No abstract

No abstract

No abstract

Atraumatic hip instability is an increasingly recognized source of pain and hip dysfunction. It can result from numerous causes, including femoroacetabular impingement, prior trauma, injury to the capsuloligamentous structures, and idiopathic etiologies. Occult hip instability can be a challenging diagnosis that requires careful attention to, and interpretation of, history, physical examination, and radiographic imaging findings. Iatrogenic hip instability is a potential complication of both open and arthroscopic hip-preserving surgical procedures that can have catastrophic results. Atraumatic hip instability is a pathologic entity that can be successfully addressed with open and arthroscopic procedures.

Simultaneous prosthetic joint infection of ipsilateral hip and knee arthroplasties is often accompanied by significant bone loss and presents a challenging reconstructive problem. Two-stage reconstruction is favored and requires the placement of a total femur spacer, which is not a commercially available device. We describe a surgical technique, reporting on 2 cases in which a customized total femur antibiotic impregnated spacer was created by combining an articulating knee spacer and an articulating hip spacer with a reinforced cement dowel construct connecting the 2 spacers. Custom total femoral spacers are useful in the management of infected femoral megaprostheses and cases with ipsilateral injected hip and knee arthroplasties and severe femoral bone loss.

Purpose To develop a nondestructive method of measuring distal radioulnar joint (DRUJ) joint reaction force (JRF) that preserves all periarticular soft tissues and more accurately reflects in vivo conditions. Methods Eight fresh-frozen human cadaveric limbs were obtained. A threaded Steinmann pin was placed in the middle of the lateral side of the distal radius transverse to the DRUJ. A second pin was placed into the middle of the medial side of the distal ulna colinear to the distal radial pin. Specimens were mounted onto a tensile testing machine using a custom fixture. A uniaxial distracting force was applied across the DRUJ while force and displacement were simultaneously measured. Force-displacement curves were generated and a best-fit polynomial was solved to determine JRF. Results All force-displacement curves demonstrated an initial high slope where relatively large forces were required to distract the joint. This ended with an inflection point followed by a linear area with a low slope, where small increases in force generated larger amounts of distraction. Each sample was measured 3 times and there was high reproducibility between repeated measurements. The average baseline DRUJ JRF was 7.5 N (n = 8). Conclusions This study describes a reproducible method of measuring DRUJ reaction forces that preserves all periarticular stabilizing structures. This technique of JRF measurement may also be suited for applications in the small joints of the wrist and hand. Clinical relevance Changes in JRF can alter native joint mechanics and lead to pathology. Reliable methods of measuring these forces are important for determining how pathology and surgical interventions affect joint biomechanics.

No abstract

Objectives:Patient reported outcomes (PRO) following surgery is vital to determining treatment efficacy and is valuable for executing comparative trials. Traditional legacy measures used to assess outcomes of patients undergoing arthroscopic hip surgery have included the modified Harris Hip Score (mHHS), the Non-arthritic Hip Score (NAHS) and the Hip Outcome Score (HOS), among others. Each of these PROs have been touted for specific advantages and criticized for certain limitations. In addition, clinical results documented for each of these PROs cannot be easily compared with those from other measures employed in patients undergoing different procedures in varying anatomic locations. The Patient Reported Outcomes Measurement Information System (PROMIS) tool was developed by the National Institute of Health to provide efficient, precise and valid patient-reported outcome data. While PROMIS has been broadly utilized due to its efficiency and generalizability, it has not yet been validated among patients undergoing hip arthroscopy. The purpose of this study was to determine whether the PORMIS Computer Adaptive Testing (CAT) tool demonstrates validity against commonly used legacy PRO measures among a population of patients undergoing arthroscopic hip surgery.Methods:A consecutive series of patients undergoing elective arthroscopic hip surgery at a single academic medical center from 4/22/15 to 3/11/16 were prospectively enrolled into an IRB approved. Patients who were under the age of 18 or who had undergone previous open or arthroscopic hip surgery were excluded. Eligible patients completed a series of outcome questionnaires including the visual analog pain scale (VAS), a hip outcome score (HOS; ADL and Sports Subscales), modified harris hip (mHHS), and non-arthritic hip score (NAHS) as well as the PROMIS CAT for pain, physical function and emotional distress (depression). Patients completed all questionnaires at their preoperative evaluation and at regular postoperative intervals (1 week, 6 weeks, 3 months). Outcome measure scores compared via the Pearson product correlation coefficient.Results:A total of 77 patents elected to be included in this study, 28 (36.8%) were male and 49 (64.5%) were female. The average age of study participants was found to be 38 years (range 18-69). With regards to questionnaire completion, data from all patient reported outcome measures were gathered from 77 patients at their preoperative clinical visit, 71 during their first postoperative follow up, 69 at 6 weeks and 58 at 3 months postoperatively. Pearson correlations between PROMIS Physical Function T scores and the HOS ADL, HOS Sports, NAHS and mHHS were found to be 0.858, 0.799, 0.773 and 0.830 respectively. With regards to pain, the Pearson correlation between the PROMIS Pain T score and the VAS for pain was found to be 0.599.Conclusion:The PROMIS tool was found to correlate well with current standards for patient reported outcome measures for individuals undergoing arthroscopic hip surgery. PROMIS Physical Function demonstrated ...