Proponents of navigated hip arthroplasty have suggested that it may increase the precision of acetabular component placement. We conducted a systematic review and meta-analysis to evaluate the validity of this theory. We searched, in duplicate, MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials for randomised trials comparing the use of computer navigation with the freehand technique for acetabular cup placement within the desired alignment. We assessed the methodological quality of the studies and abstracted the relevant data. Tests of heterogeneity and publication bias were performed. From the three studies included, there was no evidence of heterogeneity between studies. A total of 250 patients were entered into the analysis. The beneficial odds ratio for the number of outliers was 0.285 (95% confidence interval [CI]: 0.143 to 0.569; p<0.001). We conclude that navigation in hip arthroplasty improves the precision of acetabular cup placement by decreasing the number of outliers from the desired alignment.Résumé On peut penser que l'utilisation de la navigation au cours des prothèses de hanche va améliorer la précision du positionnement cotyloïdien. Nous avons conduit une étude systématique et une méta analyse de façon à valider cette théorieMéthode : les recherches ont été réalisé sur MEDLINE, EMBASE et COCHRANE, essais randomisés comparant l'utilisation de la navigation et l'utilisation des techniques classiques à main levée. Différents tests statistiques ont été réalisés.Résultat : à partir de 3 études inclues, il n'y a pas de différence entre ces 3 études. Un total de 250 patients ont été analysés, le ratio des hanches en dehors de la moyenne a été de 0,285 (95% CI: 0,143 et 0,569; p<0,001). Nous pouvons affirmer que la navigation au cours de la prothèse totale de hanche permet une meilleure précision du positionnement de la cupule et diminue le nombre de cupules en mauvaise position.

Patients with synovial chondromatosis with hip central compartment loose bodies that were less than 10 mm benefited from hip arthroscopy. Imaging studies alone failed to establish the diagnosis in 14 of 29 patients (48%). Diagnosis was made by direct visualization via arthroscopy. For patients with grade I/II cartilage change, early diagnosis and treatment via arthroscopy helped. It is a valid and effective treatment at early to intermediate follow-up.

Musical hallucinosis is a rare and poorly understood clinical phenomenon. While an association appears to exist between this phenomenon and organic brain pathology, aging and sensory impairment the precise association remains unclear. The authors present two cases of musical hallucinosis, both in elderly patients with mild-moderate cognitive impairment and mild-moderate hearing loss, who subsequently developed auditory hallucinations and in one case command hallucinations. The literature in reference to musical hallucinosis will be reviewed and a theory relating to the development of musical hallucinations will be proposed.

OBJECTIVECushing’s disease (CD) patients experience a range of debilitating symptoms that impair quality of life (QOL) as assessed using generic measures. These generic measures are inadequate to capture the disease-specific burden of illness. The development of the CD-specific QOL-CD measure of QOL using items generated by CD patients and healthcare professionals will provide a holistic assessment of patient outcomes and efficacy of novel therapies.METHODSA total of 96 CD patients participated. A list of 177 items (version 1.0) was generated by treated CD patients (n = 9), caregivers (n = 2), healthcare providers (n = 7), and results of a MEDLINE search. Item reduction was performed through content analysis and dual scaling. Patients’ rating of importance was incorporated to reduce to a final version of 56 items (version 3.0). Evidence for test-retest reliability was sought through administering the QOL-CD 1 week apart and Cronbach’s α of each subscale. Construct validity was assessed through extreme group analysis and comparison with the normal Canadian population. Concurrent validity was sought through comparison with the SF-36, Functional Assessment of Cancer Therapy–Brain (FACT-Br), and Karnofsky Performance Status (KPS). Perioperative testing was conducted on CD patients (n = 25) against nonfunctioning pituitary adenoma controls (n = 25) through pre- and postoperative testing.RESULTSA total of 96 CD patients (86 females and 10 males; mean age 45.23 ± 14.16 years) participated. The QOL-CD was feasible (mean completion time 15 minutes, with 70% believing accurate capture of QOL), reliable (CD 1 week apart: r = 0.86; control 1 week apart: r = 0.83; Cronbach’s α: general health = 0.73, emotional health = 0.85, physical health = 0.78, mental status = 0.82, social well-being = 0.63, medical treatment = 0.54), and valid (extreme group testing p < 0.001; SF-36 and QOL-CD general health: r = 0.56, social well-being: r = 0.21, emotional health: r = 0.61, total score: r = 0.58; FACT-Br and QOL-CD physical health: r = 0.47, social well-being: r = 0.21, emotional health: r = 0.34, total score: r = 0.68; KPS and QOL-CD general health: r = 0.32, total score: r = 0.14). Perioperative testing of CD patients (n = 25) demonstrated improvement in all subscales postoperatively, with a significant difference in emotional health (p < 0.001) and physical health (p < 0.001).CONCLUSIONSThe QOL-CD questionnaire has been developed for patients with CD and has demonstrated evidence for validity and reliability.

No abstract