Patient-reported outcome measures for hip preservation surgery-a systematic review of the literature.

Hip preservation surgery is rapidly advancing and patient-reported outcome (PRO) measures are becoming an integral part of measuring treatment effectiveness. Traditionally the modified Harris hip score has been used as the main outcome measure. More recently, new PRO tools in the field have been developed. We performed a systematic review of the English literature from MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and SPORTDiscus databases to identify the PRO tools used in hip preservation surgery. Our aim was to critically appraise the quality of the questionnaire properties in order to recommend the most appropriate PRO tool for future use. Measurement properties of each PRO questionnaire were rated from excellent to poor, based on Terwee criteria and the results from the included studies. Six PRO tools were identified with description or comparison of their measurement properties in 10 articles. While, most recently developed PRO tools, the hip outcome score (HOS), the Copenhagen hip and groin outcome score (HAGOS) and the international hip outcome tool (iHOT-33) scored better than the others in their measurement properties, iHOT-33 scored the best of all the PRO tools and is recommended for future use in hip preservation surgery.

Hip resurfacing revision rates: radiological audit of risk factors.

INTRODUCTION: We performed a retrospective radiological audit of the hip resurfacings carried out in our trust over a five-year period. Abnormal cup inclination angle (CIA) and stem shaft angle (SSA) are recognised risk factors for revision in hip resurfacing. Our aims were to identify the CIA and SSA for hip resurfacings in our trust, to determine the revision rate in a CIA of ≥60° and an SSA of >0° varus, thereby identifying a high risk group for close, long-term follow up. METHODS: A total of 247 patients underwent hip resurfacing in our trust between April 2003 and March 2008. The CIA and SSA were recorded. Of the 247 patients, 26 were excluded as there were no appropriate radiographs and so results were analysed for 221 patients. RESULTS: The mean CIA was 47.6°. Over a third of the patients (34%) had a CIA of >50° and 13% had >60°. The mean SSA was 1.4° varus. Over two-thirds of the patients (67%) had a varus SSA. There were six revisions but one was excluded as it was secondary to infection. The revision rate was 10% in patients with a CIA of ≥60° and 1% in those with a CIA of <60° (p=0.017), and 1% in a varus and 4% in a valgus SSA ((p)>0.05) respectively. CONCLUSIONS: The measurement of the CIA and SSA in hip resurfacings has identified a high risk group for close long-term follow up. There is already a 10% revision rate in those patients with a CIA of >60°. Hip resurfacing may generate a large revision burden in the 'average' surgeon's hands and all hospitals/surgeons should review their radiological outcomes critically and identify those at risk of revision.

Surgical repair of complete proximal hamstring tendon ruptures in water skiers and bull riders: a report of four cases and review of the literature.

OBJECTIVE: Hamstring strains are one of the most common muscle strains in athletes; however, complete rupture of the proximal hamstring origin is rare and results from significant trauma. The objective of this paper is to present our experience of management of complete ruptures where surgical repair resulted in good results in both acute and delayed cases. METHODS: Two water skiers and two bull riders sustained complete rupture of the proximal origin of the hamstring muscles. All underwent repair of the hamstring origin and sciatic nerve neurolysis. A post operative hamstring rehabilitation programme was instituted. Regular follow up was performed at 2, 3, 6, 9, and 12 months. RESULTS: At a minimum final follow up of 12 months all patients had regained functional knee flexion strength with no pain and a near normal range of knee flexion. All four individuals were able to return to their previous line of work and three were able to return to their pre-injury level of sport. CONCLUSION: Complete rupture of the hamstring origin is a potentially devastating sports injury that has implications affecting the individual's activities of daily living as well as potential as a sportsperson. Surgical repair restores the distorted anatomy, allows early functional rehabilitation, and avoids the potential debilitating neurological problem of gluteal sciatica.

Fracture of the femoral neck, the risk of serious underlying pathology.

Between 1997 and 2003, a total of 2223 patients presented to our hospital with the neck of femur fracture. This retrospective study examines the histological results of 90 patients (4%) suspected of having a fracture associated with serious underlying pathology. The mean age at the time of fracture was 80 years (44-97). The patients were divided into four groups. Group I: 34 patients with fracture without history of fall or trauma. Group II: 21 patients with suspicious lesions on the standard pelvic radiograph taken on admission. Group III: 27 patients with past history of malignancy without known bone metastases. Group IV: 8 patients with past history of malignancy and known bone metastases. None of the patients in groups I and II had significant abnormalities other than osteoporosis. Four patients (15%) in group III and six patients (75%) in group IV had metastases on histological examination. It is concluded that only groups III and IV are likely to have fractures due to metastatic disease.