Influence of High BMI on Functional Outcome After Total Hip Arthroplasty

Background High body mass index (BMI) is associated with diseases of the hip joint and subsequent total hip arthroplasty (THA). Less is known about the effects of BMI on the functional postoperative status after THA in obese patients. The purpose of this study was therefore to quantify the role of high preoperative BMI on long-term pain status and functional outcome after THA. Methods In a multi-center cohort, study data of 20,553 primary THAs (18,968 patients) and 43,562 postoperative clinical examinations were analyzed for a follow-up period of up to 15 years. Patients were classified into three BMI groups (normal weight <25 kg/m², overweight 25 to <30 kg/m², and obese ≥30 kg/m²), and pain status and functional outcome were compared accordingly. Results High preoperative BMI is associated to an almost perfect dose–effect relationship with decreased ambulation during a follow-up period of 15 years, but pain relief of THA is equally efficient for all BMI groups. Conclusion Overweight and obesity are modifiable risk factors that may warrant physicians giving recommendations to patients before or after THA, to improve postoperative functional outcome quality.     

手术治疗髋关节后脱位合并股骨头与髋臼骨折的体会

目的：探讨髋关节后脱位合并股骨头与髋臼骨折的手术治疗效果与预后。方法：回顾性总结17例髋关节后脱位合并股骨头骨折与髋臼骨折患者的手术治疗经验。所有患者于伤后12h内行髋关节手法复位,并于术前通过CT定位,股骨头骨折采用切开复位可吸收螺钉内固定,髋臼骨折根据情况或予切除,或予钢板内固定。结果：17例患者术后6个月内所有骨折均骨性愈合,无股骨头坏死,按Modifie Daobigne and Postal临床分级标准评定关节功能恢复情况,优8例,良7例,可2例。优良率为88.2%。结论：髋关节后脱位伴股骨头骨折与髋臼骨折,采取手术治疗可获得较好的预后。     

Fascia iliaca compartment block performed by junior registrars as a supplement to pre-operative analgesia for patients with hip fracture

This study investigate the efficacy of pre-operative pain treatment for patients with hip fractures using fascia lliaca compartment block (FIB) technique performed by junior registrars (JR) as a supplement to conventional pain treatment. The FIB technique has routinely been used pre-operatively in the emergency department since 1 January 2004 for all patients with hip fractures. Over an 8-month period, 187 patients were treated. FIB was performed with 40 ml lidocaine and bubivacaine. A simple 5-step verbal pain score and maximal passive hip flexion was used as objective and subjective pain measurements. Effect of FIB was prospectively assessed on 70 patients: 2/3 females, mean age 80.7 (SD = 7.8), 36% in ASA-group III and IV (95% CI, 0.25–0.48). The median pain-free hip flexion pre-block was 15° (SD = 17) this improved to a median of 28° (SD = 21) 15 min post-block (P = 0.014) and 37° (SD = 26) 60 min post-block (P = 0.030). The median simple verbal pain score (0–4) pre-block was 2.2 (SD = 0.92). This decreased to a median of 1.5 (SD = 0.78) 15 min post-block (P < 0.001) and 1.3 (SD = 0.71) 60 min post-block (P = 0.021). No side-effects were observed. There was no correlation between the number of FIB previously performed by the attending registrar and the improved maximal hip flexion (ρ = 0.090, P = 0.50) or reduction in subjective pain score (ρ = 0.005, P = 0.971). FIB performed by JR is a feasible, efficient pre-operative supplement to conventional pain-treatment for patients with hip fractures. FIB is easy to perform, requires minimal introduction, no expensive equipment and is connected with a minimal risk approach.     

Construct validity of a 12-item WOMAC for assessment of femoro-acetabular impingement and osteoarthritis of the hip

OBJECTIVE: Evaluation of the internal construct validity of the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index adapted for use in patients with femoro-acetabular impingement (FAI) and osteoarthritis (OA) of the hip. METHODS: Distribution of a German version of WOMAC to patients upon first consultation. Patients with FAI [n=100, mean age 31.7 years, standard deviation (SD) 9.7] and OA (n=57, mean age 60.3 years, SD 11.7) and without comorbidities or prior hip surgery were included and compared to age- and gender-matched control population to FAI (n=200, mean age 32.6 years, SD 5.6). WOMAC data of 157 questionnaires were evaluated by Rasch analysis using RUMM2020 software. RESULTS: Summation of total WOMAC shows misfit to the Rasch model as well as multidimensionality. While the pain subset shows adequate fit and is unidimensional, item reduction is required to fit a unidimensional subset of functional items to the Rasch model. Summating the two fitting subsets yields again slight model misfit and multidimensionality requiring further item reduction. Finally, a 12-item version of the total WOMAC shows good model fit and unidimensionality, i.e., internal construct validity, for assessment of patients with FAI and OA without differential item functioning (DIF). A person separation index (PSI)=0.93 indicates a high internal consistency reliability for the 12-item subscale. Scores for FAI are significantly higher than control (P<0.001, effect size 0.71) and lower than OA group (P<0.001, effect size 0.45). Adequate statistical power is shown discriminating the three groups, therefore indicating some evidence also for external construct validity. CONCLUSIONS: The WOMAC as a total construct is multidimensional and summating the subsets into a total score is not valid. The reduced 12-item WOMAC is demonstrated to have internal construct validity for assessing patients with FAI and OA on the same scale and high internal consistency reliability. Discrimination of the groups with adequate statistical power also indicates external construct validity.     

Does the hip powder of Rosa canina (rosehip) reduce pain in osteoarthritis patients?--a meta-analysis of randomized controlled trials

OBJECTIVE: Meta-analysis of randomized controlled trials (RCTs) - of a hip powder of Rosa canina (rosehip) preparation for symptomatic treatment of osteoarthritis (OA), in order to estimate the empirical efficacy as a pain reducing compound. METHOD: RCTs from systematic searches were included if they explicitly stated that OA patients were randomized to either rosehip or placebo. The primary outcome was reduction in pain calculated as effect size (ES), defined as the standardized mean difference (SMD). As secondary analysis the number of responders to therapy was analyzed as Odds Ratios (OR), and expressed as the Number Needed to Treat (NNT). Restricted Maximum Likelihood (REML) methods were applied for the meta-analyses using mixed effects models. RESULTS: The three studies (287 patients and a median trial-duration of 3 months) - all supported by the manufacturer (Hyben-Vital International) - showed a reduction in pain scores by rosehip powder (145 patients) compared to placebo (142 patients): ES of 0.37 [95% confidence interval (CI): 0.13-0.60], P=0.002. Test for homogeneity seemed to support that the efficacy was consistent across trials (I(2)=0%). Thus it seems reasonable to assume that the three studies were measuring the same overall effect. It seemed twice as likely that a patient allocated to rosehip powder would respond to therapy, compared to placebo (OR=2.19; P=0.0009); corresponding to a NNT of six (95% CI: 4-13) patients. CONCLUSIONS: Although based on a sparse amount of data, the results of the present meta-analysis indicate that rosehip powder does reduce pain; accordingly it may be of interest as a nutraceutical, although its efficacy and safety need evaluation and independent replication in a future large-scale/long-term trial.     

Huntingtin interacting protein 1 can regulate neurogenesis in Drosophila

Huntington's disease (HD) is associated with a range of cellular consequences including selective neuronal death and decreased levels of neurogenesis. Ultimately, these altered processes are dependent upon proteins that interact with Huntingtin (Htt) such as the Huntingtin-interacting protein 1 (Hip1) which has a reduced binding preference to expanded Htt. These effects are similar to those observed with modified Notch signal transduction. As Hip1 plays a key role in endocytosis and intracellular transport, and activation of the Notch signal requires both, we investigated putative links between Hip1 and Notch signaling in flies. We have identified two forms of Hip1 that may be produced through the use of alternative first exons: a version of Hip1 with a lipid-binding ANTH domain and Hip1ΔANTH lacking this domain. The directed expression of Hip1 decreases, while expression of Hip1ΔANTH increases, the density of sensory microchaetae on the dorsal notum, a classical model of neurogenesis. A reduction in microchaetae density associated with Notch ^{Microchaetae Deficient (MCD)} ( N ^MCD ) alleles is sensitive to both Hip1 and Hip1ΔANTH levels, as are the bristle phenotypes generated by misexpression of deltex , a key mediator of Notch signaling. Genetic studies further demonstrate that the observed effects of Hip1 and of Hip1ΔANTH are sensitive to achaete gene dosage while insensitive to the levels of E(Spl) , suggesting a non-canonical Notch neurogenic signal through a deltex- dependent pathway. The novel role we describe for Hip1 in Notch-mediated neurogenesis provides a functional link between Notch signaling and proteins related to HD.     

Charcot's joint secondary to neurologic complications of epidural anaesthesia: a case report

Neurogenic arthropathy or Charcot's Joint is an articular pathology that can strike patient with neurological effects or can be the result of a neurological lesion with deficit of the superficial and deep sensitivity. In this article we introduce one case Charcot's Joint of the hip, caused by an epidural anaesthesia performed for a surgery of the other hip.     

Prostate postbrachytherapy seed distribution: comparison of high-resolution, contrast-enhanced, T1- and T2-weighted endorectal magnetic resonance imaging versus computed tomography: initial experience

PURPOSE: To compare contrast-enhanced, T1-weighted, three-dimensional magnetic resonance imaging (CEMR) and T2-weighted magnetic resonance imaging (T2MR) with computed tomography (CT) for prostate brachytherapy seed location for dosimetric calculations. METHODS AND MATERIALS: Postbrachytherapy prostate MRI was performed on a 1.5 Tesla unit with combined surface and endorectal coils in 13 patients. Both CEMR and T2MR used a section thickness of 3 mm. Spiral CT used a section thickness of 5 mm with a pitch factor of 1.5. All images were obtained in the transverse plane. Two readers using CT and MR imaging assessed brachytherapy seed distribution independently. The dependency of data read by both readers for a specific subject was assessed with a linear mixed effects model. RESULTS: The mean percentage (+/- standard deviation) values of the readers for seed detection and location are presented. Of 1205 implanted seeds, CEMR, T2MR, and CT detected 91.5% +/- 4.8%, 78.5% +/- 8.5%, and 96.1% +/- 2.3%, respectively, with 11.8% +/- 4.5%, 8.5% +/- 3.5%, 1.9% +/- 1.0% extracapsular, respectively. Assignment to periprostatic structures was not possible with CT. Periprostatic seed assignments for CEMR and T2MR, respectively, were as follows: neurovascular bundle, 3.5% +/- 1.6% and 2.1% +/- 0.9%; seminal vesicles, 0.9% +/- 1.8% and 0.3% +/- 0.7%; periurethral, 7.1% +/- 3.3% and 5.8% +/- 2.9%; penile bulb, 0.6% +/- 0.8% and 0.3% +/- 0.6%; Denonvillier's Fascia/rectal wall, 0.5% +/- 0.6% and 0%; and urinary bladder, 0.1% +/- 0.3% and 0%. Data dependency analysis showed statistical significance for the type of imaging but not for reader identification. CONCLUSION: Both enumeration and localization of implanted seeds are readily accomplished with CEMR. Calculations with MRI dosimetry do not require CT data. Dose determinations to specific extracapsular sites can be obtained with MRI but not with CT.     

Post-discharge symptomatic thromboembolic events in hip fracture patients

INTRODUCTION

The aim of this study was to audit referral rates for post-discharge symptomatic thromboembolic events follow-hip fracture surgery to assess the extent of the clinical problem and to initiate discussion on prolonged chemoprophylaxis.

PATIENTS AND METHODS

All patients who underwent surgery for proximal hip fractures in one year (2001–2002) were followed up. Patient case-notes were used to identify all morbidity episodes within 3 months following discharge. Patients with suspected symptomatic thromboembolic episodes were investigated to confirm the diagnoses objectively. Reasons for hospital readmission and causes of death were identified.

RESULTS

A total of 267 patients who underwent surgery for proximal hip fractures were included in the study. Forty-three patients died during initial admission episode. Of the 224 patients discharged, 46 (20.54%) patients were referred back to hospital within 3 months, for unplanned emergency management. Of these, 8 patients (3.57%) were referred back for suspected thromboembolic events. Of these, 6 (2.67%) were referred with a clinical diagnoses of deep vein thrombosis (DVT) but only 1 patient (0.45%) was confirmed to have DVT. Two patients (0.89%) were referred with features of pulmonary embolism (PE). Both were confirmed on ventilation-perfusion scans and both patients died. One patient died following PE in the community. Thus, overall, 3 deaths (1.34%) following discharge were recorded to be due to pulmonary embolism.

CONCLUSIONS

Suspected thromboembolic events constitute a major proportion of unplanned referrals back to the hospital. Three deaths due to delayed pulmonary embolism may justify prolonged universal chemoprophylaxis following hip fracture surgery.