesh insertion. The operation cured groin pain in 30 (69.76%) patients, and the pain improved in another 9 (20.93%) patients. Three (6.97%) patients had no change in their symptoms, and the pain became worse in 1 (2.32%) patient. CONCLUSION: We suggest offering laparoscopic groin exploration and mesh insertion for any adult patient presenting with chronic groin pain without clinical evidence of groin hernia or radiologic abnormality regardless of age, life activities, and employment.