Diagnostic accuracy of magnetic resonance imaging and magnetic resonance arthrography of the hip is dependent on specialist training of the radiologist.

OBJECTIVE: Significant differences between magnetic resonance imaging reports and intraoperative findings at the time of hip arthroscopy were documented in our practice. We sought to examine the accuracy of radiological reporting of hip pathology based on the training level of the reporting radiologist. MATERIALS AND METHODS: A retrospective review of hip arthroscopies carried out between July 2008 and June 2009 identified 61 cases where original MRI scans had been reported by general community radiologists. These scans were then reviewed by musculoskeletal specialist radiologists who were blinded to both the original report and the surgical findings. Accuracy of both subsets of radiologists was compared to arthroscopic findings with regard to labral, acetabular, femoral and impingement lesions. RESULTS: Musculoskeletal radiologists performed better than community radiologists in terms of overall accuracy. Accuracy rates for MSK radiologists were 85, 79, 59, and 82% for labral, acetabular chondrosis, and femoral chondrosis and impingement lesions, respectively. Whereas accuracy rates for community radiologists were 70, 28, 52, and 59% (p values = 0.08, <0.001, 0.59, <0.001). Accuracy was significantly improved for both groups of radiologists when MR arthrograms were reviewed rather than conventional MRIs. CONCLUSIONS: This study establishes the relationship between accuracy of reporting and the training level of the performing radiologists.

Acetabular labral tears following pregnancy.

Acetabular labral tears are usually seen in individuals in whom the hip is exposed to elevated axial and torsional forces. In our experience we have encountered a series of female patients in whom symptom onset was during pregnancy or obstetric labour. We reviewed our patient database to identify all patients who had undergone hip arthroscopy in our hospital. The records of female patients who had a labral tear on arthroscopy and in whom symptom onset was clearly documented to be during pregnancy or labour were identified. We report three cases of acetabular labral tear occurring during pregnancy or labour. This represents 7% of all female patients undergoing hip arthroscopy during a two-year period. Ligamentous laxity and altered cartilage matrix during pregnancy may predispose to acetabular labral injury. Clinicians need to be aware of this possible intra-articular lesion in peripartum patients presenting with hip or buttock pain, and manage appropriately.

Analgesic control after hip arthroscopy: a randomised, double-blinded trial comparing portal with intra-articular infiltration of bupivacaine.

The optimum anaesthetic and analgesic management following hip arthroscopy is yet to be determined. There is, in addition, some concern over the use of intraarticular local anaesthetic. We compared the analgesic efficacy of intra-articular infiltration compared with portal infiltration of bupivacaine following hip arthroscopy. Patients were randomised to receive either 10 ml of 0.25% bupivacaine either into the joint or around the portal sites following completion of surgery. 73 patients were recruited (40 intra-articular). The portal infiltration group required significantly more rescue analgesia immediately after surgery (2.33 mg vs.0.57 mg, p=0.036). Visual Analogue Scale pain scores were not significantly different at 1 and 2 hours following surgery, but at 6 hours the portal group had significantly lower VAS scores (p=0.0036). We believe that the initial pain following surgery results from capsular injury and this explains the need for more rescue analgesia in the portal infiltration group. Further work is needed to establish the ideal regimen. A combination of portal and intra-articular infiltration may be the most efficacious.

Cow-related trauma: a 10-year review of injuries admitted to a single institution.

INTRODUCTION: Bovine-related injuries to farmers are common in rural communities. Many injuries are significant requiring hospital admission and surgery. We reviewed all cattle-related injuries admitted to a regional trauma centre over 10 years and detail the nature of the injuries. METHOD: A retrospective review was undertaken, using hospital inpatient coding system (HIPE) to identify patients admitted following cow-related trauma for the last 10 years. From retrieved charts mechanism of injury was identified, demographics recorded and Injury Severity Score (ISS) and Trauma Injury Severity Score (TRISS) calculated based on the injuries sustained. RESULTS: 47 patients were identified, with a median age of 53 years. 4 injuries occurred in children, and 12 in patients over 65 years old. Three-quarters of those injured were male. Kicking was the most common mechanism of injury (n=21), but charge/head-butt injuries and trampling injuries were associated with more serious injury scores. 72% of patients were admitted under Orthopaedics as their primary care team, 25% under General Surgeons, with one patient admitted medically. Mean ISS score was 6.9 (range 1-50). 41 operative interventions were performed on 30 patients during their admission. 6.3% of patients required admission to Intensive Care with a mean length of stay of 12.3 days (range 2-21 days). There was no mortality. CONCLUSION: Cow-related trauma is a common among farming communities and is a potentially serious mechanism of injury that appears to be under-reported in a hospital context. Bovine-related head-butt and trampling injuries should be considered akin to high-velocity trauma.