Hip offset and leg-length restoration in revision hip arthroplasty with a monoblock, hydroxyapatite-coated stem.

AIMS: Restoration of normal hip biomechanics in arthroplasty surgery is important in order to achieve good muscle function and joint stability. METHODS: In this retrospective cohort study, we examined the postoperative radiographs of 131 femoral revision arthroplasty procedures using a monoblock, fully hydroxyapatite (HA)-coated titanium stem. Femoral offset, modified-global offset and leg length were measured of the operated and contralateral hips. RESULTS: Femoral offset was restored to ±10 mm in 108 cases (82%), modified-global offset was restored ±10 mm in 93 cases (71%) and leg length was restored to ±10 mm in 102 cases (81%). There were 4 dislocations with a mean follow-up period of 38 months. CONCLUSIONS: Restoration of hip biomechanics is achievable with a monoblock stem and thus is a viable option in revision hip arthroplasty.

Risk Factors of 120-Day Mortality Among Hip Fractures With Concomitant COVID-19 Infection.

Background Hip fractures cause substantial morbidity and mortality worldwide, and the coronavirus disease 2019 (COVID-19) pandemic has only worsened the global burden. Increased 120-day mortality is well established in the literature among hip fractures with COVID-19. However, the risk factors associated with mortality have been poorly understood. We aimed to determine the risk factors associated with increased 120-day mortality among hip fractures with COVID-19. Methods Seventy patients with hip fractures with confirmed COVID-19 infection between March 2020 and December 2021 were included. Thirty-three patients who died within 120 days of admission were allotted to the non-survivor group and the rest 37 patients were allotted to the survivor group. Various parameters such as demographic variables, Nottingham Hip Fracture Score (NHFS), Charlson Comorbidity Index (CCI), American Society of Anesthesiologists (ASA), Abbreviated Mental Score Test (AMTS), National Early Warning Score (NEWS), fracture type, operation type, and delay in surgery were compared between the groups to determine the risk factors for increased mortality. Multivariate regression analysis was performed to know the independent association with increased mortality. Results A total of 33 patients died within 120 days giving the 120-day mortality rate of 47.1%. Baseline parameters such as ASA, AMTS on admission, NEWS on admission, and type of residence did not significantly affect mortality. The mean NHFS was significantly high in non-survivors (5.38 ± 1.52) compared to survivors (4.40 ± 1.75) (p < 0.001). Similarly, mean CCI was also significantly high in non-survivors (5.58 ± 1.74) compared to survivors (4.76 ± 2.29) (p < 0.001). A total of 70% (seven out of 10) of patients with delayed surgery of more than 36 hours from the admission died within 120 days of admission (p < 0.001). Mortality was significantly higher in patients who underwent internal fixation of fractures like a dynamic hip screw (DHS) or intramedullary (IM) nailing than in those who underwent hemiarthroplasty or total hip arthroplasty (THA). Post-operative parameters such as early mobilization and the multidisciplinary approach to review these patients made no difference to the mortality. Multivariate regression analysis of the parameters that made a significant difference in the mortality showed that delay in surgery and type of surgery (internal fixation) independently increased the mortality among these patients (p < 0.001). However, NHFS and CCI were not independently affecting the mortality among hip fractures with concomitant COVID-19. Conclusion The 120-day mortality rate among patients with hip fractures with concomitant COVID-19 was 47.1%. Delay in surgery of more than 36 hours and patients who underwent internal fixation were independent risk factors associated with increased mortality among these patients.

Survivorship and Radiological Analysis of a Monoblock, Hydroxyapatite-Coated Titanium Stem in Revision Hip Arthroplasty.

BACKGROUND: We evaluated the survivorship, incidence of complications, radiological subsidence, proximal stress shielding, and patient-reported outcomes of a conservative, monoblock, hydroxyapatite-coated femoral stem. METHODS: This retrospective cohort study reports on 254 revision hip arthroplasties between January 2006 and June 2016. The mean age of patients was 71 years. The mean length of follow-up was 62 months (range 12-152). RESULTS: There were 13 stem re-revisions: infection (4), periprosthetic fracture (4), aseptic stem loosening (3), stem fracture (1), and extended trochanteric osteotomy nonunion (1). Kaplan-Meier aseptic stem survivorship was 97.33% (confidence interval 94-100) at 6 years. There were 29 intraoperative fractures. There were 6 cases of subsidence greater than 10 mm; however, none required revision. Ninety-six percent of cases showed no proximal stress shielding. Thigh pain was reported in 3% of cases. CONCLUSION: This study confirms that this stem provides good survivorship at 6 years, acceptable complication rates, adequate proximal bone loading, low incidences of thigh pain, and reliable clinical performance in revision hip arthroplasty. KEY MESSAGE: A monoblock, fully hydroxyapatite-coated titanium stem is reliable in revision arthroplasty with mild-moderate femur deficiencies.

Functional outcome of total hip arthroplasty after a previous hip arthroscopy: a retrospective comparative cohort study.

BACKGROUND: Despite patients demonstrating significant short-term clinical improvement from a hip arthroscopy (HA), a number of patients progress to significant osteoarthritis of the hip requiring total hip arthroplasty (THA). This study aims to evaluate if there is any difference in the functional outcome of patients undergoing THA after a previous hip arthroscopy compared to patients undergoing THA for primary osteoarthritis of the hip. METHODS: Between 2010 and 2013, in a group of 414 patients who underwent hip arthroscopy, we identified 18 patients who underwent a subsequent uncemented THA. These formed the study group. During the same period, 625 patients underwent an uncemented THA performed for primary OA, of which 63 patients were matched to the study group for age, follow-up and implants used. These formed the control group. Pre-op and post-op Oxford Hip Scores (OHS) were recorded for all patients. RESULTS: A mean follow-up of 26.5 and 26.3 months was observed in the study and control groups respectively. The median (interquartile ranges) preoperative OHS were 14 (8.25, 17.0) and 18.5 (13.25, 24.75) in the 2 groups. Corresponding postoperative scores were 40 (31.25, 45) and 46 (43, 48). Median difference between the preoperative and postoperative OHS was 27 (19, 31) and 25 (18.25, 31). Adjusting for the pre-treatment scores, the postoperative scores in the study arm were significantly lower than for the control arm with an estimate (SE) of -0.464 (p = 0.012). Post-hoc power analysis showed that the study was sufficiently powered to detect a meaningful difference in scores. CONCLUSION: Total hip arthroplasty after hip arthroscopy leads to satisfactory functional outcomes. However, the functional outcome in this group is significantly worse than in a matched cohort of patients undergoing THA for osteoarthritis. There was no difference in the rate of complications between the 2 groups.

Characteristics and practices of Traditional Chinese Medicine retail shops in London, UK: A cross-sectional study using an observational approach.

ETHNOPHARMACOLOGICAL RELEVANCE: Traditional Chinese Medicine (TCM) is a popular form of ethnomedicine in the UK, and is accessed by Western, Chinese and other ethnic groups. The current regulatory regime does not effectively protect the public against poor-quality and unsafe TCMs. Understanding ethnopharmacological information on how TCM is promoted and practiced may help to inform initiatives aimed at ensuring the safe use of TCMs in the UK, and put laboratory-based ethnopharmacological investigations of TCMs in a broader context. AIM OF THE STUDY: This study aimed to examine the characteristics and practices of TCM retail outlets in London, UK, and to identify factors relevant to the safe use of TCM in the UK. MATERIALS AND METHODS: TCM retail outlets ('shops') in London, UK, were identified using a systematic approach. A structured questionnaire including questions on shop business type was used to recruit participant shops. Shops consenting to participate were visited within six weeks of providing consent. A piloted semi-structured questionnaire on shop characteristics was used for data collection following observation. The British National Formulary 53 was used to classify medical conditions/uses for TCMs promoted in the shops. Data were stored and analysed using MS Access 2003, MS Excel 2003 and SPSS 13. RESULTS: In total, 54 TCM shops in London were identified, of which 94% offered TCM consultations with a TCM practitioner. Detailed characteristics were described within 35/50 shops that gave consent to observing their premises. Most shops labelled and displayed over 150 Chinese Materia Medica (CMMs; crude materials, particularly herbs) for dispensing after consultations with a TCM practitioner. Medical conditions/uses and Patent Chinese Medicines (PCMs) were commonly promoted. In total, 794 occurrences of 205 different medical conditions/uses (median=32, QL=19, QU=48) were identified. These conditions/uses most commonly related to the following therapeutic systems: central nervous system (160/794, 20.2%); musculoskeletal and joint disease (133/794, 16.8%); obstetrics, gynaecology, and urinary-tract disorders (122/794, 15.4%); skin (102/794, 12.9%); gastrointestinal system (62/794, 7.8%). Specific conditions/uses that were frequently promoted included eczema (19/23 shops, 82.6%), arthritis (18/23, 78.3%), acne (17/23, 73.9%), obesity/weight loss/slimming (17/23, 73.9%) and psoriasis (17/23, 73.9%). Claimed conditions/uses included some serious medical conditions (e.g. diabetes, cancer and hypertension) and those focusing on vulnerable groups (e.g. children's diseases and pregnancy treatments). CONCLUSIONS: TCM shops in London, UK, typically displayed names of a wide range of medical conditions/uses for TCMs using readily understandable medical terms, implying TCM can be used to prevent or treat these conditions. However, many of these advertisements did not comply with UK regulations on medical claims for herbal medicines. Future studies should explore how these advertisements influence consumers' decisions to access TCM in the UK, practices of TCM shop staff towards the supply of TCMs in the UK, and what are the health implications at the individual and population levels.

Patient satisfaction with tourniquet application and local anaesthesia infiltration in carpal tunnel decompression and the relationship with overall satisfaction.

This was a prospective study designed to determine what effect poor tolerance to tourniquet application and local anaesthesia infiltration in open carpal tunnel decompression has on overall patient satisfaction with the surgical procedure. Fifty patients were recruited into the study. Visual analogue scores (VAS) were recorded postoperatively for pain related to tourniquet application, local anaesthesia infiltration and the surgical procedure overall. In terms of the procedure, poor tolerance to the tourniquet and local anaesthetic showed no significant relationship to the overall patient satisfaction (Student t-test). The factors, which are related to satisfaction with carpal tunnel decompression, are discussed.