Cup oversizing as a risk factor for postoperative groin pain in Total Hip Arthroplasty : a retrospective analysis of 437 hips.

The majority of patients are pain free after total hip replacement, but some experience anterior hip pain due to iliopsoas impingement. There is evidence that a prominent or malpositioned cup may cause iliopsoas tendonitis. The purpose of this study was to determine whether oversizing the cup is a risk factor for postoperative groin pain. We retrospectively investigated 437 total hip replacements in which the femoral head diameter had been measured for other research purposes. Data regarding the cup size and positioning was collected from implant identification labels and pelvis x-rays. Clinical data were recovered from the medical files. Native femoral head size, cup size, anteversion, inclination and DS (difference between native femoral head size and cup size) and type of pain (anterior hip pain or non-anterior hip pain) were analyzed and correlations were sought. There was a strong and significant correlation between native femoral head size and cup size. Mean DS was 5.5 mm in the no pain group, 6.9 mm in the anterior hip pain group and 5.9 mm in the non-anterior hip pain group. The difference in mean DS was significant (P=0.046) in patients experiencing anterior hip pain vs. those with no pain or non-anterior hip pain. As patients with anterior hip pain had a significant larger DS of 6.9 mm, it seems that a cup size of more than 6 mm above the native femoral head size should be avoided. We therefore recommend a systematic intraoperative head size measurement prior to definite cup choice.

Education of physical and rehabilitation medicine specialists across Europe: a call for harmonization.

BACKGROUND: Physical and rehabilitation medicine (PRM) is well established in Europe and officially recognized by the European Union of Medical Specialists (UEMS). The European PRM Board works to promote patient safety and quality of care through the development of the highest standards of medical training and healthcare across Europe as well as the harmonization of PRM specialists' qualifications. In its Action Plan for 2014-2018, the UEMS PRM Board has included the harmonization of the PRM curriculum among the EU countries, as one of its main goals. Based on a European Directive, the Belgian Superior Council is envisaging a reform of the PRM curriculum. AIM: The aim of this paper is to present the current situation of PRM education in Europe according to the survey carried out by the Belgium Task Force. DESIGN: An online survey was posted on May 3rd 2015 to all delegates of the UEMS PRM Section and Board. Two questions were formulated: 1) What is the duration and curriculum of PRM training in your country? 2) Does a Postgraduate Rehabilitation training exist for other medical specialties? RESULTS: The majority of the PRM training programs in Europe have a duration ranging from 4 to 5 years, and are not aiming at downsizing the duration to the European minimal training period of 3 years. The vast majority (70%) of the responding countries don't offer an additional accreditation of Rehabilitation for other medical specialties. CONCLUSIONS: Comparing PRM training programs in Europe can support the long-awaited reform of the PRM postgraduate curriculum in Belgium and gives perspective to agree on a transparent and comparable specialty training throughout Europe. Providing a more comparable training promotes the establishment of PRM and its rehabilitation service provisions in the world.