Clinical, functional and radiographic long-term follow-up (7-12 years) of Birmingham Hip Resurfacing, including metal ions evaluation: a single surgeon series.

Hip resurfacing arthroplasty (HRA) has been advocated as an attractive therapy for a younger, more demanding patient population with debilitating hip osteoarthritis. Controversies surrounding metal-on-metal (MoM) hip resurfacing have, however, led to a significant decline in the popularity of the HRA. Despite this, substantial evidence supports the use of specific implants in a selected group of patients. This is a continued retrospective analysis of a single surgeon series of the Birmingham Hip Resurfacing (BHR). Initial medium-term analysis was done in 2011 and published by Van der Bracht et al.13. This analysis includes a long-term follow-up of 7 to 12 years, including functional scoring (HHS, HOOS and UCLA activity score), metal ion evaluation and survival analysis. Failure was defined as revision for any cause. A total of 267 resurfacing procedures with the BHR were included in 247 patients. We had a mean follow-up of 8.3 years. Overall survival at ten years was 94.8%(97.2% for males and 90.1% for females). There was a statistically significant increase in mean HHS score at follow-up (56.03 - IQR 47-65 to 96.07 - IQR 96-100). Elevated metal ions were correlated with a statistically significant increase in the probability of complications. This cohort study further proved that hip resurfacing arthroplasty with the Birmingham Hip Resurfacing implant provides a good alternative to conventional total hip arthroplasty in young patients. There was a significant increase in functional scores at follow-up. There is further evidence of less favorable outcomes in female patients.

Trochleoplasty in dysplastic knee trochlea.

In patients complaining of recurrent patellar dislocations or persistent retropatellar pain due to a dysplastic femoral trochlea, we perform a Henri Dejour trochleoplasty. In this technique the femoral trochlea is deepened by removing the subchondral trochlear bone followed by incision, impaction and fixation of the cartilage flange along the trochlear groove. Between 1996 and 1999, 13 procedures were performed in 12 patients. Strictly lateral X-rays showed dysplasia of the trochlea, as defined by the "crossing sign", whether or not in combination with patella alta. Patients were assessed using the Larsen-Lauridsen score considering pain, stiffness, osteopatellar crepitus, flexion and loss of function. Although the majority of patients scored fair and poor on an objective scoring system, we achieved 77% good to very good subjective results. Although the result was not perfect, the patients were satisfied with the procedure. This technique might be a valuable alternative in cases of frank trochlear dysplasia associated with persistent retropatellar pain or recurrent patellar dislocations.

Double-blind clinical study comparing alprazolam and doxepin in primary unipolar depression.

The therapeutic effect and safety of alprazolam and doxepin were studied in 126 outpatients suffering from primary unipolar depression. The 6-week study was double-blind with a random allocation of treatment. Patients were treated with a flexible dose of 1.0-4.5 mg of alprazolam and 50-225 mg of doxepin per day. The mean final doses were 2.7 mg for alprazolam and 137.5 mg for doxepin. The results indicate that alprazolam and doxepin were equally efficacious. The incidence of side-effects was lower in the alprazolam treatment group.