Effects of progressive resistance training prior to total HIP arthroplasty - a secondary analysis of a randomized controlled trial.

OBJECTIVE: To investigate 1-year postoperative effect of preoperative resistance training (RT) in patients undergoing total hip arthroplasty (THA) on patient-reported outcomes on activity and function and objective outcomes on muscle strength and physical performance. DESIGN: A 3-12 months follow-up of a randomized controlled trial. Patients scheduled for THA were randomized into: RT-group, twice a week for 10 weeks prior to THA, or 'care-as-usual' (CG). Primary endpoint of this sequel analysis is HOOS-ADL at 12 months follow-up. Secondary outcome measures are; other HOOS subscales, knee- and hip muscle strength plus function (gait, ascending/descending stairs, and sit-to-stand) at three and/or 12 months. CLINICALTRIALS.GOV: NCT01164111. RESULTS: Eighty patients (70% women, 70.4 ± 7.6 years, BMI of 27.8 ± 4.6) were randomized to RT (n = 40) or CG (n = 40); data from 85% were available at 12 months. No superior effects were observed at 12 months for HOOS ADL (between-group change score [95%CI]) (2.6 [-4.2; 9.8], P = 0.44) or remaining subscales. However, ascending (1.3 s [0.3; 2.3], P = 0.01)) and descending stairs (1.6 s [0.3; 2.9], P = 0.01) demonstrated additional effects. At 3 months clinically relevant change-scores in favour of RT was observed on HOOS-Sport/Rec (10.5 points [1.4; 19.6], P = 0.023), together with higher knee strength of the affected side (14.6 Nm [6.3; 22.9], P < 0.001), and selected outcomes of physical function. CONCLUSIONS: At 12 months after surgery, there was no additional effect of preoperative RT compared with THA alone, but rehabilitation was accelerated at 3 months.

Preoperative progressive explosive-type resistance training is feasible and effective in patients with hip osteoarthritis scheduled for total hip arthroplasty--a randomized controlled trial.

OBJECTIVE: To investigate the efficacy and feasibility of progressive explosive-type resistance training (RT) in patients with osteoarthritis (OA) of the hip scheduled for total hip arthroplasty (THA). METHOD: Randomized controlled trial (1:1) in patients diagnosed with hip OA and scheduled for THA. The intervention group (IG) performed supervised preoperative progressive explosive-type RT twice a week for 10 weeks; four exercises (hip/thigh) performed in three series each (8-12 repetition maximum). The control group (CG) received 'care as usual'. Efficacy was reported as the between-group difference in the Hip Osteoarthritis Outcome Score (HOOS) (primary endpoint; ADL function), and leg muscle power at post intervention follow-up immediate before surgery. Intention-to-treat analyses were performed in a multilevel regression model adjusting for baseline, sex, age and weight. Feasibility was reported as adherence, exercise related pain and adverse effects. Post-surgical follow up will be reported separately. ClinicalTrials.gov registration: NCT01164111. RESULTS: Eighty patients (age 70.4 ± 7.6 years, BMI 27.8 ± 4.6, 52 females (65%) were included. Adherence was high (93%) with acceptable exercise related pain (VAS score ≤ 5) reported in 83% of sessions and no adverse events. Changes in HOOS 'function' was 10.0 points 95%CI [4.7; 15.3] higher in IG compared to CG (P < 0.001). For all the remaining HOOS subscales IG scored significantly better (P < 0.03) and had higher leg extension muscle power (P < 0.0001) compared to CG. CONCLUSION: Progressive explosive-type RT was feasible in the included group of hip OA patients scheduled for THA and resulted in significant improvement in self-reported outcomes and increased leg muscle power.

Human bone bank allografts stimulate bone resorption and inhibit proliferation in cultures of human osteoblast-like cells.

Incorporation of a frozen human bone allograft requires osteoclast activity and ingrowth of recipient osteoblast precursors. We examined the effects of allografts on human osteoblasts. Allografts stimulated a release of factors from normal human osteoblast-like cells, capable of inducing osteoclastic bone resorption in vivo. Further allografts inhibited osteoblast proliferation in cultures. The response was detectable within 4 days of culture and was still present after 3 weeks. Devitalized bone autografts had a similar effect. This suggests that bone bank grafts may induce a resorptive reaction at the recipient site by stimulating release of factors from osteoblasts capable of inducing osteoclastic resorption. The storage temperature was crucial for preservation of the response, since the activity was lower in allografts stored for 6 months at -20 degrees C than in those stored at -80 degrees C.

Bone banking in Denmark, results of a nationwide survey.

In a nationwide survey, all orthopaedic clinics were surveyed via a questionnaire about the use of bone allografts and how they managed their bone banks. Thirty-two clinics (100 per cent) responded to the questionnaire (mid 1991). Seventeen clinics had established bone banks on the basis of femoral heads obtained from donors during primary hip replacement. Only five used bone substitutes. The mean consumption was 30 capita per year (10-132) and ten clinics estimated an increasing demand for allografts. The storage method was by freezing at temperatures varying from minus 20 to minus 80 degrees Celsius. Contraindications to procurement comprised history of infection and malignancy, all clinics tested donors for HIV antibodies and all but one for hepatitis B. Testing for hepatitis C was about to be introduced. All but one clinic developed cultures from the procured bone. Informed consent was employed by nearly all clinics, but very few obtained written consent. Since this survey, revised recommendations have been directed from the Danish National Board of Health, these listing that an HIV-test should be performed with a 90-day interval, and that testing should also be done for hepatitis B and C. International experience and this survey show that the establishment of more specific and general national recommendations would be preferable to present practice.

Bilateral fracture of the tibial spine.

Fracture of the intercondylar eminence of the tibia in childhood is a relatively common injury, but to our knowledge a bilateral case has never been reported. A patient with bilateral fractures is presented and the literature is reviewed. An 8-year-old girl fell from a tree and sustained bilateral fractures of the tibial spine. According to Meyers' and McKeever's classification normal x rays revealed a type III fracture in the left knee and a type II fracture in the right knee. The left knee was treated by open reduction and internal fixation, and the right knee was treated conservatively. At one year follow-up the girl was fairly asymptomatic and clinically there were only few degrees' lack of extension on the left side.

[Double contrast arthrography as a screening method of suspected meniscal lesions]. / Dobbeltkontrastartrografi som screeningsundersøgelse ved mistanke om menisklaesion.

On reevaluation after one year of experience with double-contrast-arthrography (DCA) we found in 83 consecutive patients with suspected meniscal lesion a true positive diagnostic frequency of 0.84, a true negative diagnostic frequency of 0.75, a true positive nosografic frequency of 0.87 and a true negative nosografic frequency of 0.70. This gives an increased diagnostic accuracy compared to the initial evaluation of the arthrografies. No complications of the examination were registered. As DCA demands fewer resources than arthroscopy, this method is suggested as a screening procedure in patients with possible tears of the menisci.

Antibiotic prophylaxis in surgery for hip fractures.

Totally, 185 patients, operated on for a fresh hip fracture, were randomly allocated to either methicillin antibiotic prophylaxis or no prophylaxis and followed for 1 month. Two superficial wound infections were recorded in the prophylaxis group and one in the control group. Prophylactic use of antibiotics in surgery for hip fractures seems unnecessary provided strict aseptic routines in the operating room are followed.

Emergency presentation of inguinal hernia in childhood--treatment strategy. A follow-up study.

This article presents a retrospective study of 95 cases of irreducible inguinal hernia in 93 children (median age 0.5 years; range 0-13 years) admitted with this diagnosis. In 38 cases operations were performed without delay, in 51 from 12 to 48 hours after admission, and in 6 cases at a later stage. Thus, a total of 57 patients (60%) could be treated with conservative measures at the time of admission. Three instances of minor wound haematoma which did not require treatment and two instances of pneumonia caused by aspiration were recorded. Eighty-three patients could be traced, 70 of whom responded to our questionnaire. The number of infections was 2 (2.8%) and the number of recurrences was 9 (12.3%). In order to reduce the recurrence and infection rates in emergency cases of irreducible inguinal hernia in childhood, the following treatment strategy is suggested: primarily gentle taxis, combined with sedation, if necessary. If reduction is impossible, surgery should be performed without delay. If reduction is achieved, the child can be discharged after 24 hours of observation and readmitted after one week for elective out-patient herniotomy.

Closure of the abdominal fascia after clean and clean-contaminated laparotomy.

This prospective, randomized study compares continuous absorbable suture (Dexon), continuous nonabsorbable suture (Surgilon) and interrupted absorbable suture (Dexon) for fascial closure of clean and clean-contaminated laparotomy wounds. Three months postoperatively, the overall frequencies were for wound dehiscence 0% (0/238), wound infection 5.5% (13/238), hernia formation 0.4% (1/238) and sinus formation 0% (0/238). After a median period of 41 months (range 14-59 months) a physical examination was performed in 93.7% (224/238) of the patients and the observed overall frequency of hernia was 3.1% (7/224). No difference was detected in incidence of wound complications when comparing the three groups. We conclude that layered closure of a laparotomy wound is safe whether using nonabsorbable or absorbable sutures and whether applying a continuous or interrupted technique in the fascial closure of clean and clean-contaminated wounds.

Outpatient orchiopexy and herniotomy in children.

In 497 children with 528 hernia and 190 boys with 241 maldescended tests, outpatient operation was performed in 96.5% and 92.6% of the patients with an immediate surgical complication rate of 1.5% and 0% respectively. No wound infection was observed and the long term result was satisfactory with 3.7% hernia recurrences and 90% of the tests localized in the bottom of scrotum. Orchiopexy at about two years of age and early herniotomy, irrespective of age, is recommended and surgery may safely be carried out on an outpatient basis.

[Sclerotic and atrophic lichen of the genitals in boys]. / Genital lichen sclerosus et atrophicus hos drenge.

Sclerotic and atrophic lichen (LSA) is a rare condition in boys. A retrospective analysis of boys who underwent circumcision for medical reasons, revealed that nine out of 59 boys had histologically verified LSA. The condition thus appears to be a relatively frequent cause of phimosis in children.

Out-patient operation of inguinal hernia in children.

A retrospective review is presented of 496 children with a median age of 4 years (range 0-13 years) on whom a total of 527 hernia repairs were performed as out-patients. No wound infections were observed, and the rate of early surgical complications was 1.5 per cent. There were 15 (3.7 per cent) known recurrences. No complications from the anaesthetic were recorded. Owing to the negligible infection rate and the low surgical complication and recurrence rates it is concluded that children with inguinal hernia would benefit from operation as out-patients, and that they should be operated on immediately after diagnosis, irrespective of age. Besides probably minimizing the children's psychological trauma, out-patient surgery provided considerable savings to the health service in the present study.

The incidence of ureteral obstruction secondary to aorto-femoral bypass surgery. A prospective study.

Hydronephrosis is reported to be an infrequent complication of aorto-femoral bypass operations. To define the true incidence of this complication, renography (131I-Hippuran) and renal scintigraphy (99 Technetium) were performed both pre- and postoperatively on 56 asymptomatic patients following successful aortic reconstruction. No patient developed signs of ureteral obstruction. It is concluded that hydronephrosis is a rare complication to aorto-femoral bypass surgery and postoperative control is only indicated in patients with symptoms from the urinary tract.