RESUMEN
Declaration: The authors would like to declare that this study has not been published or being reviewed by other journals. Retention of new information may be impaired during recovery from general anaesthesia. Patients are likely to be anxious if they cannot recall information conveyed at the surgeons postoperative visit. Previous studies have shown evidence of short-term memory impairment after GA. Patients undergoing day case knee arthroscopy under general anaesthesia were told five random words and three diagnostic findings from their operation, by the surgeon prior to discharge. The patients were telephoned the following day to test their recall of words and diagnostic findings, with a maximum possible score of eight. 96 patients were available for the telephone follow-up. The patients were grouped according to the interval between the end of anaesthesia and the time the information was given to them. For knee arthroscopy day cases it appears that, allowing as much time as possible after anaesthesia, at least two hours if possible, before reviewing a patient in the recovery area will likely enhance his/her later recall of the clinical information, potentially setting patient expectations at the appropriate level and improving compliance with postoperative rehabilitation. For the surgeons post-operative visit to be valuable to the patient, it should take place at least two hours following cessation of anaesthesia. It is advisable to endorse verbal communication with written information (AU)
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Asunto(s)
Humanos , Anestesia General , Artroscopía/métodos , Procedimientos Quirúrgicos Ambulatorios/métodos , Osteoartritis de la Rodilla/cirugía , /métodos , Continuidad de la Atención al PacienteRESUMEN
Using general practitioner records and hospital notes and through direct telephone conversation with patients, we investigated the accuracy of nine patient-reported complications gathered from a self-completed questionnaire after elective joint replacement surgery of the hip and knee. A total of 402 post-discharge complications were reported after 8546 elective operations that were undertaken within a three-year period. These were reported by 136 men and 240 women with a mean age of 71.8 years (34 to 93). A total of 319 reported complications (79.4%; 95% confidence interval 75.4 to 83.3) were confirmed to be correct. High rates of correct reporting were demonstrated for infection (94.5%) and the need for further surgery (100%), whereas the rates of reporting deep-vein thrombosis (DVT), pulmonary embolism, myocardial infarction and stroke were lower (75% to 84.2%). Dislocation, peri-prosthetic fractures and nerve palsy had modest rates of correct reporting (36% to 57.1%). More patients who had knee surgery delivered incorrect reports of dislocation (p = 0.001) and DVT (p = 0.013). Despite these variations, it appears that post-operative complications may form part of a larger patient-reported outcome programme after elective joint replacement surgery.
Asunto(s)
Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Rodilla/efectos adversos , Autoinforme/normas , Adulto , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera/métodos , Artroplastia de Reemplazo de Rodilla/métodos , Inglaterra/epidemiología , Femenino , Luxación de la Cadera/epidemiología , Luxación de la Cadera/etiología , Humanos , Luxación de la Rodilla/epidemiología , Luxación de la Rodilla/etiología , Masculino , Persona de Mediana Edad , Infarto del Miocardio/epidemiología , Infarto del Miocardio/etiología , Satisfacción del Paciente , Infecciones Relacionadas con Prótesis/epidemiología , Infecciones Relacionadas con Prótesis/cirugía , Embolia Pulmonar/epidemiología , Embolia Pulmonar/etiología , Reoperación/métodos , Reoperación/estadística & datos numéricos , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología , Resultado del Tratamiento , Trombosis de la Vena/epidemiología , Trombosis de la Vena/etiologíaRESUMEN
Over recent years hip arthroscopic surgery has evolved into one of the most rapidly expanding fields in orthopaedic surgery. Complications are largely transient and incidences between 0.5% and 6.4% have been reported. However, major complications can and do occur. This article analyses the reported complications and makes recommendations based on the literature review and personal experience on how to minimise them.
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We retrospectively examined the long-term outcome of 96 asymptomatic hips in 96 patients with a mean age of 49.3 years (16 to 65) who had radiological evidence of femoroacetabular impingement. When surveillance commenced there were 17, 34, and 45 hips with cam, pincer, and mixed impingement, respectively. Overall, 79 hips (82.3%) remained free of osteoarthritis for a mean of 18.5 years (10 to 40). In contrast, 17 hips (17.7%) developed osteoarthritis at a mean of 12 years (2 to 28). No statistically significant difference was found in the rates of development of osteoarthritis among the three groups (p = 0.43). Regression analysis showed that only the presence of idiopathic osteoarthritis of the contralateral diseased hip was predictive of development of osteoarthritis on the asymptomatic side (p = 0.039). We conclude that a substantial proportion of hips with femoroacetabular impingement may not develop osteoarthritis in the long-term. Accordingly, in the absence of symptoms, prophylactic surgical treatment is not warranted.
Asunto(s)
Pinzamiento Femoroacetabular/complicaciones , Osteoartritis de la Cadera/etiología , Adolescente , Adulto , Anciano , Progresión de la Enfermedad , Métodos Epidemiológicos , Femenino , Pinzamiento Femoroacetabular/diagnóstico por imagen , Pinzamiento Femoroacetabular/cirugía , Humanos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Osteoartritis de la Cadera/diagnóstico por imagen , Osteoartritis de la Cadera/patología , Osteoartritis de la Cadera/prevención & control , Pronóstico , Radiografía , Adulto JovenRESUMEN
Although the association between femoroacetabular impingement and osteoarthritis is established, it is not yet clear which hips have the greatest likelihood to progress rapidly to end-stage disease. We investigated the effect of several radiological parameters, each indicative of a structural aspect of the hip joint, on the progression of osteoarthritis. Pairs of plain anteroposterior pelvic radiographs, taken at least ten years apart, of 43 patients (43 hips) with a pistol-grip deformity of the femur and mild (Tönnis grade 1) or moderate (Tönnis grade 2) osteoarthritis were reviewed. Of the 43 hips, 28 showed evidence of progression of osteoarthritis. There was no significant difference in the prevalence of progression between hips with initial Tönnis grade 1 or grade 2 osteoarthritis (p = 0.31). Comparison of the hips with and without progression of arthritis revealed a significant difference in the mean medial proximal femoral angle (81 degrees vs 87 degrees, p = 0.004) and the presence of the posterior wall sign (39% vs 7%, p = 0.02) only. A logistic regression model was constructed to predict the influence of these two variables in the development of osteoarthritis. Mild to moderate osteoarthritis in hips with a pistol-grip deformity will not progress rapidly in all patients. In one-third, progression will take more than ten years to manifest, if ever. The individual geometry of the proximal femur and acetabulum partly influences this phenomenon. A hip with cam impingement is not always destined for end-stage arthritic degeneration.
Asunto(s)
Acetábulo/diagnóstico por imagen , Cabeza Femoral/diagnóstico por imagen , Deformidades Adquiridas de la Articulación/diagnóstico por imagen , Osteoartritis de la Cadera/diagnóstico por imagen , Dolor/diagnóstico por imagen , Acetábulo/fisiopatología , Acetábulo/cirugía , Adulto , Factores de Edad , Progresión de la Enfermedad , Métodos Epidemiológicos , Femenino , Cabeza Femoral/fisiopatología , Cabeza Femoral/cirugía , Humanos , Deformidades Adquiridas de la Articulación/fisiopatología , Deformidades Adquiridas de la Articulación/cirugía , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Osteoartritis de la Cadera/fisiopatología , Osteoartritis de la Cadera/cirugía , Dolor/etiología , Pronóstico , RadiografíaRESUMEN
Advances in hip arthroscopy have renewed interest in the ligamentum teres. Considered by many to be a developmental vestige, it is now recognised as a significant potential source of pain and mechanical symptoms arising from the hip joint. Despite improvements in imaging, arthroscopy remains the optimum method of diagnosing lesions of the ligamentum teres. Several biological or mechanical roles have been proposed for the ligament. Unless these are disproved, the use of surgical procedures that sacrifice the ligamentum teres, as in surgical dislocation of the hip, should be carefully considered. This paper provides an update on the development, structure and function of the ligamentum teres, and discusses associated clinical implications.
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Enfermedades del Desarrollo Óseo/cirugía , Articulación de la Cadera/fisiopatología , Ligamentos Articulares , Adulto , Artroscopía/efectos adversos , Artroscopía/métodos , Artroscopía/tendencias , Fenómenos Biomecánicos/fisiología , Desbridamiento , Femenino , Articulación de la Cadera/cirugía , Humanos , Ligamentos Articulares/anatomía & histología , Ligamentos Articulares/embriología , Ligamentos Articulares/lesiones , Ligamentos Articulares/fisiología , Ligamentos Articulares/cirugía , Masculino , Rotura/diagnóstico , Rotura/etiologíaRESUMEN
There is a known association between femoroacetabular impingement and osteoarthritis of the hip. What is not known is whether arthroscopic excision of an impingement lesion can significantly improve a patient's symptoms. This study compares the results of hip arthroscopy for cam-type femoracetabular impingement in two groups of patients at one year. The study group comprised 24 patients (24 hips) with cam-type femoroacetabular impingement who underwent arthroscopic debridement with excision of their impingement lesion (osteoplasty). The control group comprised 47 patients (47 hips) who had arthroscopic debridement without excision of the impingement lesion. In both groups, the presence of femoroacetabular impingement was confirmed on pre-operative plain radiographs. The modified Harris hip score was used for evaluation pre-operatively and at one-year. Non-parametric tests were used for statistical analysis. A tendency towards a higher median post-operative modified Harris hip score was observed in the study group compared with the control group (83 vs 77, p = 0.11). There was a significantly higher proportion of patients in the osteoplasty group with excellent/good results compared with the controls (83% vs 60%, p = 0.043). Additional symptomatic improvement may be obtained after hip arthroscopy for femoroacetabular impingement by the inclusion of femoral osteoplasty.
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Acetábulo/cirugía , Artroscopía/métodos , Cabeza Femoral/cirugía , Articulación de la Cadera/cirugía , Artropatías/cirugía , Osteoartritis de la Cadera/cirugía , Acetábulo/diagnóstico por imagen , Adulto , Desbridamiento/métodos , Femenino , Cabeza Femoral/diagnóstico por imagen , Articulación de la Cadera/diagnóstico por imagen , Humanos , Artropatías/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Osteoartritis de la Cadera/diagnóstico por imagen , Osteoartritis de la Cadera/fisiopatología , Radiografía , Resultado del TratamientoRESUMEN
Wedging of the scoliotic inter-vertebral disc (IVD) was previously reported as a contributory factor for progression of idiopathic scoliotic (IS) curves. The present study introduces a theoretical model of IVD's role in IS pathogenesis and examines if, by reversing IVD wedging with conservative treatment (full- and night-time braces and exercises) or fusionless IS surgery with staples, we can correct the deformity of the immature spine. The proposed model implies the role of the diurnal variation and the asymmetric water distribution in the scoliotic IVD and the subsequent alteration of the mechanical environment of the adjacent vertebral growth plates. Modulation of the IVD by applying corrective forces on the scoliotic curve restores a close-to-normal force application on the vertebral growth plates through the Hueter-Volkmann principle and consequently prevents curve progression. The forces are now transmitted evenly to the growth plate and increase the rate of proliferation of chondrocytes at the corrected pressure side, the concave. Application of appropriately directed forces, ideally opposite to the apex of the deformity, likely leads to optimal correction. The wedging of the elastic IVD in the immature scoliotic spine could be reversed by application of corrective forces on it. Reversal of IVD wedging is thus amended into a "corrective", rather than "progressive", factor of the deformity. Through the proposed model, treatment of progressive IS with braces, exercises and fusionless surgery by anterior stapling could be effective.