Quantification and severity grading of femoral vessel compression by adverse reactions to metal debris in metal-on-metal total hip arthroplasty.

INTRODUCTION: Metal-on-metal (MoM) total hip arthroplasty (THA) may cause adverse reactions to metal debris (ARMD). ARMD causing femoral vessel compression with serious complications has been described in case reports, but the rate of compression by ARMD is not known. This study aims to investigate the rate, and quantify the severity, of femoral vessel compression in MoM hips with ARMD lesions. METHODS: Patients under surveillance for MoM THA investigated with MRI were studied. In patients with confirmed ARMD, femoral artery (FA) and vein (FV) diameters were measured at the point of maximal compression and compared to contralateral vessels. The primary outcome measure was presence or absence of compression. Cases were then classified by compression ratios. Secondary outcome measures were rates of deep vein thrombosis, revision surgery and time to ARMD from index procedure. RESULTS: MRI scans for 436 patients with MoM THA were screened. Of these, 211/436 (48.4%) showed evidence of ARMD. Measurements were obtained on 133/211 (63.0%) patients. The FV was compressed in 102/133 (76.7%) and FA in 58/133 (43.6%), while 31/133 (23.3%) patients had no compression. In FVs, 42 demonstrated mild compression, 39 moderate and 21 severe. In FAs, none were severely compressed, 6 were moderate and 52 showed mild compression. There were 3 DVT cases, 2 in patients with moderate FV compression and 1 in patients without FV compression. Revision rates were highest in patients with severe FV compression (14/21, 66.7%). The mean time for MRI-diagnosed ARMD from index procedure was 8 years and 1 month (range 11 months-14.5 years). CONCLUSIONS: Extra-luminal compression of the femoral vessels was found in >75% of patients with ARMD. Although it is not clear whether revision for femoral vessel compression is required, quantification of FV compression may be useful for surgeons and radiologists considering revision for ARMD.

Hip Fracture Post-operative Mortality and Polypharmacy: A New Risk Predictor?

Introduction Hip fractures include intra- and extracapsular fractures with hip hemiarthroplasty, intramedullary (IM nailing), dynamic hip screw (DHS) fixation and cannulated cancellous screws being the main treatment options. The Nottingham Hip Fracture Score (NHFS) is used to predict the risk of 30-day mortality with some studies investigating its use for one-year mortality. This study aims to investigate the impact of polypharmacy on post-operative hip fracture mortality and the correlation with NHFS predicted mortality. Methods A retrospective single-centre analysis was carried out on hip fracture patients aged 65 years and over who underwent operative management. Primary outcome measures were 30-day and one-year mortality along with the presence of polypharmacy. Secondary outcome measures were mortality based on procedure type, NHFSs for polypharmacy and non-polypharmacy groups, number of medications, American Society of Anesthesiologists (ASA) grade, age and gender. Polypharmacy was defined as five or more long-term medications from a selected list of drug classes. Results Thirty-day mortality was 19.3% for the polypharmacy group and 2.4% for the non-polypharmacy group (P≤0.00001), while one year mortality was 50.9% for the polypharmacy group and 2.4% for the non-polypharmacy group (P≤0.00001), the NHFS was 5.16 (±1.38) on average for the polypharmacy group and 5.07 (±1.47) for the non-polypharmacy group. Thirty-day mortality was 10/116 (8.6%) for the hemiarthroplasty patients, 3/66 (4.5%) for the DHS fixation patients and 1/32 (4.5%) for the IM nailing patients. One-year mortality was 33/116 (28.4%) for the hemiarthroplasty patients, 11/66 (16.7%) for the DHS fixation patients and 4/32 (12.6%) for the IM nailing patients. Conclusion Polypharmacy correlated with a significantly higher one-year and 30-day postoperative mortality after hip fractures with the NHFS predicting no difference in mortality. This finding could assist in decision making and help facilitate discussions with patients and family members regarding post-operative mortality risks. The NHFS may also benefit from integrating polypharmacy possibly leading to more accurate risk predictions. The IM nailing and DHS fixation patients were found to have a lower 30-day and one-year mortality than the hemiarthroplasty patients.

Depression and Metabolic Syndrome: A Narrative Review.

We reviewed the literature to investigate the relationship between depression and metabolic syndrome. Major depressive disorder is characterized by a low mood or a loss of interest for longer than two weeks. Metabolic syndrome describes multiple metabolic risk factors including obesity, insulin resistance, dyslipidemia, and hypertension. We divided our findings into environmental, genetic, epigenetic, and biological pathway links between depression and the different aspects of metabolic syndrome. We found various sources linking obesity and metabolic syndrome genetically, environmentally, biological pathway-wise, and, while not fully explored, epigenetically. Diabetes and depression were also found to be linked environmentally with both conditions increasing the risk of the other. Depression was also shown to be linked to cardiovascular complications as it increased the risk of occurrence of such complications in healthy people. These findings have led us to believe that there is a link between depression and metabolic syndrome on various levels, especially obesity.

Bilateral Simultaneous Asymmetrical Anterior Shoulder Dislocation With a Fracture.

In this case report, we present the case of a 19-year-old male who presented to the emergency department with bilateral shoulder pain and significantly decreased range of motion. His X-rays showed a bilateral dislocation of the glenohumeral joints, along with a proximal humeral fracture. Shoulder dislocations were manipulated, while the proximal humeral fracture was conservatively managed. Bilateral simultaneous asymmetric anterior shoulder dislocations are uncommon in such a young age group, especially when associated with a sports injury.