Two‐Stage Revision Hip Arthroplasty with or without the Use of an Interim Spacer for Managing Late Prosthetic Infection: A Systematic Review of the Literature

The aim of the present paper was to identify, appraise, and synthesize the available evidence on two‐stage revision hip arthroplasty with or without the use of an interim spacer for managing late prosthetic infection. The review methodology was designed by referencing the Preferred Reporting Items for Systematic Reviews and Meta‐analyses (PRISMA) checklist and flow diagram, and a Population, Intervention, Comparator, Outcomes and Study (PICOS) design framework was used to search for studies to incorporate within the review. Two independent investigators were involved in searching for relevant articles that fulfilled the inclusion criteria for the study. Critical appraisal of the selected articles was carried out using the relevant Critical Appraisal Skills Programme checklists. From an initial pool of 125 articles, four studies satisfied the inclusion criteria and quality assessment and were included for final review. Two patient groups were identified from within the selected studies: spacer and non‐spacer. Both groups were assessed in terms of functional outcome, infection cure rates, and technical difficulties encountered during treatment. Better functional outcome was reported in the spacer group, both in the interim period between the two stages and after completion of treatment. The use of spacers reduced operative difficulty during the second stage and accelerated patient discharge. Reinfection and infection persistence rates were higher in the non‐spacer group. Within the spacer group, articulated spacers performed better in all parameters. The results of this review reinforce the available evidence supporting the use of interim hip spacers in revision hip arthroplasty for managing prosthetic infection and also indicate that articulated hip spacers could be an attractive option going forward.     

Authors’ reply to Grundtvig Gram et al.

European Journal of Epidemiology -     

Depression,anxiety, and loneliness among adolescents and young adults with IBD in the UK: the role of disease severity,age of onset,and embarrassment of the condition

Quality of Life Research - Adolescents and young adults (AYA) with Inflammatory Bowel Disease (IBD) report higher depressive symptoms and anxiety compared to healthy controls, with disease severity...     

Relationship between Hip Extension Range of Motion and Postural Alignment

The purpose of this study was to examine the relationships between hip extension range of motion (ROM) and three determinants of postural alignment: standing pelvic tilt, standing lumbar lordosis, and abdominal muscle performance. The subjects were 25 healthy adults ranging in age from 21 to 49 years. The Pearson product-moment correlation of hip extension ROM with pelvic tilt was -0.04, with lumbar lordosis -0.09, and with abdominal muscle performance 0.09. These results indicate that these variables are not related. This study demonstrates that the hypothetical correlation among these clinical parameters needs to be reassessed. J Orthop Sports Phys Ther 1990;12(6):243-247.     

Home nutrition survey in the UK: the patient's perspective

A detailed survey questionnaire compiled by the executive committee of Patients on Intravenous and Nasogastric Nutrition Therapy (PINNT) was circulated in November 1991 to the postal addresses of all full (patient) members of PINNT in the UK. The objective of the survey was to identify current practices and problems of home nutrition support as seen from the patients perspective. 128 questionnaires were distributed. 87 (68%) analysable questionnaires were completed and returned. 77 were for parenteral nutrition (HPN) patients and 10 for patients on enteral nutrition (HEN). Areas of concern for patients include the practicalities of administration of lipid and additives, and problems associated with the appearance of air in infusion bags. Although most patients appeared happy with the home nutrition support services 18% commented on particular negative aspects. This survey highlights such areas which may not be identified during routine patient/clinician contact.     

Postoperative dilation of knitted Dacron aortic bifurcation graft

Dilation is the most common inherent "failure mode" of knitted Dacron aortic prostheses. However, the incidence of graft failure related to dilation is unknown because of insufficient data regarding the occurrence, degree, and prognostic significance of postoperative alterations in graft size. In 1979 we reported that postoperative ultrasonic examinations in 95 asymptomatic patients, selected at random after aortic surgery, revealed dilation of the aortic portion of knitted Dacron bifurcation grafts. The average follow-up was 33 months, and the mean dilation was 18%. This article provides the results of a later follow-up, averaging 175 months, in 32 patients from the 1979 study. CT scanning, rather than ultrasonic imaging, was used to evaluate all parts of the grafts. CT scans disclosed that the three parts of each graft dilated, but the parts did not always dilate uniformly. Mean percent dilation values for the entire series were aortic portion 67% +/- 38% SD; right limb 77% +/- 66% SD; left limb 54% +/- 26% SD. Maximum percent dilation for any part of the grafts ranged from 26% to 367% with a mean of 94%. At least one part of the grafts dilated 100% or greater in 12 patients. Three patients had generalized and saccular dilation of the aortic portion of the prostheses and an anastomotic aortic aneurysm; one patient had a localized aneurysm in the midportion of the right limb. Three of the latter grafts were replaced with woven Dacron prostheses.     

Clinically relevant suramin dosing regimen in mice with no effects against PC-3 prostate xenografts

The goal of these studies was to develop a suramin dosing schedule that would maintain suramin plasma concentrations in mice in the 150-250 mu g/ml range. A high pressure liquid chromatography method was used to determine suramin plasma concentrations in mice. For pharmacokinetic studies CD2F(1) mice were treated intraperitoneally with 140 mg/kg of suramin. These pharmacokinetic data were used to develop a clinically relevant dosing regimen. To test the efficacy of this dosing regimen, athymic nude mice were implanted orthotopically with PC-3 prostate carcinoma cells, randomized, and treated intraperitoneally. The pharmacokinetically derived dosing regimen resulted in no antitumor effect against PC-3 prostate tumors. Suramin plasma concentrations ranged from 155 to 258 mu g/ml over the 14-day therapy period with tumor concentrations in the 53-241 mu g/g wet weight range.