An Intraoperative Technique to Assess Tissue Tension and Leg Length When Aligning the Hip Centre of Rotation With the Acetabulum in Hip Arthroplasties.

Hip arthroplasties are cost-effective procedures; however, instability and leg length discrepancy are common complications that can lead to higher revision rates and patient dissatisfaction. Preoperative planning aids surgeons in choosing the right offset and neck length before surgery. Nonetheless, intraoperative measures are still necessary due to the differences dictated by the surgical procedure. Several hip trials might be needed to reach the optimum choice of implants. We have introduced a technique that utilizes the trunnion as a reference point to the hip centre of rotation, matching it with the acetabulum centre of rotation after applying the necessary soft tissue tension. This serves as a proximal reference point. Using the trunnion, as opposed to the trial head, allows for a better assessment of tissue tension within the acetabular void, avoiding constraints imposed by the applied trial head. Additionally, determining the acetabulum's centre of rotation is challenging if obscured by the trial head. Matching the two tibial tuberosities indicates the correct leg length, serving as the distal reference point. Both reference points should be considered together to select the right neck length and offset for optimal tissue tension. This technique has been tested on hip arthroplasty patients over five years. All hip surgeons who used this technique agree that it gives a better representation of the tissue tension, easing the challenges when preparing the acetabulum as well as reducing the need for multiple trials.

Extended proximal femoral osteotomy: technical tip.

Extended proximal femoral osteotomy is a well-established technique in complex primary and revision hip surgery. It is commonly indicated for extraction of well-fixed femoral components either cemented or uncemented. Some of the problems encountered during this procedure are gaining an accurate reduction in the osteotomized fragment and a stable reduction and fixation. Here, we present a modification to the standard surgical technique which aids in anatomical reduction and enhances the stability of the reduced fragment. We make the distal transverse cut oblique rather than vertical. This modification allows for a more stable and anatomical reduction in the osteotomy. Our experience with this modified technique demonstrated 100 % union of the osteotomy.

Posterior dislocation of the sternoclavicular joint in a young rugby player.

Posterior dislocation of the sternoclavicular joint is a well-reported condition, but can be overlooked as it is difficult to diagnose. We present the case of a 17-year-old male rugby player in which the diagnosis was not recognised at his initial presentation.

Sporting and physical activity following hip resurfacing.

The aim of this study was to assess sporting and physical activities in patients who had undergone hip resurfacing. Our study included 117 patients who underwent hip resurfacing between 2003 and 2008. University of California at Los Angeles (UCLA) activity level and Oxford hip scores (OHS) were used. Sporting and physical activities of all patients were analysed pre- and postoperatively. The mean age at surgery was 54 years. The mean follow up was 30 months. There was statistically significant improvement in UCLA activity scores from 4.4 to 6.8 (p < 0.05) and Oxford hip scores from 43.4 to 17.7 following surgery. Eighty-seven percent of patients continued to take part in sporting activities following hip resurfacing. Our study has demonstrated that hip resurfacing can allow patients to remain extremely active.

Resurfacing and uncemented arthroplasty for young hip arthritis: functional outcomes at 5 years.

The management of osteoarthritis of the hip in young active patients is challenging. We compared the functional outcomes and activity levels following hip resurfacing and uncemented THA in young active patients matched for age, gender and activity levels. Mean follow-up period was five years (4-7 years). Within each group there was a statistically significant improvement in the mean University of California at Los Angeles (UCLA) and Oxford Hip Score (OHS) scores following surgery. This study found no statistically significant difference in the levels of function (p= 0.82) or activity pursued (p= 0.60) after surgery between uncemented THA and hip resurfacing. The potential complications unique to hip resurfacing may be avoided by the use of uncemented THA which in itself has longer follow-up compared to resurfacing.

Late instability of bilateral metal on metal hip resurfacings due to progressive local tissue effects.

Reports have emerged of local debris consisting of metal particles, with the development of pseudotumours, pelvic masses, lymphocytic perivascular infiltration of tissue around the implant and a neo-capsule tissue reaction in metal on metal (MoM) hip arthroplasty. Steeply-inclined acetabular components a large abduction angle of more than 55 degrees along with a combination of small size component are likely to give rise to higher levels of metal ions. This report describes a case of localised tissue destruction of abductor muscle probably due to the metal debris causing late onset subluxation/dislocation of a hip resurfacing. Late instability of hip resurfacing should raise concerns relating to possible local tissue reaction and muscle damage, and early revision may be recommended.

Preadolescent presentation of a lumbar chordoma: results of vertebrectomy and fibula strut graft reconstruction at 8 years.

Chordoma is a tumour of notochordal origin which usually involves the sacrum or skull base presenting in adulthood. Chordoma in a mobile spinal segment is infrequent and the authors report an extremely rare presentation of L3 chordoma in a child aged 7 years. Although a benign tumour, mobile segment chordoma is more locally aggressive, more likely to metastasise and has a poorer 5 year survival than sacral and clival lesions. Wide surgical excision and reconstruction is the treatment of choice in vertebral chordoma. This case was treated with staged vertebrectomy and fibular strut graft reconstruction and the results of clinical and radiological follow up at 8 years are presented.

Management of chronic pain in whiplash injury.

We investigated the response of chronic neck and shoulder pain to decompression of the carpal tunnel in 38 patients with whiplash injury. We also determined the plasma levels of substance P (SP) and calcitonin gene-related peptide (CGRP), which are inflammatory peptides that sensitise nociceptors. Compared with normal control subjects, the mean concentrations of SP (220 v 28 ng/l; p < 0.0001) and CGRP (400 v 85 ng/l; p < 0.0005) were high in patients with chronic shoulder and neck pain before surgery. After operation their levels fell to normal. There was resolution of neurological symptoms with improvement of pain in 90% of patients. Only two of the 30 with chronic neck and shoulder pain who had been treated conservatively showed improvement when followed up at two years. In spite of having neuropathic pain arising from the median nerve, all these patients had normal electromyographic and nerve-conduction studies. Chronic pain in whiplash injury may be caused by 'atypical' carpal tunnel syndrome and responds favourably to surgery which is indicated in patients with neck, shoulder and arm pain but not in those with mild symptoms in the hand. Previously, the presence of persistent neurological symptoms has been accepted as a sign of a poor outcome after a whiplash injury, but our study suggests that it may be possible to treat chronic pain by carpal tunnel decompression.