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Murphy NJ, Diamond LE, Bennell KL, Burns A, Dickenson E, Eyles J, Fary C, Grieve SM, Griffin DR, Kim YJ, Linklater JM, Lloyd DG, Molnar R, O'Connell RL, O'Donnell J, Randhawa S, J Singh P, Spiers L, Tran P, Wrigley T, Hunter DJ. Which hip morphology measures and patient factors are associated with age of onset and symptom severity in femoroacetabular impingement syndrome? Hip Int 2023; 33:102-111. [PMID: 34424780 DOI: 10.1177/11207000211038550] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Bony morphology is central to the pathomechanism of femoroacetabular impingement syndrome (FAIS), however isolated radiographic measures poorly predict symptom onset and severity. More comprehensive morphology measurement considered together with patient factors may better predict symptom presentation. This study aimed to determine the morphological parameter(s) and patient factor(s) associated with symptom age of onset and severity in FAIS. METHODS 99 participants (age 32.9 ± 10.5 years; body mass index (BMI 24.3 ± 3.1 kg/m2; 42% females) diagnosed with FAIS received standardised plain radiographs and magnetic resonance scans. Alpha angle in four radial planes (superior to anterior), acetabular version (AV), femoral torsion, lateral centre-edge, anterior centre-edge (ACEA) and femoral neck-shaft angles were measured. Age of symptom onset (age at presentation minus duration of symptoms), international Hip Outcome Tool-33 (iHOT-33) and modified UCLA activity scores were recorded. Backward stepwise regression assessed morphological parameters and patient factors (age, sex, BMI, symptom duration, annual income, private/public healthcare system accessed) to determine variables independently associated with onset age and iHOT-33 score. RESULTS Earlier symptom onset was associated with larger superoanterior alpha angle (p = 0.007), smaller AV (p = 0.023), lower BMI (p = 0.010) and public healthcare system access (p = 0.041) (r2 = 0.320). Worse iHOT-33 score was associated with smaller ACEA (p = 0.034), female sex (p = 0.040), worse modified UCLA activity score (p = 0.010) and public healthcare system access (p < 0.001) (r2 = 0.340). CONCLUSIONS Age of symptom onset was chiefly predicted by femoral and acetabular bony morphology measures, whereas symptom severity predominantly by patient factors. Factors measured explained a small amount of variance in the data; additional unmeasured factors may be more influential.
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Affiliation(s)
- Nicholas J Murphy
- Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, St Leonards, NSW, Australia.,Department of Orthopaedic Surgery, John Hunter Hospital, Australia
| | - Laura E Diamond
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, School of Allied Health Sciences, Griffith University, Australia
| | - Kim L Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Australia
| | | | - Edward Dickenson
- Warwick Medical School, University of Warwick, Coventry, UK and University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Jillian Eyles
- Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, St Leonards, NSW, Australia.,Department of Rheumatology, Royal North Shore Hospital, Australia
| | - Camdon Fary
- Department of Orthopaedic Surgery, Western Health, Melbourne, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Melbourne, Australia
| | - Stuart M Grieve
- Sydney Translational Imaging Laboratory, Charles Perkins Centre, University of Sydney, Camperdown, Australia.,Department of Radiology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Damian R Griffin
- Warwick Medical School, University of Warwick, Coventry, UK and University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Young Jo Kim
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, USA
| | - James M Linklater
- Department of Musculoskeletal Imaging, Castlereagh Sports Imaging Centre, St Leonards, Australia
| | - David G Lloyd
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, School of Allied Health Sciences, Griffith University, Australia
| | - Robert Molnar
- Sydney Orthopaedic Trauma and Reconstructive Surgery, Sydney, Australia
| | - Rachel L O'Connell
- Department of Rheumatology, Royal North Shore Hospital, Australia.,NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - John O'Donnell
- Hip Arthroscopy Australia, Richmond, Australia.,St Vincent's Private Hospital, East Melbourne, Australia
| | - Sunny Randhawa
- Macquarie University Hospital, Macquarie University, Sydney, Australia
| | - Parminder J Singh
- Hip Arthroscopy Australia, Richmond, Australia.,Maroondah Hospital, Eastern Health, Davey Drive, Ringwood East, Melbourne, Australia
| | - Libby Spiers
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Australia
| | - Phong Tran
- Department of Orthopaedic Surgery, Western Health, Melbourne, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Melbourne, Australia
| | - Tim Wrigley
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Australia
| | - David J Hunter
- Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, St Leonards, NSW, Australia.,Department of Rheumatology, Royal North Shore Hospital, Australia
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Onggo JR, Nambiar M, Onggo JD, Ambikaipalan A, Singh PJ, Babazadeh S. Integrated dual lag screws versus single lag screw cephalomedullary nail constructs: a meta-analysis and systematic review. Hip Int 2022; 32:550-557. [PMID: 33566701 DOI: 10.1177/1120700020985067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND/AIM This study aims to determine the safety and efficacy of integrated dual lag screw (IDL) cephalomedullary nails (CMN) when compared with single lag screw (SL) constructs, in the internal fixation of intertrochanteric femoral fractures. METHODS The Smith & Nephew InterTan IDL was compared with SL CMN group consisting of the Stryker Gamma-3 (G3) and Synthes Proximal Femoral Nail Antirotation (PFNA) CMN. A multi-database search was performed according to PRISMA guidelines. Data from studies assessing the clinical and radiological outcomes, complications and perioperative parameters of InterTan versus G3 or PFNA CMN in patients with intertrochanteric femoral fractures were extracted and analysed. RESULTS 15 studies were included in this meta-analysis, consisting of 2643 patients. InterTan was associated with lower complication rates in terms of all-cause revisions (OR 0.34; 95% CI, 0.22-0.51; p < 0.001), cut-outs (OR 0.30; 95% CI, 0.17-0.51; p < 0.001), medial or lateral screw migration (OR 0.19; 95% CI, 0.06-0.65; p = 0.008) as well as persistent hip and thigh pain (OR 0.65; 95% CI, 0.47-0.90; p = 0.008). In terms of perioperative parameters, InterTan is associated with longer operative times (MD 5.57 minutes; 95% CI, 0.37-10.78 minutes, p = 0.04) and fluoroscopy times (MD 38.89 seconds, 95% CI, 15.88-61.91 seconds; p < 0.001). There was no statistically significant difference in terms of clinical Harris Hip Score and radiological outcomes, non-union, haematoma, femoral fractures, varus collapse, length of stay and mean intraoperative blood loss between the 2 groups. CONCLUSIONS Integrated dual lag screw cephalomedullary nails are associated with fewer revisions and complications. However, there is insufficient data to suggest that either nail construct is associated with better functional outcomes.
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Affiliation(s)
- James R Onggo
- Department of Orthopaedic Surgery, Maroondah Hospital, Victoria, Australia
| | - Mithun Nambiar
- Department of Orthopaedic Surgery, Maroondah Hospital, Victoria, Australia
| | - Jason D Onggo
- Department of Orthopaedic Surgery, Maroondah Hospital, Victoria, Australia
| | | | - Parminder J Singh
- Department of Orthopaedic Surgery, Maroondah Hospital, Victoria, Australia
| | - Sina Babazadeh
- Department of Orthopaedic Surgery, Maroondah Hospital, Victoria, Australia
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Nambiar M, Cheng TE, Onggo JR, Maingard J, Troupis J, Pope A, Armstrong MS, Singh PJ. No Difference in Functional, Radiographic, and Survivorship Outcomes Between Direct Anterior or Posterior Approach THA: 5-Year Results of a Randomized Trial. Clin Orthop Relat Res 2021; 479:2621-2629. [PMID: 34237041 PMCID: PMC8726547 DOI: 10.1097/corr.0000000000001855] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/13/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Both the direct anterior approach (DAA) and posterior approach (PA) to THA have known advantages and disadvantages. The comparison between DAA and PA THA has been widely explored during the early postoperative period. However, few randomized trials have compared these approaches at a minimum follow-up of 5 years; doing so would be important to establish any differences in mid-term outcomes or complications. QUESTIONS/PURPOSES We performed a randomized trial comparing DAA and PA in THA in terms of (1) patient-reported outcome scores, (2) quality of life and functional outcomes assessed by the EQ-5D and 10-meter walk test results, (3) radiographic analysis, and (4) survivorship and surgical complications at a minimum of 5 years follow-up. METHODS Two hip specialist surgeons performed both DAA and PA THA using the same THA components at two hospital sites. One hundred twelve patients on the elective THA surgical waitlist were invited to participate in the study. Thirty-four patients did not meet the study's inclusion criteria and were excluded, and three patients declined to participate in the study. The remaining 75 patients who were eligible were randomized into DAA and PA groups. Thirty-seven patients were initially randomized to receive DAA THA, but two did not and were excluded, resulting in 48% (35 of 73) of patients who received DAA THA; 52% (38 of 73) of patients were randomized into and received PA THA. Over a minimum 5 years of follow-up, 3% (1 of 35) of DAA patients were lost to follow-up, and none of the patients undergoing PA THA were lost. A per-protocol analysis was adopted, resulting in further patients being excluded from analysis. Of the 73 study patients, 99% (72; DAA: 35, PA: 37) were analyzed at 1 year, 95% (69; DAA: 34, PA: 35) were analyzed at 2 years, and 72% (52; DAA: 23, PA: 29) were analyzed at 5 years. The primary outcome was the Oxford Hip Score (OHS) and WOMAC score. Secondary outcomes included the EQ-5D and EQ-5D VAS scores, 10-meter walk test results, radiographic evidence of loosening (femoral: lucency > 2 mm at the implant-bone interface, subsidence > 2 mm; acetabular: migration or change in inclination), 5-year survivorship analysis from all-cause revisions, and surgical complications. The study was powered to detect a 10-point difference in the WOMAC score, which is equivalent to the minimum clinically important difference (MCID). RESULTS There were no differences in primary outcomes (OHS and WOMAC scores) or secondary outcomes (EQ-5D scores, EQ-5D VAS scores, and 10-meter walk test result) between the DAA and PA groups at the 5-year follow-up interval. The median (range) OHS at 5 years was 46 (16 to 48) for DAA and 47 (18 to 48) for PA groups (p = 0.93), and the median WOMAC score was 6 (0 to 81) for DAA and 7 (0 to 59) for PA groups (p = 0.96). The median EQ-5D score was 1 (0.1 to 1) for DAA and 1 (0.5 to 1) for PA groups (p = 0.45), and the median EQ-5D VAS score was 85 (60 to 100) for DAA and 95 (70 to 100) for PA groups (p = 0.29). There were no cases of component loosening on radiographs. There was no difference in component survival between the two approaches at 5 years (DAA: 97% [95% CI 85% to 100%] versus PA: 97% [95% CI 87% to 100%]). Eight of 23 patients in the DAA group reported decreased sensation in the lateral femoral cutaneous nerve distribution. CONCLUSION DAA and PA are both effective approaches in performing primary THA. Each approach has its associated risks and complications. The choice of THA should be based on individual patient factors, surgeon experience, and shared decision-making. Early registry data indicate DAA and PA THA are comparable, but longer-term data with larger numbers of patients will be required before one can safely conclude equal survivorship between both approaches. LEVEL OF EVIDENCE Level I, therapeutic study.
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Affiliation(s)
- Mithun Nambiar
- Department of Orthopaedic Surgery, Box Hill Hospital, Box Hill, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Tze E. Cheng
- Department of Orthopaedic Surgery, Box Hill Hospital, Box Hill, Victoria, Australia
- Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - James R. Onggo
- Department of Orthopaedic Surgery, Box Hill Hospital, Box Hill, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Julian Maingard
- Monash Imaging, Monash Medical Centre, Clayton, Victoria, Australia
| | - John Troupis
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
- Monash Imaging, Monash Medical Centre, Clayton, Victoria, Australia
| | - Alun Pope
- Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Michael S. Armstrong
- Department of Orthopaedic Surgery, Box Hill Hospital, Box Hill, Victoria, Australia
| | - Parminder J. Singh
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
- Department of Orthopaedic Surgery, Maroondah Hospital, Ringwood, Victoria, Australia
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Onggo JD, Onggo JR, Nambiar M, Duong A, Ayeni OR, O'Donnell J, Singh PJ. The 'wave sign' in hip arthroscopy: a systematic review of epidemiological factors, current diagnostic methods and treatment options. J Hip Preserv Surg 2020; 7:410-422. [PMID: 33948197 PMCID: PMC8081434 DOI: 10.1093/jhps/hnaa058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/28/2020] [Accepted: 11/17/2020] [Indexed: 12/22/2022] Open
Abstract
This study aims to present a systematic review and synthesized evidence on the epidemiological factors, diagnostic methods and treatment options available for this phenomenon. A multi-database search (OVID Medline, EMBASE and PubMed) was performed according to PRISMA guidelines on 18 June 2019. All studies of any study design discussing on the epidemiological factors, diagnostic methods, classification systems and treatment options of the wave sign were included. The Newcastle–Ottawa quality assessment tool was used to appraise articles. No quantitative analysis could be performed due to heterogeneous data reported; 11 studies with a total of 501 patients with the wave sign were included. Three studies examined risk factors for wave sign and concluded that cam lesions were most common. Other risk factors include alpha angle >65° (OR=4.00, 95% CI: 1.26–12.71, P=0.02), male gender (OR 2.24, 95% CI: 1.09–4.62, P=0.03) and older age (OR=1.04, 95% CI: 1.01–1.07, P=0.03). Increased acetabular coverage in setting of concurrent cam lesions may be a protective factor. Wave signs most commonly occur at the anterior, superior and anterosuperior acetabulum. In terms of staging accuracy, the Haddad classification had the highest coefficients in intraclass correlation (k=0.81, 95% CI: 0.23–0.95, P=0.011), inter-observer reliability (k=0.88, 95% CI: 0.72–0.97, P<0.001) and internal validity (k=0.89). One study investigated the utility of quantitative magnetic imaging for wave sign, concluding that significant heterogeneity in T1ρ and T2 values (P<0.05) of acetabular cartilage is indicative of acetabular debonding. Four studies reported treatment techniques, including bridging suture repair, reverse microfracture with bubble decompression and microfracture with fibrin adhesive glue, with the latter reporting statistically significant improvements in modified Harris hip scores at 6-months (MD=19.2, P<0.05), 12-months (MD=22.0, P<0.05) and 28-months (MD=17.5, P<0.001). No clinical studies were available for other treatment options. There is a scarcity of literature on the wave sign. Identifying at risk symptomatic patients is important to provide prompt diagnosis and treatment. Diagnostic techniques and operative options are still in early developmental stages. More research is needed to understand the natural history of wave sign lesions after arthroscopic surgery and whether intervention can improve long-term outcomes. Level IV, Systematic review of non-homogeneous studies.
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Affiliation(s)
- Jason Derry Onggo
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | - James Randolph Onggo
- Department of Orthopaedic Surgery, Box Hill Hospital, Box Hill, Victoria, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Mithun Nambiar
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.,Department of Orthopaedic Surgery, Maroondah Hospital, Ringwood, Victoria, Australia
| | - Andrew Duong
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University Medical Centre, McMaster University, Ontario, Canada
| | - Olufemi R Ayeni
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University Medical Centre, McMaster University, Ontario, Canada
| | - John O'Donnell
- Department of Surgery, Swinburne University of Technology, Hawthorn, Victoria, Australia.,Hip Arthroscopy Australia, Richmond, Victoria, Australia
| | - Parminder J Singh
- Department of Orthopaedic Surgery, Maroondah Hospital, Ringwood, Victoria, Australia.,Hip Arthroscopy Australia, Richmond, Victoria, Australia
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Onggo JR, Nambiar M, Onggo JD, Tay G, Singh PJ, Babazadeh S. Outcome of tantalum rod insertion in the treatment of osteonecrosis of the femoral head with minimum follow-up of 1 year: a meta-analysis and systematic review. J Hip Preserv Surg 2020; 7:329-339. [PMID: 33163219 PMCID: PMC7605767 DOI: 10.1093/jhps/hnaa020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/03/2020] [Accepted: 04/18/2020] [Indexed: 01/17/2023] Open
Abstract
Osteonecrosis of the femoral head (ONFH) is a debilitating disease that can cause deformity and collapse of the femoral head, thus leading to the development of degenerative joint disease that can incapacitate the patient with pain and reduction in hip mobility. This study aims to determine the safety and efficacy of tantalum rod insertion in the treatment of ONFH with a minimum follow-up period of 1 year. A multi-database search was performed according to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Data from studies assessing the clinical and radiological outcomes as well as complications of tantalum rod insertion in the treatment of ONFH with a minimum follow-up period of 1 year were extracted and analyzed. Ten studies were included in this meta-analysis, consisting of 550 hips. There was a statistically significant increase in HHS (MD = 30.35, 95% CI: 20.60-40.10, P < 0.001) at final follow-up versus pre-operative scores. The weighted pooled proportion (PP) of radiographic progression of ONFH was 0.221 (95% CI: 0.148-0.316), while that of progression into femoral head collapse was 0.102 (95% CI: 0.062-0.162). Conversion to total hip arthroplasty (THA) had a PP of 0.158 (95% CI: 0.107-0.227) with a mean weighted period of 32.4 months (95% CI: 24.9-39.9 months). Subgroup analysis of conversion to THA when tantalum rods were used in conjunction with bone grafting (PP = 0.150, 95% CI: 0.092-0.235) showed a marginal risk reduction than when compared with subgroup analysis of tantalum rods being used alone (PP = 0.154, 95% CI: 0.078-0.282). Tantalum rod is a safe alternative option to the current joint-preserving procedures available in the treatment of ONFH. However, more studies are needed to investigate and identify the most appropriate patients who would benefit most and the synergistic effect brought on by the use of complementary biological augmentation of bone grafting or stem cells with tantalum rods.
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Affiliation(s)
- James Randolph Onggo
- Department of Orthopaedic Surgery, Maroondah Hospital, Ringwood East, Melbourne City, VIC 3135, Australia
| | - Mithun Nambiar
- Department of Orthopaedic Surgery, Maroondah Hospital, Ringwood East, Melbourne City, VIC 3135, Australia
| | - Jason Derry Onggo
- Department of Orthopaedic Surgery, Maroondah Hospital, Ringwood East, Melbourne City, VIC 3135, Australia
| | - Guan Tay
- Department of Orthopaedic Surgery, Maroondah Hospital, Ringwood East, Melbourne City, VIC 3135, Australia
| | - Parminder J Singh
- Department of Orthopaedic Surgery, Maroondah Hospital, Ringwood East, Melbourne City, VIC 3135, Australia
| | - Sina Babazadeh
- Department of Orthopaedic Surgery, Maroondah Hospital, Ringwood East, Melbourne City, VIC 3135, Australia
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Jones DM, Webster KE, Crossley KM, Ackerman IN, Hart HF, Singh PJ, Pritchard MG, Gamboa G, Kemp JL. Psychometric Properties of the Hip-Return to Sport After Injury Scale (Short Form) for Evaluating Psychological Readiness to Return to Sports After Arthroscopic Hip Surgery. Am J Sports Med 2020; 48:376-384. [PMID: 31800298 DOI: 10.1177/0363546519888644] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Successful return to sports activity after surgery requires both physical and psychological readiness. The Hip-Return to Sport After Injury (Short Form) has been developed to assess psychological readiness to return to sports after hip injury and hip surgery, including hip arthroscopy. PURPOSE To evaluate the reliability, validity, responsiveness, and interpretability of the scale for a cohort of patients after hip arthroscopy with a range of sports participation levels. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 2. METHODS Invitations to participate were sent to 145 patients from 3 specialist surgeons. The study included 77 participants 1 to 24 months after hip arthroscopy (mean ± SD age, 35 ± 9 years; 62% women) and 33 healthy age-matched controls (age, 37 ± 7 years; 52% women). The scale was administered electronically on 3 occasions to patients: baseline (≥1 month postarthroscopy), 1 week later, and 6 months later. In addition to the scale, participants were asked about sports participation status and their global rating of postsurgical change. The scale was administered to healthy controls on 1 occasion. The minimal detectable difference, discriminant validity, floor and ceiling effects, responsiveness, and interpretability (minimally important change) were determined for the scale. RESULTS Among the postarthroscopy group, excellent test-retest reliability was found (intraclass correlation coefficient = 0.869; 95% CI, 0.756-0.932) with a minimal detectable difference of 26 points out of 100 at the individual level and 4 points out of 100 at the group level. At baseline discriminant validity was evident between those who had returned to sports (median = 69, n = 35) and those who had not returned to sports (median = 30, n = 42; Mann-Whitney U score = 232.5, z = -5.141, P < .001) and between the returned-to-sports postarthroscopy group and healthy controls (median = 96, n = 33; Mann-Whitney U score = 165.500, z = 5.666, P < .001). No floor or ceiling effects were evident. Responsiveness was demonstrated for the scale in relation to sports status. With sports status as an anchor, a minimally important change of 26 points was identified. CONCLUSION Assessment of the Hip-Return to Sport After Injury (Short Form) supports its use as a reliable and valid measure of psychological readiness to return to sports in patients after hip arthroscopy.
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Affiliation(s)
- Denise M Jones
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Kate E Webster
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Kay M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | | | - Harvi F Hart
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia.,Department of Physical Therapy, The University of Western Ontario, London, Canada
| | - Parminder J Singh
- Monash University, Melbourne, Australia.,Deakin University, Melbourne, Australia
| | | | - Gauguin Gamboa
- Queensland Hips and Knees, Brisbane Private Hospital, Queensland, Australia
| | - Joanne L Kemp
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
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Gupta A, Singh PJ, Gaikwad DY, Udupa DV, Topkar A, Sahoo NK. Instrumentation and signal processing for the detection of heavy water using off axis-integrated cavity output spectroscopy technique. Rev Sci Instrum 2018; 89:023110. [PMID: 29495821 DOI: 10.1063/1.5019892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
An experimental setup is developed for the trace level detection of heavy water (HDO) using the off axis-integrated cavity output spectroscopy technique. The absorption spectrum of water samples is recorded in the spectral range of 7190.7 cm-1-7191.5 cm-1 with the diode laser as the light source. From the recorded water vapor absorption spectrum, the heavy water concentration is determined from the HDO and water line. The effect of cavity gain nonlinearity with per pass absorption is studied. The signal processing and data fitting procedure is devised to obtain linear calibration curves by including nonlinear cavity gain effects into the calculation. Initial calibration of mirror reflectivity is performed by measurements on the natural water sample. The signal processing and data fitting method has been validated by the measurement of the HDO concentration in water samples over a wide range from 20 ppm to 2280 ppm showing a linear calibration curve. The average measurement time is about 30 s. The experimental technique presented in this paper could be applied for the development of a portable instrument for the fast measurement of water isotopic composition in heavy water plants and for the detection of heavy water leak in pressurized heavy water reactors.
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Affiliation(s)
- A Gupta
- Atomic and Molecular Physics Division, Bhabha Atomic Research Centre, Mumbai 400085, India
| | - P J Singh
- Atomic and Molecular Physics Division, Bhabha Atomic Research Centre, Mumbai 400085, India
| | - D Y Gaikwad
- Heavy Water Division, Bhabha Atomic Research Centre, Mumbai 400085, India
| | - D V Udupa
- Atomic and Molecular Physics Division, Bhabha Atomic Research Centre, Mumbai 400085, India
| | - A Topkar
- Homi Bhabha National Institute, Mumbai 400094, India
| | - N K Sahoo
- Atomic and Molecular Physics Division, Bhabha Atomic Research Centre, Mumbai 400085, India
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Wallis JA, Webster KE, Levinger P, Singh PJ, Fong C, Taylor NF. A walking program for people with severe knee osteoarthritis did not reduce pain but may have benefits for cardiovascular health: a phase II randomised controlled trial. Osteoarthritis Cartilage 2017; 25:1969-1979. [PMID: 28011099 DOI: 10.1016/j.joca.2016.12.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 11/23/2016] [Accepted: 12/14/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The primary aim was to evaluate the effect of a dosed walking program on knee pain for patients with severe knee osteoarthritis (OA). Secondary aims evaluated the effects on cardiovascular health, function and quality of life. DESIGN Participants with severe knee OA and increased cardiovascular risk were randomly assigned to a 12-week walking program of 70 min/week of at least moderate intensity, or to usual care. The primary outcome was knee pain (0-10). Secondary outcomes were of cardiovascular risk including physical activity, blood pressure, blood lipid and glucose levels, body mass index and waist circumference; WOMAC Index scores; physical function; and quality of life. RESULTS Forty-six participants (23 each group) were recruited. Sixteen participants (70%) adhered to the walking program. Intention to treat analysis showed no between-group difference in knee pain. The walking group had increased odds of achieving a healthy systolic blood pressure (OR = 5.7, 95% CI 1.2-26.9), and a faster walking speed (Mean Difference (MD) = 0.12 m/s, 95% CI 0.02-0.23). Per protocol analysis based on participant adherence showed the walking group had more daily steps (MD = 1345 steps, 95% CI 365-2325); more time walking (MD = 18 min/day, 95% CI 5-31); reduced waist circumference (MD = -5.3 cm, 95% CI -10.5 to -0.03); and increased knee stiffness (MD = 0.9 units, 95% CI 0.07-1.8). CONCLUSIONS Patients with severe knee OA prescribed a 12-week walking program of 70 min/week may have had cardiovascular benefits without decreasing knee pain. Australian New Zealand Clinical Trials Registry ACTRN12615000015549.
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Affiliation(s)
- J A Wallis
- School of Allied Health, La Trobe University, Australia; Department of Physiotherapy, Eastern Health, Australia.
| | - K E Webster
- School of Allied Health, La Trobe University, Australia
| | - P Levinger
- Institute of Sport, Exercise & Active Living (ISEAL), Victoria University, Australia
| | - P J Singh
- Department of Orthopaedics, Eastern Health, Monash and Deakin University, Australia
| | - C Fong
- Department of Rheumatology, Eastern Health, Monash University, Australia
| | - N F Taylor
- School of Allied Health, La Trobe University, Australia; Department of Physiotherapy, Eastern Health, Australia
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Wallis JA, Webster KE, Levinger P, Singh PJ, Fong C, Taylor NF. Perceptions about participation in a 12-week walking program for people with severe knee osteoarthritis: a qualitative analysis. Disabil Rehabil 2017; 41:779-785. [DOI: 10.1080/09638288.2017.1408710] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Jason A. Wallis
- School of Allied Health, La Trobe University, Melbourne, Australia
- Department of Physiotherapy, Allied Health Clinical Research Office, Eastern Health, Melbourne, Australia
| | - Kate E. Webster
- School of Allied Health, La Trobe University, Melbourne, Australia
| | - Pazit Levinger
- School of Allied Health, La Trobe University, Melbourne, Australia
- Institute of Sport, Exercise and Active Living, Victoria University, Melbourne, Australia
| | - Parminder J. Singh
- Department of Orthopaedics, Eastern Health and Monash University, Melbourne, Australia
| | - Chris Fong
- Department of Rheumatology, Eastern Health and Monash University, Melbourne, Australia
| | - Nicholas F. Taylor
- School of Allied Health, La Trobe University, Melbourne, Australia
- Department of Physiotherapy, Allied Health Clinical Research Office, Eastern Health, Melbourne, Australia
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Cheng TE, Wallis JA, Taylor NF, Holden CT, Marks P, Smith CL, Armstrong MS, Singh PJ. A Prospective Randomized Clinical Trial in Total Hip Arthroplasty-Comparing Early Results Between the Direct Anterior Approach and the Posterior Approach. J Arthroplasty 2017; 32:883-890. [PMID: 27687805 DOI: 10.1016/j.arth.2016.08.027] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 07/25/2016] [Accepted: 08/22/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND We report a prospective randomized study comparing early clinical results between the direct anterior approach (DAA) and posterior approach (PA) in primary hip arthroplasty. METHODS Surgeries were performed by 2 senior hip arthroplasty surgeons. Seventy-two patients with complete data were assessed preoperatively 2, 6, and 12 weeks postoperatively. The primary outcomes were the Western Ontario McMasters Arthritis Index and Oxford Hip Scores. Secondary outcome measures included the EuroQoL, 10-meter walk test, and clinical and radiographic parameters. RESULTS Data analyses showed no difference between DAA (n = 35) and PA (n = 37) groups when comparing total scores for primary outcomes. No significant differences were observed for 10-meter walk test, EuroQoL, and radiographic analyses. Subgroup analysis for surgeon 1 identified that the DAA group had shorter acute hospital stay, less postoperative opiate requirements, and smaller wounds. However, this was offset by increased operative time, higher intraoperative blood loss, and weaker hip flexion at 2 and 6 weeks. Subgroup analysis of items on the Western Ontario McMasters Arthritis Index and Oxford Hip Score identified that hip flexion activity favored the DAA group up to 6 weeks postoperatively. There was an 83% incidence of lateral cutaneous nerve of thigh neuropraxia at the 12-week mark in the DAA group. No neuropraxias occurred in the PA group. One dislocation occurred in each group. A single patient from the DAA group required reoperation for leg-length discrepancy. CONCLUSION DAA total hip arthroplasty (THA) has comparable results with PA THA. Choice of surgical approach for THA should be based on patient factors, surgeon preference, and experience.
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Affiliation(s)
- Tze E Cheng
- Eastern Health Clinical School, Monash University, Victoria, Australia
| | - Jason A Wallis
- Department of Physiotherapy, Eastern Health, Victoria, Australia
| | - Nicholas F Taylor
- Department of Physiotherapy, Eastern Health, Victoria, Australia; Department of Rehabilitation, Nutrition and Sports, La Trobe University, Victoria, Australia
| | | | - Paul Marks
- Imaging Associates Box Hill, Victoria, Australia
| | - Catherine L Smith
- Department of Epidemiology, School of Public Health and Preventive Medicine Monash University, The Alfred Centre, Victoria, Australia
| | - Michael S Armstrong
- Department of Orthopaedics, Eastern Health, Monash University, Victoria, Australia
| | - Parminder J Singh
- Department of Orthopaedics, Eastern Health, Monash University, Victoria, Australia
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Porthos-Salas A, Singh PJ, ODonnell JM. [Ligamentun teres of the hip. Bibliographic revision]. Acta Ortop Mex 2016; 30:267-271. [PMID: 28448713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The role and function of the ligamentum teres has drawn our attention in the last years due to the increasing and performance in hip arthroscopy, few is written in the literature, this is why we proposed to perform and assessed a review on the current literature of the anatomy, function, diagnose and rupture of the ligamentum teres of the hip.
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Affiliation(s)
- A Porthos-Salas
- Mercy Private Hospital, 159 Grey St East Melbourne Victoria 3002, Australia
| | - P J Singh
- Mercy Private Hospital, 159 Grey St East Melbourne Victoria 3002, Australia
| | - J M ODonnell
- Mercy Private Hospital, 159 Grey St East Melbourne Victoria 3002, Australia
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12
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Wallis JA, Webster KE, Levinger P, Singh PJ, Fong C, Taylor NF. The maximum tolerated dose of walking for people with severe osteoarthritis of the knee: a phase I trial. Osteoarthritis Cartilage 2015; 23:1285-93. [PMID: 25882926 DOI: 10.1016/j.joca.2015.04.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 02/10/2015] [Accepted: 04/02/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine how much physical activity, in the form of walking, can be safely and feasibly tolerated for people with severe knee osteoarthritis (OA). DESIGN Phase I dose response trial with escalating walking doses of 10, 20, 35, 50, 70, and 95 min over 1 week, were prescribed non-randomly to people with severe knee OA. The primary stopping rule was a substantial increase in knee pain. The primary outcomes were an estimation of the maximum tolerated dose of walking; and the proportion of people who did not complete the dose for feasibility reasons. The secondary outcomes were pain, stiffness and activity limitation Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). RESULTS Twenty-four participants (13 women) aged 53-83 years, and average body mass index (BMI) of 34 kg/m(2) (SD 9) were recruited. Three participants were assigned to each dose between 10 and 70 min, and nine participants assigned to the 95-min dose. The trial was stopped at 95 min due to the maximum number of adverse events occurring at this dose. Therefore, the maximum tolerated dose was 70 min. No participant stopped due to reasons related to feasibility. There was a moderate association between dose and increased activity (linear R(2) = 0.31, cubic R(2) = 0.69) and reduced stiffness (linear R(2) = 0.20, cubic R(2) = 0.52), with increased benefits at moderate to higher doses. CONCLUSIONS There is preliminary evidence that 70 min per week of moderate intensity supervised walking was safe and feasible for people with severe OA of the knee; for higher doses there was a risk of exacerbating knee pain levels.
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Affiliation(s)
- J A Wallis
- School of Allied Health, La Trobe University, Australia; Department of Physiotherapy, Eastern Health, Australia.
| | - K E Webster
- School of Allied Health, La Trobe University, Australia
| | - P Levinger
- Institute of Sport, Exercise & Active Living (ISEAL), Victoria University, Australia
| | - P J Singh
- Department of Orthopaedics, Eastern Health, Australia
| | - C Fong
- Department of Rheumatology, Eastern Health, Australia
| | - N F Taylor
- School of Allied Health, La Trobe University, Australia; Department of Physiotherapy, Eastern Health, Australia
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Guerra ML, Singh PJ, Taylor NF. Early mobilization of patients who have had a hip or knee joint replacement reduces length of stay in hospital: a systematic review. Clin Rehabil 2014; 29:844-54. [PMID: 25452634 DOI: 10.1177/0269215514558641] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 10/12/2014] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To systematically review the effect of early mobilization after hip or knee joint replacement surgery on length of stay in an acute hospital. METHODS Randomized controlled trials were selected from electronic databases based on inclusion criterion requiring an experimental group mobilizing (sitting out of bed/walking) earlier than a comparison group post joint replacement surgery of the hip or knee in an acute hospital. Clinically homogeneous data were analyzed with meta-analysis. RESULTS Five randomized controlled trials (totaling 622 participants) were included for review. A meta-analysis of 5 trials found a reduced length of stay of 1.8 days (95% confidence interval 1.1 to 2.6) in favor of the experimental group. In 4 of the 5 trials the experimental group first sat out of bed within 24 hours post operatively. In 4 of the 5 trials the experimental group first walked within 48 hours post operatively. Individual trials reported benefits in range of motion, muscle strength and health-related quality of life in favor of the experimental group. There were no differences in discharge destinations, incidence of negative outcomes or adverse events attributable to early mobilization when compared to the comparison groups. CONCLUSION Early mobilization post hip or knee joint replacement surgery can result in a reduced length of stay of about 1.8 days. Trials that reported these positive results showed that early mobilization can be achieved within 24 hours of operation. This positive gain was achieved without an increase in negative outcomes.
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Affiliation(s)
- Mark L Guerra
- Physiotherapy Department, Eastern Health, Melbourne, Victoria, Australia
| | - Parminder J Singh
- Orthopaedic Consultant, Eastern Health, Melbourne, Victoria, Australia
| | - Nicholas F Taylor
- Allied Health Clinical Research Office, Eastern Health, Australia Department of Physiotherapy, La Trobe University, Australia
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Ye K, Singh PJ. Arthroscopic labral repair of the hip, using a through-labral double-stranded single-pass suture technique. Arthrosc Tech 2014; 3:e615-9. [PMID: 25473617 PMCID: PMC4246392 DOI: 10.1016/j.eats.2014.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 07/10/2014] [Indexed: 02/03/2023] Open
Abstract
The normal labrum is crucial to the biomechanical function of the hip joint, not only increasing the surface area and depth of the acetabulum but also maintaining a suction seal to assist in normal synovial fluid flow from the peripheral to the central compartment. Simple loop suture repairs of the labrum may evert the labrum, thus losing the optimal seal, as well as causing abrasion of the articular cartilage. Vertical mattress suture and labral base fixation techniques aim to leave the free edge of the labrum intact and undisturbed, therefore improving the contact of the labrum to the femoral head and neck to improve the seal of the acetabulum. We aim to describe a double-stranded single-pass vertical mattress suture technique that may allow greater versatility to the surgeon in repairing thinner labrums while still achieving a free and continuous free edge.
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Affiliation(s)
- Ken Ye
- Bellbird Private Hospital, Melbourne, Australia
| | - Parminder J. Singh
- Maroondah Hospital, Melbourne, Australia,Eastern Health, Melbourne, Australia,Monash & Deakin University, Melbourne, Australia,St. Vincent's Private Hospital East Melbourne, Melbourne, Australia,Hip Arthroscopy Australia, Melbourne, Australia,Address correspondence to Parminder J. Singh, M.B.B.S., M.R.C.S., F.R.C.S.(Tr&Orth), M.S., F.R.A.C.S., 21 Erin Street, Richmond VIC 3121, Australia.
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O'Donnell JM, Pritchard M, Salas AP, Singh PJ. The ligamentum teres-its increasing importance. J Hip Preserv Surg 2014; 1:3-11. [PMID: 27011796 PMCID: PMC4765261 DOI: 10.1093/jhps/hnu003] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 05/04/2014] [Accepted: 05/06/2014] [Indexed: 12/19/2022] Open
Abstract
The ligamentum teres (LT) has attracted much greater interest over recent years due to the increased use of hip arthroscopy. There have been advancements in our understanding of the LT's biomechanical function and its role in hip and groin pain. Our ability to suspect LT tears by clinical examination and imaging has improved. Publications by many authors concerning LT tear treatment and outcomes continue to increase. This manuscript is a review of the function, mechanism of injury, clinical assessment, imaging, arthroscopic assessment, treatment, outcomes, reconstruction, and unusual conditions of the LT.
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Affiliation(s)
- John M. O'Donnell
- 1. 21 Erin Street, Richmond, Victoria 3121, Australia
- 2. Hip Arthroscopy Australia, 21Erin St Richmond, Australia
| | - Michael Pritchard
- 3. Hip Arthroscopy Australia, 30 Cascade Rd South Hobart, Hobart, Australia
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Abstract
The hip joint capsule is a critical static stabilizer of the hip. During hip arthroscopy, the capsule is breached to gain exposure to treat femoroacetabular impingement lesions. There have been recent concerns regarding hip instability after hip arthroscopy, and relatively few techniques have been described for atraumatic arthroscopic closure of the hip capsule. We describe an atraumatic, inside-out, 2-portal technique to repair the capsule.
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Affiliation(s)
- Vipin Asopa
- Address correspondence to Vipin Asopa, M.B.Ch.B., B.Sc., M.R.C.S., Ph.D., F.R.C.S.(Tr&Orth), St. Vincent's Private East Melbourne Hospital, 159 Grey St, East Melbourne, Victoria 3065, Australia.
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Abstract
We describe a hip condition with a recognisable pattern of clinical signs and radiological findings thought to result from chronic capsular injury. Between June 2006 and October 2009, ten patients (11 hips), four men and six women, were identified with an abnormality of external rotation at the hip joint. A detailed history and clinical examination was undertaken for each patient. Dynamic magnetic resonance imaging of symptomatic and control hips were evaluated for bony and soft tissue appearances. The relative positions of the femoral head and the acetabulum were assessed through a range of hip rotation. In affected hips, a loss of normal log roll recoil was observed. Three distortions of the iliofemoral ligament were identified on axial MR images; thinning at the lateral insertion of the ligament, attenuation of the iliofemoral ligament most noticeably on maximum external rotation (60º) and the appearance of laxity despite full external rotation. Stability of the hip is dependent on the interaction of bony and soft tissue structures. Hip instability is recognised in dysplasia and is known to lead to premature degeneration of the joint. Chronic capsular injury may destabilise previously asymptomatic hips with subsequent development of pain in young, active patients.
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Haviv B, Singh PJ, Takla A, O'Donnell J. Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damage. ACTA ACUST UNITED AC 2010; 92:629-33. [PMID: 20435997 DOI: 10.1302/0301-620x.92b5.23667] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This study evaluates the outcome of arthroscopic femoral osteochondroplasty for cam lesions of the hip in the absence of additional pathology other than acetabular chondral lesions. We retrospectively reviewed 166 patients (170 hips) who were categorised according to three different grades of chondral damage. The outcome was assessed in each grade using the modified Harris Hip Score (MHHS) and the Non-Arthritic Hip Score (NAHS). Overall, at the last follow-up (mean 22 months, 12 to 72), the mean MHHS had improved by 15.3 points (95% confidence interval (CI), 8.9 to 21.7) and the mean NAHS by 15 points (95% CI, 9.4 to 20.5). Significantly better results were observed in hips with less severe chondral damage. Microfracture in limited chondral lesions showed superior results. Arthroscopic femoral osteochondroplasty for cam impingement with microfracture in selected cases is beneficial. The outcome correlates with the severity of acetabular chondral damage.
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Affiliation(s)
- B Haviv
- Orthopaedic Surgery Department, Sport Injuries and Arthroscopy Unit, Rabin Medical Center, 39 Jabotinski Street, Petach-Tikva 49100, Israel.
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Singh PJ, O'Donnell JM. The outcome of hip arthroscopy in Australian football league players: a review of 27 hips. Arthroscopy 2010; 26:743-9. [PMID: 20511031 DOI: 10.1016/j.arthro.2009.10.010] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Revised: 08/17/2009] [Accepted: 10/16/2009] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to investigate on hip pathology found at hip arthroscopy in Australian Football League (AFL) players and describe our current treatments and outcomes. METHODS From 2003 to 2008, 24 consecutive AFL players (27 hips) had arthroscopic hip surgery by use of the lateral position. Patients were assessed preoperatively and postoperatively with the modified Harris Hip Score (MHHS) and Nonarthritic Hip Score (NAHS) and postoperatively with a satisfaction survey. RESULTS All hips were available for review. The mean duration of follow up was 22 months (range, 6 to 60 months). The mean age was 22 years (range, 16 to 29 years). The mean body mass index was 24 points (range, 21 to 26 points). The mean traction time was 21 minutes (range, 11 to 60 minutes). The most common pathology was a rim lesion, affecting 93% of cases. Microfracture was performed in 22%. Synovitis was found in 70%, and this was most commonly associated with a rim lesion. Labral pathology was present in 33%, the most common of which was labral separation. On the femoral side, 81% had cam impingement and underwent a femoral neck ostectomy. Rim lesions and labral pathology were the most commonly associated lesions. Also seen were loose os acetabuli in 7% and loose bodies in 7%. The former were associated with labral tears and required repair. The MHHS and NAHS improved in all patients postoperatively, and they maintained their improvement from 1 year up to 4 years. In all but 1 case, the players returned to playing at the AFL level and were satisfied with their outcome. CONCLUSIONS Using hip arthroscopy, we have observed high satisfaction levels and return to preinjury levels of play in all but 1 case. Postoperative hip scores (MHHS and NAHS) have improved significantly, and this improvement has been maintained for up to 4 years. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Parminder J Singh
- Mercy and Belbird Private Hospitals, 21 Erin Street, East Melbourne, Australia.
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20
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Abstract
Primary giant-cell tumour of soft tissue arising in the ligamentum teres has not been previously described. We report a case of such a tumour in a 46-year-old woman. The lesion was only detected at the time of hip arthroscopy despite pre-operative MRI being performed. It was successfully excised arthroscopically with resolution of the symptoms.
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Affiliation(s)
- P J Singh
- Mercy and Bellbird Private Hospitals, Melbourne, Australia.
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Abstract
INTRODUCTION A posterior entry point, a neutral tip position and neutral stem alignment are recommended to avoid a thin cement mantle and ensure an optimal outcome in total hip arthroplasty (THA). Our aim was to highlight any influence of surgical approach in obtaining an optimal stem orientation. METHODS We examined the post-operative, digitised radiographs of 100 (50 each group) polished, tapered Exeter THA, inserted via the antero-lateral or posterior approaches. Stem tip position was assessed in both coronal and sagittal planes and stem alignment was assessed in the coronal plane. RESULTS There was a significant difference between the two approaches in the sagittal stem tip position only (p=0.01). DISCUSSION Our results illustrate that a neutral stem tip position in THA is significantly more difficult to obtain with an antero-lateral approach, when compared to the posterior approach. A posterior approach to the hip avoids the cuff of glutei that can lever the proximal stem anteriorly causing an anterior entry point and a posterior stem tip position. We also illustrate how the anatomy of the proximal femur in the sagittal plane makes a neutral stem alignment difficult to achieve with either approach.
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Affiliation(s)
- P D Vaughan
- Department of Trauma and Orthopaedics, Heatherwood and Wexham Park NHS Trust, Slough, Berkshire, UK.
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Abstract
We carried out a prospective study over a period of 12 months to measure the exposure to radiation of the hands of a dedicated foot and ankle surgeon. A thermoluminescent dosimeter ring (TLD) was used to measure the cumulative dose of radiation. Fluoroscopy was used in operations on the foot and ankle. The total screening time was 3028 s, with a mean time per procedure of 37.4 s (0.6 to 197). This correlated positively with the number of procedures performed (r = 0.92, p < 0.001), and with the dose of radiation in both the left (r = 0.85, p = 0.0005) and right TLDs (r = 0.59, p = 0.419). There was no significant difference in the dose of radiation between the two hands (t-test, p = 0.62). The total dose to the right TLD over the 12 months was 2.4 millisieverts. This is a simple and convenient method for evaluating the exposure of a single surgeon to radiation. The radiation detected was well below the annual dose limit set by the International Commission on Radiological Protection.
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Affiliation(s)
- P J Singh
- Nuffield Orthopaedic Centre, Headington, Oxford, UK.
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Abstract
BACKGROUND In a prospective 2-year study we have used dual-energy X-ray absorptiometry to measure periprosthetic bone mineral density (BMD) following implantation of a novel, "physiological", acetabular component designed using composite materials. METHOD The acetabular components were implanted in hydroxyapatite (HA) and HA-removed options. They were implanted in conjunction with a cemented femoral component in 50 female patients who presented with displaced, subcapital, fractures of the neck of the femur. Regions of interest (ROI) were defined according to De Lee and Charnley. BMD during follow-up was compared with immediate postoperative values for the affected limb. RESULTS The mean precision error (CV%) was 1.01%, 2.26% and 1.12%, for ROI I, II and III respectively. The mean change in BMD, for both cups, was analyzed. There was no significant difference between the BMD changes induced with the HA- and non-HA-coated cups. INTERPRETATION After an initial fall in BMD in all 3 ROI at 6 months, ROI I and ROI II showed return to baseline BMD by 2 years. ROI III showed no significant decrease in BMD beyond 6 months, but did not return to baseline levels. Statistical analysis revealed no significant decrease in BMD in ROI I and ROI II at 2 years, compared with immediate postoperative values. The changes in BMD reflect a pattern of maximally reduced stress in the non-weight-bearing zone (ROI III), with preservation of bone density in weight bearing zones ROI I and ROI II. These results support the design principles of the Cambridge cup.
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Affiliation(s)
- Richard E Field
- Orthopaedic Research Unit, South West London Elective Orthopaedic Centre, Epsom, Surrey, UK.
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Field RE, Singh PJ, Latif AMH, Cronin MD, Matthews DJ. Five-year prospective clinical and radiological results of a new cannulated cemented polished Tri-Taper femoral stem. J Bone Joint Surg Br 2006; 88:315-20. [PMID: 16498003 DOI: 10.1302/0301-620x.88b3.17314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We describe the results at five years of a prospective study of a new tri-tapered polished, cannulated, cemented femoral stem implanted in 51 patients (54 hips) with osteoarthritis. The mean age and body mass index of the patients was 74 years and 27.9, respectively. Using the anterolateral approach, half of the stems were implanted by a consultant orthopaedic surgeon and half by six different registrars. There were three withdrawals from the study because of psychiatric illness, a deep infection and a recurrent dislocation. Five deaths occurred prior to five-year follow-up and one patient withdrew from clinical review. In the remaining 51 hips the mean pre-operative Oxford hip score was 47 points which decreased to 19 points at five years (45 hips). Of the stems 49 (98%) were implanted within 1 degrees of neutral in the femoral canal. The mean migration of the stem at five years was 1.9 mm and the survivorship for aseptic loosening was 100%. There was no significant difference in outcome between the consultant and registrar groups. At five years, the results were comparable with those of other polished, tapered, cemented stems. Long-term surveillance continues.
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Affiliation(s)
- R E Field
- South West London Elective Orthopaedic Centre, Epsom General Hospital, Dorking Road, Epsom, and St Helier University Hospitals NHS Trust, Surrey KT18 7EG, UK.
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Abstract
We have used the Oxford hip score to monitor the progress of 1908 primary and 279 revision hip replacements undertaken since the start of 1995. Our review programme began in early 1999 and has generated 3900 assessments. The mean pre-operative scores for primary and revision cases were 40.95 and 40.11, respectively. The mean annual score for primary replacement at between 12 and 84 months ranged between 20.60 and 22.57. A comparison of cross-sectional and longitudinal data showed no significant differences. All post-operative reviews showed a significant improvement (p ≤ 0.0001). The 50- to 60-year-old group scored significantly better than the patients over 80 years of age up to 48 months (p < 0.01). A subgroup of 826 National Health Service (NHS) and 397 private patients, treated by the senior author (2292 Oxford assessments), had a higher (i.e. worse) mean pre-operative score for the NHS patients (p ≤ 0.001). The private patients scored better than the NHS group up to 84 months (p < 0.05). Patients treated by a surgeon performing more than 100 replacements each year had a significantly better outcome up to five years than those operated on by surgeons performing fewer than 20 replacements each year. The age of the patients at the time of operation, and their pre-operative level of disability, have both been identified as affecting the long-term outcome. Awareness of the influence of these factors should assist surgeons to provide balanced advice.
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Affiliation(s)
- R E Field
- Epson and St Helier Hospital NHS Trust, Carshalton, Surrey SM5 1AA, UK
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Singh PJ, Nash JL, Santella RN, Zawada ET. Gitelman's syndrome: report of a 19-year old woman with intractable hypomagnesemia and hypokalemia, and a review of the syndrome. S D J Med 1999; 52:377-80. [PMID: 10546515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
A case of refractory hypomagnesemia associated with hypokalemic alkalosis and hypocalciuria (Gitelman's syndrome) is described. The genetic mutations discovered to cause the hypokalemic alkalotic syndromes are described (the thiazide-sensitive sodium chloride co-transporter gene or TSC mutations in Gitelman's syndrome, and the sodium-potassium-chloride co-transporter gene or NKCC2 mutations in Bartter's syndrome). The molecular, electrolyte, and volume abnormalities are described, and the implications for diagnosis, therapy, and future research discussed.
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Affiliation(s)
- P J Singh
- Internal Medicine Service, Jackson Medical Center, MN, USA
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Singh PJ, Santella RN, Zawada ET. Gastrointestinal prokinetic agents for enhancing drug response in gastroparesis. Am J Health Syst Pharm 1997; 54:2609-12. [PMID: 9397225 DOI: 10.1093/ajhp/54.22.2609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- P J Singh
- Department of Internal Medicine, University of South Dakota School of Medicine, Sioux Falls 57105-1570, USA
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Singh PJ, Zawada ET, Santella RN. A case of 'reverse' pseudohyperkalemia. Miner Electrolyte Metab 1997; 23:58-61. [PMID: 9058371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Pseudohyperkalemia is diagnosed when the serum potassium level exceeds the plasma potassium level by 0.4 mmol/l. This is commonly encountered in settings of high leukocyte or platelet counts, since under these conditions, potassium, an intracellular cation, is released in supranormal amounts during the process of clotting. We report an unusual case wherein the reverse was true, i.e., the plasma potassium concentrations was higher than that found in the serum. Heparin, which is known to cause cell lysis, was used as the anti-coagulant in the plasma tubes. We propose that the underlying mechanism in this particular case is a heightened sensitivity to heparin-induced membrane damage in the face of a hematological malignancy.
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Affiliation(s)
- P J Singh
- Department of Internal Medicine, University of South Dakota School of Medicine, Sioux Falls 57105-1570, USA
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Abstract
Mutations in the mitochondrial genome have been shown to be responsible for several neuromuscular diseases in humans. In this article, we discuss the molecular genetics of mitochondria, their centrality in cellular energy production, and reasons why their genome is extremely vulnerable to mutation. Mitochondrial DNA (mtDNA) mutations and their classic encephalomyopathic clinical phenotypes are briefly reviewed, and evidence presented that mtDNA mutations also present primarily as kidney diseases. Research trends in the field are discussed. Suggestions are made regarding future work, the clinical implications thereof, and potential therapeutic utility accruing from these advances.
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Affiliation(s)
- P J Singh
- Department of Internal Medicine, University of South Dakota School of Medicine, Sioux Falls, SD 57105, USA
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Singh PJ, Julien P, Mirault ME, Murthy MR. Quick preparation of mitochondrial DNA fractions free from nuclear DNA for polymerase chain reaction amplification. Anal Biochem 1995; 225:155-7. [PMID: 7778768 DOI: 10.1006/abio.1995.1123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- P J Singh
- Department of Biochemistry, Molecular Biology Laboratory on Human Diseases, Faculty of Medicine, Laval University, Québec, P.Q., Canada
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Singh PJ, Julien P, Mirault ME, Murthy MR. Amplification of the entire mitochondrial DNA by polymerase chain reaction in two large overlapping segments. Anal Biochem 1995; 225:152-5. [PMID: 7778767 DOI: 10.1006/abio.1995.1122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- P J Singh
- Department of Biochemistry, Faculty of Medicine, Laval University, Québec, P.Q., Canada
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Carp H, Singh PJ, Vadhera R, Jayaram A. Effects of the serotonin-receptor agonist sumatriptan on postdural puncture headache: report of six cases. Anesth Analg 1994; 79:180-2. [PMID: 8010433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- H Carp
- Department of Anesthesiology, Oregon Health Sciences University, Portland 97201-3098
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Abstract
The tracer concept was applied to evaluate the delivery of family health care and the training of family health workers. A retrospective evaluation permitted linking the products of care to process, input and context, by isolating and analysing potential factors contributing to a limited number of representative concerns. Contributory learning deficiencies identified in health workers, one input to health care as well as a product of training, enabled the evaluation of training programmes to be focused on related segments of the courses. The latter were evaluated through a pathway analysis which followed the same deficiency model as the evaluation of health care. Links were thus established between the traditionally compartmentalized training and service sectors in health.
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Singh PJ, Guatee C, John R. Infant health care practices-a study in three communities. Med J Malaysia 1981; 36:166-170. [PMID: 7329373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Singh PJ. Low attendance of preschool children in government clinics in a rural community. Med J Malaysia 1980; 34:199-204. [PMID: 7412659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Gupta CD, Gupta SC, Arora AK, Singh PJ. Vascular segments in the human spleen. J Anat 1976; 121:613-6. [PMID: 1018011 PMCID: PMC1231750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Corrosion casts of human splenic arterial trees revealed the presence of two segments-a superior, and an inferior - in 84% of cases and three segments - a superior, a middle and an inferior - in 16% of cases. These segments are separated by avascular planes.
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Abstract
To determine whether bilateral olfactory bulbectomy led to a change in nursing behavior, and thus death, we bilaterally bulbectomized (BX) pups from 14 litters at 2, 7, and 11 days of age. Litters treated on Days 2 and 7 consisted of 3 BX pups, 2 surgical control (SC) pups, and 2 handling control (HC) pups. Litters treated on Day 11 consisted of 1 or 2 BX, 1 or 2 incompletely bulbectomized pups (IBX), 2 SC pups, and 2 HC pups. These litters and 3 additional nontreated litters were observed on Days 4,7,10,13, and 16. A smaller number of BX pups survived through Day 10 than SC, HC, IBX, and nontreated pups. Differential treatment of the BX pups by females or littermates was not found. The females' mammary glands were functional but the BX pup stomachs had little or no milk. The BX pups spent less time nursing and more time away from the female and their littermates than did the other pups.
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