Effects of ligation of lateral intermuscular septum perforating vessels on blood supply to the femur.

INTRODUCTION: With a subvastus approach to the femur, the vessels that perforate the lateral intermuscular septum (LISP-vessels) must be ligated. The effect on the blood supply to the femur remains unclear. The purpose of the current study was to investigate the effect of ligation of the LISP-Vessels on the blood supply and to examine the anatomy of the LISP-vessels and the anastomoses around the femur. MATERIALS: In six human cadavers the LISP vessels were ligated by a lateral subvastus approach on one side. The contralateral side served as control group. After bilateral injection of different coloured silicon dyes into the lateral and medial circumflex femoral artery (green), deep femoral artery (red) and the superficial femoral artery (blue) dissection was performed bilaterally. The arterial perfusion on both sides was compared and the anatomy of the LISP vessels studied. RESULTS: The medullary perfusion of the femur was not altered by the ligation of the LISP vessels. It did also not lead to a decrease in periosteal vessel filling. The LISP vessels were shown to be a part of a complex and rich anastomotic network and play an important role in the perfusion of the femur and quadriceps muscle group. The ligature could be compensated for by this anastomotic network. Branches to the periosteum separate from the LISP vessels immediately after perforating the lateral intermuscular septum. The linea aspera turned out to be an important area for the femoral blood supply. DISCUSSION AND CONCLUSIONS: Exposure of the femur through a lateral subvastus approach with ligation of LISP vessels causes a certain degree of soft tissue trauma. However, by using a gentle surgical technique the periostal perfusion of the femur can be preserved by a potent anastomotic network after ligation of the LISP vessels if they are not ligated to close to the lateral intermuscular septum and the linea aspera is not unnecessarily exposed.

Functional recovery and timing of hospital discharge after primary total hip arthroplasty.

BACKGROUND: Early discharge programmes in hospitals are encouraged to increase financial efficiency and bed availability, but standards of clinical care must not be compromised. Criteria for safe hospital discharge must be established and objective data are needed to assess how rapidly patients can achieve these discharge criteria. METHODS: A prospective study was performed on 65 patients (mean age = 71 years) scheduled for primary total hip arthroplasty (THA). The Modified Barthel Index (MBI) was measured pre-operatively and postoperatively at set intervals to asses recovery of function after THA. A score of 90 out of a possible 100 was used as a discharge criterion and indicated that the patient was functionally independent for safe hospital discharge. In addition, a combined score for thigh flexion and extension isokinetic peak strength was recorded for each patient before and after surgery. The number and nature of comorbidities and complications were also recorded. RESULTS: The length of hospital stay in this sample varied from 5 to 39 days. The MBI scores increased rapidly between days 3 and 5, then began to plateau from day 8 onwards. Based on the MBI, 58% of patients were fit for discharge at or before day 8. The remainder were fit for discharge from day 10 onwards (mean = 14.2 days). The latter group who required an extended hospital stay were older (P = 0.003), had more identified comorbidities (P = 0.01) and were weaker in their hip musculature prior to surgery (P = 0.001), compared to those who were discharged by day 8. A logistic regression analysis indicated that the pre-operative MBI score and hip strength score were strong predictors of timing for hospital discharge. CONCLUSIONS: A clinical pathway with functional milestones laid out over 8 days would be an appropriate criterion for the discharge of the majority of patients. However, approximately 40% of the patients presented in this study required a longer hospital stay before the criteria for safe discharge could be achieved. These patients can be identified pre-operatively by screening their MBI and composite hip strength scores.

Role of taste preference on fluid intake during and after 90 min of running at 60% of VO2max in the heat.

PURPOSE: The purpose of this study was to determine the relationship between taste preference and total fluid intake during a 90-min run at 60% VO2max as well as during a 90-min period of seated recovery under hyperthermic conditions (30 degrees C, 50% RH), comparing the ad libitum intake of water and two carbohydrate-electrolyte drinks (one containing 6% CHO and the other 8% CHO) randomized over three trails. METHODS: Fifteen men runners and triathletes, 18 to 40 yr of age, completed an initial test to determine VO2max, a practice 90-min run at 60% VO2max, and three experimental 90-min run/90-min recovery trials on separate days approximately 1 wk apart. RESULTS: There were no differences across the three treatments in fluid intake, rectal temperature, or RPE during exercise, but subjects consumed 54% and 59% more fluid during recovery with the two carbohydrate-electrolyte drinks compared with water. When comparing the subjects' trials with the most liked versus the least liked of the three fluids, they consumed more of the most liked fluid during exercise (1.10 vs 0.97 L.90 min-1) but not during recovery (1.02 vs 0.90 L.90 min-1.ns). CONCLUSIONS: Thus, perceived taste of a beverage is important for fluid replacement during exercise.

Patient variability and the design of clinical pathways after primary total hip replacement surgery.

Objective data are necessary for the design of clinical pathways of total hip replacement (THR) surgery. The functional recovery and timing for hospital discharge was studied in a consecutive series of 65 patients undergoing primary THR. The Modified Barthel Index (MBI) was serially measured after surgery to assess the recovery of functional independence. A MBI score of 90 out of a maximum of 100 is required before patients are fit for hospital discharge. The length of hospital stay varied from 5 days to 39 days. Fifty-eight percent of patients were fit for discharge by day 8, and 42% required 10 days or longer (mean = 14.2 days) in hospital. Patients in these two groups differed significantly with respect to age, the number of associated comorbidities, preoperative and early MBI scores, and muscle strength parameters. These data suggest that there is wide variability in patients presenting for primary THR. One single clinical pathway may not accommodate this patient variability, whereas two clinical pathways (one with a day 8 and another with an extended [day 10 +] time frame) may be more appropriate.