Birmingham hip resurfacing: a systematic review of outcomes at minimum 10-years follow-up.

Although controversy surrounding the use of metal-on-metal (MoM) arthroplasty implants continues to exist, satisfactory clinical and radiological outcomes have been reported following Birmingham Hip Resurfacing (BHR) at long-term follow-up, leading to an Orthopaedic Data Evaluation Panel (ODEP) rating of 13A. The purpose of this study was to systematically review the literature to evaluate the functional outcomes, radiological outcomes and revision rates following BHR at a minimum of 10 years follow-up. Using the PRISMA guidelines, two independent reviewers performed a literature search using Pubmed, Embase and Scopus databases. Only studies reporting on outcomes of BHR with a minimum of 10 years' follow-up were considered for inclusion. A total of 12 studies including 7132 hips (64.8% males), with mean follow-up of 11.5 years (10-15.3), met our inclusion criteria. Of included patients, 94.3% of patient underwent BHR for osteoarthritis at a mean age was 52.0 years (48-52). At final follow-up, 96% of patients reported being satisfied with their BHR, with mean Harris Hip Scores of 93.6 and Oxford Hip Scores of 16.5. Rates of radiological femoral neck narrowing of greater than 10% and non-progressive radiological loosening were reported as 2.0% and 3.8% respectively. At final follow-up, the overall revision rate was 4.9% (334/7132), deep infection rate was 0.4%, metal allergy/insensitivity rate was 1.6%, metal reaction rate was 0.3%, rate of peri-prosthetic fracture was 0.9% and aseptic loosening rates were 1.6%. This systematic review demonstrates that BHR results in satisfactory clinical outcomes, acceptable implant survivorship, low complication rates and modest surgical revision rates in the long-term at minimum 10-year follow-up.

Trends in fractures and fatalities of farmyard injuries in Ireland: a 10 year analysis.

The farming and agricultural sector remains one of Ireland's primary industries. Fatality rates remain higher than the European average. The aim of this study was to analyze the national trend in hospital in-patient admissions for farmyard related fractures and related fatalities in Ireland from 2005 to 2014. Relevant socioeconomic trends were used for comparison. There were 2,064 farm-related fractures and 187 fatalities recorded over the same period. Despite a decrease in incidence of farmyard fractures over 2005-2014, fatality rates have increased indicating the alarming continued occupational hazards and severity of sustained injuries.

Diathermy versus scalpel incisions for hemiarthroplasty for hip fracture: a randomised prospective trial.

As the age profile of our population expands, we can expect subsequent increase in patients presenting with intracapsular fracture. The onus remains on the surgeon to make all reasonable efforts to find new and innovative means of reducing associated morbidity and mortality of the treatment of these injuries. This challenge is particularly relevant in the elderly and in patients with multiple co-morbidities. In this study, 100 patients were randomly allocated into two groups. One group had dissection to the level of the hip joint under direct diathermy control; the other group had dissection using a scalpel with supplementary electrocautery. Intraoperative total blood loss prior to dissection of the abductors was measured by collecting blood using wound swabs using a local protocol and results were statistically analysed using PROC GLM SAS. We demonstrate a clear advantage in the use of diathermy to create a hip incision showing a significant reduction in wound-related blood loss and a reduction, whilst not statistically significant, in total operative blood loss using diathermy incision. Larger randomised prospective trials are necessary to study the effects of this intervention in a larger patient population so that these end-points can be adequately assessed.

Coracoid impingement syndrome: a treatable cause of anterior shoulder pain.

BACKGROUND: Coracoid Impingement Syndrome is a relatively uncommon but generally treatable cause of anterior shoulder pain that can be easily overlooked. It typically presents with anterior shoulder joint pain in activities involving forward flexion, adduction and internal rotation. AIMS: To assess the outcome of a cohort of patients diagnosed with Coracoid Impingement Syndrome. METHODS: Patients were investigated clinically and radiologically. They received appropriate therapeutic measures and were followed-up in an orthopaedic outpatient setting. RESULTS: Twelve patients were identified over a four-year period. All patients have made good progress. Thus far, none have needed operative intervention for symptom relief. CONCLUSION: Coracoid impingement syndrome is an uncommon cause of anterior shoulder pain but diagnosed patients can expect good symptomatic relief following referral to a dedicated shoulder unit. An increase in clinical awareness of the condition may prevent undue diagnostic delay in such cases.

Comparison of a local injection of hyperosmolar glucose solution with salpingostomy for the conservative treatment of tubal pregnancy.

OBJECTIVE: To compare a local injection of hyperosmolar glucose and salpingostomy for the laparoscopic treatment of tubal pregnancy in terms of immediate success and postoperative tubal patency. DESIGN: Prospective. PATIENTS, SETTING: Forty women with an unruptured tubal pregnancy were enrolled from among 117 women with ectopic pregnancies (EPs) admitted consecutively to the university clinic. The inclusion criteria were as follows: [1] concentration of beta-hCG in the serum < or = 5,000 IU/L; [2] no living fetus in the EP; and [3] unruptured tubal pregnancy at laparoscopy. INTERVENTIONS: After randomization, 20 of these patients were treated with a local injection of hyperosmolar (50%) glucose solution and 20 women by salpingostomy. Tubal patency was evaluated at relaparoscopy or by hysterosalpingography 6 to 13 months after the primary treatment. RESULTS: The mean decrease in beta-hCG concentration from the preoperative value to the first postoperative day was 37% and 52% in the glucose and salpingostomy groups, respectively, and the mean resolution time was 13 and 12 days, respectively. Human chorionic gonadotropin showed a persistent EP in 4 women (20%) in the glucose group and 2 (10%) in the salpingostomy group. A patent treated tube was found in 9 of 13 women in the glucose group and 9 of 10 in the salpingostomy group at re-examination. During a follow-up of 6 to 20 months 4 women in the glucose group and 4 women in the salpingostomy group had an intrauterine pregnancy. CONCLUSION: A local injection of hyperosmolar glucose is a reasonable method treating tubal pregnancy in selected cases but does not seem to offer any advantage over salpingostomy concerning persistent trophoblastic disease rate.

Serum levels of 3-keto-desogestrel after oral administration of desogestrel and 3-keto-desogestrel.

In a cross-over study with orally administered desogestrel (0.150 mg) plus ethinyloestradiol (0.030 mg) and 3-keto-desogestrel (0.150 mg) plus ethinyloestradiol (0.030 mg) in ten women under steady-state conditions, the serum levels of 3-keto-desogestrel were monitored by radioimmunoassay. No statistically significant differences between treatment groups were found with respect to the areas under the curve of the serum levels versus time (AUC), peak heights and peak times. The individual AUCs for 3-keto-desogestrel after dosing with desogestrel (plus EE) or 3-keto-desogestrel (plus EE) show a similar degree of variation. The biotransformation of desogestrel into 3-keto-desogestrel is rapid and appears not to be limited by the metabolic capacity of the normal liver.

Strain on the human sciatic nerve in vivo during movement of the hip and knee.

Injuries to the sciatic nerve are an occasional complication of surgery to the hip and acetabulum, and traction is frequently the causative mechanism. In vitro and animal experiments have shown that increased tensile strain on peripheral nerves, when applied for prolonged periods, impairs nerve function. We have used video-extensometry to measure strain on the human sciatic nerve during total hip replacement (THR). Ten consecutive patients with a mean age of 72 years undergoing primary THR by the posterior approach were recruited, and strains in the sciatic nerve were measured in different combinations of flexion and extension of the hip and knee, before dislocation of the hip. Significant increases (p = 0.02) in strain in the sciatic nerve were observed in flexion of the hip and extension of the knee. The mean increase was 26% (19% to 30%). In animal studies increases of this magnitude have been shown to impair electrophysiological function in peripheral nerves. Our results suggest that excessive flexion of the hip and extension of the knee should be avoided during THR.

Effects of desogestrel, levonorgestrel and lynestrenol on serum sex hormone binding globulin, cortisol binding globulin, ceruloplasmin and HDL-cholesterol.

The effects of 0.125 mg daily doses of the new progestagen, desogestrel, 0.125 mg of levonorgestrel or 5 mg of lynestrenol on serum sex hormone binding globulin (SHBG), cortisol binding globulin (CBG), ceruloplasmin and HDL-cholesterol were studied in 30 healthy female volunteers to compare the possible androgenic and oestrogenic effects of these contraceptive steroids in vivo. All the progestagens in the applied dosages decreased SHBG and HDL-cholesterol concentrations, suggesting some androgenicity. Lynestrenol increased ceruloplasmin and CBG concentrations, indicating weak oestrogenic effects of the steroid. During desogestrel treatments, CBG and ceruloplasmin concentrations remained unchanged. After 30 days treatment with levonorgestrel there was a slight decrease (P less than 0.05) in ceruloplasmin concentrations. Thirty days after finishing the progestagen treatments serum protein concentrations were normal. In conclusion, at the doses used and under the present test conditions the progestagens studied had a weak androgen-like effect and lynestrenol also showed weak oestrogenic activity, as determined by their effects on serum proteins.

Effect of suprapubic operation on urethral closure. Evaluation by single cough urethrocystometry.

To evaluate urodynamic effects of modified Burch colposuspension, 24 patients with stress urinary incontinence were investigated before and 6 to 9 months after the operation. A new method of urodynamic evaluation was performed using a multitransducer-catheter, 5 microtransducers inside the urethra and 1 in the bladder, connected to a computer and graphic plotter. Single coughs were analysed with the catheter in a fixed position and the patient in the standing position. The operation, which was successful, in all but 1 patient, did not alter urethral pressure at rest, but urethral closure pressure at stress after the operation (mean 45.0 cm H2O (SD 21.6) was significantly higher (P less than 0.005) than the -3.6 cm H2O (SD 10.2) recorded before the operation. The pressure transmission ratio was less than 100% in 22 patients before the operation and more than 100% in 18 patients afterwards, the pre- and post-operative mean values being 78.9% (SD 11.9) and 109.5% (SD 17.2) respectively (P less than 0.0005). Burch colposuspension markedly improves urethral closure function as evaluated by this method, which analyses the pressure data at different points of the urethra and bladder during one single cough.

Colposuspension and transvaginal bladder neck suspension in the treatment of stress incontinence.

The present work was performed to evaluate the clinical usefulness of colposuspension in stress urinary incontinence without uterovaginal descent and bladder neck suspension in cases with uterovaginal descent. Modified Burch colposuspension was performed in 29 patients and modified Raz bladder neck suspension in 19 patients. The patients were examined clinically and urodynamically before and 8-12 months after operation. All patients in the colposuspension group regarded themselves as being totally continent postoperatively. In the bladder neck suspension group the respective figure was 58%, plus 21% showing improvement and 21% failures. Urodynamically, the cure rates (positive urethral closure pressure at stress) were 100% for colposuspension and 79% for bladder neck suspension. After colposuspension the urethral closure pressure at stress and the pressure transmission ratio were significantly increased whereas successful bladder neck suspension increased only urethral closure pressure at stress. The failed bladder neck suspensions did not induce any urodynamic changes. The present data confirms that Burch colposuspension is effective in stress urinary incontinence in women without simultaneous uterovaginal descent, whereas bladder neck suspension by the modified Raz technique did not appear to be optimal for the treatment of stress incontinence in patients with uterovaginal descent.

Short-term effects of desogestrel and ethinyloestradiol on serum proteins in women.

The effects of the new progestagen desogestrel on the changes induced by ethinyloestradiol (EE) on the serum levels of sex hormone binding globulin (SHBG), transcortin, ceruloplasmin and haptoglobin were studied in healthy female volunteers. Desogestrel (0.125 mg or 0.250 mg) administered in combination with 0.050 mg EE was compared with 0.050 mg EE alone. After 7 and 14 days the three regimens induced similar changes in the serum levels of transcortin, ceruloplasmin and haptoglobin. Desogestrel at a dose level used in oral contraceptives did not inhibit the EE-induced increase in SHBG capacity while its influence on this parameter at twice the clinical dosage (0.250 mg) used was still minor. It can be concluded that with respect to the parameters studied desogestrel in the clinical dosage used has no detectable oestrogenic or androgenic effect.

Successful colposuspension in stress urinary incontinence reduces bladder neck mobility and increases pressure transmission to the urethra.

Twenty-nine consecutive patients with stress urinary incontinence were investigated by bead chain urethrocystography (UCG) and single cough urethrocystometry before operation and 8-12 months after a Burch colposuspension producing clinical improvement. The operation significantly elevated the bladder neck and reduced its mobility during acute stress. The urethral inclination angle and the posterior urethrovesical angle also became smaller at rest and on straining. A significant negative correlation was found between the postoperative mobility of the bladder neck and the post-operative pressure transmission ratio (PTR), indicating that correction of the urethrovesical anatomical disorder eliminates the functional disorder in this disease and restores continence.

Intravesical prostaglandin F2 for promoting bladder emptying after surgery for female stress incontinence.

Prostaglandin F2 alpha 10 mg was administered intravesically in a double-blind placebo-controlled study to promote micturition in cases of urinary retention after operative treatment of urinary stress incontinence in women. Fifteen of 18 patients (83%) succeeded in voiding after treatment with prostaglandin F2 alpha, but the placebo was ineffective in all 18 patients (P less than 0.001). Although the effect of prostaglandin F2 alpha on bladder muscle contraction was short-lived, it seemed to enhance the restoration of bladder motor function with no serious side effects, and thus to be clinically useful in the treatment of post-operative urinary retention.

Tibial shaft fractures in amateur footballers.

BACKGROUND: Footballers constitute a unique group of patients with tibial shaft fractures. They tend to have excellent general health and well developed musculature in the leg, and their fractures are generally closed injuries caused by low velocity trauma. However, little has been reported on the outcome after tibial shaft fractures in this group. OBJECTIVE: To identify patterns of injury, response to treatment, and functional outcome in such a group. METHOD: Fifty consecutive tibial shaft fractures in adult footballers treated at Merlin Park Regional Hospital over a five year period were analysed. RESULTS: Most of the fractures were type A injuries (AO/ASIF classification). The incidence of complications was low. All patients reported good or excellent satisfaction with their outcome. However, only 54% of patients returned to playing competitive football. CONCLUSION: Tibial shaft fractures in amateur footballers are associated with good results when traditional outcome criteria are used, but many patients do not regain their previous level of function.

Fetal heart rate patterns and uterine activity after segmental epidural analgesia.

The effects of low-dose segmental epidural analgesia on fetal heart rate (FHR) patterns, uterine activity, and some clinical features were examined in a series of 105 normal parturients. The aim of the analgesic technique was to relieve pain during the first stage of labour by blocking the sensory nerve fibres at the spinal level of T 10 to T12, with either 0-5 per cent bupivacaine or bupivacaine with adrenaline 1 : 200 000, the dose varying from 10 to 25 mg. Obvious pathological changes (late decelerations, prolonged fetal bradycardia, variable deceleration, or loss of beat to beat variation) in FHR patterns within the first 30 minutes after the beginning of analgesia were noted in 9 per cent of the patients. Addition of adrenaline to the analgesic agent seemed to reduce uterine activity for 60 minutes after the analgesia and this was reflected in a longer interval between the block and delivery. A 25 per cent fall in systolic blood pressure was recorded in 11 per cent of the patients. Nine patients required vacuum extractions. Our results show that the epidural technique employed has distinct advantages over the previous methods, which require larger doses of the analgesic, agent, and is therefore safer for the fetus; the addition of adrenaline to the analgesic agent is contraindicated.

The surgical treatment of hyperparathyroidism: a regional hospital experience.

Parathyroidectomy is an established surgical treatment for symptomatic hyperparathyroidism. In this regional hospital experience, 50 patients who had undergone a parathyroidectomy were looked at. We examined clinical indications and noted trends for hypertension, neuromuscular symptomatology and psychiatric complaints to occur commonly as presenting symptoms. Operative results and histology results are examined and correlated. Particular note is made of any postoperative complications.

Traumatic dislocation of hip joint following low-velocity trauma, similarities to glenohumeral instability.

Acute posterior hip dislocation following low velocity trauma in a young healthy adult is a rare injury. Almost 30 cases previously have been described in the literature. They are usually associated with prior trauma to the hip joint and will lead to recurrent instability after relocation. This injury is similar to shoulder instability: lesions and anomalies present in the hip joint with posterior instability are identical to the ones in the shoulder with instability. These are Bankart-like lesion of the posterior labrum, defect in ischiofemoral ligament similar to inferior glenohumeral ligament laxity of the shoulder, relative retroversion of femoral neck angle similar to loss of retroversion of the humeral neck and, finally, Pipkin type 1 fracture of the femoral head resembling a Hill-Sachs lesion of the humeral head. Successful treatment of this injury depends on addressing these pathologies. We present three cases of acute posterior hip dislocation in young adults after low-energy trauma, which presented to our unit over a 4-year period, and a review of another 21 cases of similar injury previously described in the literature. We will demonstrate these lesions and discuss the investigation and treatment modalities for posterior instability of the hip joint. We conclude that hip dislocation caused by low-energy trauma must be investigated and treated to avoid recurrence of dislocation and associated complications.

Intervillous blood flow in normal and complicated late pregnancy measured by means of an intravenous 133Xe method.

Intervillous blood flow (IVBF) was measured intravenously with a new quantitative 133Xe method in 50 normal and 74 complicated late pregnancies between the 35th and 42nd weeks. The distribution of individual flow rates seemed to be fairly wide in both the normal and the pathological groups. The mean rate of IVBF in normal pregnancies was 140 ml/100 ml of intervillous space/min. The lowest mean flow values were observed in pregnancies complicated by diabetes mellitus (class B-E), cholestasis of pregnancy and severe pre-eclampsia, a highly significant difference (p less than 0.001) from the mean IVBF observed in normal pregnancies. The significance of the results in the different groups has been discussed in detail. This method may open up a new diagnostic area in the management of high-risk pregnancies.