The effectiveness of hydrotherapy on return to play in sports following hip arthroscopic surgery: a comparative study.

BACKGROUND: The postoperative management of femoroacetabular impingement (FAI) is variable with favourable surgical outcomes. Yet there is no evidence on the efficacy of hydrotherapy in athletes undergoing hip arthroscopy for FAI. The purpose of this study was to evaluate the role and the impact of hydrotherapy on return to sports following hip arthroscopy for symptomatic FAI. METHODS: 2 cohorts of mixed level of athletes from various sports: a hydrotherapy group that followed land-based exercises in combination with hydrotherapy exercises and a control group that followed solely the same land-based exercises. Pre- and postoperative pain and hip-specific outcome scores were completed, and patient satisfaction was rated. RESULTS: A total of 88 hip arthroscopies were included with a minimum of 2 years follow-up; the hydrotherapy group comprised of 36 hips and the control group, 52 hips. There was a significant improvement in time to return to previous performance (HR 1.91, 95% CI, 1.21-3.01; p = 0.005) in the hydrotherapy group compared with the control. The hip-specific scores and patient satisfaction were considerably improved in the hydrotherapy group. CONCLUSIONS: The analysis of our data indicates that the incorporation of hydrotherapy into postoperative rehabilitation for hip arthroscopy for FAI accelerates the return of athletes to their pre-injury performance, since recovery time decreased significantly.

Is Intraoperative Blood Cell Salvage Effective in Hip Surgery? / A recuperação intraoperatória de células sanguíneas é eficaz em cirurgias de quadril?

Abstract Objective The present study aims to evaluate the efficacy of blood cell salvage (CS) as a method of reducing allogeneic blood transfusion in patients submitted to transtrochanteric femoral and hip surgeries due to injury. Methods Prospective cohort of 38 patients froma school hospital submitted to hip or trochanteric surgeries and divided into two groups from August 2015 to February 2017. Patients with any malignancy or infectious condition were excluded from the study. Cell savage group (19 patients) received autologous blood using cell saver, whereas control group (19 patients) received just allogeneic blood, if needed. Red blood cell parameters, blood transfusion requirements, and clinical and surgical characteristics, such as age, gender, ASA scale and type of surgery, were compared both preoperatively and postoperatively. Data was processed in SPSS 20.0. Results There were no differences in the clinical parameters studied (age, gender and ASA scale). Red blood cell parameters on the first day postoperative were higher in the cell savage group (p < 0.05). No significant reduction of intraoperative and postoperative allogeneic blood transfusion requirements was found. Conclusion This study found that CS was not effective in reducing intraoperative and postoperative allogeneic blood transfusion requirements in patients submitted to transtrochanteric femoral and hip surgery.

Resumo Objetivo O estudo visa avaliar a eficácia da recuperação intraoperatória de sangue (RIOS) na redução de hemotransfusão alogênica em pacientes submetidos à cirurgia por fratura de fêmur e quadril. Métodos Coorte prospectiva com 38 pacientes submetidos a cirurgia traumatológica para fraturas em quadril e transtrocantéricas de fêmur, divididos em dois grupos em um hospital de ensino de agosto de 2015 a fevereiro de 2017. Pacientes com qualquer enfermidade ou condição infecciosa foram excluídos do presente estudo. O grupo RIOS (19 pacientes) recebeu sangue autólogo com a utilização de Cell Saver, enquanto o grupo controle (19 pacientes) recebeu apenas sangue alogênico, quando necessário.. Grupos comparados em relação ao gênero, idade na cirurgia, escala da Sociedade Americana de Anestesiologistas (ASA) (I, II ou III), uso intraoperatório da RIOS, volume sanguíneo reinfundido pela RIOS, parâmetros hematimétricos pré- e pósoperatórios, volume intra e pós-operatório de sangue alogênico transfundido. Dados processados no software SPSS Statistics for Windows, Versão 20.0 (IBM Corp, Armonk, NY, EUA). Resultados Sem diferenças significativas entre os grupos com as variáveis: idade, gênero e ASA. Percebeu-se que os valores finais de hemoglobina e hematócrito (no 1° dia de pós-operatório) foram mais elevados no grupo que utilizou o dispositivo (p < 0,05). Não houve redução significativa da transfusão alogênica intra e pósoperatória no grupo RIOS em comparação ao controle. Conclusões O presente estudo constatou que a RIOS não foi eficaz em reduzir a transfusão alogênica no intra e pós-operatório de pacientes submetidos à cirurgia de fêmur transtrocantérica e de quadril.

Effect of Listening to Music on Postoperative Cognitive Function in Older Adults After Hip or Knee Surgery: A Randomized Controlled Trial.

PURPOSE: This study aimed to assess the effect of listening to music on postoperative cognitive function in older adults after hip or knee surgery. DESIGN: This work was a randomized controlled study that involved an intervention group and control group. METHODS: Study data were recollected by using a patient information form, Mini-Mental State Examination (MMSE), and NEECHAM Confusion Scale. Music was played three times a day to the participants in the intervention group for 3 days postoperatively. FINDINGS: The mean MMSE and NEECHAM scores of the intervention and control groups were compared. No statistically significant difference was found in the mean MMSE (P > .05) between the two groups. A statistically significant difference in the mean NEECHAM Confusion Scale score was observed between the groups (P < .001). CONCLUSIONS: This study demonstrated that listening to music was important in preventing postoperative cognitive dysfunction in patients who underwent hip or knee arthroplasty.

A systematic review of the use of music interventions to improve outcomes for patients undergoing hip or knee surgery.

AIM: To examine the effectiveness of music as an adjunct treatment for pain, anxiety, and/or postoperative delirium, for patients undergoing hip or knee surgery. BACKGROUND: Patients undergoing hip or knee surgery are known to experience pain and anxiety before and after surgery and be prone to postoperative delirium. DESIGN: Quantitative systematic review. DATA SOURCES: CENTRAL, Embase, Ovid MEDLINE, CINAHL, and PsycINFO databases were systematically searched without time limits (to June 2018). REVIEW METHODS: A systematic search yielded 10 randomized controlled trials and quasi-experimental designs. Studies were appraised using the Cochrane Risk of Bias Tool. Data were extracted using the Effective Practice and Organization of Care data extraction tool. RESULTS: Mixed results were found for the effect of music on anxiety, pain, and postoperative delirium in patients undergoing hip or knee surgery. Six of 10 included studies provided evidence that music can improve anxiety, pain, or postoperative delirium outcomes for patients undergoing hip or knee surgery. Music effectively reduced anxiety in one of three studies. Three of seven studies reported benefits of music for reducing postoperative pain. Positive effects of music on postoperative delirium were reported in all three studies that evaluated this outcome. Within group improvements were observed in many of the studies. CONCLUSION: Music has the potential to improve outcomes of anxiety, pain, and postoperative delirium, for patients undergoing hip or knee surgery. The low number of studies found indicates results should be treated with caution. Further studies are required to provide strong evidence generalizable to a broader population.

Effects of electrical stimulation in the treatment of osteonecrosis of the femoral head.

INTRODUCTION: The aim of this study was to examine whether the use of an internal electrostimulator could improve the results obtained with core decompression alone in the treatment of osteonecrosis of the femoral head. METHODS: We performed a retrospective study of 41 patients (55 hips) treated for osteonecrosis of the femoral head between 2005 and 2014. Mean follow-up time was 56 (12-108) months. We recorded 3 parameters: time to recurrence of pain, time to conversion to arthroplasty and time to radiographic failure. Survival was estimated using the Kaplan-Meier method. The equality of the survival distributions was determined by the Log rank test. RESULTS: Implanted electrostimulator was a factor that increased the survival of hips in a pre-op Steinberg stage of II or below, while it remained unchanged if the stage was III or higher. CONCLUSIONS: The addition of an internal electrostimulator provides increased survival compared to core decompression alone at stages below III.

Pediatric Hip Fractures in California: Results from a Community-Based Hip Fracture Registry.

CONTEXT: Hip fracture registries offer an opportunity to identify and to monitor patients with rare conditions and outcomes, including hip fractures in pediatric patients. OBJECTIVE: To report patient demographics and surgical outcomes of pediatric patients treated surgically for hip fractures in a large integrated health care system. DESIGN: Pediatric patients (< 21 years old at the time of fracture) with hip fractures were identified between 2009 and 2012 using our health care system's hip fracture registry. MAIN OUTCOME MEASURES: Patient characteristics, type of fracture, surgical treatment, and short-term complications. RESULTS: Among 39 patients identified, 31 (79.5%) were male, and the median age was 15 years old (interquartile range: 11-17 years). Most patients were Hispanic (n = 17, 43.6%) or white (n = 14, 35.9%). There were 8 patients (20.5%) with 15 comorbidities. Delbet Type IV (intertrochanteric) fractures were the most common fracture type (n = 22, 56.4%), and fixation method was equally distributed between intramedullary, screw and sideplate, and screws (n = 12, 30.8% for each). Most surgeries were performed by medium-volume surgeons (n = 22, 56.4%) at medium- and high-volume hospitals (n = 37, 94.9%). Three 90-day readmissions (7.7%), 1 infection (2.6%), 1 malunion (2.6%), and 1 revision (2.6%) were observed in this cohort during the study period. CONCLUSION: In our series using registry data, hip fractures younger than age 21 years were more common in boys and Hispanic patients. Intertrochanteric fractures (Delbet Type IV) were the most frequently observed type in our community-based hip fracture registry. Short-term complications were infrequent.

[The influence of the technique for the post-isometric relaxation of the muscles of the lumbosacral region of the spine on the manifestations of the flexion contracture in the hip joint in the men at the age of 50-60 years following amputation of the lower limb at the hip level in the course of the rehabilitation process].

AIM: The objective of the present study was to evaluate the outcome the application of the technique for the post-isometric relaxation of the muscles of the lumbosacral region of the spine and of the lumbosacral junction as a component of the combined rehabilitation on the manifestations of the flexion contracture in the hip joint in the men at the age of 50-60 years following amputation of the lower limb at the hip level throughout the course of the rehabilitative process. MATERIALS AND METHODS: A total of 243 patients who had undergone ablation of a femur available for the examination. 153 of them were treatment with the use of the technique for the post-isometric relaxation of the muscles of the lumbosacral region of the spine and of the lumbosacral junction. The control group was comprised of the remaining 90 patients treated without the application of the technique for post-isometric relaxation. The analysis of the degree of flexion contracture of the hip joint on the side of ablation was carried out by means of the Thomas test. RESULTS: The results of the study give evidence that that use of the technique for the post-isometric relaxation of muscles of the lumbar spine and sacroiliac joint makes it possible to reduce the time needed to decrease the severity of contracture of the hip joint during the rehabilitation process. CONCLUSION: The data obtained provide a basis for recommending the inclusion of the technique for the post-isometric relaxation of muscles of the lumbar spine and the lumbosacral junction into the program of the combined rehabilitation of the patients who had undergone ablation of a femur.

Hip fracture evaluation with alternatives of total hip arthroplasty versus hemiarthroplasty (HEALTH): protocol for a multicentre randomised trial.

INTRODUCTION: Hip fractures are a leading cause of mortality and disability worldwide, and the number of hip fractures is expected to rise to over 6 million per year by 2050. The optimal approach for the surgical management of displaced femoral neck fractures remains unknown. Current evidence suggests the use of arthroplasty; however, there is lack of evidence regarding whether patients with displaced femoral neck fractures experience better outcomes with total hip arthroplasty (THA) or hemiarthroplasty (HA). The HEALTH trial compares outcomes following THA versus HA in patients 50 years of age or older with displaced femoral neck fractures. METHODS AND ANALYSIS: HEALTH is a multicentre, randomised controlled trial where 1434 patients, 50 years of age or older, with displaced femoral neck fractures from international sites are randomised to receive either THA or HA. Exclusion criteria include associated major injuries of the lower extremity, hip infection(s) and a history of frank dementia. The primary outcome is unplanned secondary procedures and the secondary outcomes include functional outcomes, patient quality of life, mortality and hip-related complications-both within 2 years of the initial surgery. We are using minimisation to ensure balance between intervention groups for the following factors: age, prefracture living, prefracture functional status, American Society for Anesthesiologists (ASA) Class and centre number. Data analysts and the HEALTH Steering Committee are blinded to the surgical allocation throughout the trial. Outcome analysis will be performed using a χ(2) test (or Fisher's exact test) and Cox proportional hazards modelling estimate. All results will be presented with 95% CIs. ETHICS AND DISSEMINATION: The HEALTH trial has received local and McMaster University Research Ethics Board (REB) approval (REB#: 06-151). RESULTS: Outcomes from the primary manuscript will be disseminated through publications in academic journals and presentations at relevant orthopaedic conferences. We will communicate trial results to all participating sites. Participating sites will communicate results with patients who have indicated an interest in knowing the results. TRIAL REGISTRATION NUMBER: The HEALTH trial is registered with clinicaltrials.gov (NCT00556842).

Pain after hip arthroplasty managed by Brennan Healing Science.

A case is presented illustrating the potential effect of Brennan Healing Science on pain following hip arthroplasty for avascular necrosis. A 54-year-old woman experienced anterior groin pain, numbness at the bottom of her foot, and occasional grinding at her hip 22 years after right total hip arthroplasty secondary to avascular necrosis. X-ray films showed signs of osteolysis behind the acetabular cup and asymmetric decreased polyethylene thickness of the acetabular prosthetic. Her orthopedic surgeon advised the patient to follow up every 6-9 months to avoid catastrophic failure of the implant, with plans for surgical revision to be scheduled at the next appointment. The patient sought alternative treatment to avoid an invasive procedure. On presentation, the patient had difficulty walking up the stairs into the treatment room due to pain which she rated a 9/10. She found it painful to rotate, flex, extend her hip, or to sit. Hands-on healing techniques based on the Brennan Healing Science method were initiated, starting at the feet, balancing the energy, and working the way up the joints. Once the work at the hip was completed, the hands-on techniques continued up the centerline of the body and the healing was brought to a close. On completion of a 60-minute healing, the patient was able to stand freely and rated her pain as a 4/10. Flexion, extension, and rotation at the hip were no longer distressing. She was able to walk up and down stairs without distress and denied instability, bursitis, or trochanteric or iliopsoas pain or swelling. Repeat X-rays showed decrease in bone spurs and no hardware problem, and her orthopedic surgeon recommended follow-up after 2 years. It is suggested that Brennan Healing Science techniques could play an effective and cost-efficient role in the treatment of pain following hip arthroplasty.

Treatment of chronic intractable hip pain after iliac crest bone graft harvest using peripheral nerve field stimulation.

INTRODUCTION: Autologous iliac crest bone graft (ICBG) harvest is a common procedure performed at the time of many spinal surgical procedures and associated with morbidity incurred at the harvest site, the most troublesome being chronic donor site pain. METHODS: The patient underwent an uneventful peripheral nerve field stimulation (PNFS) trial with percutaneous placement of two temporary eight-electrode leads (Medtronic Inc., Minneapolis, MN, USA) placed in epifascial plane over the left ICBG harvest site. RESULTS: After experiencing excellent pain relief over the next two days, the patient was implanted with permanent leads and generator two weeks later and reported sustained pain relief at 12-month follow-up visit. DISCUSSION: Peripheral nerve field stimulation provides an effective treatment option for patients suffering from chronic hip pain after ICBG harvest who have failed conservative treatment. PNFS may provide pain relief with advantages over conservative treatments and more invasive techniques. CONCLUSION: Peripheral nerve field stimulation offers an alternative treatment option for select patients with chronic hip pain after ICBG harvest.

Resurfacing total hip replacement--a therapeutical approach in postmenopausal women with osteoporosis and hip arthrosis.

AIM: Patients with incipient hip arthrosis may benefit from a relatively new therapeutical approach using resurfacing total hip replacement, but in those with associated osteoporosis, this type of surgical intervention is contraindicated, given the poor quality of osteoporotic bones. We assessed the efficacy of the antiosteoporotic pharmacological therapy to improve bone quality and bone strength in postmenopausal women diagnosed with hip arthrosis and osteoporosis thus facilitating the hip surgical intervention. METHODS: We evaluated 20 postmenopausal women aged between 53-60 years diagnosed with osteoporosis according to the WHO criteria, by using dual-energy X-ray absorptiometry (DXA) for bone mineral density measurements. All these patients had low hip T score (osteopenia/ osteoporosis) and also incipient hip arthrosis. The surgical approach was delayed for 12 months and all the patients received bisphosphonate therapy with calcium and vitamin D supplements. DXA scans were performed after 12 months of therapy in all the patients. RESULTS: A surgical intervention with resurfacing total hip replacement was performed in 12 of the 16 patients presenting with increasing BMD, 4 of them showing elements of rapidly advancing hip arthrosis to a stage that made this type of intervention impossible. We chose not to use this technique in the group with stable BMD (4 patients). All 12 women surgically treated had a favorable post-operative outcome without experiencing a femoral neck fracture during the surgical intervention or during the twelve-month follow-up. All 20 patients continued to receive bisphosphonate therapy. CONCLUSION: In postmenopausal women with osteoporosis and associated hip arthrosis, improving bone mass and bone quality with bisphosphonate therapy is necessary and important in order to allow hip arthroplasty, by using the technique of resurfacing, avoiding the risk of intra-operative fractures and with a favorable post-operative long-term outcome.

Double-blind, randomized, intraindividual comparison study of the efficacy of prilocaine and lidocaine in tumescent local anesthesia.

BACKGROUND: Tumescent local anesthesia (TLA) with lidocaine or prilocaine solutions is widely used in dermatology. OBJECTIVE: Comparison of efficacy and safety of lidocaine and prilocaine in liposuctions with TLA. METHODS: TLA was performed using defined dilutions of lidocaine or prilocaine. Half-side comparisons were applied on 26 patients undergoing symmetric liposuction. Pain reduction (overall sensation and pain at lancet prick) and tolerance were assessed before, during and 2-24 h after liposuction. RESULTS: No differences in overall pain sensation between the substances were detected during and after liposuction except a more rapid onset with lidocaine (less pain after 15 min, p < 0.043). Local tolerance of both substances was excellent. CONCLUSION: Lidocaine and prilocaine used in TLA for liposuction show good efficacy and tolerance. A fixed combination of lidocaine and prilocaine may reduce the risk of side effects when great quantities of TLA are needed.

Autotransfusión y hemodilución normovólemica en pacientes intervenidos quirúrgicamente por afecciones de caderas / Autotransfusion and normovolemic hemodilution in patients surgically operated due to hipaffections

La transfusión sanguínea autóloga, surge como una alternativa a la transfusión homóloga, especialmente en el perìodo perioperatorio. Es objetivo de este trabajo identificar el comportamiento clínico de los pacientes tratados con autotransfusión y hemodilución normovólemica aguda durante la cirugía de cadera, así como las modificaciones de los parámetros cardiovasculares y las complicaciones intraoperatorias en ambos grupos. Se realizó un estudio de cohorte en 40 pacientes intervenidos quirúrgicamente por enfermedad de la cadera, en el Hospital Docente Provincial "Vladimir Ilich Lenin" de Holguín, se conformaron 2 grupos de pacientes cada uno (no expuestos y expuestos al proceder). Durante el perioperatorio se monitorizó tensión arterial sistólica, diastólica y media, frecuencia cardiaca, diuresis y saturación parcial de oxígeno.Durante el intraoperatorio se observó un aumento de la tensión arterial sistólica, media, de la saturación...(AU)

"Three-dimensional tumescent liposculpture" of the abdomen, waist, and flanks.

Treating the entire area as a cosmetic unit is the best approach to tumescent liposculpture of the abdomen, waist, and flanks. This "Three-Dimensional Tumescent Liposculpture" procedure is performed under tumescent local anesthesia with optional intraoperative external ultrasound. Areas treated are the abdomen, waist, flanks, and infrascapular fat pad if indicated. Postoperatively, patients show a flatter abdomen, a smaller and better-defined waist (the "Cook waist"), reduction of unsightly bulges, and a smoother, better proportioned and more attractive overall contour. Patient recovery is rapid with minimal complications.

Contouring the female buttocks. Liposculpting the buttocks.

Body sculpting has progressed during the past decade to a point where cosmetic units may be sculpted to improve contours which blend imperceptibly and appropriately with adjacent cosmetic units. The buttocks is ideally suited for sophisticated contouring as its frame is determined by the hips, thighs, and lower back and its proportions are balanced by the anterior projection of the breasts. In addition, ethnic differences in the shape and proportions of the buttocks create a variety of aesthetically pleasing variations in size and shape. The article attempts to elucidate these considerations combined with a logical surgical approach to achieve pleasing results in body sculpting.

Liposuction of the thigh.

This article discusses liposuction of the thigh. All aspects of preoperative evaluation, anesthesia, operative technique, and postoperative care are reviewed. Issues relating to safety are emphasized as are aesthetic dimensions of liposuction of the thigh.

Effectiveness of very low doses of subcutaneous recombinant human erythropoietin in facilitating autologous blood donation before orthopedic surgery.

BACKGROUND: Clinical and pharmacokinetic data suggest that very low doses of subcutaneous recombinant human erythropoietin (rHuEPO) may be effective in a preoperative autologous blood deposit program. STUDY DESIGN AND METHODS: Fifty-two patients, scheduled for orthopedic surgery, were enrolled in a double-blind and placebo-controlled study. Patients were randomly assigned to the placebo group or to receive 30, 60, or 100 IU per kg of rHuEPO subcutaneously twice a week for 2 weeks before surgery. The dose of rHuEPO that was effective in facilitating the collection of 4 units of blood in the 2 weeks before surgery and that prevented a sharp decrease in hematocrit was determined. RESULTS: Only in patients receiving 100 IU per kg of rHuEPO did the outcome measurements differ significantly from those in the placebo group. With a higher (p < 0.01) cumulative increase in red cell volume during the study period (297 +/- 127 vs. 121 +/- 44 mL), 64 percent of those receiving 100 IU per kg of rHuEPO were able to donate 4 units of blood for autologous use, as compared with 23 percent of the placebo group (p < 0.05). Allogeneic transfusion was avoided, and the preoperative hematocrit and reticulocyte count were significantly higher in the patients receiving 100 IU per kg of rHuEPO (p < 0.05 and p < 0.01, respectively). CONCLUSION: Subcutaneously administered rHuEPO at a dose of 100 IU per kg twice a week for 2 weeks is effective in facilitating the collection of blood for autologous use and may improve the cost-benefit ratio of blood conservation interventions. Doses < or = 60 IU per kg are ineffective in facilitating such collections in this surgical setting.

Reinfusion of shed blood after orthopaedic procedures in children and adolescents.

A prospective study was done of the results of infusion of drained blood after major procedures on the spine and hip in twenty-six patients. The Solcotrans system was used to salvage drained blood in the first six hours after the operation. Transfusion requirements, blood loss, hematocrit, temperature, prothrombin time, partial prothrombin time, platelet count, results of blood cultures, and levels of factor VIII, factor V,D-dimer, antithrombin III, plasminogen, protein C, and complement C3a des arginine were determined for some or all of the patients. A mean of 375 milliliters of blood from the Solcotrans receptacle was reinfused. All of the cultures were negative. There were no febrile reactions. The mean values for the specimens of the salvaged blood were: hematocrit, 0.20; hemoglobin, seventy-one grams per liter; plasma hemoglobin, 2.36 grams per liter; C3a des arginine, 9.4 x 10(-3) grams per liter; fat particles of less than nine micrometers in diameter, 23,643 per milliliter; and D-dimer, 205 x 10(-3) grams per liter. Studies of blood samples that were collected from patients one to two hours and twelve to eighteen hours after the transfusion showed only slight increases in fibrin split products one hour after the transfusion; these values reverted to normal by eighteen hours. No clinical coagulopathy associated with reinfusion was observed. The reinfusion of unwashed, filtered shed blood that was as much as 15 per cent of the total blood volume proved to be a safe technique after major orthopaedic procedures.