Preliminary results of a new test for rapid diagnosis of septic arthritis with use of leukocyte esterase and glucose reagent strips
Mohamed Omar, Max Ettinger, Moritz Reichling, Maximilian Petri, Ralf Lichtinghagen, Daniel Guenther, Eduardo M Suero, Michael Jagodzinski, Christian Krettek
Journal of Bone and Joint Surgery. American Volume 2014 December 17, 96 (24): 2032-7
BACKGROUND: Most currently used tools to diagnose septic arthritis are either not readily available or fail to provide real-time results. Reagent strip tests have identified infections in various body fluids. We hypothesized that combined leukocyte esterase and glucose strip tests can aid in diagnosing septic arthritis in native synovial fluid because (1) leukocyte esterase concentrations would be elevated at the infection site because of secretion by recruited neutrophils, and (2) glucose concentrations would be reduced because of bacterial metabolism.
METHODS: We prospectively investigated synovial fluid from consecutive patients with an atraumatic joint effusion who underwent arthrocentesis in our emergency department during a one-year period. Leukocyte esterase and glucose strip tests were performed on the synovial fluid. Synovial fluid leukocyte count, crystal analysis, Gram staining, culture, and glucose concentration results were also assessed.
RESULTS: Nineteen fluids were classified as septic and 127 as aseptic. Considering septic arthritis to be present when the leukocyte esterase reading was positive (++ or +++) and the glucose reading was negative (-) yielded a sensitivity of 89.5% (95% confidence interval [CI], 66.9% to 98.7%), specificity of 99.2% (95% CI, 95.7% to 99.9%), positive predictive value of 94.4% (95% CI, 72.7% to 99.9%), negative predictive value of 98.4% (95% CI, 94.5% to 99.8%), positive likelihood ratio of 114, and negative likelihood ratio of 0.11. The synovial leukocyte counts and polymorphonuclear cell percentages were consistent with the semiquantitative readings on the leukocyte esterase strip tests, and the glucose concentrations were consistent with the glucose strip test results.
CONCLUSIONS: Combined leukocyte esterase and glucose strip tests can be a useful additional tool to help confirm or rule out a diagnosis of septic arthritis.
LEVEL OF EVIDENCE: Diagnostic Level II
30 diciembre 2014
Rodilla/Knee/Knie/Genou:¿Con menos complicaciones de lo imaginado?
The John Insall Award: Morbid Obesity Independently Impacts Complications, Mortality, and Resource Use After TKA
Michele R D'Apuzzo, Wendy M Novicoff, James A Browne
Clinical Orthopaedics and related Research 2015, 473 (1): 57-63
BACKGROUND: The importance of morbid obesity as a risk factor for complications after total knee arthroplasty (TKA) continues to be debated. Obesity is rarely an isolated diagnosis and tends to cluster with other comorbidities that may independently lead to increased risk and confound outcomes. It is unknown whether morbid obesity independently affects postoperative complications and resource use after TKA.
QUESTIONS/PURPOSES: The purpose of this study was to determine whether morbid obesity is an independent risk factor for inpatient postoperative complications, mortality, and increased resource use in patients undergoing primary TKA.
METHODS: The Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS) database was used to identify patients undergoing primary TKA from October 2005 to December 2008. Morbid obesity (body mass index ≥ 40 kg/m(2)) was determined using International Classification of Diseases, 9(th) Revision, Clinical Modification codes. In-hospital postoperative complications, mortality, costs, and disposition for morbidly obese patients were compared with nonobese patients. To control for potential confounders and comorbid conditions, each morbidly obese patient was matched to a nonobese patient using age, sex, and all 28 comorbid-defined elements in the NIS database based on the Elixhauser Comorbidity Index. Of 1,777,068 primary TKAs, 98,410 (5.5%) patients were categorized as morbidly obese. Of these, 90,045 patients (91%) were able to be matched one-to-one to a nonobese patient for the adjusted analysis.
RESULTS: Morbidly obese patients had a higher risk of postoperative in-hospital infection (0.24% versus 0.17%; odds ratio [OR], 1.3; 95% confidence interval [CI], 1.1-1.7; p = 0.001), wound dehiscence (0.11% versus 0.08%; OR, 1.3; 95% CI, 1.0-1.7; p = 0.28), and genitourinary-related complications (0.60% versus 0.44%; OR, 1.3; 95% CI, 1.1-1.5; p < 0.001). There was no increase in the prevalence of cardiovascular or thromboembolic-related complications. Morbidly obese patients were at higher risk of in-hospital death after primary TKA compared with nonobese patients (0.08% versus 0.02%; OR, 3.2; 95% CI, 2.0-5.2; p < 0.001). Total hospital costs (USD 15,174 versus USD 14,715, p < 0.001), length of stay (3.6 days versus 3.5 days, p < 0.001), and rate of discharge to a facility (40% versus 30%, p < 0.001) were all higher in morbidly obese patients.
CONCLUSIONS: Morbid obesity appears to be independently associated with a higher risk for a small number of select in-hospital postoperative complications and mortality after matching for comorbid medical conditions linked to obesity. However, the independent impact of morbid obesity appears to be fairly modest, and morbid obesity did not appear to be an independent risk factor for many systemic complications. Continued research is necessary to identify the influence of associated comorbidities on early postoperative complications in morbidly obese patients after TKA.
LEVEL OF EVIDENCE: Level II, prognostic study.
Michele R D'Apuzzo, Wendy M Novicoff, James A Browne
Clinical Orthopaedics and related Research 2015, 473 (1): 57-63
BACKGROUND: The importance of morbid obesity as a risk factor for complications after total knee arthroplasty (TKA) continues to be debated. Obesity is rarely an isolated diagnosis and tends to cluster with other comorbidities that may independently lead to increased risk and confound outcomes. It is unknown whether morbid obesity independently affects postoperative complications and resource use after TKA.
QUESTIONS/PURPOSES: The purpose of this study was to determine whether morbid obesity is an independent risk factor for inpatient postoperative complications, mortality, and increased resource use in patients undergoing primary TKA.
METHODS: The Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS) database was used to identify patients undergoing primary TKA from October 2005 to December 2008. Morbid obesity (body mass index ≥ 40 kg/m(2)) was determined using International Classification of Diseases, 9(th) Revision, Clinical Modification codes. In-hospital postoperative complications, mortality, costs, and disposition for morbidly obese patients were compared with nonobese patients. To control for potential confounders and comorbid conditions, each morbidly obese patient was matched to a nonobese patient using age, sex, and all 28 comorbid-defined elements in the NIS database based on the Elixhauser Comorbidity Index. Of 1,777,068 primary TKAs, 98,410 (5.5%) patients were categorized as morbidly obese. Of these, 90,045 patients (91%) were able to be matched one-to-one to a nonobese patient for the adjusted analysis.
RESULTS: Morbidly obese patients had a higher risk of postoperative in-hospital infection (0.24% versus 0.17%; odds ratio [OR], 1.3; 95% confidence interval [CI], 1.1-1.7; p = 0.001), wound dehiscence (0.11% versus 0.08%; OR, 1.3; 95% CI, 1.0-1.7; p = 0.28), and genitourinary-related complications (0.60% versus 0.44%; OR, 1.3; 95% CI, 1.1-1.5; p < 0.001). There was no increase in the prevalence of cardiovascular or thromboembolic-related complications. Morbidly obese patients were at higher risk of in-hospital death after primary TKA compared with nonobese patients (0.08% versus 0.02%; OR, 3.2; 95% CI, 2.0-5.2; p < 0.001). Total hospital costs (USD 15,174 versus USD 14,715, p < 0.001), length of stay (3.6 days versus 3.5 days, p < 0.001), and rate of discharge to a facility (40% versus 30%, p < 0.001) were all higher in morbidly obese patients.
CONCLUSIONS: Morbid obesity appears to be independently associated with a higher risk for a small number of select in-hospital postoperative complications and mortality after matching for comorbid medical conditions linked to obesity. However, the independent impact of morbid obesity appears to be fairly modest, and morbid obesity did not appear to be an independent risk factor for many systemic complications. Continued research is necessary to identify the influence of associated comorbidities on early postoperative complications in morbidly obese patients after TKA.
LEVEL OF EVIDENCE: Level II, prognostic study.
17 diciembre 2014
Rodilla/Knee: Tendencias de una década
Trends in Total Knee Arthroplasty Implant Utilization
Long-Co L. Nguyen, Mandeep Lehil, Kevin J. Bozic
The Journal of Arthroplasty
Published Online: December 13, 2014
DOI: http://dx.doi.org/10.1016/j.arth.2014.12.009
Abstract
The incidence of total knee arthroplasty (TKA) has increased alongside our knowledge of knee physiology, kinematics, and technology resulting in an evolution of TKA implants. This study examines the trends in TKA implant utilization in the United States.
Data from 2001 to 2012 was extracted from The Orthopedic Research Network to evaluate trends in level of constraint, fixed vs. mobile bearing, fixation, and type of polyethylene.
In 2012, 88% of primary TKAs used cemented femoral and tibial implants. 38% of primary TKA implants were cruciate retaining, 53% posterior stabilized or condylar stabilized, 3% constrained. 91% was fixed-bearing, 7% mobile-bearing. 52% of tibial inserts were HXLPE.
TKA implant trends demonstrate a preference for cemented femoral and tibial components, fixed-bearing constructs, the use of metal-backed tibial components, and increased usage of HXLPE liners.
Long-Co L. Nguyen, Mandeep Lehil, Kevin J. Bozic
The Journal of Arthroplasty
Published Online: December 13, 2014
DOI: http://dx.doi.org/10.1016/j.arth.2014.12.009
Abstract
The incidence of total knee arthroplasty (TKA) has increased alongside our knowledge of knee physiology, kinematics, and technology resulting in an evolution of TKA implants. This study examines the trends in TKA implant utilization in the United States.
Data from 2001 to 2012 was extracted from The Orthopedic Research Network to evaluate trends in level of constraint, fixed vs. mobile bearing, fixation, and type of polyethylene.
In 2012, 88% of primary TKAs used cemented femoral and tibial implants. 38% of primary TKA implants were cruciate retaining, 53% posterior stabilized or condylar stabilized, 3% constrained. 91% was fixed-bearing, 7% mobile-bearing. 52% of tibial inserts were HXLPE.
TKA implant trends demonstrate a preference for cemented femoral and tibial components, fixed-bearing constructs, the use of metal-backed tibial components, and increased usage of HXLPE liners.
Rodilla-cadera/Knee-Hip: Postoperatorio más gravoso a mayor ASA
The Association of ASA Class on Total Knee and Total Hip Arthroplasty Readmission Rates in an Academic Hospital
Jordan F. Schaeffer, Daniel J. Scott, Jonathan A. Godin, David E. Attarian, Samuel S. Wellman, Richard C. Mather III
The Journal of Arthroplasty
Published Online: December 16, 2014
DOI: http://dx.doi.org/10.1016/j.arth.2014.12.01
Abstract
Total hip and knee arthroplasty are two of the most successful procedures in orthopaedics. However, with the increasing demand, estimated future costs for these procedures are enormous. Recent data suggests that post-discharge care may account for up to 35% of total episode payments. Yet, little is known about targets that can help improve quality and reduce cost. This retrospective study shows that an ASA score of ≥3 is associated with a 2.9 times (p = 0.0082) greater risk of re-admission in total joint arthroplasty patients. The current literature corroborates this finding by demonstrating an increase risk of post-operative complications in patients with an ASA of ≥3. Therefore, the ASA score is a potential target for interventions designed to increase quality and lower cost in arthroplasty patients.
Jordan F. Schaeffer, Daniel J. Scott, Jonathan A. Godin, David E. Attarian, Samuel S. Wellman, Richard C. Mather III
The Journal of Arthroplasty
Published Online: December 16, 2014
DOI: http://dx.doi.org/10.1016/j.arth.2014.12.01
Abstract
Total hip and knee arthroplasty are two of the most successful procedures in orthopaedics. However, with the increasing demand, estimated future costs for these procedures are enormous. Recent data suggests that post-discharge care may account for up to 35% of total episode payments. Yet, little is known about targets that can help improve quality and reduce cost. This retrospective study shows that an ASA score of ≥3 is associated with a 2.9 times (p = 0.0082) greater risk of re-admission in total joint arthroplasty patients. The current literature corroborates this finding by demonstrating an increase risk of post-operative complications in patients with an ASA of ≥3. Therefore, the ASA score is a potential target for interventions designed to increase quality and lower cost in arthroplasty patients.
Rodilla/Knee/Knie/Genou: la prótesis unicondílea lateral parece ir bien
The Current Trends for Lateral Unicondylar Knee Arthroplasty
Keith R. Berend, Nathan J. Turnbull, Robert E. Howell, Adolph V. Lombardi
Orthop Clinics of North America
Published Online: December 03, 2014
DOI: http://dx.doi.org/10.1016/j.ocl.2014.10.001
Unicompartmental osteoarthritis of the knee is a relatively common disease that is seen in 40% of the population. Although disease isolated to the medial compartment of the knee is more common, isolated lateral disease also frequently exists (25% vs 10%). However, surgeons perform medial unicondylar knee replacement at a ratio of 10:1 when compared with lateral unicondylar knee replacement. This may be attributed to lack of familiarity or the increased difficulty of the procedure. Recent literature suggests that with proper patient selection, surgical technique, and implant choice, early survivorship ranges from 95% to 99%.
Keith R. Berend, Nathan J. Turnbull, Robert E. Howell, Adolph V. Lombardi
Orthop Clinics of North America
Published Online: December 03, 2014
DOI: http://dx.doi.org/10.1016/j.ocl.2014.10.001
Unicompartmental osteoarthritis of the knee is a relatively common disease that is seen in 40% of the population. Although disease isolated to the medial compartment of the knee is more common, isolated lateral disease also frequently exists (25% vs 10%). However, surgeons perform medial unicondylar knee replacement at a ratio of 10:1 when compared with lateral unicondylar knee replacement. This may be attributed to lack of familiarity or the increased difficulty of the procedure. Recent literature suggests that with proper patient selection, surgical technique, and implant choice, early survivorship ranges from 95% to 99%.
15 diciembre 2014
Rodilla/Knee/Knie/Genou: Por el bien de todos, cuanto antes mucho mejor
Joint infection after knee arthroscopy: Medicolegal aspects
S. Marmora,T. Farmanb, A. Lortat-Jacobc
Orthopaedics & Traumatology: Surgery & Research (2009) 95, 278—283
Summary
Introduction:
Septic knee arthritis following arthroscopy is a rare but dreaded complication: it might compromise patients’ functional prognosis and engage surgeon’s liability. This study analyzes the context of such infection occurrences, their management as well as their medicolegal consequences.
Patients and methods:
Twenty-two cases of knee septic arthritis following arthroscopy were examined during the medicolegal litigation process and collected for assessment from a medical liability specialised insurer. Half of the patients were manual workers who worked on their knees, and seven knees had a previous surgical history. The procedures performed at arthroscopy included seven ligamentoplasties, nine meniscotomies, three arthroscopic lavages, one arthrol- ysis, one chondroma removal and one plica resection. Seven patients, to some point, received corticosteroids: three preoperative joint injections, three intraoperative injections, and one oral corticotherapy.
Results:
Clinical signs of septic arthritis appeared after a median interval of 8 days (0—37), twice after a hemarthrosis and once after an articular burn. The median delay before treatment initiation was 4.2 days, and in 10 cases this therapeutic delay exceeded 3 days. On average, 3.5 additional procedures (1—9) were required to treat the infection and its residual sequels. Two total knee prostheses were implanted. Only two patients were free of disabling sequellae, and in five patients these sequels affected their livelihood. The medicolegal consequences were a partially permanent disability averaging 5% (0—20), a total temporary work incapacity of 120 days (40—790), a suffering burden averaging 3 out of 7 (0—4,5) points on the scale conventionally used in France. Twelve of these legal claims led to court ordered patient compensation.
Discussion:
Some risk factors of articular infection are known and well-identified. They can be linked to the patient’s condition (addiction to smoking, surgical history, professional activity) or to medical management (intra-articular corticoid injections, interventions under oral anti- coagulants, inadvertently overheated irrigation fluid). When infection is suspected, it is often the needle-aspirated fluid’s inappropriate handling (such as absence of bacteriological testing or defective waiting time for the results), which delays the diagnostic or therapeutic management of this complication. All failures of infection diagnosis or treatment heavily contribute to malpractice claims against the surgeon. Early and appropriate management of postoperative infections helps limiting the risk of functional sequellae for the patient and reduces the risk of malpractice litigation for the practitioner.
Level of evidence: Level IV; economic and decision analysis, retrospective study.
KEYWORDS
Knee;
Septic arthritis; Arthroscopy; Complications; Medicolegal
S. Marmora,T. Farmanb, A. Lortat-Jacobc
Orthopaedics & Traumatology: Surgery & Research (2009) 95, 278—283
Summary
Introduction:
Septic knee arthritis following arthroscopy is a rare but dreaded complication: it might compromise patients’ functional prognosis and engage surgeon’s liability. This study analyzes the context of such infection occurrences, their management as well as their medicolegal consequences.
Patients and methods:
Twenty-two cases of knee septic arthritis following arthroscopy were examined during the medicolegal litigation process and collected for assessment from a medical liability specialised insurer. Half of the patients were manual workers who worked on their knees, and seven knees had a previous surgical history. The procedures performed at arthroscopy included seven ligamentoplasties, nine meniscotomies, three arthroscopic lavages, one arthrol- ysis, one chondroma removal and one plica resection. Seven patients, to some point, received corticosteroids: three preoperative joint injections, three intraoperative injections, and one oral corticotherapy.
Results:
Clinical signs of septic arthritis appeared after a median interval of 8 days (0—37), twice after a hemarthrosis and once after an articular burn. The median delay before treatment initiation was 4.2 days, and in 10 cases this therapeutic delay exceeded 3 days. On average, 3.5 additional procedures (1—9) were required to treat the infection and its residual sequels. Two total knee prostheses were implanted. Only two patients were free of disabling sequellae, and in five patients these sequels affected their livelihood. The medicolegal consequences were a partially permanent disability averaging 5% (0—20), a total temporary work incapacity of 120 days (40—790), a suffering burden averaging 3 out of 7 (0—4,5) points on the scale conventionally used in France. Twelve of these legal claims led to court ordered patient compensation.
Discussion:
Some risk factors of articular infection are known and well-identified. They can be linked to the patient’s condition (addiction to smoking, surgical history, professional activity) or to medical management (intra-articular corticoid injections, interventions under oral anti- coagulants, inadvertently overheated irrigation fluid). When infection is suspected, it is often the needle-aspirated fluid’s inappropriate handling (such as absence of bacteriological testing or defective waiting time for the results), which delays the diagnostic or therapeutic management of this complication. All failures of infection diagnosis or treatment heavily contribute to malpractice claims against the surgeon. Early and appropriate management of postoperative infections helps limiting the risk of functional sequellae for the patient and reduces the risk of malpractice litigation for the practitioner.
Level of evidence: Level IV; economic and decision analysis, retrospective study.
KEYWORDS
Knee;
Septic arthritis; Arthroscopy; Complications; Medicolegal
14 diciembre 2014
Rodilla/Knee/Knie/Genou: Es fácil dañar las ramas del safeno al extraer los tendones
The Course And Distribution Of The Infra Patellar Nerve In Relation To Acl Reconstruction
T. Walshaw , S.V. Karuppiah , I. Stewart
The Knee
Publication date: Available online 26 November 2014
Introduction
A common complication after ACL (anterior cruciate ligament reconstruction) is injury to the infra-patellar branch of the saphenous nerve (IPBSN). Very little about its origin and course of this nerve has been described. The aim of this study was to understand the course of IPBSN in relation to surgery around the knee.
Materials and method
The course of the nerve was dissected and traced in 25 knees from 14 cadaveric knees (10 male; 4 female). An incision was made posterior to the medial condyle of the tibia and continued deeper towards the saphenous nerve which is located under the sartorius muscle. The sapheneous nerve branch was then followed distally supply the anterior leg (IPBSN). The relationship of saphenous nerve and IPBSN to each other and the hamstrings were recorded
Results
Four paths of IPBSN, in relation to the Sartorius muscle, were identified: (1) posterior - inferior posterior border of the muscle, (2) transmuscular - penetrating through the muscle, (3) anterior - anterior border of the muscle, (4) posterior patellar - posterior of the muscle at the level of the patellar bone and (5) combined The posterior pathway of IPSBN was the most common (57%) and had the closest proximity to the tendons of semintendinosus and gracilis muscles. The terminal branches of the IPSBN crossed over the patella tendon in every dissection.
Conclusions
A posterior path IPBSN is more prone to damage during a tendon harvest due to its proximity to the gracilis and semitendinosus muscle tendons.
A common complication after ACL (anterior cruciate ligament reconstruction) is injury to the infra-patellar branch of the saphenous nerve (IPBSN). Very little about its origin and course of this nerve has been described. The aim of this study was to understand the course of IPBSN in relation to surgery around the knee.
Materials and method
The course of the nerve was dissected and traced in 25 knees from 14 cadaveric knees (10 male; 4 female). An incision was made posterior to the medial condyle of the tibia and continued deeper towards the saphenous nerve which is located under the sartorius muscle. The sapheneous nerve branch was then followed distally supply the anterior leg (IPBSN). The relationship of saphenous nerve and IPBSN to each other and the hamstrings were recorded
Results
Four paths of IPBSN, in relation to the Sartorius muscle, were identified: (1) posterior - inferior posterior border of the muscle, (2) transmuscular - penetrating through the muscle, (3) anterior - anterior border of the muscle, (4) posterior patellar - posterior of the muscle at the level of the patellar bone and (5) combined The posterior pathway of IPSBN was the most common (57%) and had the closest proximity to the tendons of semintendinosus and gracilis muscles. The terminal branches of the IPSBN crossed over the patella tendon in every dissection.
Conclusions
A posterior path IPBSN is more prone to damage during a tendon harvest due to its proximity to the gracilis and semitendinosus muscle tendons.
08 diciembre 2014
Cadera/Hip/Hüfte/Hanche: un agujerito para ver el futuro
Can we predict femoral head vitality during surgical hip dislocation?
Alessandro Aprato, Andrea Bonani, Matteo Giachino, Marco Favuto, Francesco Atzori, Alessandro Masse
Journal of Hip Preservation Surgery Volume 1, Issue 2, Pp. 77-81.
Abstract
Purpose
Surgical hip dislocation is commonly performed in orthopaedic surgery for several pathologies that often present risk of avascular necrosis (AVN) of femoral head. Observation of blood spilling out from a drill hole, performed in the head after dislocation, has been proposed as a predictive test for AVN. No data have been published about test reliability. Study’s aim was to evaluate the correlation between ‘bleeding sign’ and AVN in surgical dislocation for elective disease and for acetabular fractures.
Methods
All patients meeting the indication for surgical dislocation were included in this prospective study. Patients with follow-up shorter than 8 months were excluded. Intra-operative assessment of head vascularity was performed in 44 patients through the ‘bleeding sign’: a 2.0-mm drill hole carried out on the head during surgery. A positive bleeding test was considered an immediate appearance of active bleeding. Development of AVN was considered the main outcome. Necrosis group criteria were detection of type II, III or IV X-ray according to Ficat classification.
Results
Forty-four patients with selected acetabular fractures, slipped capital femoral epiphysis and femoral head deformity were enrolled. Mean age was 25 years and mean follow-up was 36 months. Thirty-eight patients presented positive intra-operative bleeding sign and six demonstrated no bleeding. Sensitivity for the ‘bleeding sign’ was 97%, specificity was 83%, positive predictive value was 97%, negative predictive value was 83% and accuracy was 95% (P < 0.001).
Conclusions
Bleeding after head drilling is a reliable test for AVN in patients who undergo a surgical hip dislocation.
Cadera/Hip/Hüfte/Hanche: no siempre es trocanteritis
Intra-articular hip injections for lateral hip pain
Matthew C. Bessette, Joshua R. Olsen, Tobias R. Mann and Brian D. Giordano
Journal of Hip Preservation Surgery Volume 1, Issue 2Pp. 71-76.
Abstract
Occult intra-articular hip pathology is commonly found in patients with greater trochanteric pain syndrome, and may be a possible pain generator in patients with recalcitrant lateral hip pain. We investigated the effect of intra-articular hip injections in patients with recalcitrant lateral hip pain. Between September 2012 and May 2013, patients over the age of 18 with a history lateral hip pain who had received prior treatment with non-steroidal anti-inflammatory medications, physical therapy and peritrochanteric corticostroid injections were enrolled. Treatment consisted of an ultrasound guided intra-articular corticosteroid injection followed by a course of directed physical therapy and a non-steroidal anti-inflammatory medication. Patients performed GaitRite analysis at baseline and 12 weeks following the injection. In addition, the Modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Scores (HOS), Short Form 36 (SF-36) and a visual analogue pain score (VAS) were collected at baseline, 1, 6 and 12 weeks.A total of 16 patients were studied. Patients experienced significant improvements from their baseline mHHS at 1 and 12 weeks (P = 0.03, P = 0.04). The minimal clinically important difference (MCID) was exceeded at multiple timepoints on various clinical outcome surveys. Velocity and stride length were not significantly improved at 12 weeks. Intra-articular hip injections may decrease pain and improve function in patients with recalcitrant lateral hip pain, and occult intra-articular hip pathology should be considered in the etiology of lateral hip pain. Though low enrollment numbers left this study underpowered, MCID comparisons demonstrated potential benefit from this treatment.
07 diciembre 2014
Cadera/Hip/Hüfte/Hanche: osteotomía valguizante cuando no una el cuello femoral
Managing Failed Fixation: Valgus osteotomy for femoral neck nonunion
D.E Deakin, P Guy, P.J O’Brien, P.A Blachut, K.A Lefaivre
Published Online: December 05, 2014
DOI: http://dx.doi.org/10.1016/j.injury.2014.11.022
Abstract
Femoral neck non union is a relatively uncommon complication following intracapsular hip fracture in the young patient. Almost all patients with femoral neck non union are symptomatic for which they will require some form of revision surgery. This review discusses the role of valgus osteotomy in managing the younger patient with femoral neck non union.
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