RESUMEN
OBJECTIVE: An appropriate measuring instrument for assessing if sports activity changes after a surgical treatment is not available yet. We hypothesised that the Heidelberg Sport Activity Score is a valid and adequate instrument for measuring sport activity in patients before and after operative treatment. DESIGN: This retrospective study presents a new score (Heidelberg Sports Activity Score - HAS) for measuring the sport activity in 11 selected sports. Validity, sensitivity and test-retest-reliability have been assessed. SETTING: The score includes importance of the sports for patients, impairment of the corresponding joint, and frequency and duration of the sporting activities undertaken. The HAS was validated using 3 criteria: external validation, internal comparison of groups and correlation with the Tegner Score. PATIENTS: A total of 655 patients were recruited for this study. The inclusion criterion was a planned or already received reconstruction (such as a high tibial osteotomy or implantation of a hip or knee prosthesis). The sport activity of these patients was evaluated before and after treatment. MAIN OUTCOME MEASUREMENT: The mean HAS was 32.1 points preoperatively and 37.0 postoperatively (p=0.017). RESULTS: A high correlation was found between the HAS and the Tegner Score (TS) (r=0.729; p=0.010). The Test-Retest- Reliability was performed within a time interval of 2 weeks and a significant correlation of r=0.752 was found (p<0.01). Sensitivity was analysed using a sample of patients before and after high tibial osteotomy. CONCLUSIONS: The HAS is a new, easy to use, effective and valid measuring instrument for the assessment of sports activity in patients before and after operative treatment.
RESUMEN
A consecutive series of 52 acetabular revisions was evaluated retrospectively. Inclusion criteria for all patients were at least one former exchange of the acetabular component. Reconstruction was performed with reliable techniques and implants other than extensively porous coated device (e.g. tantalum). The mean follow up was 5.63 (0.01-14.05) years. Cumulative survival at 14.05 years with removal of the acetabular component due to aseptic loosening or the worst case criterion (removal of the acetabular component for any cause and/or lost to follow-up) as the end point was 66.38 (95 % C.-I.: 47.80-84.96) % and 58.42 (95 % C.-I.: 41.01-75.83) %, respectively. The cumulative survival rate with mechanical failure of the acetabular reconstruction as the endpoint was significantly lower in patients with two or more previous revisions in comparison to those with only one former procedure (log rank test: p=0,0112 respectively). The mean Merle d'Aubignée-score improved from 7.3 (0-14) preoperatively to 10.6 (0-17) points at latest follow up examination.Survival of acetabular reconstructions with common techniques and implants is decreasing with the number of previous revisions. This may cause major concerns with regard to the rising number of patients needing repeated revisions. Maximizing durability of primary THA, precise preoperative planning as well as improved techniques and implants for revision may decrease this problem in the long term.
RESUMEN
Although the prevalence of tuberculosis reduces, it still belongs to the most important infectious diseases worldwide even in industrial countries.We report an unusual case of tuberculous coxitis in a 28-year-old healthy native female with recurrent hip pain. While X-ray and microbiological examination of the aspirate showed no abnormality, only extended diagnostic measurements and detailed history led to the diagnosis of TBC. Although the patient did not show any pulmonary symptoms open tuberculosis was confirmed. After a course of antibiotic treatment she underwent reconstructive surgery which consecutively improved range of motion. This case report emphasizes that tuberculosis should still be considered as a significant disease even in healthy patients with uncertain complaints in joints without significant initial radiographic abnormalities. We recommend the described diagnostic procedures as well as an antibiotic and surgical treatment.