Muscle atrophy and metal-on-metal hip implants

Background and purpose — Muscle atrophy is seen in patients with metal-on-metal (MOM) hip implants, probably because of inflammatory destruction of the musculo-tendon junction. However, like pseudotumors, it is unclear when atrophy occurs and whether it progresses with time. Our objective was to determine whether muscle atrophy associated with MOM hip implants progresses with time.

Patients and methods — We retrospectively reviewed 74 hips in 56 patients (32 of them women) using serial MRI. Median age was 59 (23–83) years. The median time post-implantation was 83 (35–142) months, and the median interval between scans was 11 months. Hip muscles were scored using the Pfirrmann system. The mean scores for muscle atrophy were compared between the first and second MRI scans. Blood cobalt and chromium concentrations were determined.

Results — The median blood cobalt was 6.84 (0.24–90) ppb and median chromium level was 4.42 (0.20–45) ppb. The median Oxford hip score was 34 (5–48). The change in the gluteus minimus mean atrophy score between first and second MRI was 0.12 (p = 0.002). Mean change in the gluteus medius posterior portion (unaffected by surgical approach) was 0.08 (p = 0.01) and mean change in the inferior portion was 0.10 (p = 0.05). Mean pseudotumor grade increased by 0.18 (p = 0.02).

Interpretation — Worsening muscle atrophy and worsening pseudotumor grade occur over a 1-year period in a substantial proportion of patients with MOM hip implants. Serial MRI helps to identify those patients who are at risk of developing worsening soft-tissue pathology. These patients should be considered for revision surgery before irreversible muscle destruction occurs.     

Prevalence and Associated Factors of Suicidal Ideation and Attempt among Prisoners in Ethiopia: A cross-sectional study

BackgroundSuicide is a serious cause of mortality worldwide and the single most common cause of death in the prison population. Studies on suicidal ideation and attempt among prison people in Ethiopia are limited. Therefore, the objective of this study was to assess the prevalence and associated factors of suicidal ideation and attempt among prisoners in Debre Markos Correctional Center, northwest, Ethiopia, 2019.MethodAn institution-based cross-sectional study was conducted using the simple random sampling technique; a total of 640 participants was recruited. Suicidal ideation and attempts were assessed using the suicidality module of the World Mental Health (WMH) survey initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI).ResultsThe prevalence of suicidal ideation and attempt were 21.9% and 13.1% with 95% CI (18.40, 25.20) and (10.60, 15.80) respectively. The study revealed that female sex (AOR=2.60, 95%CI: 1.39, 8.20) and family history of mental illness (AOR=2.08, 95%CI: 1.11, 3.90) were significantly associated with both suicidal ideation and attempt. Whereas divorced/widowed (AOR=3.67, 95%CI: 2.05, 6.58), common mental disorder (AOR=1.98, 95%CI: 1.25, 3.16) and poor social support (AOR=2.68, 95%CI: 1.42, 5.06) were statistically associated with suicidal ideation, and previous incarceration (AOR=2.38, 95%CI: 1.20, 5.16) was significantly associated with a suicide attempt.ConclusionThe result shows that the prevalence of suicidal ideation and attempt were serious problems among prisoners. As a result, inmate people need greater attention and interventions for suicidal behaviors.     

Clinical significance of corrosion of cemented femoral stems in metal-on-metal hips: a retrieval study

Purpose

The clinical significance of corrosion of cemented femoral stems is unclear. The purpose of this retrieval study was to: (1) report on corrosion at the stem-cement interface and (2) correlate these findings with clinical data.

Methods

We analysed cemented stems (n?=?36) composed of cobalt-chromium (CoCr) and stainless steel (SS) in a series of revised metal-on-metal hips. We performed detailed inspection of each stem to assess the severity of corrosion at the stem-cement interface using a scale of 1 (low) to 5 (severe). We assessed the severity of corrosion at each stem trunnion and measured wear rates at the head taper and bearing surfaces. We used non-parametric tests to determine the significance of differences between the CoCr and SS stems in relation to: (1) pre-revision whole blood Co and Cr metal ion levels, (2) trunnion corrosion, (3) bearing surface wear and (4) taper material loss.

Results

The corrosion scores of CoCr stems were significantly greater than SS stems (p?<?0.01). Virtually all stem trunnions in both alloy groups had minimal evidence of corrosion. The median pre-revision Co levels of implants with CoCr stems were significantly greater than the SS stems (p?<?0.01). There was no significant difference in relation to pre-revision Cr levels (p?=?0.521). There was no significant difference between the two stem types in relation to bearing wear (p?=?0.926) or taper wear (p?=?0.148).

Conclusions

Severe corrosion of cemented femoral stems is a common finding at our retrieval centre; surgeons should consider corrosion of CoCr stems as a potential source of metal ions when revising a hip.

     

Hemorrhagic cholecystitis with auto-avulsion

Acute cholecystitis is a common condition, with varying presentations and complications, and is frequently treated in the emergency department. This case report illustrates hemorrhagic cholecystitis (HC) as a rare complication of cholecystitis. A 74-year-old woman presented to our emergency department with intermittent abdominal discomfort and continued vomiting after any oral ingestion as well as watery diarrhea. Patient history included mitral valve replacement and a daily dose of warfarin. Emergent cross-sectional abdominopelvic computed tomography (CT) and magnetic resonance imaging (MRI) revealed a large mass that occupied most of the right abdominal cavity. An exploratory laparotomy revealed a necrotizing and hemorrhagic enlarged gallbladder with cholelithiasis. This enlargement appeared adherent and fistulizing into the cecum, without signs of bowel perforation. The postoperative period was uneventful, and the patient recovered well. Owing to its non-specific presentation, imaging studies are essential in establishing a diagnosis for HC. Although CT has not been advocated as a primary imaging examination for acute right upper quadrant pain, it is a valuable tool for assessing HC, along with MRI.     

Knowledge,attitude, and practice towards blood donation among health care providers in hospitals at Bahir Dar City,Ethiopia

Like other sub-Saharan Africa, in Ethiopia there is a shortage of adequate and safe blood supplies. Health care providers are potential resource and promoter of voluntary blood donation. This study was conducted to determine the knowledge, attitude and practice towards blood donation among health care providers in Bahir Dar City, Ethiopia. Paper based questionnaire was distributed to 276 health care providers from May 01 to June 30, 2016. Overall, 42.8% had donated blood at least once. Of these, males accounted for 60%. The median age of blood donors was 26 years. Voluntary-unpaid donation was 21.2%. Overall, 75.5% health care providers were knowledgeable. The levels of knowledge were significantly different among different disciplines (One-way ANOVA; F = 69.7; P = 0.004). Males were more knowledgeable than females (P < 0.05). The overall favorable attitude was 78.6%. Previous practice of blood donation determined the odds of favorable attitude to be a future regular voluntary-unpaid blood donor (OR: 5.7, 95% CI: 3.2–10.4). Majority of health care providers had adequate knowledge and favorable attitude. However, voluntary-unpaid donation practice (21.1%) was lower compared to 100% target of voluntary-unpaid donation. There should be motivation packages to enhance voluntary-unpaid blood donation among health care professionals.     

Postero-medial approach for complex tibial plateau injuries with a postero-medial or postero-lateral shear fragment

This study demonstrates the utility of a modified postero-medial surgical approach to the knee in treating a series of patients with complex tibial plateau injuries with associated postero-medial and postero-lateral shear fractures. Posterior coronal shear fractures are underappreciated and their clinical relevance has recently been characterised. Less-invasive surgery and indirect reduction techniques are inadequate for treating these coronal plane fractures.     

Factors Associated With Trunnionosis in the Metal-on-Metal Pinnacle Hip

Background

Trunnionosis of the tapered head-stem junction of total hip arthroplasties, either through corrosion or mechanical wear, has been implicated in early implant failure. Retrieval analysis of large numbers of failed implants can help us better understand the factors that influence damage at this interface.

Management of metal-on-metal hip implant patients: Who,when and how to revise?

The debate on how best to manage patients with metal-on-metal(MOM) hip implants continues. With over 1 million patients affected worldwide, the impact is far reaching. The majority of the aggressive failures of MOM hip implants have been dealt with by revision hip surgery, leaving patients with a much more indolent pattern of failure of devices that have been in situ for more than 10 years. The longer-term outcome for such patients remains unknown, and much debate exists on how best to manage these patients. Regulatory guidance is available but remains open to interpretation due to the lack of current evidence and long-term studies. Metal ion thresholds for concern have been suggested at 7 ppb for hip resurfacing arthroplasty and below this level for large diameter total hip arthroplasties. Soft tissue changes including pseudotumours and muscle atrophy have been shown to progress, but this is not consistent. New advanced imaging techniques are helping to diagnose complications with metal hips and the reasons for failure, however these are not widely available. This has led to some centres to tackle difficult cases through multidisciplinary collaboration, for both surgical management decisions and also follow-up decisions. We summarise current evidence and consider who is at risk, when revision should be undertaken and how patients should be managed.