A rare soccer-related injury: Traumatic posterior hip fracture-dislocation - Case series and overview of the literature.

BACKGROUND: Soccer is one of the most popular sports with millions of active professional and non-professional players worldwide. Traumatic hip dislocations are rare in soccer but can lead to major sequelae both physically and psychologically. The aim of this review was to obtain insight into the outcomes after surgerically repaired hip fracture-dislocation in soccer players as well as rehabilitation and prevention. METHODS: Two cases of a posterior hip fracture-dislocation that occurred during an amateur soccer match are presented and mechanism of injury, complications and rehabilitation were analysed. Follow-up of both patients was at least one year after surgery. Questionnaires and physical examinations were obtained to quantify and qualify outcome. RESULTS: In both cases the hip-dislocations were reduced within 3 h after injury. Semi-elective open reduction and internal fixation was performed within seven days. In one case, there was a concomitant Pipkin fracture and sciatic nerve neuropathy. There were no postoperative complications. Follow-up showed full of range of motion and normal hip functionality in both cases. However, both patients indicated a reduced quality of life and anxiety related to the accident. CONCLUSION: Traumatic hip fracture-dislocations during soccer practice are extremely rare. Despite uncomplicated fracture healing after surgery and return of hip function, both patients still suffer from psychological problems resulting in a decreased quality of life. Further research is required to enhance psychological outcomes, as well as to facilitate return to pre-injury levels of participation and engagement in sports following traumatic hip fracture-dislocations related to soccer.

Spine Fusions, Yoga Instructors, and Hip Fractures: The Role of Dual Mobility in Primary Total Hip Arthroplasty.

BACKGROUND: Despite the increased use of dual mobility (DM) in primary total hip arthroplasty (THA), debate exists regarding the indications for its use. No specific algorithm exists to guide this decision-making process. Therefore, the purpose of this article is to summarize the currently available literature regarding the use of DM in primary THA and provide evidence-based guidelines based on specific patient populations and risk factors for instability. METHODS: We reviewed the current literature for studies evaluating risk factors for dislocation in primary THA, as well as the clinical use and results of DM in primary THA. Based on the strength of the literature, we discuss the use of DM in specific patient populations. We provide a decision-making algorithm to determine whether a patient may be indicated for DM in primary THA. RESULTS: Surgeons should consider preoperative patient demographics, risk factors for instability (eg, significant hip-spine issues), type of procedure to be performed (eg, conversion arthroplasty), and indications for surgery (eg, THA for femoral neck fracture). Based on this algorithmic assessment, DM may be warranted in the primary THA setting if a patient's combined risk reaches an established threshold based on the literature. CONCLUSION: This evidence-based algorithm may help guide current practice in the use of DM in primary THA. We advocate the continued judicious use of DM in hip arthroplasty. Longer term studies are needed in order to evaluate the durability of DM, as well as any complications related to the DM articulation.

Holistic decomposition convolution for effective semantic segmentation of medical volume images.

Convolutional Neural Networks (CNNs) have achieved state-of-the-art performance in many different 2D medical image analysis tasks. In clinical practice, however, a large part of the medical imaging data available is in 3D, e.g, magnetic resonance imaging (MRI) data, computed tomography (CT) data and data generated by many other modalities. This has motivated the development of 3D CNNs for volumetric image segmentation in order to benefit from more spatial context. Due to GPU memory restrictions caused by moving to fully 3D, state-of-the-art methods depend on subvolume/patch processing and the size of the input patch is usually small, limiting the incorporation of larger context information for a better performance. In this paper, we propose a novel Holistic Decomposition Convolution (HDC), which learns a number of separate kernels within the same layer and can be regarded as an inverse operation to the previously introduced Dense Upsampling Convolution (DUC), for an effective and efficient semantic segmentation of medical volume images. HDC consists of a periodic down-shuffling operation followed by a conventional 3D convolution. HDC has the advantage of significantly reducing the size of the data for sub-sequential processing while using all the information available in the input irrespective of the down-shuffling factors. We apply HDC directly to the input data, whose output will be used as the input to sub-sequential CNNs. In order to achieve volumetric dense prediction at final output, we need to recover full resolution, which is done by using DUC. We show that both HDC and DUC are network agnostic and can be combined with different CNNs for an improved performance in both training and testing phases. Results obtained from comprehensive experiments conducted on both MRI and CT data of different anatomical regions demonstrate the efficacy of the present approach.

Diagnostic yield of sonography in infants with suspected hip dysplasia: diagnostic thinking efficiency and therapeutic efficiency.

OBJECTIVE: The purpose of this study is to determine the impact of sonographic information on surgeons' diagnostic thinking and decision making in the management of infants with a possible diagnosis of developmental dysplasia of the hip (DDH). SUBJECTS AND METHODS: Five experienced orthopedic surgeons examined 66 hips of infants who were referred for a possible diagnosis of DDH and reported for each hip a confidence level about the diagnosis of DDH using a visual analog scale (VAS) before and after hip sonography was obtained. In addition, they reported a management plan. We determined the efficiency in diagnostic thinking by calculating the mean gain in diagnostic confidence as the percentage change in VAS scores and the impact of sonography on the management plan (therapeutic efficiency). RESULTS: Sonography led to a change in diagnosis in 52% (34/66) of hips. The management plan changed in 32% (21/66) of hips. The mean gain in reported diagnostic confidence was 19.4% (95% CI, 17.3-21.5%), but it was 46.0% (95% CI, 30.5-60.8%) in cases where the management changed as a result of sonography (difference, 37.7%; p < 0.0001). The greatest yield of sonography was found in hips showing limited abduction. Sonography obviated further follow-up in 23% (15/66) of cases. CONCLUSION: Sonography refined the diagnostic thinking of clinicians and led to a change in diagnosis in 52% of cases. Management plans changed in 32% of cases.

[Effects of transcutaneous electrical acupoint stimulation combined with general anesthesia on cerebral oxygen metabolism in elderly hip replacement patients during controlled hypotension].

OBJECTIVE: To observe the protective effect of transcutaneous electrical acupoint stimulation (TEAS) on cerebral tissue in elderly hip replacement operation patients during general anesthesia under controlled hypotension. METHODS: Forty hip replacement operation patients were randomly divided into general anesthesia (GA) control group and TEAS + GA group (n = 20 in each group). Patients of the two groups during operation were treated with controlled hypotension for reducing blood loss. TEAS (2 Hz/100 Hz, 8-12 mA) was applied to bilateral Yuyao (EX-HN 4) and Fengchi (GB 20) and began 30 min before GA. General anesthesia was performed by intravenous injection of Midazolam, Diprivan, Fentanyl and Cis-atracurium, sevoflurane-inhaling, Remifentanil, etc., and the patient's mean arterial pressure was maintained to be about 70% of the normal level (controlled hypotension) by using venous administration of Remifentanil about 10 min after the operation. GEM Premier 3000 blood gas analyzer was used to analyze levels of the arterial oxygen (CaO2), internal jugular venous oxygen (CjvO2), arterio-venous oxygen content difference (Da-jvO2) and cerebral oxygen (CERO2) uptake rates of blood samples before controlled hypotension (T0), 20 min after controlled hypotension (T ). 40 min after controlled hypotension (T2) and 20 min after the end of controlled hypotension (T3). RESULTS: Self-comparison of each group showed that in comparison with pre-controlled hypotension, CjvO2 levels at the time-points of T, T2 and T3 were significantly increased in both GA control and TEAS+GA groups (P < 0.05), while Da-jvO2 and CERO2 uptake rate levels at the time-points of T,. T2 and T3 in these two groups were significantly decreased (P < 0.05). Comparison between two groups showed that CivO2 levels at the time-points of T2 and T3 were significantly higher in the TEAS + GA group than in the GA control group (P<0. 05). while Da-jvO2 and CERO2 uptake rate levels at the time-point of T2 were obviously lower in the TEAS + GA group than in the GA control group(P<0. 05), suggesting a reduction of cerebral oxygen consumption after TEAS. No significant differences were found between these two groups in blood CjvO2, Da-jvO2 and CERO2 uptake rate levels at the time-points of T0 and T1 (P > 0.05). CONCLUSION: TEAS can reduce cerebral oxygen uptake rate in elderly patients undergoing hip replacement during controlled hypotension, suggesting a protective effect of TEAS on patient's cerebral tissue.

The impact of complementary and alternative medicine on hip development in children with cerebral palsy.

AIM: This study aimed to evaluate the effect of complementary and alternative medicine (CAM) approaches on long-term surgical requirements, and clinical and radiographic outcomes for children with cerebral palsy and hip displacement. METHOD: Twenty-three children with cerebral palsy and early hip displacement who were offered preventive hip surgery and whose parents declined in favour of CAM approaches were followed (13 males, 10 females; mean age 13 y 9 mo [SD 3 y 1 mo]; mean length of follow-up 10 y 2 mo [SD 2 y 11 mo]; 17 with spastic quadriplegia, two with spastic triplegia, and four with spastic diplegia; three with gross motor function classified at Gross Motor Function Classification System [GMFCS] level II, four at level III, six at level IV, and 10 at level V). Principal outcome measures were progression of hip displacement (measured by migration percentage: the percentage of the femoral head sitting outside of the acetabulum), eventual need for reconstructive or salvage surgery, and long-term hip morphology (classified by the Melbourne Cerebral Palsy Hip Classification Scale). The results were compared with a previously reported cohort of 46 children who had surgery when recommended (31 males, 15 females; mean age 13 y 11 mo [SD 1 y 6 mo]; mean length of follow-up 10 y 10 mo; 10 with diplegia and 36 with quadriplegia; three at GMFCS level II, 11 at level III, 20 at level IV, and 12 at level V). RESULTS: Outcomes for 23 children who had pursued CAM were analysed (mean length of follow-up 10 y 2 mo). Hip displacement progressed in one or both hips in all non-ambulant children (GMFCS level IV or V). Of the 20 children with documented progressive hip displacement, eight developed pain and deformity requiring salvage surgery. An additional 11 children with progressive hip displacement had late reconstructive surgery when symptoms first started. There was strong evidence of a relationship between GMFCS and both progressive hip displacement (χ(2) =17.78; p=0.001) and final Melbourne Cerebral Palsy Hip Classification Scale grade (odds ratio 12.5; p=0.012; 95% confidence interval 1.7-90.4). There was also evidence of those children who pursued CAM requiring more complex surgery than the group who had surgery when recommended (odds ratio 2.5; p=0.002; 95% confidence interval 1.4-4.5). INTERPRETATION: CAM therapy did not appear to influence the progression of hip displacement in children with cerebral palsy. Most children required major reconstructive surgery or salvage surgery despite pursuing CAM.

Alumina-on-alumina THA in patients with juvenile idiopathic arthritis: a 5-year followup study.

BACKGROUND: THA is a concern in juvenile idiopathic arthritis (JIA) owing to patients' youth, poor bone stock, and small physical size. QUESTIONS/PURPOSES: We asked whether (1) uncemented alumina-on-alumina THAs have good clinical and radiographic results at midterm followup in young patients with inflammatory arthritis and end-stage hip disease secondary to JIA, and (2) the anatomic center of rotation of the hip could be reconstructed in patients with acetabular protrusion. We also assessed the rate of surgical complications. PATIENTS AND METHODS: We retrospectively reviewed 31 alumina-on-alumina THAs in 21 patients with a mean age of 30.9 years (range, 14-48 years). Minimum followup until the time of revision of any component or the latest evaluation was 16 months. For nonrevised cases, the minimum followup was 60 months (range, 60-108 months). Acetabular protrusion was mild in 17 hips (Group 1) and moderate-severe in 14 (Group 2). Bone autograft was used to reconstruct the acetabulum in Group 2. Acetabular reconstruction was evaluated according to Ranawat et al. RESULTS: One cup was revised owing to aseptic loosening at 16 months; the remaining hips showed good clinical and radiographic results. The mean postoperative horizontal distance and the distance between the center of the head of the prosthesis and the true center of the femoral head improved in Group 2. There were no complications related to alumina. CONCLUSIONS: Although THA is a technically demanding procedure in patients with JIA, uncemented alumina-on-alumina THA provides pain relief and improves quality of life. In patients with acetabular protrusion, bone grafts enable anatomic cup positioning. Continued followup will be required to determine whether the alumina-on-alumina bearings in patients with JIA result in less osteolysis and loosening. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Alumina-on-alumina hip replacement in developmental dysplasia of the hip.

Total hip arthroplasty (THA) in patients with developmental dysplasia of the hip (DDH) requires complex reconstructive techniques and presents an increased risk of complications. Because of these patients' young age, alternative bearing surfaces such as alumina-on-alumina couples could be an option. We asked whether moderate or severe congenital dysplasia of the hip would influence the clinical outcome and rates of cup loosening in our patients. We prospectively compared 50 hips in patients with dysplastic hip (group 1) and 22 hips in patients with a low or high dislocation (group 2) using an alumina-on-alumina THA. The minimum follow-up was 5 years (range 5-10 years). Age, activity level, and implant size were greater in group 1. Preoperative function and range of mobility were worse in group 2. The survival rate for cup loosening at 5 years was 89.8% (95% confidence interval, 78.7%-100%) for group 1 and 81.7% (95% confidence interval, 57.6%-100%) for group 2. An alumina-on-alumina THA provides a high level of pain relief and functional improvement in hip dysplasia. Continued follow-up will be required to determine if the alumina-on-alumina bearings in these patients result in less osteolysis and loosening.

Wear of a highly cross-linked polyethylene liner associated with metallic deposition on a ceramic femoral head.

A 68-year-old patient underwent revision surgery for recurrent dislocation of a ceramic-on-polyethylene uncemented hip arthroplasty implanted 6 months previously. The aluminum oxide femoral head was found to have titanium deposition measuring 5 by 10 mm in an area articulating with the highly cross-linked polyethylene liner. The liner was observed to possess severe scratching produced by articulation with the titanium deposited on the ceramic head. Despite improved scratch resistance of ceramic-bearing surfaces, irregularities introduced by metallic deposition after recurrent dislocation can damage a highly cross-linked polyethylene liner.

The Metal-Cancellous Cementless Lübeck total hip arthroplasty. Five-to-nine-year results.

We implanted 51 Metal-Cancellous Cementless Lübeck (MCCL) prostheses into 45 patients with dysplastic hips and followed 49 hips (96.1%) for five to nine years. One had needed revision for stem fracture and one for infection; the clinical outcome of the other 47 hips was assessed using the Merle d'Aubigné and Postel hip score. All hips were either excellent (63%) or good (37%). Three patients (6%) had mild thigh pain at six months, but this had settled within two years. Serial radiographs showed stable fixation with bone ingrowth in all hips, with increased density of the cancellous bone in contact with the implant and some trabecular ingrowth. There was early varus shift of the stem in one hip, but this stabilised in three months. Osteolysis of the femoral cortex was seen in one hip at seven years after surgery, and mild bone resorption due to stress shielding in 31 (63%). Acetabular bone grafting with autogenous bone from the femoral head gave successful support to the socket in 13 hips. The MCCL prosthesis gave satisfactory mid-term results in patients with osteoarthritis secondary to hip dysplasia.