Particulate steroids in axial spinal blockade and the increasing role of patient consent: .

The complexity of modern medical practice is such that it is very unlikely that on any single issue we can give a definitive answer in any circumstance, and in our view the medical debate as to the use of particulate corticosteroid medicines in axial spinal blockade is one such argument. The medical discussion of the use of particulate corticosteroids has to be set against the uncertain risk and benefits of axial spinal procedures in which the drugs are utilised, and in which the most likely catastrophic complication may occur with their use, and then, as the law now demands, involve the patient in the relevant consenting issues.

International consensus on a complications list after gastrectomy for cancer.

Background: Perioperative complications can affect outcomes after gastrectomy for cancer, with high mortality and morbidity rates ranging between 10 and 40%. The absence of a standardized system for recording complications generates wide variation in evaluating their impacts on outcomes and hinders proposals of quality-improvement projects. The aim of this study was to provide a list of defined gastrectomy complications approved through international consensus.

The current situation in hip arthroscopy.

Hip arthroscopy is an evolving surgical technique that has recently increased in popularity.Although femoroacetabular impingement was an important launch pad for this technique, extra-articular pathology has been described through hip endoscopy.Good clinical results in the medium term will allow improvements in this technique and increase its indications.

ClariVein® - Early results from a large single-centre series of mechanochemical endovenous ablation for varicose veins.

Objectives This study assessed the effectiveness and patient experience of the ClariVein® endovenous occlusion catheter for varicose veins from a large single-centre series in the UK. Methods A total of 300 patients (371 legs) underwent ClariVein® treatment for their varicose veins; 184 for great saphenous vein (GSV) incompetence, 62 bilateral GSV, 23 short saphenous vein (SSV), 6 bilateral SSV and 25 combined unilateral great saphenous vein and SSV. Patients were reviewed at an interval of two months post procedure and underwent Duplex ultrasound assessment.

Hip Arthroscopy in the Presence of Acetabular Dysplasia.

Purpose: Hip arthroscopy is a well established therapeutic intervention for an increasing number of painful hip conditions. Developmental dysplasia of the hip (DDH) is commonly associated with intra-articular hip pathology. However, some surgeons perceive patients with hip dysplasia as poor candidates for hip arthroscopy.

Outcome of arthroscopy in patients with advanced osteoarthritis of the hip.

Hip arthroscopy has continued to expand its horizons in treating many conditions other than femoroacetabular impingement (FAI). However, the results of hip arthroscopy are known to be poor if the degree of articular cartilage damage is significant. We wanted to assess, whether the procedure might have a role in the management of young and active patients with advanced osteoarthritis (OA) and whether it should be offered as a treatment modality.

Fat pad entrapment at the hip: a new diagnosis.

Purpose: To establish if a positive impingement sign in femoroacetabular impingement (FAI) may result from entrapment of the fat pad located at the anterior head-neck junction of the upper femur. This fat pad is routinely removed before any cam lesion excision.

Methods: We report a prospective study of 142 consecutive hip arthroscopies for symptomatic FAI where the aim was to remove the arthroscopically identified area of impingement, not necessarily to create a spherical femoral head.

Peri-articular diseases of the hip: emerging frontiers in arthroscopic and endoscopic treatments.

The precise diagnosis of both intra and extra-capsular disease of the hip is now possible because of commonly available advanced diagnostic imaging techniques. An increasing number of reports in the orthopedic literature describe new endoscopic and arthroscopic techniques to address peri-articular pathology of the hip. The purpose of this paper is to review current techniques in the management of extra-articular hip conditions.

Are crutches required after hip arthroscopy? A case-control study.

Hip arthroscopy provides a less invasive alternative to arthrotomy and has the potential for more rapid rehabilitation. Few guidelines exist for rehabilitation after hip arthroscopic surgery. However, these are not corroborated with evidence of objective outcome measures.

Revision hip arthroscopic surgery: outcome at three years.

Purpose: This study describes the medium-term results of revision hip arthroscopy.

Methods: Patients with persistent hip pain and a positive impingement sign were considered for revision surgery after the exclusion of other causes of groin pain. Seventy-four consecutive patients were prospectively assessed using the modified Harris hip score for a period of 3 years after surgery.

The accuracy of magnetic resonance arthrography in hip arthroscopic labral revision surgery.

The interpretation of a magnetic resonance arthrogram (MRA) after a labral tear has been surgically treated can be challenging and there is no published evidence on its accuracy. The aim of this study was to evaluate the MRA accuracy in identifying labral pathology after hip arthroscopy. We reviewed 60 patients who had undergone a revision hip arthroscopy.

Does the modified Harris hip score reflect patient satisfaction after hip arthroscopy?

Background: No published studies have explored the relationship between commonly reported clinical outcomes and patient satisfaction after hip arthroscopy.

Purpose: To compare the modified Harris Hip Score (mHHS) with patient satisfaction in a prospective study over a 2-year period.

Study Design: Case series; Level of evidence, 4.

Timing in hip arthroscopy: does surgical timing change clinical results?

Purpose: To our knowledge, there is no report in the orthopaedic literature that correlates the duration of hip pain with the results of hip arthroscopic surgery. The aim of this study was to compare the modified Harris Hip Score (mHHS) with patient satisfaction in a prospective study over a two year period.

Methods: We present a prospective single-surgeon series of 525 consecutive patients undergoing hip arthroscopy for a labral tear, femoroacetabular impingement (FAI), or a chondral lesion.

Have the media influenced the use of hip resurfacing arthroplasty? A review of UK print media.

Introduction: The aim of this study was to look at the different claims made about hip resurfacing arthroplasty in the popular UK print media and how this relates to findings in the scientific literature.

Methods: A review of UK popular print media from January 1992 to June 2011 was performed using the Lexis(®) Library online news database. Only articles discussing the clinical results of hip resurfacing arthroplasty were included.

Is hip arthroscopy for femoroacetabular impingement only for athletes?

Purpose: The aim of this study was to compare the outcome of hip arthroscopy for femoroacetabular impingement (FAI) between athletes and non-athletes.

Methods: The authors prospectively collected data on 122 patients, the largest comparative series reported, who underwent hip arthroscopy for FAI. Of these, 80 actively participated in sporting activities (athletes), while 42 did not (non-athletes).

Arthroscopic repair of delaminated acetabular articular cartilage using fibrin adhesive. Results at one to three years.

We describe one- to three-year results of a novel use of fibrin glue in the treatment of cartilage damage by arthroscopy in the hip. This technique uses the microfracture technique and fibrin adhesive to bond delaminated articular cartilage to the underlying subchondral bone. This is generally performed in conjunction with treatment of underlying pathology such as femoroacetabular impingement.

Fluid extravasation during hip arthroscopy.

The amount of fluid that may be lost into the soft tissues during hip arthroscopic surgery is unknown. We measured the volumes of irrigation fluid infused, operating time, fluid pressures and volumes of fluid recovered in 36 therapeutic hip arthroscopies. We excluded those where fluid was lost to the floor, leaving 28 patients.

Ischiofemoral impingement.

Femoroacetabular impingement is a well-documented cause of hip pain. There is, however, increasing evidence for the presence of a previously unrecognised impingement-type condition around the hip - ischiofemoral impingement. This is caused by abnormal contact between the lesser trochanter of the femur and the ischium, and presents as atypical groin and/or posterior buttock pain.

Resurfacing registers concern.

We review the history and literature of hip resurfacing arthroplasty. Resurfacing and the science behind it continues to evolve. Recent results, particularly from the national arthroplasty registers, have spread disquiet among both surgeons and patients.

Hip arthroscopy technique and complications.

Hip arthroscopy is not a new technique but the seemingly limited indications and technical challenges involved have discouraged many since Burman documented his initial experiences (Burman, 1991). The current renaissance is largely driven by the expanding indications particularly in the management of femoroacetabular impingement. The figures from our own unit illustrate this well with 40% of hip arthroscopies in 1990 being purely diagnostic as compared with less than 5% at the present time.