Injection-induced low-grade infection of the shoulder joint: preliminary results

Background

Purulent arthritis of the shoulder has been widely reported. Low-grade post-operative infections of the shoulder have also been observed. Low-grade infections of the shoulder without prior surgery have not been reported in the literature. The purpose of this study is to present our experience of seven patients with low-grade infections of the shoulder without a history of prior surgery.

Methods

We retrospectively reviewed seven patients, mean age of 45?years that originally presented with diffuse shoulder pain, with or without stiffness. None had prior surgery but all had prior injections, average 5.6, into the shoulder. All patients were treated with various arthroscopic procedures. All had harvesting of four tissue probes identifying low-grade infection. Pre/post-operative pain score, pre/post-operative range of motion, intraoperative findings, post-operative Constant score, Subjective Shoulder Value and pre/post operative radiographs were analyzed. Post-operative antibiotic therapy was recorded.

Results

All patients showed synovitis without pus or any other sign of infection. Propionibacterium acnes were identified in five, coagulase-negative Staphylococcus in two, and Staphylococcus saccharolyticus in one shoulder. One patient had a mixed infection (Propionibacterium acnes and coagulase-negative Staphylococcus). Therapy consisted of oral antibiotics for 1–6?months. Four patients had a satisfactory and three an unsatisfactory outcome.

Conclusions

Diffuse shoulder pain with or without stiffness in patients without prior surgical history can be caused by low-grade infection. Treatment using oral antibiotics has unpredictable outcomes. Further studies are necessary to analyze this pathology.

Level of evidence

Level IV, retrospective case series, treatment study.     

Comparison of analgesic methods by using ropivacaine after arthroscopic shoulder surgery

Background

There is no clinical study which has evaluated real effectiveness of ropivacaine when it is used in a subacromial pump in addition to its bolus injection in a mixture of agents. The aim of the study is to evaluate pain relieving effect of ropivacaine infusion by a pain pump after arthroscopic shoulder surgery.

Method

Thirty-six patients were randomly divided into three groups. Arthroscopic subacromial surgery was performed under general anesthesia. A subacromial catheter was placed in groups 1 and 2 patients. At the end of the operation, 15 ml of 0.5 % ropivacaine, 15 mg of ketolorac, and 4 mg morphine sulfate mixture was applied to all patients into the subacromial space. In addition to that, group 1 patients were applied with 0.5 % ropivacaine running through a pain pump at 4 cm³/h. Group 2 patients only received 100 cm³ saline (placebo) through the same pain pump, which was also running at 4 cm³/h. No additional intervention except subacromial mixture application was performed in group 3. Pain levels were evaluated by using the visual analogue scale.

Results

Twelve male and 19 female patients were included in this study. During the first postoperative hour, there was no difference between the groups in terms of pain scores. During the ongoing 24-h period, group 2 patients suffered less pain and had less analgesic need compared with the other two groups (p?<?0.05). However, in the same day, there was no significant difference in pain scores and analgesic consumption between groups 1 and 3 (p?>?0.05).

Conclusion

In terms of pain relief, the mixture of morphine, ropivacaine, and ketolorac was found to be as effective as the 24-h pump infusion of ropivacaine following arthroscopic rotator cuff repair. It was observed that placebo-given patients suffered less pain because saline increased the long-term effect of ropivacaine. So if an appropriate analgesic agent is applied to the subacromial space, there is no need for a pump infusion postoperatively.     

Indications for free vascularized fibular grafting for the treatment of osteonecrosis of the femoral head

Background

Subacromial impingement syndrome (SIS) is the most frequently recorded shoulder disorder. When conservative treatment of SIS fails, a subacromial decompression is warranted. However, the best moment of referral for surgery is not well defined. Both early and late referrals have disadvantages – unnecessary operations and smaller improvements in shoulder function, respectively. This paper describes the design of a new interdisciplinary treatment strategy for SIS (TRANSIT), which comprises rules to treat SIS in primary care and a well-defined moment of referral for surgery.

Methods/Design

The effectiveness of an arthroscopic subacromial decompression versus usual medical care will be evaluated in a randomized controlled trial (RCT). Patients are eligible for inclusion when experiencing a recurrence of SIS within one year after a first episode of SIS which was successfully treated with a subacromial corticosteroid injection. After inclusion they will receive injection treatment again by their general practitioner. When, after this treatment, there is a second recurrence within a year post-injection, the participants will be randomized to either an arthroscopic subacromial decompression (intervention group) or continuation of usual medical care (control group). The latter will be performed by a general practitioner according to the Dutch National Guidelines for Shoulder Problems. At inclusion, at randomization and three, six and 12 months post-randomization an outcome assessment will take place. The primary outcome measure is the patient-reported Shoulder Disability Questionnaire. The secondary outcome measures include both disease-specific and generic measures, and an economic evaluation. Treatment effects will be compared for all measurement points by using a GLM repeated measures analyses.

Discussion

The rationale and design of an RCT comparing arthroscopic subacromial decompression with usual medical care for subacromial impingement syndrome are presented. The results of this study will improve insight into the best moment of referral for surgery for SIS.     

Internalized Weight Bias in Weight-Loss Surgery Patients: Psychosocial Correlates and Weight Loss Outcomes

Purpose

In this study, we examined the relationship between pre-operative internalized weight bias and 12-month post-operative weight loss in adult bariatric surgery patients.

Methods

Bariatric surgery patients (n?=?170) from one urban and one rural medical center completed an internalized weight bias measure (the weight bias internalization scale, WBIS) and a depression survey (Beck depression inventory-II, BDI-II) before surgery, and provided consent to access their medical records.

Results

Participants (BMI?=?47.8 kg/m2, age?=?45.7 years) were mostly female (82.0 %), White (89.5 %), and underwent gastric bypass (83.6 %). The average WBIS score by item was 4.54?±?1.3. Higher pre-operative WBIS scores were associated with diminished weight loss at 12 months after surgery (p?=?0.035). Pre-operative WBIS scores were positively associated with depressive symptoms (p?Conclusion Greater internalized weight bias was associated with more depressive symptoms before surgery and less weight loss 1 year after surgery.     

Arthroskopische Resektion des Akromioklavikulargelenks

Objective

Arthroscopic resection of the painful and degenerative altered acromioclavicular (AC) joint without destabilization of the joint and therefore pain relief and improvement in function.

Indications

Conservative failed therapy of painful AC joint osteoarthritis. Impingement caused by caudal AC joint osteophytes. Lateral clavicular osteolysis.

Contraindications

General contraindications (infection, local tumor, coagulation disorders), higher grade instability of the AC joint (resection only together with stabilization).

Surgical technique

Diagnostic glenohumeral arthroscopy. Treatment of accompanying lesions (subacromial impingement, rotator cuff, long head of biceps). Subacromial arthroscopy with bursectomy (partial) and visualization of the AC joint. Resection of caudal osteophytes. Localization of the anterior portal using a spinal needle in the outside-in technique. Resection of 2–3 mm of the acromial side and the 3–4 mm of the clavicular side with shaver/acromionizer.

Results

An isolated open AC joint resection was performed in 9 studies and an arthroscopic resection in 6 studies. Good and very good results were obtained in 79?% (range 54–100?%) in open resection and 91?% (range 85–100?%) in arthroscopic resections. Patients were able to return to activities of daily life more quickly after arthroscopic resections than after open surgery.     

Three-dimensional in vivo difference between native acetabular version and acetabular component version influences iliopsoas impingement after total hip arthroplasty

Purpose

The potential influence of acetabular component orientation on iliopsoas impingement in total hip arthroplasty (THA) has not been previously quantified. The aim of the present study was to utilize pre- and post-operative CT-based 3D models to quantify iliopsoas impingement on acetabular components, and to identify any potential factors associated with iliopsoas impingement.

Methods

Iliopsoas muscle was modelled from pre-operative CT scans and transferred to the post-operative 3D models in 19 THAs. The volume and the area of the overlap between iliopsoas muscle and acetabular cup (iliopsoas volume & area) was measured on axial and sagittal images. Most protruded lengths of cup uncovered by acetabular bone were measured on axial sagittal scan of CT scans. Version of acetabulum, acetabular cup, and the difference between the two (version difference) were also measured with cup inclination and size. Linear regression analysis was performed to identify any factor influencing iliopsoas impingement.

Results

Iliopsoas impingement volume and area were 100.6?±?226.1 (range, 0.0–663.9) mm³ and 52.6?±?102.0 (0.0–342.3) mm³, respectively. The protruded lengths on axial and sagittal view were 6.9?±?5.3 (0.0–16.0) and 2.1?±?2.7 (0.0–8.0). Linear regression model showed that version difference was significantly related to the iliopsoas impingement volume and area (beta?=??0.709, p?=?0.041 for volume, and beta?=??0.684, p?=?0.047 for area).

Conclusions

The results of this study demonstrate that iliopsoas impingement on acetabular components was influenced by the version difference between pre-operative acetabular bone and acetabular component rather than the magnitude of post-operative cup version alone.

     

Arthroscopic double-loaded single-row repair in chronic traumatic anterior shoulder dislocation

Purpose

We evaluated the clinical results of arthroscopic double-loaded single-row repair for chronic anterior shoulder dislocation.

Methods

From January 2007 to December 2008, of the 47 shoulders with chronic anterior shoulder dislocation that consecutively underwent arthroscopic double-loaded single-row repair using bio-absorbable suture anchors containing two non-absorbable braided sutures, 45 shoulders (95.7?%) had successful follow-up for a minimum of 2?years. The mean age of patients was 23.7?years, the mean frequency of dislocations before surgery was 6.8 events, and the mean interval between the initial dislocation and surgery was 47.9?months. Clinical results were evaluated using ASES, Rowe, VAS score, and range of motion before surgery and at the final follow-up.

Results

The mean number of suture anchors was 3.38 (range 2–6) and the mean number of stitches was 6.32 (range 4–10). Four of the 45 cases had recurrence (8.9?%). Of these four, three cases underwent re-operation using the same method and the other one case showed no specific discomfort except a one-time dislocation that underwent conservative treatment. The preoperative and the final follow-up ASES and Rowe scores were statistically significantly improved (P?P?P?>?0.05), but external rotation at the side was significantly decreased (P?=?0.001).

Conclusions

Arthroscopic double-loaded single-row repair using suture anchors, containing two sutures in chronic anterior shoulder dislocation, is a reliable procedure with respect to recurrence rate, range of motion, and shoulder function.     

Functional and clinical outcome of total shoulder arthroplasty with oversized glenoid

Background

The Epoca-Reconstruction-(Reco)^?-Glenoid has been developed to treat patients with cuff-tear-arthropathy. The glenoid component of this system has a hemispheric shape that canopies the humeral head. This design is believed to provide a stable fulcrum and restore normal deltoid function. The purpose of this study was to analyse strengths and disadvantages of the Epoca-Reco^?-Glenoid in cuff-tear-arthropathy patients. Changes in functional outcome using Constant-Murley-Scoring(CMS), CMS sub-scoring parameters and radiological outcome were analysed. For this purpose, a classification for radiologic lucency was proposed. Diverging results, influencing factors and alternative treatment options have been discussed to analyse weaknesses and enhance future development of this arthroplastic model.

Materials and methods

23 patients aged 68?±?8.4?years with irreparable cuff-tear-arthropathy refractory to physiotherapeutic treatment were treated with Reco-Glenoid Total-Shoulder-Arthroplasty (TSA). Pre-operative standardized evaluations included history, physical examination, radiographs, computer tomography and clinical scorings. The post-operative controls included physical examination with CMS, video documentation and radiological evaluation.

Results

After a median follow-up time of 38?±?18?months, the CMS had been significantly improved (p?p?p?=?0.006) was achieved. Significantly, inferior results in functional outcome and higher lucency rates were observed in female patients and in patients treated with small glenoid components. The follow-up rate was 100?%.

Conclusion

The semi-constraint reconstruction glenoid prosthesis model in cuff-tear-arthropathy patients significantly improves shoulder function, however, it yields controversial results, with satisfactory results in male and poor results in female patients. Revision rate of the female cohort and loosening of the glenoid component in this short-term follow-up is of concern. Further investigations taking BMD, osteopenic conditions and influence of surface area in smaller individuals into consideration are recommended, to determine whether this is the underlying cause of the inferior results in females.     

Synoviales Plica-Impingement nach inverser Schulterarthroplastik

Background

Persisting pain following artificial joint replacement is a diagnostic and therapeutic challenge. Based on a case report, the feasibility of arthroscopy of a reverse shoulder prosthesis as a diagnostic and therapeutic tool is discussed.

Case report

The case of a 67-year-old woman with refractory pain in the anterior aspect of the shoulder when flexing and internally rotating the joint 14?months after an uneventful implantation and rehabilitation of a reverse shoulder arthroplasty is reported. Imaging and laboratory findings were all normal. Diagnostic arthroscopy confirmed the suspected plica-like synovial proliferation impinging between the glenosphere and humeral components.

Results

By means of arthroscopic resection of the plica, the patient recovered pain free and with full range of motion within weeks following the revision. Neither at the time of the index operation nor after the revision was instability of the implant evident.

Conclusion

Arthroscopy of reverse shoulder arthroplasty is technically feasible and safe. Its diagnostic potential is high and not only facilitates detection but also allows soft tissue impingement to be successfully treated. Nevertheless, introduction of the instruments has to be performed carefully in order to prevent iatrogenic damage to the prosthesis.     

Arthroskopische und offene Arthrolyse bei sekundären Schultersteifen

Purpose

The purpose of this study was to compare results after arthrolysis in cases of secondary shoulder stiffness. The hypothesis was that patients with posttraumatic/-operative shoulder stiffness benefit less than patients with shoulder stiffness due to subacromial syndrome.

Materials and Methods

A total of 82 patients with the median age of 54 years (range, 23–82 years) were followed up 14 months (median; range, 3–40 months) after operative arthrolysis. Three groups could be differentiated: group l (n=25) arthroscopic arthrolysis in patients with shoulder stiffness due to subacromial syndrome, group ll (n=31) arthroscopic arthrolysis in patients with posttraumatic/-operative shoulder stiffness, and group lll (n=26) open arthrolysis in patients with posttraumatic and -operative shoulder stiffness. Pre- and postoperative Simple Shoulder Test (SST) and Constant Murley score (CMS) results were compared.

Results

The SST score improved significantly in all groups postoperatively. In group l, the adjusted CMS increased significantly from a median 30% (range, 18–36%) to 81% (range, 47–100%), in group ll from 29% (range, 16–51%) to 68% (range, 14–100%) and in group lll from 35% (range, 18–71%) to 76% (range, 31–100%). Group l improved significantly more in the categories “pain” and “activities of daily living” than group lll, which in turn improved more than group ll.

Conclusions

In case of secondary shoulder stiffness, arthrolysis based on pathology resulted in significantly improved shoulder function. Statistically significant in the subjective scores and by the trend in the CMS, patients with shoulder stiffness due to subacromial syndrome benefit more than the other groups.     

Gastric Histopathology in Laparoscopic Sleeve Gastrectomy: Pre- and Post-Operative Comparison

Background

Sleeve gastrectomy (SG) produces excellent results in weight reduction and resolution of comorbidities. The histology of the gastric mucosa can be affected by the surgical procedure, with alterations of inflammatory patterns. The objective of this study is to evaluate alterations of the inflammatory patterns of the gastric mucosa in SG and the results in weight loss and resolution of comorbidities.

Methods

Morbidly obese patients were selected to undergo SG. Endoscopies were performed pre-operatively and post-operatively after 6 months, with an incisura and 3 cm before the pylorus biopsies. Data on weight, height, and associated diseases were collected. The data were compared, and the biopsies evaluate the inflammatory patterns.

Results

There was a reduction of body weight with a pre-operative weight of 132.5?±?15.7 kg and a post-operative weight of 95.8 ±10.6 kg with a p?<?0.001. Also, the body mass index (BMI) was reduced significantly with a mean pre-operative of 42.6?±?10.6 kg/m² and a post-operative of 30.9?±?3.2 kg/m² with a p?<?0.001. The comorbidities were all resolved or improved. The pattern of gastric histology showed chronic gastritis with inflammatory activity associated with Helicobacter pylori in 33.3 % of the patients, along with foveolar hyperplasia at 58.3 %. The chronic gastritis with discrete inflammatory activity was reduced by 16.7 %, and the foveolar hyperplasia was reduced by 33.3 %.

Conclusion

The inflammatory alterations in the pre-operative period were mainly foveolar hyperplasia and chronic gastritis associated with H. pylori, and they were reduced in the post-operative period. A significant reduction of weight and BMI occurred, and a resolution of comorbidities was observed.     

Influence of pre-operative tear size and tendon retraction on repair outcomes for isolated subscapularis tears

Purpose

The purpose of this study was to investigate the influence of tendon tear size, in terms of length and retraction, on clinical and anatomic outcomes following repair for isolated subscapularis tears.

Methods

The records of 47 consecutive repairs of isolated subscapularis lesions were studied to correlate pre-operative tear characteristics with clinical and radiographic outcomes.

Results

Forty patients had complete radiographic outcomes at 3.2?±?1.1 years, of which 36 had complete clinical outcomes at 3.5?±?0.9 years. Re-tears were observed in five shoulders (12.5 %). Fatty infiltration increased by one grade in 20 shoulders (50 %), and by two grades in four shoulders (10 %). Pre-operative tear size was associated with the post-operative belly-press test (BPT) (p?=?0.042) and fatty infiltration (p?=?0.051). Pre-operative tendon retraction was associated with post-operative BPT (p?<?0.001) and fatty infiltration (p?=?0.023).

Conclusions

Our results do not entirely prove that prognostic factors used for superior and posterior tendon tears apply for the subscapularis. Pre-operative tendon retraction is a better predictor of outcomes than tear size. When tear size and tendon retraction are simultaneously severe, re-tears and poor outcomes are more likely.

     

Effect of depressive symptoms on perceived disability in patients with chronic shoulder pain

Background

Psychological distress may be an important determinant of perceived disability in patients with chronic musculoskeletal disorders. We evaluated the relationship between depressive symptoms and perceived disability in patients with chronic shoulder pain and quantified the contribution made by depression to perceived disability.

Methods

In this prospective study, 109 patients with chronic shoulder pain caused by degenerative or inflammatory disorders were evaluated using the Disability of Arm, Shoulder and Hand (DASH) questionnaire and the Center for Epidemiologic Studies-Depression (CES-D) Scale to determine relationships between depressive symptoms and perceived disability in patients with chronic shoulder pain. In addition, pain scores were evaluated using a visual analog scale (VAS) during activity, and range of motion (ROM) and abduction strength (strength) measurements were measured. Multivariate analyses of variance and regression modeling were used to assess the relative contributions made by depressive symptoms (CES-D) and other clinical parameters to patient-perceived disability (DASH).

Results

DASH scores were found to be moderately correlated (0.3?r?r?=?0.58; p?p?p?=?0.04 respectively). Multiple stepwise regression analyses revealed that gender, ROM, pain VAS and CES-D scores independently predicted DASH score and accounted for 43?% of the variance. CES-D score was found to be the strongest predictor of DASH score and accounted for 23?% of the variance.

Conclusions

Degrees of depressive symptoms were found to be significantly associated with higher symptom scores and greater disability in patients with chronic shoulder pain. Although a large proportion of perceived disability remains unexplained, perceived disability in patients with chronic shoulder pain was found to be strongly influenced by depressive symptoms.

Type of study/level of evidence

Level 2, prospective cohort study, prognostic study.     

Risk factors for urinary tract infection following incontinence surgery

Introduction and hypothesis

The purpose of this study is to describe risk factors for post-operative urinary tract infection (UTI) the first year after stress urinary incontinence surgery.

Methods

Multivariable logistic regression analyses were performed on data from 1,252 women randomized in two surgical trials, Stress Incontinence Surgical Treatment Efficacy trial (SISTEr) and Trial Of Mid-Urethral Slings (TOMUS).

Results

Baseline recurrent UTI (rUTI; ??3 in 12?months) increased the risk of UTI in the first 6?weeks in both study populations, as did sling procedure and self-catheterization in SISTEr, and bladder perforation in TOMUS. Baseline rUTI, UTI in the first 6?weeks, and PVR?>?100?cc at 12?months were independent risk factors for UTI between 6?weeks and 12?months in the SISTEr population. Few (2.3?C2.4%) had post-operative rUTI, precluding multivariable analysis. In women with pre-operative rUTI, successful surgery (negative cough stress test) at 1?year did not appear to decrease the risk of persistent rUTI.

Conclusions

Pre-operative rUTI is the strongest risk factor for post-operative UTI.     

Patients with shoulder impingement remain satisfied 6 years after arthroscopic subacromial decompression: a prospective study of 46 patients

Background

Although arthroscopic subacromial decompression (ASD) is a common procedure for treatment of shoulder impingement, few long term results have been published. In this prospective study, we determined whether the high degree of patient satisfaction at 6 months postoperatively reported by us earlier remained at the 6-year follow-up.

Patients and methods

We originally reported high patient satisfaction 6 months after ASD for shoulder impingement in 50 prospectively studied patients using the Disability of the Arm Shoulder and Hand questionnaire (DASH) and the Visual Analog Scale (VAS). Patients with associated shoulder disorders were excluded. The surgeons were experienced shoulder arthroscopists. 6 years after surgery, the DASH questionnaire and the VAS were sent to these 50 patients. 2 patients had other medical problems of the upper extremity that affected the DASH and VAS scores, 1 patient was lost to follow-up, and another refused to participate. Thus, 46 patients with a mean age of 55 (33–78) years were included in this 6-year evaluation.

Results

The considerable improvement in both the DASH score and the VAS that was observed 6 months after surgery persisted or had even improved 6 years after surgery.

Interpretation

Properly selected patients with shoulder impingement treated with ASD remain satisfied 6 years after surgery.Patients with shoulder impingement may have associated conditions such as painful osteoarthrosis of the acromioclavicular joint, degenerative biceps tendon, or rotator cuff tear. There have been few studies describing the long-term results of arthroscopic subacromial decompression (ASD) for patients with pure shoulder impingement, especially from the standpoint of patient satisfaction. The Constant-Murley score (1987) is commonly used; it provides objective information including strength and range of motion. The DASH score reflects the patient''s own experience of disability and is used to study rotator cuff disorders (Norlin and Adolfsson 2008, Björnsson et al. 2010). Pain is the main complaint in shoulder impingement patients. Thus, it is important to compare preoperative and postoperative pain to evaluate the surgical results. The VAS is a validated and widely accepted tool that measures the severity of pain.We have already reported that ASD in properly selected patients with impingement is an operation that gives high patient satisfaction 6 months after surgery when using DASH and VAS as evaluation tools (Bengtsson et al. 2006). We have now evaluated the patients 6 years after surgery.     

Post-operative benefits of Tisseel®/Tissucol® for mesh fixation in patients undergoing Lichtenstein inguinal hernia repair: secondary results from the TIMELI trial

Purpose

The Tisseel/Tissucol for mesh fixation in Lichtenstein hernia repair (TIMELI) study showed that mesh fixation with human fibrin sealant during inguinal hernia repair significantly reduced moderate–severe complications of pain 12 months post-operatively compared with sutures. Further analyses may assist surgeons by investigating predictors of post-surgical complications and identifying patients that may benefit from Tisseel/Tissucol intervention.

Methods

Univariate and multivariate analyses identified risk factors for combined pain, numbness and groin discomfort (PND) visual analogue scale (VAS) score 12 months post-operatively. Variables tested were: fixation method, age, employment status, physical activity, nerve handling, PND VAS score at pre-operative visit and 1 week post-operatively. The effect of fixation technique on separate PND outcomes 12 months post-surgery was also assessed. Analyses included the intention-to-treat (ITT) population and a subpopulation with pre-operative PND VAS > 30 mm.

Results

316 patients were included in the ITT, with 130 patients in the subpopulation with pre-operative PND VAS > 30. Multivariate analysis identified mesh fixation with sutures, worsening pre-operative PND and worsening PND 1 week post-surgery as significant predictors of 12-month PND in the ITT population; mesh fixation with sutures was a significant predictor of 12-month PND in the pre-operative PND VAS > 30 subpopulation (p < 0.05). Mesh fixation with Tisseel/Tissucol resulted in significantly less numbness and a lower intensity of groin discomfort compared with sutures at 12 months; there was no difference in pain between the treatment groups.

Conclusions

Pre-operative discomfort may be an important predictor of post-operative pain, numbness and discomfort. Tisseel/Tissucol may improve long-term morbidity over conventional sutures in these patients.     

Teaching patients clean intermittent self-catheterisation prior to anti-incontinence or prolapse surgery: is it necessary in women with obstructive voiding dysfunction?

Purpose

To determine the value of pre-operative teaching of clean intermittent self-catheterisation (CISC) in women who undergo anti-incontinence and/or prolapse surgery and who are at ??high risk?? to have post-operative incomplete bladder emptying.

Methods

Out of the 402 patients who underwent anti-incontinence and/or prolapse surgery at our institute (March 2008?CMarch 2009), 48 patients had at least one obstructive lower urinary tract symptom and one obstructive urodynamic parameter before surgery and were considered at ??high risk?? to have post-operative incomplete bladder emptying. They were taught CISC pre-operatively.

Results

Out of the 48 patients, 7 (14.6%) had incomplete bladder emptying. The incidence of post-operative incomplete bladder emptying was higher in the older women (P?Conclusions Routine teaching of the technique of CISC to ??high risk?? patients prior to anti-incontinence and/or prolapse surgery appears to be an unnecessary use of valuable nursing time as well as being an invasive intervention which is unlikely to be required post-operatively.     

Improved Quality of Life Following Total Pancreatectomy and Auto-islet Transplantation for Chronic Pancreatitis

Background

Total pancreatectomy (TP) with auto-islet transplant (AIT) is an extreme treatment for chronic pancreatitis, and we reviewed our experience to assess the impact on quality of life (QOL).

Methods

A prospective cohort study from 2007 through 2010 with pre- and postoperative assessments of the Depression Anxiety Stress Scale, Pain Disability Index, and visual analogue pain scale was performed.

Results

Twenty patients underwent TP-AIT with a median follow-up of 12?months (6.75?C24?months). All patients reported moderate (45?%) to severe (55?%) pain prior to surgery. TP-AIT resulted in significant decreases in abdominal pain (p?p?=?0.002), with greatest improvements seen in those without prior pancreatic surgery, younger patients, and in those with higher levels of preoperative pain. Patients were less affected by depression and anxiety prior to surgery, but 60 and 70?% did show improvement in depression and anxiety, respectively (p?=?0.033). Sixteen patients (80?%) required exogenous insulin at last follow-up (mean total dose of insulin 11.6?U/day).

Conclusions

TP-AIT significantly improves pain and QOL measures in appropriately selected patients with CP.     

Predictors of Success of Corticosteroid Injection for the Management of Rotator Cuff Disease

Background

The use of subacromial corticosteroid injection (CSI) to treat rotator cuff tendinopathy is controversial. We hypothesized that characteristics such as activity level, American Shoulder and Elbow Surgeons (ASES) score, duration of symptoms, and status of the rotator cuff may be prognostic factors for resolution of symptoms postinjection.

Methods

During a 12-month period, consecutive patients with rotator cuff disease were analyzed. Patients received subacromial CSI, oral NSAIDs, and physical therapy. Baseline ASES score, simple shoulder test, an activity scale, and demographic data were recorded. Patients who remained symptomatic and were indicated for surgery were considered failures. Patients that did not undergo surgery were reassessed after a minimum of 1 year.

Results

Forty-nine patients met our criteria. Follow-up was obtained for 81.6%. Sixteen cases (40%) failed conservative treatment at final follow-up (22.4?±?11 months). CSI were successful in 76.2% of males and 45% of females (p?=?0.04). Full-thickness tears were present in 8% of the patients with symptom resolution and 25% of those that failed conservative treatment (p?=?0.29). No significant difference was found in age, hand dominance, duration of symptoms, or any of the scoring systems.

Conclusion

It is difficult to predict outcomes after CSI. Our treatment strategy showed a 40% failure rate.     

Abductor mechanism tears in primary total hip arthroplasty

Introduction

Tears of the abductor mechanism of the hip are well recognized, but poorly understood. Little is known of the effect of demographics and pathology on prevalence of abductor mechanism tears or the impact on clinical outcome.

Methods

This prospective study analysed the effect of age, gender, medical co-morbidity and social deprivation on prevalence of abductor mechanism tears of the hip in 835 consecutive patients undergoing total hip arthroplasty (THA) between 2003 and 2011. Effect on clinical outcome relating to presence of abductor mechanism tear was analysed in a subset at pre-op and at 1?year post-operation using the Oxford hip score (OHS).

Results

The prevalence of abductor mechanism tears was 25.4?% (n?=?212). Female patients (p?<?0.001), older patients (p?=?0.001) and those of lower socioeconomic status (p?<?0.001) were significantly more likely to have a pre-operative abductor mechanism tear. In older socially deprived females the predicted rate of tear is 70.9?%. The aetiology of the hip disease (p?=?0.593) or presence of any specific co-morbidity (p?=?0.085–0.929) had no significant effect on the prevalence of abductor mechanism tears. In patients with protrusion or dysplasia there was an increased prevalence of tears (p?=?0.002). There was no significant difference in pre-operative (p?=?0.775) or post-operative (p?=?0.604) OHSs regardless of the tears when the tears were recognized and treated at the time of THA.

Conclusions

Tears are increasingly prevalent in women of advancing years and lower socioeconomic status which should be considered when planning operative approach in this demographic. When recognised and repaired there is no difference in the clinical outcome for those with abductor mechanism tears of the hip.