Fracture of a BIOLOX Delta Ceramic Femoral Head: A Case Report and Update of the Literature

CASE

A 52-year-old man underwent right total hip replacement with a 32-mm BIOLOX delta ceramic head with a polyethylene liner. At 8 months, he fell onto his right hip. Radiographs at the time were unremarkable. One month later, he noticed a sharp pain and a sensation of grinding in his right hip; radiographs of the hip showed a fracture of the ceramic head.

CONCLUSIONS

This case further demonstrates that fourth-generation ceramic heads can fracture, and delays in catastrophic failure of ceramics in total hip arthroplasty (THA) following trauma may be secondary to the "slow crack growth" hypothesis.

Surgery performed by supervised registrars does not adversely affect medium-term functional outcomes after total knee replacement

Introduction Although total knee arthroplasty (TKA) is an index procedure for orthopaedic registrars, there is a lack of published research as to the effects of surgery when performed by supervised trainees. The aim of this study was to compare functional outcomes up to five years after primary TKA performed by consultants and trainee surgeons. Methods A retrospective analysis was conducted of prospectively collected data for 609 consecutive patients (339 female, 270 male) undergoing TKA. Patients were assessed preoperatively as well as at 18 months, three years and five years postoperatively, and American Knee Society objective knee and functional scores (AKSK and AKSF) were recorded. Results Surgery was performed by a consultant in 465 cases and a supervised trainee in 144 cases. There were no significant differences between the two groups in preoperative patient characteristics, operative time (p=0.15), transfusion rates (p=0.84), length of stay (p=0.98), manipulation under anaesthesia (p=0.69), or mortality rates at one year (p=0.73) or five years (p=0.81). Postoperatively, the median magnitude of improvement in AKSK (48 points for consultant group vs 45 points for trainee group, p=0.74) and in AKSF (both groups 15, p=0.995) was similar between the groups. AKSK and AKSF scores were similar at all timepoints up to five years following surgery, and there was no difference in the median range of motion (both groups 100°, IQR: 18°) at five years (p=0.43). Conclusions TKA performed by supervised registrars gives functional outcomes that are equivalent to consultant performed TKA, without affecting postoperative range of movement, or increasing operative time, length of stay or transfusion rates. Rates of postoperative MUA and mortality are also comparable.

The natural history of primary anterior dislocation of the glenohumeral joint in adolescence

The natural history of primary anterior dislocation of the glenohumeral joint in adolescent patients remains unclear and there is no consensus for management of these patients.

The objectives of this study were to report the natural history of primary anterior dislocation of the glenohumeral joint in adolescent patients and to identify the risk factors for recurrent dislocation.

We reviewed prospectively-collected clinical and radiological data on 133 adolescent patients diagnosed with a primary anterior dislocation of the glenohumeral joint who had been managed non-operatively at our hospital between 1996 and 2008. There were 115 male (86.5%) and 18 female patients (13.5%) with a mean age of 16.3 years (13 to 18) and a mean follow-up of 95.2 months (1 to 215).

During follow-up, 102 (absolute incidence of 76.7%) patients had a recurrent dislocation. The median interval between primary and recurrent dislocation was ten months (95% CI 7.4 to 12.6). Applying survival analysis the likelihood of having a stable shoulder one year after the initial injury was 59% (95% CI 51.2 to 66.8), 38% (95% CI 30.2 to 45.8%) after two years, 21% (95% CI 13.2 to 28.8) after five years, and 7% (95% CI 1.1 to 12.9) after ten years. Neither age nor gender significantly predicted recurrent dislocation during follow-up.

We conclude that adolescent patients with a primary anterior dislocation of the glenohumeral joint have a high rate of recurrent dislocation, which usually occurs within two years of their initial injury: these patients should be considered for early operative stabilisation.

Cite this article: Bone Joint J 2015;97-B:520–6.

The major genetic determinants of HIV-1 control affect HLA class I peptide presentation

Infectious and inflammatory diseases have repeatedly shown strong genetic associations within the major histocompatibility complex (MHC); however, the basis for these associations remains elusive. To define host genetic effects on the outcome of a chronic viral infection, we performed genome-wide association analysis in a multiethnic cohort of HIV-1 controllers and progressors, and we analyzed the effects of individual amino acids within the classical human leukocyte antigen (HLA) proteins. We identified >300 genome-wide significant single-nucleotide polymorphisms (SNPs) within the MHC and none elsewhere. Specific amino acids in the HLA-B peptide binding groove, as well as an independent HLA-C effect, explain the SNP associations and reconcile both protective and risk HLA alleles. These results implicate the nature of the HLA-viral peptide interaction as the major factor modulating durable control of HIV infection.

Developing competencies for remote and rural senior allied health professionals in Western Australia

Competency frameworks are an increasingly popular clinical governance, performance management, and professional development tool in health care. However, to date there is a dearth of information relating to competencies for allied health professionals (AHPs) working in remote and rural environments. This project aimed to develop a competency framework for senior level AHPs across a core of allied health professions in remote and rural Western Australia. The framework was designed to be used by individual AHPs to identify areas of professional proficiency and weakness, by staff managing senior AHPs when undertaking performance development processes, and by an organisation to identify common areas of need among disciplines that can be addressed through targeted support strategies.

Water safety in the bush: strategies for addressing training needs in remote areas

CONTEXT

This article describes a unique, remote, water safety-training program delivered to 11 remote Australian communities during 2006-2007. The program, known as 'Water Safety in the Bush', was developed by Combined Universities Centre for Rural Health in Geraldton Western Australia in consultation with the Commonwealth Government Department of Health and Ageing, and the Royal Life Saving Society of Australia.

PROGRAM DESCRIPTION

Drowning and near drowning are major causes of childhood death and injury in rural and remote Australia, making improved water safety awareness and skills a public health priority. Water Safety in the Bush employed a flexible, community development model to meet the special requirements of remote and isolated communities. The model had three elements: coordination by a local organisation; a water safety instruction program based on a Royal Life Saving Society of Australia curriculum adapted to meet local priorities; and strategies for sustainability.

PROGRAM EVALUATION

In the delivery of the program a total of 873 children and 219 adults received swimming and water safety instruction; 47 adults and older children received first-aid training; and 38 community members became AUSTAWIM (the Australian Council for the Teaching of Swimming and Water Safety) accredited instructors. Project evaluation showed parents and community organisations were very satisfied with the program which met a real need. Parents and instructors gave evidence of children's increased skills in water safety, swimming ability, life-saving and water confidence. Training programs with greater contact hours showed greater skill gains. Sustainability strategies included accreditation of local AUSTSWIM instructors, the erection of water safety signs, sourcing of continuing funding, and the introduction of water safety theory into the school curriculum.

LESSONS LEARNED

Flexibility was the major success factor. Within the parameters of minimum guidelines, communities were encouraged to choose the timing, venue and delivery mode of the training to ensure the program was best suited to the local community. Community ownership was achieved by requiring that local organisations design and implement the projects. Designing programs that addressed local constraints ensured high participation rates. A number of challenges were also identified. Not all community organisations had the capacity to take on the coordinating role, and struggled to effectively deliver a sustainable program. Other models may be needed for these communities. Accessing appropriately qualified water safety instructors in local areas also proved difficult at several of the sites. Further, designing standardised outcome evaluation strategies that could be implemented across all participating sites was problematic.

IMPLICATIONS

Remote and isolated communities have a pressing need to gain the knowledge and skills necessary for water safety and survival. Standard training programs, which in the case of swimming and water safety instruction are generally run in two-week blocks, are often not feasible. Models for delivering training, which give resources and power to local organisations to find innovative ways to meet their priorities, build capacity and ensure high participation rates.

Stigma, social function and symptoms in schizophrenia and schizoaffective disorder: associations across 6 months

Research suggests stigma is a barrier to self-esteem and the attainment of resources in schizophrenia. Less clear is the association of stigma experiences with symptoms and social function both concurrently and prospectively. To assess this, symptoms were measured using the Positive and Negative Syndrome Scale, social function was measured using the Quality of Life Scale and stigma experience was assessed using the Internalized Stigma of Mental Illness Scale among 36 persons with schizophrenia at two points, 6 months apart. Correlations found stigma was associated with concurrent levels of positive and emotional discomfort symptoms and degree of social contact. When initial stigma levels were controlled for, stigma at 6 months was predicted by baseline levels of positive symptoms. Greater initial stigma predicted greater emotional discomfort at follow-up. Results suggest internalized stigma is linked with social function and symptoms. Positive symptoms may make some persons with schizophrenia more vulnerable to ongoing stigma experience.

The Scale to Assess Narrative Development: association with other measures of self and readiness for recovery in schizophrenia spectrum disorders

While changes in self-experience have been suggested as an element of recovery from schizophrenia, little is known about how they are linked with other subjective indicators of recovery. To examine this, we have developed methods of eliciting narratives of self and illness in schizophrenia and quantitatively rating self-experience expressed within those narratives. In this study, we rated the narratives of 34 persons with schizophrenia spectrum disorder prior to entry into rehabilitation using the Scale to Assess Narrative Development (STAND). STAND scores were then correlated with concurrent assessments of self-esteem using the Rosenberg Self Esteem schedule and readiness for change using the Stages of Change Questionnaire. Results indicated that higher ratings on the STAND were associated with greater levels of self-esteem and greater overall readiness for change. This may suggest that qualities of self-experience within personal narratives of persons with schizophrenia are linked to objective and subjective assessments of recovery.