Complications following hip arthroscopy: a retrospective review of the McMaster experience (2009–2012)

Background

The use of hip arthroscopy has been steadily rising as technology, experience and surgical education continue to advance. Previous reports of the complication rate associated with hip arthroscopy have varied. The purpose of this study was to report our experience with hip arthroscopy complications at a single Canadian institution (McMaster University).

Methods

We performed a retrospective chart review of 2 hip arthroscopists at the same institution to identify patients who had undergone the index surgery and had been followed for a minimum of 6 months postoperatively. We used a standard data entry form to collect information on patient demographic and clinical characteristics, including age, sex, surgical indication and type of complication if any.

Results

A total of 211 patients underwent 236 hip arthroscopies. The mean age at time of surgery was 37 ± 13 years and mean follow-up was 394 ± 216.5 days. The overall complication rate associated with hip arthroscopy was 4.2% (95% confidence interval 2.3%–7.6%). We identified 4 major and 6 minor complications.

Conclusion

Overall, hip arthroscopy appears to be safe, with minor complications occurring more frequently than major ones. However, surgeons should recognize the possibility of serious complications associated with this procedure. Future research should focus on prospective designs looking for potential prognostic factors associated with hip arthroscopy complications.     

Tear film measurements in four different ethnic groups: Malay, Chinese, Indian and Nigerian

AIM: To compare the non-invasive tear film break-up time (NIBUT), tear break up time (TBUT), basal tear secretion (BTS) and blink rate in four ethnic groups: Malay, Chinese, Indian and Nigerian. METHODS: Totally 120 healthy (61 males and 59 females) subjects (without dry eye symptoms and ocular surface disorder) with the age 20 to 39 years were recruited; 30 were Malays, 30 were Chinese, 31 were Indians and 29 were Nigerians. Based on McMonnies questionnaire and clinical examination, normal subjects were selected. NIBUT, TBUT, BTS were assessed in only one eye (right) of each subject and blink rate was also assessed. RESULTS: There was significant difference in the NIBUT, TBUT, BTS and blink rate among 4 different ethnic groups (P=0.018, 0.001, 0.011, and 0.004 respectively). No statistically significant difference of NIBUT, TBUT, BTS and blink rate was found between the genders among different ethnic groups. Indian had higher median for NIBUT (10±6s), TBUT (7±5s) and BTS (20±20 mm) than other races. Chinese had lower median for NIBUT (7.5±4s) and TBUT (4±2s) while Malay had for BTS (9.5±16 mm) among the groups. There was no significant correlation of blink rate with NIBUT (r=-0.119, P=0.195), TBUT (r=-0.086, P=0.352), and BTS (r=-0.123, P=0.180) respectively. CONCLUSION: The tear-film measurement values are variability in four ethnic groups.     

Ring-opening cyclization of activated spiro-aziridine oxindoles with heteroarenes: a facile synthetic approach to spiro-oxindole-fused pyrroloindolines

Herein, we report a facile tandem approach for the synthesis of both spiro-oxindole-fused pyrroloindolines and benzofurano-pyrrolidines via a Lewis acid-catalyzed domino ring-opening with concomitant ring annulation using activated spiro-aziridines and heteroarenes. This method offers a new class of novel spiro-fused polycyclic pyrrolidines in a one-pot and sustainable manner with good yields and high diastereoselectivity. In addition, the structure of 3d was confirmed by single X-ray crystallography analysis.

Herein, we report a facile tandem approach for the synthesis of both spiro-oxindole-fused pyrroloindolines and benzofurano-pyrrolidines via a Lewis acid-catalyzed domino ring-opening annulation using activated spiro-aziridines and heteroarenes.     

Tip to apex distance in femoral intertrochanteric fractures: a systematic review

Background

Hip fractures are associated with high morbidity, mortality, and cost. Implants used for hip fracture fixation can fail for many reasons including lag screw cut-out. Tip–apex distance (TAD) is indicative of the position and depth of a screw in the femoral head and has been shown to be associated with cut-out failure. We conducted a systematic review of the published literature to quantify the association between TAD and cut-out failure for patients undergoing hip fracture fixation surgery.

Methods

We performed a search of the Medline, Embase, and Cochrane databases. We performed abstract and full text reviews independently and in duplicate. We used a random effects model to combine, in duplicate, the incidence of cut-out for patients who had TAD <25 mm and TAD >25 mm. We also combined mean TAD values for patients who had cut-out failure and those who did not.

Results

Seventeen studies were eligible for this review, four of which were included in combined analysis of dichotomous outcomes and seven in combined analysis of continuous outcomes. Patients with TAD >25 mm had a significantly greater risk of cut-out than patients with TAD <25 mm (RR = 12.71). Patients who experienced implant cut-out had significantly higher TAD scores than those who did not (mean difference = 6.54 mm).

Conclusion

Tip–apex distance is an important concept in relation to cut-out failure of hip fracture fixation surgery. Surgeons should understand and apply the concept of TAD to improve outcomes for their patients.     

Loss to follow-up in orthopaedic clinical trials: a systematic review

Purpose

The rate of patients lost to follow-up may contribute to bias in randomized controlled trials (RCTs).

Methods

We systematically reviewed orthopaedic RCTs from 2008 to 2011, including 559 RCTs with 131,836 enrolled subjects. The loss to follow-up rates and minimum follow-up times were recorded for each trial. Orthopaedic subspecialty, country of origin, number of enrolled patients, patient age, follow-up strategy, and funding type were also recorded.

Results

Loss to follow-up was not reported in 111 of these studies (20 %). Mean loss to follow-up was 10.4 %. No orthopaedic subspecialty demonstrated significantly different follow-up rates. Remote follow-up strategies did not reduce the loss to follow-up rate. Studies with a minimum follow-up length of three years showed significantly higher loss to follow-up rates compared with studies with shorter minimum follow-up time (14.8 % versus 9.8 %, p?=?0.01). Studies performed in the United States had a significantly higher rate of loss to follow-up compared with non-United States studies (13.8 % versus 9.4 %; p?=?0.01).

Conclusions

Loss to follow-up rates in published orthopaedic randomized controlled trials is overall relatively low. A substantial portion of publications does not adequately report follow-up data. Studies performed in the United States and studies with longer follow-up periods seem to be at higher risk for loss to follow-up.

     

Effect of sleeve gastrectomy bariatric surgery-induced weight loss on serum AMH levels in reproductive aged women

Objective: This study aims to evaluate the change in serum anti-Mullerian hormone (AMH) levels in patients with morbid obesity undergoing bariatric surgery for weight loss.

Material and methods: In this prospective observational study, 75 patients of reproductive age (20–35 years) undergoing bariatric surgery for morbid obesity were followed up after six months to determine the changes in weight, Body Mass Index (BMI), menstrual pattern and serum AMH. The results were further studied on basis of pre operative classification of patients in polycystic ovary syndrome (PCOS) and non-PCOS group.

Result: The serum AMH levels were statistically higher in patients of PCOS group pre operatively and at the end of six months in comparison to non-PCOS patients. The AMH values reduced post operatively in both groups significantly so much in the values though not significant statistically. Non-PCOS patients had lower AMH values pre operatively and showed a trend towards reducing ovarian reserve after six months. The overall change in AMH values in both groups was statistically significant as was the normalization of menstrual irregularity.

Conclusion: Morbidly obese patients with PCOS appear to benefit from bariatric surgery both in terms of regularization of menstrual function and normalization of serum AMH values.