Sample records for acetabular labral tears

  1. Nonsurgical Treatment of Acetabular Labral Tears.

    PubMed

    Theige, Melissa; David, Shannon

    2018-05-04

    Clinical Scenario: Surgical treatment of acetabular labral tears has been explored in multiple studies, while there is a lack of research on the effectiveness of conservative methods. Focused Clinical Question: To what extent can nonsurgical treatment produce symptomatic or functional improvements in athletes with an acetabular labral tear? Summary of Search, Best Evidence Appraised, and Key Findings: The literature was searched for studies of patients with confirmed acetabular labral tears who participated in any level of sport. Four studies were located, all of which were included. Clinical Bottom Line: The research discussed in this review agreed that conservative management of acetabular labral tears produced measurable improvements in pain and function among the athletes studied, including their ability to participate in sport activities. Based on these findings, it appears that conservative management is effective at rehabilitating athletes with acetabular labral tears. However, this method should not be applied to every athlete based on the low strength of current research. Treatment plans should be decided upon on a case-by-case basis. Strength of Recommendation: The studies located were of low quality. The highest Oxford Center for Evidence-Based Medicine Level of Evidence achieved was 4. Higher level studies must be conducted before the conclusions of this research can be applied clinically with assertion. Strength of recommendation is level 3.

  2. Acetabular labral tears in patients with sports injury.

    PubMed

    Kang, Chan; Hwang, Deuk-Soo; Cha, Soo-Min

    2009-12-01

    We wanted to investigate acetabular labral tears and their correlation with femoroacetabular impingement in patients with sports injury. Among 111 patients who were diagnosed with the acetabular labral tears after arthroscopic treatment from January 2004 to December 2007, we selected 41 patients with sports injury. There were 12 cases of Taekwondo injury, 5 of golf injury, 4 of soccer injury, 3 of gymnastics injury, 2 of Hapkido injury, 2 of aerobics injury, 2 of rock-climbing injury, 2 of fitness training injury and 9 of other sports injuries. We checked the subtypes of acetabular labral tears and the accompanying femoroacetabular impingement. For the cases with accompanying femoroacetabular impingement, we investigated the subtypes according to the types of sports, gender and age. At last follow-up, we checked the Harris Hip Score (HHS), the Hip Outcome Score (HOS) sports scale and the percentage of patients who returned to their sports activity. The average age of symptomatic onset was 26 years (range, 12 to 65 years). The ratio of males to females was 29 : 12. An average duration of the hip pain was 17 months (range, 1 to 60 months). The degenerative type of acetabular labral tears was the most prevalent with 32 cases (78%), and there were 9 cases (22%) of the partial tear type. Thirty cases (73%) were accompanied by femoroacetabular impingement. The average age of the 23 cases (56%) of the cam-type was 23 years (range, 12 to 48 years), and it was more likely to occur in men (87%) and for people practicing martial arts such as Taekwondo or Hapkido. An average age of the 5 cases (12%) of the pincer-type was 26 (range, 16 to 43 years), it usually occurred in women (60%) and for non-martial arts such as golf and gymnastics. There were 2 cases of the mixed type (cam + pincer-type). At 27 months follow-up, the HHS was 61 to 92 points, the HOS sports scale increased 43 to 75%, and the rate of returning to sports was 71%. In spite of the early expression of symptoms

  3. Examination and treatment of a professional ballet dancer with a suspected acetabular labral tear: A case report.

    PubMed

    Khoo-Summers, Lynnette; Bloom, Nancy J

    2015-08-01

    Dancers are at risk for developing groin pain that is due to acetabular labral tears. Although surgical management of labral tears has been reported extensively, conservative management has been poorly described. This case report describes the examination, diagnosis, and treatment of groin pain in a professional ballet dancer with a suspected acetabular labral tear. Treatment focused on decreasing anterior hip joint stresses and improving the precision of hip motion through correction of alignment and movement impairments noted during functional activities and dance. Successful outcomes included a reduction in pain and return to professional ballet dancing. Copyright © 2015 Elsevier Ltd. All rights reserved.

  4. Acetabular labral tears with underlying chondromalacia: a possible association with high-level running.

    PubMed

    Guanche, Carlos A; Sikka, Robby S

    2005-05-01

    The use of hip arthroscopy has helped delineate intra-articular pathology and has enabled clinicians to further elucidate the factors responsible for injuries, such as running. The subtle development of degenerative changes may be a result of repetitive impact loading associated with this sport. This study presents a population of runners with common pathologic acetabular changes. Case series. Eight high-level runners with an average age of 36 years (range, 19 to 45 years) were seen for complaints of increasing hip pain with running without any history of macrotrauma. All of the patients had either run several marathons (4), were triathletes (1), Olympic middle distance runners (1), or had run more than 10 miles per week for longer than 5 years (2). Plain radiographic analysis revealed no degenerative changes and an average center-edge (CE) angle of 36.7 degrees (range, 28 degrees to 44 degrees). All patients underwent hip arthroscopy with labral debridement. In 6 patients (75%), a chondral injury of the acetabular cartilage underlying the labral tear was noted. In addition, 3 patients had ligamentum teres disruptions. It is possible that the development of these tears is the result of subtle instability, which may be exacerbated by running, eventually leading to labral tearing and possible ligamentum teres disruption. While perhaps concurrently, subtle acetabular dysplasia may play a role. Although this study does not confirm an association between running and the development of labral tears or chondral lesions in the hip, it certainly questions whether there is an injury pattern common to this population, a "runner's hip." Level IV.

  5. The prevalence of acetabular labral tears and associated pathology in a young asymptomatic population.

    PubMed

    Lee, A J J; Armour, P; Thind, D; Coates, M H; Kang, A C L

    2015-05-01

    Acetabular labral tears and associated intra-articular pathology of the hip have been recognised as a source of symptoms. However, it is now appreciated that there is a relatively high prevalence of asymptomatic labral tears. In this study, 70 young asymptomatic adult volunteers with a mean age of 26 years (19 to 41) were recruited and underwent three tesla non-arthrographic MR scans. There were 47 women (67.1%) and 23 men (32.9%). Labral tears were found in 27 volunteers (38.6%); these were an isolated finding in 16 (22.9%) and were associated with other intra-articular pathology in the remaining 11 (15.7%) volunteers. Furthermore, five (7.1%) had intra-articular pathology without an associated labral tear. Given the high prevalence of labral pathology in the asymptomatic population, it is important to confirm that a patient's symptoms are due to the demonstrated abnormalities when considering surgery. ©2015 The British Editorial Society of Bone & Joint Surgery.

  6. Similar Prevalence of Acetabular Labral Tear in Professional Ballet Dancers and Sporting Participants.

    PubMed

    Mayes, Susan; Ferris, April-Rose; Smith, Peter; Garnham, Andrew; Cook, Jill

    2016-07-01

    To compare the prevalence of acetabular labral tear in male and female professional ballet dancers with age-matched and sex-matched sporting participants and to determine the relationship to clinical findings and cartilage defects. Case-control study. Clinical and radiology practices. Forty-nine (98 hips) male and female professional ballet dancers (current and retired) with median age 30 years (range: 19-64 years) and 49 (98 hips) age-matched and sex-matched sporting participants. Group (ballet or sports), sex, age, hip cartilage defects, history of hip pain, Hip and Groin Outcome Score, passive hip internal rotation (IR), and external rotation range of movement (ROM). Labral tear identified with 3T magnetic resonance imaging (MRI). Labral tears were identified in 51% of all 196 hips. The prevalence did not differ significantly between the ballet and sporting participants (P = 0.41) or between sexes (P = 0.34). Labral tear was not significantly associated with clinical measures, such as pain and function scores or rotation ROM (P > 0.01 for all). Pain provocation test using IR at 90° of hip flexion had excellent specificity [96%, 95% confidence intervals (CIs), 0.77%-0.998%] but poor sensitivity (50%, 95% CI, 0.26%-0.74%) for identifying labral tear in participants reporting hip pain. Older age and cartilage defect presence were independently associated with an increased risk of labral tear (both P < 0.001). The prevalence of labral tear in male and female professional ballet dancers was similar to a sporting population. Labral tears were not associated with clinical findings but were related to cartilage defects, independent of aging. Caution is required when interpreting MRI findings as labral tear may not be the source of the ballet dancer's symptoms.

  7. Myofascial treatment for patients with acetabular labral tears: a single-subject research design study.

    PubMed

    Cashman, Glenn E; Mortenson, W Ben; Gilbart, Michael K

    2014-08-01

    Single-subject research design using 4 consecutive patients. To assess whether treatment using soft tissue therapy (ART or Active Release Technique), stretching, and strengthening of the hip abductors, hip external rotators, and tensor fascia latae muscles reduces pain and improves self-reported hip function in patients with acetabular labral tears who also have posterolateral hip pain of suspected myofascial origin. Acetabular labral tears cause pain in some but not all patients. Pain commonly presents anteriorly but may also present posteriorly and laterally. The standard of care is arthroscopic repair, which helps many but not all patients. It is possible that these patients may present with extra-articular contributions to their pain, such as myofascial pain, making their clinical presentation more complex. No previous study has assessed soft tissue therapy as a treatment option for this subset of patients. This A-B-A design used repeated measures of the Hip Outcome Score and visual analog scale for pain. Four patients were treated for 6 to 8 weeks, using a combination of soft tissue therapy, stretching, and strengthening for the hip abductors, external rotators, and tensor fascia latae. Data were assessed visually, statistically, and by comparing mean differences before and after intervention. All 4 patients experienced both statistically significant and clinically meaningful improvement in posterolateral hip pain and hip-related function. Three patients also experienced reduction in anteromedial hip pain. Myofascial hip pain may contribute to hip-related symptoms and disability in patients with acetabular labral tears and posterolateral hip pain. These patients may benefit from soft tissue therapy combined with stretching and strengthening exercises targeting the hip abductors, tensor fascia latae, and hip external rotator muscles. Level of Evidence Therapy, level 4.

  8. The hip fluid seal--Part II: The effect of an acetabular labral tear, repair, resection, and reconstruction on hip stability to distraction.

    PubMed

    Nepple, Jeffrey J; Philippon, Marc J; Campbell, Kevin J; Dornan, Grant J; Jansson, Kyle S; LaPrade, Robert F; Wijdicks, Coen A

    2014-04-01

    The acetabular labrum is theorized to be important to normal hip function by providing stability to distraction forces through the suction effect of the hip fluid seal. The purpose of this study was to determine the relative contributions of the hip capsule and labrum to the distractive stability of the hip, and to characterize hip stability to distraction forces in six labral conditions: intact labrum, labral tear, labral repair (looped vs. through sutures), partial resection, labral reconstruction with iliotibial band, and complete resection. Eight cadaveric hips with a mean age of 47.8 years (SD 4.3, range 41-51 years) were included. For each condition, the hip seal was broken by distracting the hip at a rate of 0.33 mm/s while the required force, energy, and negative intra-articular pressure were measured. For comparisons between labral conditions, measurements were normalized to the intact labral state (percent of intact). The relative contribution of the labrum to distractive stability was greatest at 1 and 2 mm of displacement, where it was significantly greater than the role of the capsule and accounted for 77 % (SD 27 %, p = 0.006) and 70 % (SD 7 %, p = 0.009) of total distractive stability, respectively. The relative contribution of the capsule to distractive stability increased with progressive displacement, providing 41 % (SD 49 %) and 52 % (SD 53 %) of distractive stability at 3 and 5 mm of distraction, respectively. The maximal distraction force required to break the hip seal in the intact labral state (capsule removed) varied from 124 to 150 N. Labral tear, partial resection, and complete resection resulted in average maximal distraction forces of 76 % (SD 34 %), 29 % (SD 26 %), and 27 % (SD 22 %), respectively, compared to the intact state. Through type labral repairs resulted in significantly greater improvements (from the labral tear state) in maximal negative pressure generated, compared to looped type repairs (median increase; +32 vs. -9 %, p

  9. Debridement versus re-attachment of acetabular labral tears: A review of the literature and quantitative analysis.

    PubMed

    Haddad, B; Konan, S; Haddad, F S

    2014-01-01

    We have reviewed the current literature to compare the results of surgery aimed to repair or debride a damaged acetabular labrum. We identified 28 studies to be included in the review containing a total of 1631 hips in 1609 patients. Of these studies 12 reported a mean rate of good results of 82% (from 67% to 100%) for labral debridement. Of the 16 studies that reported a combination of debridement and re-attachment, five reported a comparative outcome for the two methods, four reported better results with re-attachment and one study did not find any significant difference in outcomes. Due to the heterogeneity of the studies it was not possible to perform a meta-analysis or draw accurate conclusions. Confounding factors in the studies include selection bias, use of historical controls and high rates of loss of follow-up. It seems logical to repair an unstable tear in a good quality labrum with good potential to heal in order potentially to preserve its physiological function. A degenerative labrum on the other hand may be the source of discomfort and its preservation may result in persistent pain and the added risk of failure of re-attachment. The results of the present study do not support routine refixation for all labral tears.

  10. Examination of acetabular labral tear: a continued diagnostic challenge.

    PubMed

    Reiman, Michael P; Mather, Richard C; Hash, Thomas W; Cook, Chad E

    2014-02-01

    Acetabular labrum tears (ALT) are present in 22-55% of individuals with hip or groin pain. Tears can occur as a result of trauma or degeneration and are markedly associated with femoral acetabular morphological variations. An ALT can lead to biomechanical deficiencies and a loss of stability to the coxafemoral joint due to the labrum serving as a stabilising structure of this joint. The diagnosis of ALT is complex and multidimensional. Although tremendous improvements in diagnostic utility for ALT have occurred in the past 25 years, there are few patient history, clinical examination and special test findings that are unique to the condition. Imaging methods such as MRI, CT and ultrasonography have demonstrated reasonable accuracy, but not at a level that allows use as a stand-alone measure. Outcomes measures that focus on functional limitation or that are used to measure recovery should envelop the complexities of the condition and be captured using both self-report and physical performance measures. Only when patient history, objective testing, clinical examination special testing and imaging are combined can a clinician fully elucidate the multidimensional diagnosis of ALT.

  11. Is labral hypotrophy correlated with increased acetabular depth?

    PubMed Central

    Toft, Felix; Anliker, Elmar; Beck, Martin

    2015-01-01

    Labral hypertrophy is a distinct feature in hip dysplasia. Occasionally, very small, hypotrophic labra are observed. However, there is no literature concerning this pathology. We investigated if the size of the labrum correlated with any radiologic parameters reflecting the amount of acetabular coverage. It was hypothezised that there is a negative correlation between labrum size and acetabular coverage. Labra were categorized into three groups depending on the relation between length of the articular sided surface and height of bony attachment. Labra with a height:length ratio of 2 were classified as hypotrophic, with a height:length ratio of 1 as normal and with a ratio of 0.5 as hypertrophic. Labral cross-sectional areas (CSA) were measured on radial magnetic resonance imaging-arthrography slices using the measuring tool of the PACS system of 20 hips with hypotrophic labra (group 1), 20 hips with normal labral appearance (group 2) and 10 hips with hypertrophic labra (group 3). These values were then analyzed against following parameters: neck-shaft-angle (NSA), lateral center-edge angle (LCE), acetabular index (AI), femoral extrusion index (FEI) and acetabular retroversion index (ARI). Analyses of variance were used to determine differences in mean values between the three groups. Mean labral CSA differed significantly between all groups (group 1: 12.1 ± 2.9 mm2; group 2: 25.2 ± 6.2 mm2; group 3: 41.1 ± 12.3 mm2; P < 0.001). NSA, LCE, AI and FEI all showed a significant difference between group 3 and 1 or 2. The ARI showed no difference between groups. Stepwise linear regression analyses showed a significant correlation between LCE angle and labral CSA with a corrected R2-value of 0.301. Labral CSA correlates with the LCE. No statistically significant difference between groups 1 and 2 concerning the LCE, AI or FEI could be identified. Nevertheless, group 1 had the highest mean coverage of all groups, hips with hypertrophic labra

  12. The Economic Impact of Acetabular Labral Tears: A Cost-effectiveness Analysis Comparing Hip Arthroscopic Surgery and Structured Rehabilitation Alone in Patients Without Osteoarthritis.

    PubMed

    Lodhia, Parth; Gui, Chengcheng; Chandrasekaran, Sivashankar; Suarez-Ahedo, Carlos; Dirschl, Douglas R; Domb, Benjamin G

    2016-07-01

    Hip arthroscopic surgery has emerged as a successful procedure to manage acetabular labral tears and concurrent hip injuries, which if left untreated, may contribute to hip osteoarthritis (OA). Therefore, it is essential to analyze the economic impact of this treatment option. To investigate the cost-effectiveness of hip arthroscopic surgery versus structured rehabilitation alone for acetabular labral tears, to examine the effects of age on cost-effectiveness, and to estimate the rate of symptomatic OA and total hip arthroplasty (THA) in both treatment arms over a lifetime horizon. Economic and decision analysis; Level of evidence, 2. A cost-effectiveness analysis of hip arthroscopic surgery compared with structured rehabilitation for symptomatic labral tears was performed using a Markov decision model constructed over a lifetime horizon. It was assumed that patients did not have OA. Direct costs (in 2014 United States dollars), utilities of health states (in quality-adjusted life years [QALYs] gained), and probabilities of transitioning between health states were estimated from a comprehensive literature review. Costs were estimated using national averages of Medicare reimbursements, adjusted for all payers in the United States from a societal perspective. Utilities were estimated from the Harris Hip Score. Cost-effectiveness was assessed using the incremental cost-effectiveness ratio (ICER). One-way and probabilistic sensitivity analyses were performed to determine the effect of uncertainty on the model outcomes. For a cohort representative of patients undergoing hip arthroscopic surgery at our facility, arthroscopic surgery was more costly (additional $2653) but generated more utility (additional 3.94 QALYs) compared with rehabilitation over a lifetime. The mean ICER was $754/QALY, well below the conventional willingness to pay of $50,000/QALY. Arthroscopic surgery was cost-effective for 94.5% of patients. Although arthroscopic surgery decreased in cost

  13. Sex differences of hip morphology in young adults with hip pain and labral tears.

    PubMed

    Hetsroni, Iftach; Dela Torre, Katrina; Duke, Gavin; Lyman, Stephen; Kelly, Bryan T

    2013-01-01

    To compare hip morphology between young men and women who presented with hip pain and labral tears. A retrospective review of our hip arthroscopy registry from March 2008 to June 2010 was completed. We identified 217 patients (249 hips) who were between the ages of 18 to 30 years. The inclusion criteria were (1) insidious-onset hip pain or worsening pain after low-energy sports trauma, (2) positive hip impingement sign, (3) Tönnis grades 0 to 1, (4) magnetic resonance imaging showing labral tear, and (5) primary hip arthroscopy confirming labral tear. Forty-five patients (52 hips) were excluded for the following reasons: (1) revision hip arthroscopy, (2) high-energy hip trauma, (3) history of surgery involving the femur or pelvis, (4) previous fractures of the femur or pelvis, (5) Tönnis grades 2 or above, (6) proliferative disease of the hip (i.e., synovial chondromatosis, pigmented villonodular synovitis), (7) neuromuscular disease (i.e., cerebral palsy), and (8) deformities related to Legg-Calvé-Perthes disease or developmental dysplasia of the hip. Therefore, the cohort study group included 105 (61%) men (123 [62.4%] hips) and 67 (39%) women (74 [37.6%] hips). Sex comparisons were made for the following variables measured on preoperative hip computed tomography scans: alpha angle, acetabular version, femoral version, lateral center-edge angle, and neck-shaft angle. Women had smaller alpha angles (47.8°v 63.6°, P < .001), increased acetabular version (17.3°v 13.9°, P < .001), and increased femoral anteversion (14.4°v 12.1°, P = .05). In young adults with hip pain and labral tears, women have smaller alpha angles and hips that are generally more anteverted. Therefore, in women, cam lesions may be more subtle, preoperative hip version analyses should be encouraged, and rim trimming may need to be cautiously planned to avoid increasing contact stresses at weight-bearing areas after such a procedure. Level III, retrospective comparative study. Copyright

  14. Hip Labral Tear

    MedlinePlus

    ... participate in such sports as ice hockey, soccer, football, golf and ballet are at higher risk of ... accidents or from playing contact sports such as football or hockey — can cause a hip labral tear. ...

  15. Imaging the Glenoid Labrum and Labral Tears.

    PubMed

    De Coninck, Tineke; Ngai, Steven S; Tafur, Monica; Chung, Christine B

    2016-10-01

    The shoulder joint is the most unstable articulation in the entire human body. While this certainly introduces vulnerability to injury, it also confers the advantage of broad range of motion. There are many elements that work in combination to offset the inherent instability of the glenohumeral joint, but the glenoid labrum is perhaps related most often. Broadly, clinical unidirectional instability can be subdivided into anterior and posterior instability, which usually raise concern for anteroinferior and posteroinferior labral lesions, respectively. In the special case of superior labral damage, potential dislocation is blocked by structures that include the acromion; hence, while damage elsewhere commonly manifests as clinical instability, damage to the superior labrum is often described by the term microinstability. In this particular case, one of the radiologist's main concerns should be classic superior labral anteroposterior lesions. The glenoid labrum is also subject to a wide range of normal variants that can mimic labral tears. Knowledge of these variants is central to interpreting an imaging study of the labrum because misdiagnosis of labral variants as tears can lead to superfluous surgical procedures and decreased shoulder mobility. This article reviews labral anatomy and normal labral variants, describes their imaging features, and discusses how to discriminate normal variants from labral tears. Specific labral pathologic lesions are described per labral quadrant (anteroinferior, posteroinferior, and superior), and imaging features are described in detail. Online supplemental material is available for this article. © RSNA, 2016.

  16. REHABILITATION AFTER HIP ARTHROSCOPY AND LABRAL REPAIR IN A HIGH SCHOOL FOOTBALL ATHLETE

    PubMed Central

    Kolber, Morey J.

    2012-01-01

    Study Design: Case Report Background: Femoral acetabular impingement (FAI) has been implicated in the etiology of acetabular labral tears. The rehabilitation of younger athletes following arthroscopic surgery for FAI and labral tears is often complex and multifactorial. A paucity of evidence exists to describe the rehabilitation of younger athletes who have undergone arthroscopic hip surgery. Case Presentation: This case report describes a four-phase rehabilitation program for a high school football player who underwent hip arthroscopy with a labral repair and chondroplasty. Outcomes: The player returned to training for football 16 weeks later and at the 4 month follow-up was pain free with no signs of FAI. Discussion: There is little evidence regarding the rehabilitation of younger athletes who undergo arthroscopic hip surgery. This case study described a four phase rehabilitation program for a high school football player who underwent hip arthroscopy and labral repair. The patient achieved positive outcomes with a full return to athletic activity and football. The overall success of these patients depends on the appropriate surgical procedure and rehabilitation program. Key Words: Femoral acetabular impingement (FAI), hip, hip impingement Level of evidence: 4-Case report PMID:22530192

  17. Glenohumeral Instability Related to Special Conditions: SLAP Tears, Pan-labral Tears, and Multidirectional Instability.

    PubMed

    Van Blarcum, Gregory S; Svoboda, Steven J

    2017-09-01

    Glenohumeral instability is one of the more common conditions seen by sports medicine physicians, especially in young, active athletes. The associated anatomy of the glenohumeral joint (the shallow nature of the glenoid and the increased motion it allows) make the shoulder more prone to instability events as compared with other joints. Although traumatic dislocations or instability events associated with acute labral tears (ie, Bankart lesions) are well described in the literature, there exists other special shoulder conditions that are also associated with shoulder instability: superior labrum anterior/posterior (SLAP) tears, pan-labral tears, and multidirectional instability. SLAP tears can be difficult to diagnose and arthroscopic diagnosis remains the gold standard. Surgical treatment as ranged from repair to biceps tenodesis with varying reports of success. Along the spectrum of SLAP tears, pan-labral tears consist of 360-degree injuries to the labrum. Patients can present complaining of either anterior or posterior instability alone, making the physical examination and advanced imaging a crucial component of the work up of the patients. Arthroscopic labral repair remains a good initial option for surgical treatment of these conditions. Multidirectional instability remains one of the more difficult conditions for the sports medicine physician to diagnose and treat. Symptoms may only be reported as vague pain versus frank instability making the diagnoses particularly challenging, especially in a patient with overall joint laxity. Conservative management to include physical therapy is the mainstay initial treatment in patients without an identifiable structural abnormality. Surgical management of this condition has evolved from open to arthroscopic capsular shifts with comparable results.

  18. Magnetic resonance imaging with gadolinium arthrography to assess acetabular cartilage delamination.

    PubMed

    Zaragoza, Edward; Lattanzio, Pierre-Jean; Beaule, Paul E

    2009-01-01

    Recent reports have demonstrated magnetic resonance imaging (MRI) as a promising technique in detecting articular cartilage lesions of the hip joint. The purpose of our study was to evaluate the diagnostic performance of MRI with gadolinium arthrography in detecting acetabular cartilage delamination in patients with pre-arthritic hip pain. 46 patients (48 hips) underwent surgical dislocation of the hip. Mean age was 38.8 (range 17-56). There were 26 males and 20 females. All patients had Magnetic Resonance Imaging with gadolinium arthrography (MRA) before undergoing open hip surgery where the acetabular cartilage was inspected. Acetabular cartilage delamination on MRA was seen on sagittal images as a linear intra-articular filling defect of low signal intensity >1mm in thickness on T1 weighted images and surrounded by contrast. On MRA all hips had a labral tear confirmed at surgery. At surgery 30 hips had evidence of acetabular cartilage delamination, 4 hips had ulceration and 14 had no articular cartilage damage. The majority of labral tears and cartilage damage were located in the antero-superior quadrant. The sensitivity and specificity of MRA detection of cartilage delamination confirmed at surgery were 97% and 84%, respectively. The positive and negative predictive values of the MRA finding were 90% and 94%, respectively. The presence of the acetabular cartilage delamination represents an early stage of articular cartilage degeneration. When evaluating a young adult with hip pain, labral tears in association with cartilage delamination should be considered. MRA represents an effective diagnostic tool.

  19. Eversion-Inversion Labral Repair and Reconstruction Technique for Optimal Suction Seal.

    PubMed

    Moreira, Brett; Pascual-Garrido, Cecilia; Chadayamurri, Vivek; Mei-Dan, Omer

    2015-12-01

    Labral tears are a significant cause of hip pain and are currently the most common indication for hip arthroscopy. Compared with labral debridement, labral repair has significantly better outcomes in terms of both daily activities and athletic pursuits in the setting of femoral acetabular impingement. The classic techniques described in the literature for labral repair all use loop or pass-through intrasubstance labral sutures to achieve a functional hip seal. This hip seal is important for hip stability and optimal joint biomechanics, as well as in the prevention of long-term osteoarthritis. We describe a novel eversion-inversion intrasubstance suturing technique for labral repair and reconstruction that can assist in restoration of the native labrum position by re-creating an optimal seal around the femoral head.

  20. Recurrent Labral Tearing on Magnetic Resonance Imaging Is Not Predictive of Diminished Participation Among National Football League Athletes.

    PubMed

    Knapik, Derrick M; Gebhart, Jeremy J; Sheehan, Joseph; Tanenbaum, Joseph E; Salata, Michael J; Voos, James E

    2018-01-01

    To investigate the prevalence of shoulder labral repair and utility of magnetic resonance imaging (MRI) in determining the risks of recurrent labral tearing and impact on future participation in the National Football League (NFL). Athletes invited to the NFL Combine between 2012 and 2015 were retrospectively reviewed. Athletes with a history of labral repair and MRI of the operative shoulder at the Combine were included in the study for further analysis, excluding athletes without a history of labral repair, labral repair without MRI at the Combine, additional procedure to the operative shoulder, or athletes still undergoing rehabilitation at the time of the Combine after labral repair. All MRIs were reviewed to determine initial labral repair location, the presence of recurrent tearing, and any concomitant shoulder pathology. Prospective information on future NFL participation in regard to draft status, games played, and games started in the athlete's first NFL season after the Combine was compared between athletes with a history of labral repair with and without recurrent tearing versus all other athletes participating in the Combine. A total of 132 (10.1%) athletes underwent 146 shoulder labral repair procedures before the NFL Combine, of whom 32% (n = 39 athletes, n = 46 shoulders) had recurrent labral tears on MRI. Athletes with recurrent tears were more likely to have undergone bilateral labral repairs (P = .048) and possess concomitant shoulder pathology (P < .001). Recurrent labral tearing was significantly more common in the posterior labrum in athletes with a history of posterior labral repairs (P = .032). Prospective participation in the NFL in terms of games played (P = .38) or started (P = .98) was not significantly reduced in athletes with a history of labral repair compared with those without repair. Participation was not diminished in athletes with recurrent labral tears compared with those with intact repairs or those with evidence of

  1. Diagnosis of lesions of the acetabular labrum, of the labral-chondral transition zone, and of the cartilage in femoroacetabular impingement: Correlation between direct magnetic resonance arthrography and hip arthroscopy.

    PubMed

    Crespo Rodríguez, A M; de Lucas Villarrubia, J C; Pastrana Ledesma, M A; Millán Santos, I; Padrón, M

    2015-01-01

    To determine the sensitivity and accuracy of direct MR arthrography in the diagnosis of intra-articular lesions associated with femoroacetabular impingement. We used direct MR arthrography to study 51 patients with femoroacetabular impingement who underwent arthroscopic hip surgery. Surgery demonstrated 37 labral tears, 44 lesions in the labral-chondral transitional zone, and 40 lesions of the articular cartilage. We correlated the findings at preoperative direct MR arthrography with those of hip arthroscopy and calculated the sensitivity, specificity, positive predictive value, negative predictive value, and validity index for direct MR arthrography. The sensitivity and specificity of MR arthrography were 94.5% and 100%, respectively, for diagnosing labral tears, 100% and 87.5%, respectively, for diagnosing lesions of the labral-chondral transition zone, and 92.5% and 54.5%, respectively, for diagnosing lesions of the articular cartilage. The negative predictive value of MR arthrography for lesions of the labral-chondral transitional zone was 100%. MR arthrography accurately defined extensive lesions of the cartilage and the secondary osseous changes (the main factor in poor prognosis), although its diagnostic performance was not so good in small chondral lesions. In patients with femoroacetabular impingement, direct MR arthrography can adequately detect and characterize lesions of the acetabular labrum and of the labral-chondral transitional zone as well as extensive lesions of the articular cartilage and secondary osseous changes. Copyright © 2013 SERAM. Published by Elsevier España, S.L.U. All rights reserved.

  2. Superior Labral Anterior-Posterior (SLAP) Tears in the Military.

    PubMed

    Rossy, William; Sanchez, George; Sanchez, Anthony; Provencher, Matthew T

    Given the notable physical demands placed on active members of the military, comprehension of recent trends in management and outcomes of superior labral anterior-posterior (SLAP) tears in this patient population is critical for successful treatment. Electronic databases, including PubMed, MEDLINE, and Embase, were reviewed for the years 1985 through 2016. Database review. Level 5. Active members of the military are at increased risk of sustaining shoulder injuries, particularly SLAP tears. Recent trends in management of SLAP lesions have shifted toward operative intervention. In the correct patient population, repairs of superior labrum tears demonstrate improved function and pain. Surgical repair of SLAP tears, especially in young and active military personnel, is supported. Military personnel are at greater risk of suffering a SLAP tear in comparison with their civilian counterparts. Surgical repair of these lesions is advocated in this subpopulation when the patient is younger than approximately 36 years of age, and if older, biceps tenodesis is likely superior.

  3. Reliability and diagnostic accuracy of history and physical examination for diagnosing glenoid labral tears.

    PubMed

    Walsworth, Matthew K; Doukas, William C; Murphy, Kevin P; Mielcarek, Billie J; Michener, Lori A

    2008-01-01

    Glenoid labral tears provide a diagnostic challenge. Combinations of items in the patient history and physical examination will provide stronger diagnostic accuracy to suggest the presence or absence of glenoid labral tear than will individual items. Cohort study (diagnosis); Level of evidence, 1. History and examination findings in patients with shoulder pain (N = 55) were compared with arthroscopic findings to determine diagnostic accuracy and intertester reliability. The intertester reliability of the crank, anterior slide, and active compression tests was 0.20 to 0.24. A combined history of popping or catching and positive crank or anterior slide results yielded specificities of 0.91 and 1.00 and positive likelihood ratios of 3.0 and infinity, respectively. A positive anterior slide result combined with either a positive active compression or crank result yielded specificities of 0.91 and positive likelihood ratio of 2.75 and 3.75, respectively. Requiring only a single positive finding in the combination of popping or catching and the anterior slide or crank yielded sensitivities of 0.82 and 0.89 and negative likelihood ratios of 0.31 and 0.33, respectively. The diagnostic accuracy of individual tests in previous studies is quite variable, which may be explained in part by the modest reliability of these tests. The combination of popping or catching with a positive crank or anterior slide result or a positive anterior slide result with a positive active compression or crank test result suggests the presence of a labral tear. The combined absence of popping or catching and a negative anterior slide or crank result suggests the absence of a labral tear.

  4. Arthroscopic treatment of femoral nerve paresthesia caused by an acetabular paralabral cyst.

    PubMed

    Kanauchi, Taira; Suganuma, Jun; Mochizuki, Ryuta; Uchikawa, Shinichi

    2014-05-01

    This report describes a rare case of femoral nerve paresthesia caused by an acetabular paralabral cyst of the hip joint. A 68-year-old woman presented with a 6-month history of right hip pain and paresthesia along the anterior thigh and radiating down to the anterior aspect of the knee. Radiography showed osteoarthritis with a narrowed joint space in the right hip joint. Magnetic resonance imaging showed a cyst with low T1- and high T2-weighted signal intensity arising from a labral tear at the anterior aspect of the acetabulum. The cyst was connected to the joint space and displaced the femoral nerve to the anteromedial side. The lesion was diagnosed as an acetabular paralabral cyst causing femoral neuropathy. Because the main symptom was femoral nerve paresthesia and the patient desired a less invasive procedure, arthroscopic labral repair was performed to stop synovial fluid flow to the paralabral cyst that was causing the femoral nerve paresthesia. After surgery, the cyst and femoral nerve paresthesia disappeared. At the 18-month follow-up, the patient had no recurrence. There have been several reports of neurovascular compression caused by the cyst around the hip joint. To the authors' knowledge, only 3 cases of acetabular paralabral cysts causing sciatica have been reported. The current patient appears to represent a rare case of an acetabular paralabral cyst causing femoral nerve paresthesia. The authors suggest that arthroscopic labral repair for an acetabular paralabral cyst causing neuropathy can be an option for patients who desire a less invasive procedure. Copyright 2014, SLACK Incorporated.

  5. Sex-Based Differences in the Clinical Presentation of Patients With Symptomatic Hip Labral Tears.

    PubMed

    Lindner, Dror; El Bitar, Youssef F; Jackson, Timothy J; Sadik, Adam Y; Stake, Christine E; Domb, Benjamin G

    2014-06-01

    An increasing body of literature describes the clinical presentation and demographics of patients with hip labral tears. The differences in pelvic structure and joint laxity between sexes have been described; however, no study has evaluated differences in the clinical presentation of patients with symptomatic labral tears between sexes. To describe the differences between sexes in demographics, clinical history, physical examination, and intraoperative findings in patients with symptomatic labral tears. Cohort study; Level of evidence, 3. Data were prospectively collected between February 2008 and February 2013 on 1401 patients who had symptomatic labral tears and underwent arthroscopic surgery. Hips with previous pathologic disorders were excluded. Data on demographics and clinical history were gathered, and a physical examination was performed. Preoperative pain was estimated on the visual analog scale (VAS), and 4 hip-specific patient-reported outcomes (PROs) were administered to evaluate functional status. Intraoperative findings were recorded. A total of 654 patients met our inclusion/exclusion criteria, with 320 males and 334 females. The median age for males was 38.3 years (range, 15.0-69.6 years) and for females 40.4 years (range, 13.1-66.8 years). Male patients had a higher incidence of acute injury than females (39.6% vs 27.6%, respectively; P < .05) and a higher incidence of workers' compensation status (14.1% vs 4.5%, respectively; P < .05). Females had increased range of motion compared with males, which was statistically significant for all range of motion measurements (P < .05). The anterior impingement test was positive in 94.4% of females and 92.9% of males, the flexion/abduction/external rotation test was positive in 59.5% of females and 61.5% of males, and the lateral impingement test was positive in 55.0% of females and 59.2% of males, but there was no statistically significant difference between sexes in any of the tests. Pain with palpation

  6. Postural correction reduces hip pain in adult with acetabular dysplasia: A case report.

    PubMed

    Lewis, Cara L; Khuu, Anne; Marinko, Lee N

    2015-06-01

    Developmental dysplasia of the hip is often diagnosed in infancy, but less severe cases of acetabular dysplasia are being detected in young active adults. The purpose of this case report is to present a non-surgical intervention for a 31-year-old female with mild acetabular dysplasia and an anterior acetabular labral tear. The patient presented with right anterior hip and groin pain, and she stood with the trunk swayed posterior to the pelvis (swayback posture). The hip pain was reproduced with the anterior impingement test. During gait, the patient maintained the swayback posture and reported 6/10 hip pain. Following correction of the patient's posture, the patient's pain rating was reduced to a 2/10 while walking. The patient was instructed to maintain the improved posture. At the 1 year follow-up, she demonstrated significantly improved posture in standing and walking. She had returned to recreational running and was generally pain-free. The patient demonstrated improvement on self-reported questionnaires for pain, function, and activity. These findings suggest that alteration of posture can have an immediate and lasting effect on hip pain in persons with structural abnormality and labral pathology. Copyright © 2015 Elsevier Ltd. All rights reserved.

  7. Postural correction reduces hip pain in adult with acetabular dysplasia: a case report

    PubMed Central

    Lewis, Cara L.; Khuu, Anne; Marinko, Lee

    2015-01-01

    Developmental dysplasia of the hip is often diagnosed in infancy, but less severe cases of acetabular dysplasia are being detected in young active adults. The purpose of this case report is to present a non-surgical intervention for a 31-year-old female with mild acetabular dysplasia and an anterior acetabular labral tear. The patient presented with right anterior hip and groin pain, and she stood with the trunk swayed posterior to the pelvis (swayback posture). The hip pain was reproduced with the anterior impingement test. During gait, the patient maintained the swayback posture and reported 6/10 hip pain. Following correction of the patient’s posture, the patient’s pain rating was reduced to a 2/10 while walking. The patient was instructed to maintain the improved posture. At the 1 year follow-up, she demonstrated significantly improved posture in standing and walking. She had returned to recreational running and was generally pain-free. The patient demonstrated improvement on self-reported questionnaires for pain, function and activity. These findings suggest that alteration of posture can have an immediate and lasting effect on hip pain in persons with structural abnormality and labral pathology. PMID:25731688

  8. Brake Reaction Time After Hip Arthroscopy for Femoroacetabular Impingement and Labral Tear.

    PubMed

    Vera, Angelina M; Beauchman, Naseem; McCulloch, Patrick C; Gerrie, Brayden J; Delgado, Domenica A; Harris, Joshua D

    2017-05-01

    To determine if a difference exists in brake reaction time (BRT) before and after hip arthroscopy for femoroacetabular impingement (FAI) and labral tear compared with age- and gender-matched controls. Consecutive adult subjects undergoing primary hip arthroscopy were eligible for this prospective investigation. Individuals with symptomatic FAI and labral tear that underwent hip arthroscopy with minimum 8 weeks follow-up were included. BRT was measured using the RT-2S reaction time tester a maximum of 6 weeks preoperatively and every 2 weeks postoperatively for 8 weeks. Sit-to-stand test (STST) was measured at each BRT testing session. An age- and gender-matched control group without hip or lower extremity symptoms were selected and completed both BRT and STST. Continuous pre- and postoperative BRT values were compared with Mann-Whitney and analyses of variance. Association of BRT and STST tests was performed with Spearman correlation. An a priori sample size calculation determined that minimally 18 subjects per group (surgery group vs control group) were necessary to detect, with 80% power (difference of 0.2 seconds in BRT). Nineteen subjects (age 37.1 ± 12.7 years, 10 women, 11 right hip) were analyzed. All subjects underwent arthroscopic labral repair and FAI correction. There was no difference between preoperative (604 ± 148 milliseconds [ms]) and postoperative (608 ms 2 weeks; 566 ms 4 weeks; 559 ms 6 weeks; 595 ms 8 weeks) BRT. There was no difference between controls and subjects at any time point. There was a strong negative correlation between BRT and STST preoperatively and at 4 and 6 weeks postoperatively and a moderate negative correlation at 2 weeks postoperatively. After hip arthroscopy for FAI and labral tear, BRT is not different from preoperative values or that of controls. In addition, BRT had a significant correlation with STST in the first 6 weeks after surgery. Level II, diagnostic, prospective. Copyright © 2016

  9. Does duration of symptoms affect clinical outcome after hip arthroscopy for labral tears? Analysis of prospectively collected outcomes with minimum 2-year follow-up

    PubMed Central

    Ni, Jake; Hohn, Eric A; Domb, Benjamin G

    2017-01-01

    Abstract Limited research exists on the possible association between duration of symptoms and clinical outcomes following hip arthroscopy for labral tears. The purpose of this study was to evaluate whether duration of symptoms affected clinical and patient-reported outcome (PRO) scores following hip arthroscopy for labral tears. From 2008 to 2011, data were collected prospectively on all patients undergoing primary hip arthroscopy for labral tears. Workers’ compensation cases, dysplasia cases and patients with previous ipsilateral hip surgeries were excluded. A total of 738 patients were identified with a minimum of 2-year follow-up, and clinical and PRO data were available for 680 patients. Uni- and multivariate analyses were performed to determine the relationship between duration of symptoms along with other variables and PROs. Overall, patients experienced significant improvements in all clinical and PRO scores. Results of univariate analysis revealed that all PROs were negatively associated with increasing Log10 months of symptoms as were pain and satisfaction scores. During multivariate analyses, increasing Log10 months of symptoms, age, body mass index and trauma were all negatively associated with PROs (P  < 0.05). Our study demonstrates that clinical and PRO scores were negatively associated with increasing duration of symptoms prior to hip arthroscopy for treatment of labral tears. Although this implies that delay in treatment may adversely affect outcome, conservative treatment remains the gold standard first line of treatment. Surgeons should incorporate this information into their treatment algorithm to maximize patient outcomes following treatment for labral tears. Level of evidence: Level IV, prospective case series. PMID:29250339

  10. Diagnostic Accuracy of Imaging Modalities and Injection Techniques for the Diagnosis of Femoroacetabular Impingement/Labral Tear: A Systematic Review With Meta-analysis.

    PubMed

    Reiman, Michael P; Thorborg, Kristian; Goode, Adam P; Cook, Chad E; Weir, Adam; Hölmich, Per

    2017-09-01

    Diagnosing femoroacetabular impingement/acetabular labral tear (FAI/ALT) and subsequently making a decision regarding surgery are based primarily on diagnostic imaging and intra-articular hip joint injection techniques of unknown accuracy. Summarize and evaluate the diagnostic accuracy and clinical utility of various imaging modalities and injection techniques relevant to hip FAI/ALT. Systematic review with meta-analysis. A computer-assisted literature search was conducted of MEDLINE, CINAHL, and EMBASE databases using keywords related to diagnostic accuracy of hip joint pathologic changes. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used for the search and reporting phases of the study. Quality assessment of bias and applicability was conducted using the Quality of Diagnostic Accuracy Studies (QUADAS) tool. Random effects models were used to summarize sensitivities (SN), specificities (SP), likelihood ratios (+LR and -LR), diagnostic odds ratios (DOR), and respective confidence intervals (CI). The search strategy and assessment for risk of bias revealed 25 articles scoring above 10/14 on the items of the QUADAS. Four studies investigated FAI, and the data were not pooled. Twenty articles on ALT qualified for meta-analysis. Pretest probability of ALT in the studies in this review was 81% (72%-88%), while the pretest probability of FAI diagnosis was 74% (95% CI, 51%-91%). The meta-analysis showed that computed tomography arthrography (CTA) demonstrated the strongest overall diagnostic accuracy: pooled SN 0.91 (95% CI, 0.83-0.96); SP 0.89 (95% CI, 0.74-0.97); +LR 6.28 (95% CI, 2.78-14.21); -LR 0.11 (95% CI, 0.06-0.21); and DOR 64.38 (95% CI, 19.17-216.21). High pretest probability of disease was demonstrated. Positive imaging findings increased the probability that a labral tear existed by a minimal to small degree with the use of magnetic resonance imaging/magnetic resonance angiogram (MRI/MRA) and ultrasound (US

  11. Diagnosis of glenoid labral tears using 3-tesla MRI vs. 3-tesla MRA: a systematic review and meta-analysis.

    PubMed

    Ajuied, Adil; McGarvey, Ciaran P; Harb, Ziad; Smith, Christian C; Houghton, Russell P; Corbett, Steven A

    2018-05-01

    Various protocols exist for magnetic resonance arthrogram (MRA) of the shoulder, including 3D isotropic scanning and positioning in neutral (2D neutral MRA), or abduction-external-rotation (ABER). MRA does not improve diagnostic accuracy for labral tears when compared to magnetic resonance imaging (MRI) performed using 3-Tesla (3T) magnets. Systematic review of the Cochrane, MEDLINE, and PubMed databases according to PRISMA guidelines. Included studies compared 3T MRI or 3T MRA (index tests) to arthroscopic findings (reference test). Methodological appraisal performed using QUADAS-2. Pooled sensitivity and specificity were calculated. Ten studies including 929 patients were included. Index test bias and applicability were a concern in the majority of studies. The use of arthroscopy as the reference test raised concern of verification bias in all studies. For anterior labral lesions, 3T MRI was less sensitive (0.83 vs. 0.87 p = 0.083) than 3T 2D neutral MRA. Compared to 3T 2D neutral MRA, both 3T 3D Isotropic MRA and 3T ABER MRA significantly improved sensitivity (0.87 vs. 0.95 vs. 0.94). For SLAP lesions, 3T 2D neutral MRA was of similar sensitivity to 3T MRI (0.84 vs. 0.83, p = 0.575), but less specific (0.99 vs. 0.92 p < 0.0001). For posterior labral lesions, 3T 2D neutral MRA had greater sensitivity than 3T 3D Isotropic MRA and 3T MRI (0.90 vs. 0.83 vs. 0.83). At 3-T, MRA improved sensitivity for diagnosis of anterior and posterior labral lesions, but reduced specificity in diagnosis of SLAP tears. 3T MRA with ABER positioning further improved sensitivity in diagnosis of anterior labral tears. IV.

  12. How often do surgeons intervene on shoulder labral lesions detected at MR examination? A retrospective review of MR examinations correlated with arthroscopy

    PubMed Central

    2014-01-01

    Objective: We report the prevalence of surgical intervention on shoulder labral lesions detected at MR examinations and how surgeons describe labral tears seen at MR examinations in their arthroscopy reports. Methods: A retrospective review of 100 consecutive patients aged 50 years or younger who had shoulder labral tears on MR and went on to have surgery performed. It was determined whether surgical intervention was performed on the MR lesions. Results: Of these 100 patients, 72 had superior labral anterior to posterior (SLAP) tears, 38 had posterior labral tears and 28 had anterior labral tears on MR examination. All 100 patients went on to arthroscopy. All lesions described on MRI were described on arthroscopy. Of the 72 SLAP tears, 64 were described as fraying on arthroscopy with 51 debrided. The remaining eight SLAP tears were tacked surgically. Of the 38 posterior labral tears, 36 were described as fraying on arthroscopy with 29 debrided and 2 had surgical tacking performed. Of the 28 anterior labral tears described on MR examination, 26 had surgical tacking performed and 2 were debrided. There were four SLAP tears, two anterior labral tears and three posterior labral tears seen on arthroscopy but not seen on MR examination. Conclusion: In this series, a high percentage of SLAP tears and posterior labral tears described on MR examination did not have surgical tacking. Most anterior labral tears had surgical tacking. Based on the above, our surgeons request we describe superior and posterior labral lesions as fraying and/or tearing, unless we can see a displaced tear. Most anterior labral lesions are treated with surgical tacking. Advances in knowledge: MRI allows for sensitive detection of labral tears. The tears often are not clinically significant. PMID:24712320

  13. Labral cuff refixation in the hip: rationale and operative technique for preserving the chondrolabral interface for labral repair: a case series

    PubMed Central

    Filan, David

    2018-01-01

    ABSTRACT Arthroscopic labral ‘takedown’ and refixation is utilized to permit adequate visualization and resection of the acetabular rim deformity, in patients with pincer or mixed femoroacetabular impingement. Deficiencies exist in present techniques, which include disruption of vital anatomical support and vascular structures to the labrum and chondrolabral junction, drill or anchor articular penetration risk, bunching, elevation and instability of the labrum. A new operative technique is described which preserves the important chondrolabral interface, accurately restoring the ‘flap seal’ of the acetabular labrum while minimizing vascular disruption and reducing the risk of drill and anchor penetration. A prospective series of 123 consecutive cases of pincer or mixed femoroacetabular impingement, treated with arthroscopic labral cuff refixation and preservation of the chondrolabral interface, is reported; operative technique and 2-year outcomes are presented. PMID:29423255

  14. Arthroscopic Anterior and Posterior Labral Repair After Traumatic Hip Dislocation: Case Report and Review of the Literature

    PubMed Central

    Shindle, Michael K.; Kelly, Bryan T.

    2010-01-01

    With the improvements in flexible instrumentation, hip arthroscopy is being increasingly used to treat a variety of hip pathology, including labral tears. However, up to this point, there has not been a case report of an anterior and a posterior labral tear successfully repaired arthroscopically. We present a case report of a 27-year-old male firefighter who presented to our institution with an anterior and posterior labral tear, as well as a cam lesion and loose body, following a traumatic hip dislocation. The purpose of this case report is to illustrate that both anterior and posterior labral tears can be repaired using hip arthroscopy. Anterior and posterior labral tears can be caused by a traumatic hip dislocation, and both can be successfully repaired using arthroscopic techniques. PMID:21886540

  15. A pilot trial comparing the tear-out behavior in screw-sockets and cemented polyethylene acetabular components - a cadaveric study.

    PubMed

    Möbius, R; Schleifenbaum, S; Grunert, R; Löffler, S; Werner, M; Prietzel, T; Hammer, N

    2016-10-01

    The removal of well-fixed acetabular components following THA (total hip arthroplasty) is a difficult operation and could be accompanied by the loss of acetabular bone stock. The optimal method for fixation is still under debate. The aim of this pilot study was to compare the tear-out resistance and failure behavior between osseo-integrated and non-integrated screw cups. Furthermore, we examined whether there are differences in the properties mentioned between screw sockets and cemented polyethylene cups. Tear-out resistance and related mechanical work required for the tear-out of osseo-integrated screw sockets are higher than in non-integrated screw sockets. Ten human coxal bones from six cadavers with osseo-integrated screw sockets (n=4), non-integrated (implanted post-mortem, n=3) screw sockets and cemented polyethylene cups (n=3) were used for tear-out testing. The parameters axial failure load and mechanical work for tear-out were introduced as measures for determining the stability of acetabular components following THA. The osseo-integrated screw sockets yielded slightly higher tear-out resistance (1.61±0.26kN) and related mechanical work compared to the non-integrated screw sockets (1.23±0.39kN, P=0.4). The cemented polyethylene cups yielded the lowest tear-out resistance with a failure load of 1.18±0.24kN. Compared to the screw cups implanted while alive, they also differ on a non-significant level (P=0.1). Osseous failure patterns differed especially for the screw sockets compared to the cemented polyethylene cups. Osseo-integration did not greatly influence the tear-out stability in cementless screw sockets following axial loading. Furthermore, the strength of the bone-implant-interface of cementless screw sockets appears to be similar to cemented polyethylene cups. However, given the high failure load, high mechanical load and because of the related bone failure patterns, removal should not be performed by means of tear-out but rather by osteotomes

  16. Hip Arthroscopy for Femoral-Acetabular Impingement: Do Active Claims Affect Outcomes?

    PubMed

    Gigi, Roy; Rath, Ehud; Sharfman, Zachary T; Shimonovich, Shachar; Ronen, Itai; Amar, Eyal

    2016-04-01

    To compare outcomes of 3 patient groups undergoing hip arthroscopy. This study included 138 consecutive hip arthroscopies (106 analyzed) for femoral-acetabular impingement (FAI) with or without labral tear in patients with a minimum 1-year follow-up. Inclusion criteria included patients older than 18 with clinical or radiologic manifestation of FAI with or without labral tear. Exclusion criteria included previous hip surgery and various hip pathologies. Patients were classified into 3 study groups. Group 1 included work-related injuries with active claims ACs (n = 33); mean age, 32 (range, 19 to 63); group 2 included sports injuries with no ACs (n = 35); mean age, 32 (range, 18 to 69); and group 3 included non-sports-related injuries without pending ACs (NAS; n = 38); mean age, 45 (range, 20 to 68). Outcomes were assessed using modified Harris hip scores (mHHS) and hip outcome scores (HOS) preoperatively and during the final evaluation. Baseline score for all groups did not significantly differ (P = .210 for mHHS, P = .176 for HOS). All groups significantly improved from preoperative to final evaluation (group 1: mHHS P = .42, HOS P = .001; group 2: mHHS P < .001, HOS P < .001; group 3 NAS: mHHS P = .001, HOS P = .007). AC patients had the lowest final evaluation scores, while the sports group had the highest. The NAS group did not differ from either group at final evaluation. Preoperative and final evaluation scores inversely correlated with age (r range, -24 to -28; P < .05). This study has shown that patients may benefit from arthroscopic repair of FAI and labral tears regardless of ACs. The level of improvement, however, is not constant across patients with different characteristics. Moreover, it appears that age may impact perceived improvement after hip arthroscopy. Hip arthroscopy as an intervention in patients with ACs provided positive outcomes, corroborating that an AC is not a contraindication for this procedure. Level III, retrospective comparative

  17. Atraumatic tears of the ligamentum teres are more frequent in professional ballet dancers than a sporting population.

    PubMed

    Mayes, Susan; Ferris, April-Rose; Smith, Peter; Garnham, Andrew; Cook, Jill

    2016-07-01

    To compare the frequency of atraumatic ligamentum teres (LT) tear in professional ballet dancers with that of athletes, and to determine the relationship with clinical and imaging findings. Forty-nine male and female professional ballet dancers (98 hips) and 49 age and sex-matched non-dancing athletes (98 hips) completed questionnaires on hip symptoms and physical activity levels, underwent hip rotation range of movement (ROM) and hypermobility testing, and 3.0-Tesla magnetic resonance imaging (3 T MRI) on both hips to detect LT tears, acetabular labral tears, and articular cartilage defects, and to measure the lateral centre edge angles (LCE). A higher frequency of LT tear was found in dancers (55 %) compared with athletes (22 %, P = 0.001). The frequency and severity of LT tears in dancers increased with older age (P = 0.004, P = 0.006, respectively). The Hip and Groin Outcome Score (HAGOS) pain scores or hip rotation ROM did not differ significantly among participants with normal, partial, or complete tears of LT (P > 0.01 for all). Neither the frequency of generalised joint hypermobility (P = 0.09) nor the LCE angles (P = 0.32, P = 0.16, left and right hips respectively) differed between those with and those without LT tear. In most hips, LT tear co-existed with either a labral tear or a cartilage defect, or both. The higher frequency of atraumatic LT tears in professional ballet dancers suggests that the LT might be abnormally loaded in ballet, and caution is required when evaluating MRI, as LT tears may be asymptomatic. A longitudinal study of this cohort is required to determine if LT tear predisposes the hip joint to osteoarthritis.

  18. Hip arthroscopy in patients with recurrent pain following Bernese periacetabular osteotomy for acetabular dysplasia: operative findings and clinical outcomes

    PubMed Central

    Cvetanovich, Gregory L.; Heyworth, Benton E.; Murray, Kerri; Yen, Yi-Meng; Kocher, Mininder S.; Millis, Michael B.

    2015-01-01

    To report the operative findings and outcomes of hip arthroscopy for recurrent pain following periacetabular osteotomy (PAO) for acetabular dysplasia. A departmental database was used to identify patients who underwent hip arthroscopy following PAO between 2000 and 2009. Demographic data, arthroscopic findings, functional outcome scores and patient satisfaction were analysed. Of 556 PAO patients, 17 hips in 16 patients (3.1%) underwent post-PAO hip arthroscopy. Mean age at PAO was 23.8 years, and mean age at arthroscopy was 27.0 years. Common hip arthroscopy findings included labral tears (13 hips, 81.3%), significant (≥grade 2) chondral changes (12 hips, 75%), cam impingement (7 hips, 43.8%) and pincer impingement (6 hips, 37.5%). At mean follow-up 2.8 years after arthroscopy, additional procedures had been performed in six hips (37.5%), including total hip arthroplasty in one hip. Post-PAO arthroscopy questionnaire revealed 85.7% of patients with improved hip pain, 57.1% improved hip stiffness and 57.1% improved hip function. There was no significant difference in functional outcome measures. Common post-PAO hip arthroscopy findings include labral tears, chondral changes and femoroacetabular impingement. Many patients reported subjective hip improvement from post-PAO arthroscopy, but hip outcome scores were unchanged and one-third of patients had further surgery. PMID:27011852

  19. Arthroscopic isolated posterior labral repair in rugby players

    PubMed Central

    Badge, Ravi; Tambe, Amol; Funk, Lennard

    2009-01-01

    Background The shoulder is the second most frequently injured joint after the knee in rugby players and labral tears appear to be common. There is limited data available in the literature regarding the mechanisms of posterior labral injury in rugby players and the management of these injuries. Objective The aim of this study is to report the clinical presentation, arthroscopic findings, surgical technique for repair, and the functional outcome in elite English rugby players with isolated posterior labral injuries. Study Design Case series (level IV evidence) Materials and Methods Over a 5-year period we surgically treated 142 elite rugby players, of whom 11 (7.8%) had isolated posterior labral injuries. All these 11 patients had significant contact injury. Only three (24%) patients had a true posterior shoulder dislocation. Pre- and postoperative assessment included Constant score, Oxford shoulder score, and Oxford instability score. We also assessed the time taken to return to preinjury level of fitness and the complications of surgery. Results Average follow-up was for 32 months (range 17–54 months). The mean Constant score improved from 66 to 99. The Oxford score indicated improvement, decreasing from 33 to 18; similarly, the Oxford instability score also decreased from 52.2 to 12.3. Return to playing rugby at peak level was at a mean of 4.3 months after arthroscopic repair. Conclusion Successful clinical results and rapid return to play can be achieved by appropriate early arthroscopic repair and supervised accelerated rehabilitation for posterior labral tears in elite rugby players. PMID:20616949

  20. The use of ultrasound in the assessment of the glenoid labrum of the glenohumeral joint. Part II: Examples of labral pathologies

    PubMed Central

    Tarczyńska, Marta

    2012-01-01

    Labral pathologies of the glenohumeral joint are most commonly caused by trauma. The majority of lesions affect the anterior part of labrum, resulting from much higher frequency of anterior shoulder dislocations over posterior ones. Another subgroup of labral lesions, not directly related to joint instability, are SLAP tears. Other findings include degenerative changes of labrum and paralabral cysts. Diagnostic imaging is crucial for making a decision regarding operative treatment. Apart from a standard X-ray examination, the imaging mainly relies on magnetic resonance or computed tomography arthrography. Based on their own experience, the authors propose the use of ultrasound in the assessment of labral tears of the glenohumeral joint. Different signs indicating labral pathology may be discovered and assessed during ultrasound examination. They include permanent displacement of the labrum onto the glenoid, labral instability during dynamic examination, lack of the labrum in the anatomical position, hypoechoic zone at the base of the labrum >2 mm in width, residual or swollen labrum as well as paralabral cyst(s). The most frequent appearance of labral pathology is displacement of the anteroinferior labrum onto the external aspect of the glenoid typically seen after anterior shoulder dislocation. The another most important US feature is labral instability while dynamically examined. The swelling or reduced size of the labrum usually indicates degeneration. This article presents sonographic images of selected labral pathologies. PMID:26672471

  1. The use of ultrasound in the assessment of the glenoid labrum of the glenohumeral joint. Part II: Examples of labral pathologies.

    PubMed

    Krzyżanowski, Wojciech; Tarczyńska, Marta

    2012-09-01

    Labral pathologies of the glenohumeral joint are most commonly caused by trauma. The majority of lesions affect the anterior part of labrum, resulting from much higher frequency of anterior shoulder dislocations over posterior ones. Another subgroup of labral lesions, not directly related to joint instability, are SLAP tears. Other findings include degenerative changes of labrum and paralabral cysts. Diagnostic imaging is crucial for making a decision regarding operative treatment. Apart from a standard X-ray examination, the imaging mainly relies on magnetic resonance or computed tomography arthrography. Based on their own experience, the authors propose the use of ultrasound in the assessment of labral tears of the glenohumeral joint. Different signs indicating labral pathology may be discovered and assessed during ultrasound examination. They include permanent displacement of the labrum onto the glenoid, labral instability during dynamic examination, lack of the labrum in the anatomical position, hypoechoic zone at the base of the labrum >2 mm in width, residual or swollen labrum as well as paralabral cyst(s). The most frequent appearance of labral pathology is displacement of the anteroinferior labrum onto the external aspect of the glenoid typically seen after anterior shoulder dislocation. The another most important US feature is labral instability while dynamically examined. The swelling or reduced size of the labrum usually indicates degeneration. This article presents sonographic images of selected labral pathologies.

  2. Diagnostic performance of direct traction MR arthrography of the hip: detection of chondral and labral lesions with arthroscopic comparison.

    PubMed

    Schmaranzer, Florian; Klauser, Andrea; Kogler, Michael; Henninger, Benjamin; Forstner, Thomas; Reichkendler, Markus; Schmaranzer, Ehrenfried

    2015-06-01

    To assess diagnostic performance of traction MR arthrography of the hip in detection and grading of chondral and labral lesions with arthroscopic comparison. Seventy-five MR arthrograms obtained ± traction of 73 consecutive patients (mean age, 34.5 years; range, 14-54 years) who underwent arthroscopy were included. Traction technique included weight-adapted traction (15-23 kg), a supporting plate for the contralateral leg, and intra-articular injection of 18-27 ml (local anaesthetic and contrast agent). Patients reported on neuropraxia and on pain. Two blinded readers independently assessed femoroacetabular cartilage and labrum lesions which were correlated with arthroscopy. Interobserver agreement was calculated using κ values. Joint distraction ± traction was evaluated in consensus. No procedure had to be stopped. There were no cases of neuropraxia. Accuracy for detection of labral lesions was 92 %/93 %, 91 %/83 % for acetabular lesions, and 92 %/88 % for femoral cartilage lesions for reader 1/reader 2, respectively. Interobserver agreement was moderate (κ = 0.58) for grading of labrum lesions and substantial (κ = 0.7, κ = 0.68) for grading of acetabular and femoral cartilage lesions. Joint distraction was achieved in 72/75 and 14/75 hips with/without traction, respectively. Traction MR arthrography safely enabled accurate detection and grading of labral and chondral lesions. • The used traction technique was well tolerated by most patients. • The used traction technique almost consistently achieved separation of cartilage layers. • Traction MR arthrography enabled accurate detection of chondral and labral lesions.

  3. Conservative management of an elite ice hockey goaltender with femoroacetabular impingement (FAI): a case report.

    PubMed

    MacIntyre, Kyle; Gomes, Brendan; MacKenzie, Steven; D'Angelo, Kevin

    2015-12-01

    To detail the presentation of an elite male ice hockey goaltender with cam-type femoroacetabular impingement (FAI) and acetabular labral tears. This case will outline the prevalence, clinical presentation, imaging criteria, pathomechanics, and management of FAI, with specific emphasis on the ice hockey goaltender. A 22-year old retired ice hockey goaltender presented to a chiropractor after being diagnosed by an orthopaedic surgeon with MRI confirmed left longitudinal and chondral flap acetabular labral tears and cam-type femoroacetabular impingement (FAI). As the patient was not a candidate for surgical intervention, a multimodal conservative treatment approach including manual therapy, electroacupuncture and rehabilitation exercises were implemented. FAI is prevalent in ice hockey players, particularly with goaltenders. Both skating and position-dependent hip joint mechanics involved in ice hockey may exacerbate or contribute to acquired and congenital forms of symptomatic FAI. As such, practitioners managing this population must address sport-specific demands in manual therapy, rehabilitation and physical training, to improve functional outcomes and prevent future injury.

  4. Rotator cuff tears in children and adolescents: experience at a large pediatric hospital.

    PubMed

    Zbojniewicz, Andrew M; Maeder, Matthew E; Emery, Kathleen H; Salisbury, Shelia R

    2014-06-01

    Prior literature, limited to small case series and case reports, suggests that rotator cuff tears are rare in adolescents. However, we have identified rotator cuff tears in numerous children and adolescents who have undergone shoulder MRI evaluation. The purpose of this study is to describe the prevalence and characteristics of rotator cuff tears in children and adolescents referred for MRI evaluation of the shoulder at a large pediatric hospital and to correlate the presence of rotator cuff tears with concurrent labral pathology, skeletal maturity and patient activity and outcomes. We reviewed reports from 455 consecutive non-contrast MRI and magnetic resonance arthrogram examinations of the shoulder performed during a 2-year period, and following exclusions we yielded 205 examinations in 201 patients (ages 8-18 years; 75 girls, 126 boys). Rotator cuff tears were classified by tendon involved, tear thickness (partial or full), surface and location of tear (when partial) and presence of delamination. We recorded concurrent labral pathology when present. Physeal patency of the proximal humerus was considered open, closing or closed. Statistical analysis was performed to evaluate for a relationship between rotator cuff tears and degree of physeal patency. We obtained patient activity at the time of injury, surgical reports and outcomes from clinical records when available. Twenty-five (12.2%) rotator cuff tears were identified in 17 boys and 7 girls (ages 10-18 years; one patient had bilateral tears). The supraspinatus tendon was most frequently involved (56%). There were 2 full-thickness and 23 partial-thickness tears with articular-side partial-thickness tears most frequent (78%). Insertional partial-thickness tears were more common (78%) than critical zone tears (22%) and 10 (43%) partial-thickness tears were delamination tears. Nine (36%) patients with rotator cuff tears had concurrent labral pathology. There was no statistically significant relationship between

  5. Current Concepts in Labral Repair and Refixation: Anatomical Approach to Labral Management.

    PubMed

    Kollmorgen, Robert; Mather, Richard

    Arthroscopic labral repair and refixation have garnered much attention over the past several years. Restoration of suction seal and native labral function has been an evolving focus for achieving excellent results in hip preservation surgery. Authors have reported using several labral management techniques: débridement, labralization, looped suture fixation, base stitch fixation, inversion-eversion, and reconstruction. The optimal technique is yet to be determined. Absolute indications for labral repair are symptomatic intra-articular pain, joint space >2 mm, and failed conservative management. Extreme attention is given to identifying and addressing the cause, whether it be acute or repetitive trauma, instability, or femoroacetabular impingement. In this article, we discuss indications for labral repair; describe Dr. Mather's preoperative planning, labral repair technique, and postoperative care; and review published outcomes and future trends in labral repair.

  6. Conservative management of an elite ice hockey goaltender with femoroacetabular impingement (FAI): a case report

    PubMed Central

    MacIntyre, Kyle; Gomes, Brendan; MacKenzie, Steven; D’Angelo, Kevin

    2015-01-01

    Objective: To detail the presentation of an elite male ice hockey goaltender with cam-type femoroacetabular impingement (FAI) and acetabular labral tears. This case will outline the prevalence, clinical presentation, imaging criteria, pathomechanics, and management of FAI, with specific emphasis on the ice hockey goaltender. Clinical Features: A 22-year old retired ice hockey goaltender presented to a chiropractor after being diagnosed by an orthopaedic surgeon with MRI confirmed left longitudinal and chondral flap acetabular labral tears and cam-type femoroacetabular impingement (FAI). As the patient was not a candidate for surgical intervention, a multimodal conservative treatment approach including manual therapy, electroacupuncture and rehabilitation exercises were implemented. Summary: FAI is prevalent in ice hockey players, particularly with goaltenders. Both skating and position-dependent hip joint mechanics involved in ice hockey may exacerbate or contribute to acquired and congenital forms of symptomatic FAI. As such, practitioners managing this population must address sport-specific demands in manual therapy, rehabilitation and physical training, to improve functional outcomes and prevent future injury. PMID:26816416

  7. Periacetabular Osteotomy Provides Higher Survivorship Than Rim Trimming for Acetabular Retroversion.

    PubMed

    Zurmühle, Corinne A; Anwander, Helen; Albers, Christoph E; Hanke, Markus S; Steppacher, Simon D; Siebenrock, Klaus A; Tannast, Moritz

    2017-04-01

    index, preoperative ROM, preoperative Merle d'Aubigné-Postel score, radiographic morphology of the acetabulum (except total and anterior acetabular coverage), alpha angle, Tönnis grade of osteoarthritis, and labral and chondral lesions on the preoperative MRI. During the period in question, we generally performed PAO from 1997 to 2003. With the availability of surgical hip dislocation and labral refixation, we generally performed rim trimming from 2004 to 2010. With growing knowledge of the underlying pathomorphology, anteverting PAOs became more common again around 2007 to 2008. A minimum followup of 2 years was required for this study. Failures were included at any time. The median followup for the anteverting PAO group was 9.5 years (range, 2-17.4 years) and 6.8 years (range, 2.2-10.5 years) for the rim trimming group (p < 0.001). Kaplan-Meier survivorship analysis was performed using the following endpoints at 5 and 10 years: THA, radiographic progression of osteoarthritis by one Tönnis grade, and/or Merle d'Aubigné-Postel score < 15 points. Although the 5-year survivorship of the two groups was not different with the numbers available (86% [95% confidence interval {CI}, 76%-94%] for anteverting PAO versus 86% [95% CI, 76%-96%] for acetabular rim trimming), we found increased survivorship at 10 years in hips undergoing anteverting PAO for acetabular retroversion (79% [95% CI, 68%-90%]) compared with acetabular rim trimming (23% [95% CI, 6%-40%]) at 10 years (p < 0.001). The drop in the survivorship curve for the acetabular rim trimming through surgical hip dislocation group started at Year 6. The main reason for failure was a decreased Merle d'Aubigné score. Anteverting PAO may be the more appropriate treatment for hips with substantial acetabular retroversion. This may be the result of reduction of an already smaller lunate surface of hips with acetabular retroversion through rim trimming. However, rim trimming may still benefit hips with acetabular

  8. Risk factors for the need of hip arthroscopy following periacetabular osteotomy

    PubMed Central

    Hartig-Andreasen, Charlotte; Troelsen, Anders; Thillemann, Theis M.; Gelineck, John; Søballe, Kjeld

    2015-01-01

    Despite the frequency of labral tears in symptomatic developmental dysplasia of the hip, no consensus exists regarding the treatment of coexisting dysplasia of the hip and tearing of the acetabular labrum. The purpose of this prospective, MR arthrography (MRA) based 2-year follow-up study was to identify risk factors predicting the need for a hip arthroscopy (HA) after periacetabular osteotomy (PAO). Ninety-nine patients (104 hips) scheduled for PAO were evaluated preoperatively and at 2-year follow-up. MRA was performed in all patients prior to PAO. At follow-up, patients were divided into a non-arthroscopy and arthroscopy group. The two groups were compared clinical and radiological, and risk factors for HA after PAO were calculated. Patient reported outcome measures (WOMAC, Oxford Hip and SF36) were filled out before PAO and at follow-up. Ninety-five hips (91.3%) were evaluated. Twenty-six hips (27%) required an arthroscopy within 2 years of the PAO. Risk factors were preoperative borderline dysplasia, acetabular retroversion and complete labral detachment. Labral tearing, degeneration or hypertrophy did not negatively affect the outcome of PAO. Patients not requiring an arthroscopy had a statistically significant better outcome measured by patients reported outcome measures. After PAO, 27% of the hips needed intra-articular assessment. Conventional radiographs and MRA analysis can be used to identify predictors for patients requiring HA after PAO. At 2-year follow-up, the clinical outcome improved in all patients. However, those patients who had no need of a HA after their PAO had superior results. PMID:27011862

  9. Endoscopic Gluteus Medius Repair With Concomitant Arthroscopy for Labral Tears: A Case Series With Minimum 5-Year Outcomes.

    PubMed

    Perets, Itay; Mansor, Yosif; Yuen, Leslie C; Chen, Austin W; Chaharbakhshi, Edwin O; Domb, Benjamin G

    2017-12-01

    To report the minimum 5-year outcomes of endoscopic gluteus medius repair for partial- and full-thickness tears with concomitant hip arthroscopy. Data for all patients who underwent hip arthroscopy between February 2009 and September 2011 were prospectively collected. We included patients who underwent endoscopic gluteus medius repair with concomitant arthroscopic labral treatment and for whom the following measures were obtained preoperatively and at a minimum of 5 years' follow-up: modified Harris Hip Score, Non-Arthritic Hip Score, Hip Outcome Score-Sports Specific Subscale, and visual analog scale score for pain. For included patients, the International Hip Outcome Tool-12 (iHOT-12) score and satisfaction rating were also available at latest follow-up. Patients with at least 1 of the following criteria were excluded: preoperative Tönnis osteoarthritis grade of 2 or greater, previous hip conditions, severe dysplasia, and Workers' Compensation claims. There were 16 patients eligible for inclusion, 14 (87.5%) of whom had minimum 5-year follow-up, with a mean of 68.8 months (range, 60.1-79.6 months). The study group consisted of 13 women (92.9%) and 1 man (7.1%) with a mean age at surgery of 57.4 years (range, 46.3-74.8 years). Outcome scores improved as follows: modified Harris Hip Score, from 52.4 to 81.2 (P = .004); Non-Arthritic Hip Score, from 48.0 to 82.5 (P = .002); Hip Outcome Score-Sports Specific Subscale, from 30.1 to 66.4 (P < .001); and visual analog scale score, from 6.2 to 2.6 (P = .001). At minimum 5-year follow-up, the mean iHOT-12 score was 73.8 and the mean patient satisfaction rating was 8.4. Survivorship was 92.9%, with 1 patient who underwent conversion to total hip arthroplasty. There was no deterioration in patient outcomes and satisfaction between 2 and 5 years postoperatively. There were no clinical failures of gluteus medius repair and no complications. Endoscopic gluteus medius repair with concomitant hip arthroscopy for labral

  10. The validity and accuracy of MRI arthrogram in the assessment of painful articular disorders of the hip.

    PubMed

    Rajeev, Aysha; Tuinebreijer, Wim; Mohamed, Abdalla; Newby, Mike

    2018-01-01

    The assessment of a patient with chronic hip pain can be challenging. The differential diagnosis of intra-articular pathology causing hip pain can be diverse. These includes conditions such as osteoarthritis, fracture, and avascular necrosis, synovitis, loose bodies, labral tears, articular pathology and, femoro-acetabular impingement. Magnetic resonance imaging (MRI) arthrography of the hip has been widely used now for diagnosis of articular pathology of the hip. A retrospective analysis of 113 patients who had MRI arthrogram and who underwent hip arthroscopy was included in the study. The MRI arthrogram was performed using gadolinium injection and reported by a single radiologist. The findings were then compared to that found on arthroscopy. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy and 95% confidence interval were calculated for each pathology. Labral tear-sensitivity 84% (74.3-90.5), specificity 64% (40.7-82.8), PPV 91% (82.1-95.8), NPV 48% (29.5-67.5), accuracy 80%. Delamination -sensitivity 7% (0.8-22.1), specificity 98% (91.6-99.7), PPV 50% (6.8-93.2), NPV 74% (65.1-82.2) and accuracy 39%. Chondral changes-sensitivity 25% (13.3-38.9), specificity 83% (71.3-91.1), PPV 52% (30.6-73.2), NPV 59% (48.0-69.2) and accuracy 58%. Femoro-acetabular impingement (CAM deformity)-sensitivity 34% (19.6-51.4), specificity 83% (72.2-90.4), PPV 50% (29.9-70.1), NPV 71% (60.6-80.5) and accuracy 66%. Synovitis-sensitivity 11% (2.3-28.2), specificity 99% (93.6-100), PPV 75% (19.4-99.4), NPV 77% (68.1-84.6) and accuracy 77%. Our study conclusions are MRI arthrogram is a useful investigation tool in detecting labral tears, it is also helpful in the diagnosis of femoro-acetabular impingement. However, when it comes to the diagnosis of chondral changes, defects and cartilage delamination, the sensitivity and accuracy are low.

  11. Morphological experimental study of bone stress at the interface acetabular bone/prosthetic cup in the bipolar hip prosthesis.

    PubMed

    Anuşca, D; Pleşea, I E; Iliescu, N; Tomescu, P; Poenaru, F; Dascălu, V; Pop, O T

    2006-01-01

    By calculating the tension and distortion of the elements composing the bipolar prosthesis under extreme conditions encountered in real life using a special post-processing program, we established the variation curves of the contact pressure at the hip bone-cup, armor-cup and cup-femoral head interface. By comparing the data obtained from all the examined cases, important conclusions were drawn regarding the influence of tension and pressure distribution on the structural integrity and biomechanics of the prosthesis, as well as the acetabular wear and tear, in order to assess its reliability. The experimentally determined tension and distortion status at the acetabular bone-metal armour interface, lead to the wear and tear phenomenon, which can be explained by three mechanisms and theories incompletely reflecting the overall process. The histopathologic study of the acetabular bone tissue using FEM (finite elements method) on surgically removed specimens will probably lead to the identification of a series of factors that could reduce the rate of the wear and tear process.

  12. Labral Reattachment in Femoroacetabular Impingement Surgery Results in Increased 10-year Survivorship Compared With Resection.

    PubMed

    Anwander, Helen; Siebenrock, Klaus A; Tannast, Moritz; Steppacher, Simon D

    2017-04-01

    Since the importance of an intact labrum for normal hip function has been shown, labral reattachment has become the standard method for open or arthroscopic treatment of hips with femoroacetabular impingement (FAI). However, no long-term clinical results exist evaluating the effect of labral reattachment. A 2-year followup comparing open surgical treatment of FAI with labral resection versus reattachment was previously performed at our clinic. The goal of this study was to report a concise followup of these patients at a minimum of 10 years. We asked if patients undergoing surgical hip dislocation for the treatment of mixed-type FAI with labral reattachment compared with labral resection had (1) improved hip pain and function based on the Merle d'Aubigné-Postel score; and (2) improved survival at 10-year followup. Between June 1999 and July 2002, we performed surgical hip dislocation with femoral neck osteoplasty and acetabular rim trimming in 52 patients (60 hips) with mixed-type FAI. In the first 20 patients (25 hips) until June 2001, a torn labrum or a detached labrum in the area of acetabular rim resection was resected. In the next 32 patients (35 hips), reattachment of the labrum was performed. The same indications were used to perform both procedures during the periods in question. Of the 20 patients (25 hips) in the first group, 19 patients (95%) (24 hips [96%]) were available for clinical and/or radiographic followup at a minimum of 10 years (mean, 13 years; range, 12-14 years). Of the 32 patients (35 hips) in the second group, 29 patients (91%) (32 hips [91%]) were available for clinical and/or radiographic followup at a minimum of 10 years (mean, 12 years; range, 10-13 years). We used the anterior impingement test to assess pain. Function was assessed using the Merle d'Aubigné- Postel score and ROM. Survivorship calculation was performed using the method of Kaplan-Meier with failure defined as conversion to THA, progression of osteoarthritis (of one

  13. Diagnostic glenohumeral arthroscopy fails to fully evaluate the biceps-labral complex.

    PubMed

    Taylor, Samuel A; Khair, M Michael; Gulotta, Lawrence V; Pearle, Andrew D; Baret, Nikolas J; Newman, Ashley M; Dy, Christopher J; O'Brien, Stephen J

    2015-02-01

    The purpose of this study was to define the limits of diagnostic glenohumeral arthroscopy and determine the prevalence and frequency of hidden extra-articular "bicipital tunnel" lesions among chronically symptomatic patients. Eight fresh-frozen cadaveric specimens underwent diagnostic glenohumeral arthroscopy with percutaneous tagging of the long head of the biceps tendon (LHBT) during maximal tendon excursion. The percentage of visualized LHBT was calculated relative to the distal margin of subscapularis tendon and the proximal margin of the pectoralis major tendon. Then, a retrospective review of 277 patients who underwent subdeltoid transfer of the LHBT to the conjoint tendon were retrospectively analyzed for lesions of the biceps-labral complex. Lesions were categorized by anatomic location (inside, junctional, or bicipital tunnel). Inside lesions were labral tears. Junctional lesions were LHBT tears visualized during glenohumeral arthroscopy. Bicipital tunnel lesions were extra-articular lesions hidden from view during standard glenohumeral arthroscopy. Seventy-eight percent of LHBT were visualized relative to the distal margin of the subscapularis tendon and only 55% relative to the proximal margin of the pectoralis major tendon. No portion of the LHBT inferior to the subscapularis tendon was visualized. Forty-seven percent of patients had hidden bicipital tunnel lesions. Scarring was most common and accounted for 48% of all such lesions. Thirty-seven percent of patients had multiple lesion locations. Forty-five percent of patients with junctional lesions also had hidden bicipital tunnel lesions. The only offending lesion was in the bicipital tunnel for 18% of patients. Diagnostic glenohumeral arthroscopy fails to fully evaluate the biceps-labral complex because it visualizes only 55% of the LHBT relative to the proximal margin of the pectoralis major tendon and did not identify extra-articular bicipital tunnel lesions present in 47% of chronically

  14. Posterior Displacement of Supraspinatus Central Tendon Observed on Magnetic Resonance Imaging: A Useful Preoperative Indicator of Rotator Cuff Tear Characteristics.

    PubMed

    Updegrove, Gary F; Armstrong, April D; Mosher, Timothy J; Kim, H Mike

    2015-11-01

    To characterize the orientation of the normal supraspinatus central tendon and describe the displacement patterns of the central tendon in rotator cuff tears using a magnetic resonance imaging (MRI)-based method. We performed a retrospective MRI and chart review of 183 patients with a rotator cuff tear (cuff tear group), 52 with a labral tear but no rotator cuff tear (labral tear group), and 74 with a normal shoulder (normal group). The orientation of the supraspinatus central tendon relative to the bicipital groove was evaluated based on axial MRI and was numerically represented by the shortest distance from the lateral extension line of the central tendon to the bicipital groove. Tear size, fatty degeneration, and involvement of the anterior supraspinatus were evaluated to identify the factors associated with orientation changes. The mean distance from the bicipital groove to the central tendon line was 0.7 mm and 1.3 mm in the normal group and labral tear group, respectively. Full-thickness cuff tears involving the anterior supraspinatus showed a significantly greater distance (17.7 mm) than those sparing the anterior supraspinatus (4.9 mm, P = .001). Fatty degeneration of the supraspinatus was significantly correlated with the distance (P = .006). Disruption of the anterior supraspinatus and fatty degeneration of the supraspinatus were independent predictors of posterior displacement. The supraspinatus central tendon has a constant orientation toward the bicipital groove in normal shoulders, and the central tendon is frequently displaced posteriorly in full-thickness rotator cuff tears involving the anterior leading edge of the supraspinatus. The degree of posterior displacement is proportional to tear size and severity of fatty degeneration of the supraspinatus muscle. A simple and quick assessment of the central tendon orientation on preoperative MRI can be a useful indicator of tear characteristics, potentially providing insight into the intraoperative

  15. [Rotator cuff tear athropathy prevalence].

    PubMed

    Guerra-Soriano, F; Encalada-Díaz, M I; Ruiz-Suárez, M; Valero-González, F S

    2017-01-01

    Glenohumeral arthritis secondary to massive rotator cuff tear presents with a superior displacement and femoralization of the humeral head with coracoacromial arch acetabularization. The purpose of this study was to establish prevalence of rotator cuff tear artropathy (CTA) at our institution. Four hundred electronic records were reviewed from which we identified 136 patients with rotator cuff tears. A second group was composed with patients with massive cuff tears that were analized and staged by the Seebauer cuff tear arthropathy classification. Thirty four patients with massive rotator cuff tears were identified, 8 male and 26 female (age 60.1 ± 10.26 years). Massive rotator cuff tear prevalence was 25%. CTA prevalence found in the rotator cuff group was 19 and 76% in the massive cuff tears group. Patients were staged according to the classification with 32% in stage 1a, 11% 1b, 32% 2a and 0% 2b. CTA prevalence in patients with rotator cuff tears and massive cuff tears is higher than the one reported in American population. We consider that a revision of the Seebauer classification to be appropriate to determine its reliability.

  16. Do Ligamentum Teres Tears Portend Inferior Outcomes in Patients With Borderline Dysplasia Undergoing Hip Arthroscopic Surgery? A Match-Controlled Study With a Minimum 2-Year Follow-up.

    PubMed

    Chaharbakhshi, Edwin O; Perets, Itay; Ashberg, Lyall; Mu, Brian; Lenkeit, Christopher; Domb, Benjamin G

    2017-09-01

    Arthroscopic surgery in borderline dysplastic hips remains controversial, but the role of the ligamentum teres (LT) has not been studied in this setting. Borderline dysplastic patients with LT tears have worse short-term outcomes than those without LT tears. Cohort study; Level of evidence, 3. Data were prospectively collected on patients who underwent arthroscopic surgery between February 2008 and April 2014. The inclusion criteria were borderline dysplasia (lateral center-edge angle [LCEA], 18°-25°) and labral tears; arthroscopic treatments including labral preservation and capsular plication; and preoperative patient-reported outcome scores including the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sport-Specific Subscale, and visual analog scale for pain. Patients were excluded for preoperative Tönnis osteoarthritis grade >0, workers' compensation claims, previous ipsilateral hip surgery and conditions, or frank dysplasia (LCEA <18°). Patients with LT tears were pair-matched to patients without tears for sex, age at surgery ±10 years, body mass index (<30 kg/m 2 vs ≥30 kg/m 2 ), labral treatment type, and microfracture. Of 68 eligible patients, 63 (93%) had a minimum 2-year follow-up, and 30 (48%) had LT tears. Twenty patients in each group were pair-matched. The mean follow-up time was 54.3 months (range, 24.2-83.8 months) for the LT tear group and 38.6 months (range, 24.6-70.6 months) for the control group ( P = .002). Ninety percent were female. There were no significant differences regarding demographics or intra-operative procedures. The LT tear group trended toward lower postoperative mHHS ( P = .09) and NAHS ( P = .09) values. Mean satisfaction was 8.1 for the LT tear group and 7.9 for the control group. Preoperative and follow-up scores were not significantly different between the groups. The LT tear group had 5 revisions, with 1 revision in the control group. Three patients (15%) in the LT tear group

  17. Labral reconstruction with iliotibial band autografts and semitendinosus allografts improves hip joint contact area and contact pressure: an in vitro analysis.

    PubMed

    Lee, Simon; Wuerz, Thomas H; Shewman, Elizabeth; McCormick, Frank M; Salata, Michael J; Philippon, Marc J; Nho, Shane J

    2015-01-01

    .2%, P=.0014) and contact pressure (at 20°: 97.1%±3.18%, P=.0017; at 60°: 97.4%±4.39%, P=.0027) from the resected state. Comparative analysis demonstrated no statistically significant differences between either graft reconstruction in relation to contact area, contact pressure, or peak force. Segmental anterosuperior labral resection results in significantly decreased contact areas and increased contact pressures, while labral reconstruction partially restores time-zero acetabular contact areas and pressures as compared with the resected state. Although labral reconstruction improved the measured biomechanical properties as compared with the resected state, some of these properties remained significantly different compared with the native intact labrum. Labral reconstruction appears to improve femoroacetabular joint biomechanics as compared with the labrum-resected state; these improved biomechanics may translate into increased joint function clinically. © 2014 The Author(s).

  18. Restoration of labral anatomy and biomechanics after superior labral anterior-posterior repair: comparison of mattress versus simple technique.

    PubMed

    Boddula, Madhav R; Adamson, Gregory J; Gupta, Akash; McGarry, Michelle H; Lee, Thay Q

    2012-04-01

    Both simple and mattress repair techniques have been utilized with success for type II superior labral anterior-posterior (SLAP) lesions; however, direct anatomic and biomechanical comparisons of these techniques have yet to be clearly demonstrated. For type II SLAP lesions, the mattress suture repair technique will result in greater labral height and better position on the glenoid face and exhibit stronger biomechanical characteristics, when cyclically loaded and loaded to failure through the biceps, compared with the simple suture repair technique. Controlled laboratory study. Six matched pairs of cadaveric shoulders were dissected, and a clock face was created on the glenoid from 9 o'clock (posterior) to 3 o'clock (anterior). For the intact specimen, labral height and labral distance from the glenoid edge were measured using a MicroScribe. A SLAP lesion was then created from 10 o'clock to 2 o'clock. Lesions were repaired with two 3.0-mm BioSuture-Tak anchors placed at 11 o'clock and 1 o'clock. For each pair, a mattress repair was used for one shoulder, and a simple repair was used for the contralateral shoulder. After repair, labral height and labral distance from the glenoid edge were again measured. The specimens were then cyclically loaded and loaded to failure through the biceps using an Instron machine. A paired t test was used for statistical analysis. After mattress repair, a significant increase in labral height occurred compared with intact from 2.5 ± 0.3 mm to 4.3 ± 0.3 mm at 11 o'clock (P = .013), 2.7 ± 0.5 mm to 4.2 ± 0.7 mm at 12:30 o'clock (P = .007), 3.1 ± 0.5 mm to 4.2 ± 0.7 mm at 1 o'clock (P = .006), and 2.8 ± 0.7 mm to 3.7 ± 0.8 mm at 1:30 o'clock (P = .037). There was no significant difference in labral height between the intact condition and after simple repair at any clock face position. Labral height was significantly increased in the mattress repairs compared with simple repairs at 11 o'clock (mean difference, 2.0 mm; P = .008

  19. Acetabular Cup Revision.

    PubMed

    Kim, Young-Ho

    2017-09-01

    The use of acetabular cup revision arthroplasty is on the rise as demands for total hip arthroplasty, improved life expectancies, and the need for individual activity increase. For an acetabular cup revision to be successful, the cup should gain stable fixation within the remaining supportive bone of the acetabulum. Since the patient's remaining supportive acetabular bone stock plays an important role in the success of revision, accurate classification of the degree of acetabular bone defect is necessary. The Paprosky classification system is most commonly used when determining the location and degree of acetabular bone loss. Common treatment options include: acetabular liner exchange, high hip center, oblong cup, trabecular metal cup with augment, bipolar cup, bulk structural graft, cemented cup, uncemented cup including jumbo cup, acetabular reinforcement device (cage), trabecular metal cup cage. The optimal treatment option is dependent upon the degree of the discontinuity, the amount of available bone stock and the likelihood of achieving stable fixation upon supportive host bone. To achieve successful acetabular cup revision, accurate evaluation of bone defect preoperatively and intraoperatively, proper choice of method of acetabular revision according to the evaluation of acetabular bone deficiency, proper technique to get primary stability of implant such as precise grafting technique, and stable fixation of implant are mandatory.

  20. A meta-analysis of the diagnostic test accuracy of MRA and MRI for the detection of glenoid labral injury.

    PubMed

    Smith, Toby O; Drew, Benjamin T; Toms, Andoni P

    2012-07-01

    Magnetic resonance imaging (MRI) and magnetic resonance arthrography (MRA) have gained increasing favour in the assessment of patients with suspected glenoid labral injuries. The purpose of this study was to determine the diagnostic accuracy of MRI or MRA in the detection of gleniod labral lesions. A systematic review was undertaken of the electronic databases Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, AMED and CINAHL, in addition to a search of unpublished literature databases. All studies which compared the ability of MRI or MRA (index test) to assess gleniod labral tears or lesions, when verified with a surgical procedure (arthroscopy or open surgery-reference test) were included. Data extraction and methodological appraisal using the QUADAS tool were both conducted by two reviewers independently. Data were analysed through a summary receiver operator characteristic curve and pooled sensitivity and specificity analysis were calculated with 95% confidence intervals. Sixty studies including 4,667 shoulders from 4,574 patients were reviewed. There appeared slightly greater diagnostic test accuracy for MRA over MRI for the detection of overall gleniod labral lesions (MRA-sensitivity 88%, specificity 93% vs. MRI sensitivity 76% vs. specificity 87%). Methodologically, studies recruited and identified their samples appropriately and clearly defined the radiological procedures. In general, it was not clearly defined why patients were lost during the study, and studies were poor at recording whether the same clinical data were available to the radiologist interpreting the MRI or MRA as would be available in clinical practice. Most studies did not state whether the surgeon interpreting the arthroscopic procedure was blinded to the results of the MR or MRA imaging. Based on the available literature, overall MRA appeared marginally superior to MRI for the detection of glenohumeral labral lesions. Level 2a.

  1. Clinical and surgical correlation of hip MR arthrographic findings in adolescents.

    PubMed

    Jawahar, Anugayathri; Vade, Aruna; Lomasney, Laurie; Okur, Gokcan; Evans, Douglas; Subbaiah, Perla

    2016-06-01

    The purpose of this study was to analyze the utility of MRA-H in adolescents by comparing the results of imaging with surgical findings and/or clinical outcome. After obtaining appropriate IRB approval, the Radiologic Information System database was queried for all patients 13-18 years of age who underwent MRA-H from 2004 through 2013. The electronic medical record was reviewed for clinical history, clinical examination findings, and operative notes. MRA-H images were reviewed for soft tissue abnormalities (labral tear, paralabral ganglion, articular cartilage loss, synovitis, ligament tears) and bony abnormalities (cam-type femoroacetabular impingement (FAI), pincer-type FAI, hip dysplasia). MRA-H findings were correlated with surgical findings and with clinical outcomes. Twenty-six patients with labral tears by MRA-H were included in study and grouped as follows: Group I) patients who underwent surgical management (n=10); group II) patients managed non-surgically (medication, intra-articular injection, physical therapy) (n=9); group III) patients lost to follow up after being advised to have surgery (n=7). With regard to presenting symptomatology, 87.5% of patients with labral tear had groin pain. Of those patients who were diagnosed with a labral tear, 52% were categorized as idiopathic labral tears, 26% as secondary tears (secondary to abnormal bony morphology), and 22% as traumatic labral tears. The labral tears were found to be anterior in 61% and posterior in 22%. Associated articular cartilage lesions were found in 29% of patients. In group I (surgical patients), MRA-H labral findings were confirmed at surgery in 9/10. Seventy percent of labral tears in our study had some form of abnormal bony morphology. Nine of the 12 patients with bone abnormalities were derived from group I patients. Six out of 7 patients with cam-type FAI had a labral tear. Labral tears diagnosed by MRA-H in the adolescent population correlated well with clinical examination and

  2. Non-contrast magnetic resonance imaging for diagnosing shoulder injuries.

    PubMed

    Arnold, Heino

    2012-12-01

    To compare preoperative non-contrast magnetic resonance imaging (MRI) with arthroscopy findings in diagnosing labral and rotator cuff tears. 86 men and 60 women aged 21 to 70 (mean, 52) years underwent non-contrast MRI before arthroscopic operations on the glenohumeral joint. Slices were made in a transverse, parasagittal, and paracoronar orientation. The sequences used were T2- and proton-weighted for paracoronar imaging, T1- and T2-weighted for transverse and parasagittal imaging, and T2-weigthed sequences with fat suppression and short tau inversion recovery sequences. MRI was evaluated with the surgeon to eliminate interobserver bias. Arthroscopic surgery was performed by a single surgeon. If a labral or rotator cuff tear was found, surgery was performed using corkscrew anchors. For full thickness rotator cuff tears, MRI and arthroscopy detected them in 76 and 82 patients, respectively. One such tear found by MRI could not be confirmed by arthroscopy. MRI missed 4 subscapularis and 3 supraspinatus tears. The sensitivity and specificity of MRI in diagnosing full thickness rotator cuff tears were 0.90 and 0.91, respectively. For labral tears, MRI and arthroscopy detected them in 16 and 31 patients, respectively. One anterior labral tear detected by MRI could not be verified by arthroscopy. All 16 labral tears detected by MRI were Bankart type-I tears (of the anterior glenoid) except for one superior labral tear from anterior to posterior (SLAP tear). All 13 SLAP tears (10 type 2 and 3 type 3) except for one could be found by arthroscopy only. The sensitivity and specificity of MRI in diagnosing labral tears were 0.52 and 0.89, respectively. Non-contrast MRI is reliable only for diagnosing full thickness rotator cuff tears and anterior labral tears. Direct or indirect contrast enhancement is recommended for more differentiation. Special scan orientation is necessary for SLAP tears.

  3. Arthroscopic Triple Labral Repair in an Adolescent.

    PubMed

    Cotter, Eric J; Frank, Rachel M; Trenhaile, Scott W

    2017-10-01

    Traumatic glenohumeral dislocations often result in significant injury to the anterior-inferior labrum, most commonly leading to recurrent anterior instability. While in skeletally immature patients, shoulder trauma more commonly results in fracture versus a true dislocation, shoulder instability does occur and can be difficult to manage in the setting of open physes. In any event, the goal of treatment is to reduce the risk of recurrence and allow full participation in activities, including sports. Arthroscopic stabilization has been shown to be an effective treatment option for young patients, with good return to sport rates; however, the vast majority of literature on shoulder instability in the youth patient population focuses on anterior instability. Concomitant lesions of the anterior, posterior, and superior labrum have been rarely described in youth athletes and present a formidable clinical challenge, particularly in skeletally immature patients. In this Technical Note, we describe the authors' preferred technique for arthroscopic repair of a traumatic triple labral tear, including anterior, posterior, and type IV SLAP components, in adolescent patients.

  4. Posterior labral injury in contact athletes.

    PubMed

    Mair, S D; Zarzour, R H; Speer, K P

    1998-01-01

    Nine athletes (seven football offensive linemen, one defensive lineman, and one lacrosse player) were found at arthroscopy to have posterior labral detachment from the glenoid. In our series, this lesion is specific to contact athletes who engage their opponents with arms in front of the body. All patients had pain with bench pressing and while participating in their sport, diminishing their ability to play effectively. Conservative measures were ineffective in relieving their symptoms. Examination under anesthesia revealed symmetric glenohumeral translation bilaterally, without evidence of posterior instability. Treatment consisted of glenoid rim abradement and posterior labral repair with a bioabsorbable tack. All patients returned to complete at least one full season of contact sports and weightlifting without pain (minimum follow-up, > or = 2 years). Although many injuries leading to subluxation of the glenohumeral joint occur when an unanticipated force is applied, contact athletes ready their shoulder muscles in anticipation of impact with opponents. This leads to a compressive force at the glenohumeral joint. We hypothesize that, in combination with a posteriorly directed force at impact, the resultant vector is a shearing force to the posterior labrum and articular surface. Repeated exposure leads to posterior labral detachment without capsular injury. Posterior labral reattachment provides consistently good results, allowing the athlete to return to competition.

  5. Pathological findings in patients with low anterior inferior iliac spine impingement.

    PubMed

    Amar, Eyal; Warschawski, Yaniv; Sharfman, Zachary T; Martin, Hal David; Safran, Marc R; Rath, Ehud

    2016-07-01

    Femoroacetabular impingement (FAI) has been well described in recent years as one of the major causes of hip pain potentially leading to acetabular labral tears and cartilage damage, which may in turn lead to the development of early degenerative changes. More recently, extra-articular patterns of impingement such as the anterior inferior iliac spine (AIIS)/subspine hip impingement have gained focus as a cause of hip pain and limitation in terminal hip flexion and internal rotation. The purpose of this study was to evaluate the prevalence of low AIIS in patients undergoing hip arthroscopy and to characterize the concomitant intra-articular lesions. Between November 2011 and April 2013, 100 consecutive patients underwent hip arthroscopy for various diagnoses by a single surgeon. After intra-operative diagnosis of low AIIS was made, a comprehensive review of the patients' records, preoperative radiographs, and intra-operative findings was conducted to document the existence and location of labral and chondral lesions. Twenty-one (21 %) patients had low AIIS. There were 13 males (mean age 38.4 years) and eight females (mean age 35.5 years). Eight patients had pre-operative radiographic evidence of low AIIS. All patients had a labral tear anteriorly, at the level of the AIIS; 17 had chondrolabral disruption and 17 had chondral lesions in zone two (antero-superior); and four patients had lesion in zones two and three. Low AIIS is a common intra-operative finding in hip arthroscopy patients. Characteristic labral and chondral lesions are routinely found in a predictable location that effaces the low AIIS. Level of Evidence-Level IV, Case Series.

  6. Hip Arthroscopic Synovectomy and Labral Repair in a Patient With Rheumatoid Arthritis With a 2-Year Follow-up

    PubMed Central

    Watanabe, Nobuyuki; Iguchi, Hirotaka; Mitsui, Hiroto; Tawada, Kaneaki; Murakami, Satona; Otsuka, Takanobu

    2014-01-01

    The arthroscopic surgical procedures reported previously for a rheumatic hip joint have been primarily performed as diagnostic procedures. Only a few studies have reported the success of arthroscopic surgery in hip joint preservation. We encountered a special case in which joint remodeling was seen in a patient with rheumatoid arthritis treated with biological drugs after hip arthroscopic synovectomy and labral repair. We report the case of a 39-year-old woman with rheumatism, which was controlled with tocilizumab, prednisolone, and tacrolimus. The hip joint showed Larsen grade 3 destruction, and the Harris Hip Score was 55 points. Because of the patient's strong desire to undergo a hip preservation operation, we performed hip arthroscopic synovectomy and repair of a longitudinal labral tear. After 2.5 years, the joint space had undergone rebuilding with improvement to Larsen grade 2, and the Harris Hip Score had improved to 78 points; the patient was able to return to work with the use of 1 crutch. It is possible to perform hip arthroscopic surgery for rheumatoid arthritis with a hip preservation operation with biological drugs. PMID:25276611

  7. Hip arthroscopy: prevalence of intra-articular pathologic findings after traumatic injury of the hip.

    PubMed

    Khanna, Vickas; Harris, Adam; Farrokhyar, Forough; Choudur, Hema N; Wong, Ivan H

    2014-03-01

    The purpose of this study was to document and compare the incidence of intra-articular hip pathologic findings identified using arthroscopy versus conventional imaging in patients with acute trauma to the hip. This was a blinded prospective case series study designed to review the incidence of intra-articular pathologic disorders in patients with post-traumatic injury between the ages of 18 and 65 years who were referred to a single surgeon. Injuries included hip dislocation, proximal femur fracture, pelvic ring fracture, acetabular fracture, penetrating injury (gunshot wound), and soft tissue injury. Preoperative radiographs, computed tomographic (CT) scans, or magnetic resonance imaging/magnetic resonance angiography (MRI/MRA) scans (or a combination of these) were obtained. Findings were documented and compared with intraoperative findings. A total of 29 post-traumatic hips were enrolled in this study. Hip arthroscopy identified 17 of 29 hips (59%) as having loose bodies, 11 of 29 (38%) hips as having an intra-articular step deformity, 14 of 29 (49%) hips as having an osteochondral lesion, and 27 of 29 (93%) hips as having a labral tear. Plain radiographs and CT scans yielded low sensitivity when compared with arthroscopy for the identification of loose bodies and step deformities. MRI/MRA comparison with arthroscopic findings suggest that MRI/MRA is an accurate tool for identification of labral tears, because 91% of tears seen on arthroscopy were also identified by MRI/MRA. In 4 hips, however, MRI/MRA failed to identify osteochondral lesions that were subsequently identified by arthroscopy. Traumatic injuries of the hip result in substantial intra-articular pathologic findings, including loose bodies, labral tears, step deformities, and osteochondral lesions. The arthroscope is a powerful tool in identifying these injuries. Plain radiographs and CT scans appear to underestimate the true incidence of loose bodies and step deformities within the joint when

  8. The diagnostic performance of non-contrast 3-Tesla magnetic resonance imaging (3-T MRI) versus 1.5-Tesla magnetic resonance arthrography (1.5-T MRA) in femoro-acetabular impingement.

    PubMed

    Crespo-Rodríguez, Ana M; De Lucas-Villarrubia, Jose C; Pastrana-Ledesma, Miguel; Hualde-Juvera, Ana; Méndez-Alonso, Santiago; Padron, Mario

    2017-03-01

    The aim of this study was to evaluate the diagnostic accuracy of 3-T non-contrast MRI versus 1.5-T MRA for assessing labrum and articular cartilage lesions in patients with clinical suspicion of femoro-acetabular impingement (FAI). Fifty patients (thirty men and twenty women, mean age 42.5 years) underwent 1.5-T MRA, 3-T MRI and arthroscopy on the same hip. An optimized high-resolution proton density spin echo pulse sequence was included in the 3-T non-contrast MRI protocol. The 3-T non-contrast MRI identified forty-two of the forty-three arthroscopically proven tears at the labral-chondral transitional zone (sensitivity, 97.7%; specificity, 100%; positive predictive value (PPV), 100%; negative predictive value (NPV), 87.5%; accuracy 98%). With 1.5-T MRA, forty-four tears were diagnosed. However, there was one false positive (sensitivity, 100%; specificity, 85.7%; PPV, 97.7%; NPV, 100%; accuracy 98%). Agreement between arthroscopy and MRI, whether 3-T non-contrast MRI or 1.5-T MRA, as to the degree of chondral lesion in the acetabulum was reached in half of the patients and in the femur in 76% of patients. Non-invasive assessment of the hip is possible with 3-T MR magnet. 3-T non-contrast MRI could replace MRA as the workhorse technique for assessing hip internal damage. MRA would then be reserved for young adults with a strong clinical suspicion of FAI but normal findings on 3-T non-contrast MRI. When compared with 1.5-T MRA, optimized sequences with 3-T non-contrast MRI help in detecting normal variants and in diagnosing articular cartilage lesions. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

  9. MR arthrography of the posterior labrocapsular complex: relationship with glenohumeral joint alignment and clinical posterior instability.

    PubMed

    Tung, Glenn A; Hou, David D

    2003-02-01

    The purpose of our study was to investigate the relationship between tears of the posterior labrocapsular complex and glenohumeral alignment on MR arthrography and the presence and extent of posterior labrocapsular tears in patients with posterior instability. Posterior labrocapsular tears identified on 24 MR arthrograms and surgically confirmed were evaluated for length of tear and labrocapsular avulsion. These examinations and a comparison cohort of 70 normal MR arthrograms with normal findings were also evaluated for humeral head position relative to the glenoid fossa. Medical records were reviewed for clinical diagnosis of posterior instability and history of shoulder trauma. The position of the humeral head relative to the glenoid was significantly more posterior in patients with posterior labral tear than in patients with a normal posterior labrum (4.9 mm versus 0.7 mm; p < 0.0001). The mean length (+/- SD) of posterior labral tear was 15.9 +/- 1.7 mm, and a direct correlation was found between tear length and posterior humeral translation (r = -0.65; p = 0.002). Posterior labral tears were significantly longer (18.6 vs 13.1 mm; p = 0.04), and posterior humeral translation was greater (6.4 vs 3.4 mm; p = 0.006) in patients with labrocapsular avulsion than in those without avulsion. Twelve (50%) of the patients with posterior labrocapsular tear had posterior instability, and 10 (83%) had a history of macrotrauma. On MR arthrography, the mean posterior humeral translation was greater (6.2 mm +/- 0.08; p = 0.019), posterior labral tears were longer (19.4 mm +/- 1.7; p = 0.0008), and labrocapsular avulsion was more common (83%; p = 0.0001) in patients with posterior instability than in patients who had a posterior labral tear but a clinically stable shoulder. Clinical posterior instability is associated with excessive posterior humeral translation, long posterior labral tears, and posterior labrocapsular avulsion.

  10. Glenohumeral instability: evaluation with MR arthrography.

    PubMed

    Beltran, J; Rosenberg, Z S; Chandnani, V P; Cuomo, F; Beltran, S; Rokito, A

    1997-01-01

    Magnetic resonance arthrography is superior to other imaging techniques in evaluation of the glenohumeral joint. Normal variants that can be diagnostic pitfalls include the anterosuperior sublabral foramen, the Buford complex, and hyaline cartilage under the labrum. Anteroinferior dislocation is the most frequent cause of anterior glenohumeral instability and produces a constellation of lesions (anteroinferior labral tear, classic and osseous Bankart lesions, Hill-Sachs lesion). Variants of anteroinferior labral tears include anterior labroligamentous periosteal sleeve avulsion and glenoid labral articular disruption. Anterior glenohumeral instability can also involve tears of the anterior or anterosuperior labrum or the glenohumeral ligaments. Posterior glenohumeral instability can involve a posterior labral tear, posterior capsular stripping or laxity; fracture, erosion, or sclerosis and ectopic ossification of the posterior glenoid fossa; reverse Hill-Sachs lesion; McLaughlin fracture; or posterosuperior glenoid impingement. Superior labral anterior and posterior lesions involve the superior labrum with varying degrees of biceps tendon involvement.

  11. Acetabular Morphology: Implications for Joint-preserving Surgery

    PubMed Central

    Ganz, Reinhold; Impellizzeri, Franco M.; Leunig, Michael

    2009-01-01

    Appropriate anatomic concepts for surgery to treat femoroacetabular impingement require a precise appreciation of the native acetabular anatomy. We therefore determined (1) the spatial acetabular rim profile, (2) the topography of the articular lunate surface, and (3) the 3-D relationships of the acetabular opening plane comparing 66 bony acetabula from 33 pelves in female and male pelves. The acetabular rim profile had a constant and regular wave-like outline without gender differences. Three prominences anterosuperiorly, anteroinferiorly and posteroinferiorly extended just above hemispheric level. Two depressions were below hemispheric level, of 9° at the anterior wall and of 21° along the posterosuperior wall. In 94% of all acetabula, the deepest extent of the articular surface was within 30° of the anterosuperior acetabular sector. In 99% of men and in 91% of women, the depth of the articular surface was at least 55° along almost half of the upper acetabular cup. The articular surface was smaller in women than in men. The acetabular opening plane was orientated in 21° ± 5° for version, 48° ± 4° for inclination and 19° ± 6° for acetabular tilt with no gender differences. We defined tilt as forward rotation of the entire acetabular cup around its central axis; because of interindividual variability of acetabular tilt, descriptions of acetabular lesions during surgery, CT scanning and MRI should be defined and recorded in relation to the acetabular notch. Acetabular tilt and pelvic tilt should be separately identified. We believe this information important for surgeons performing rim trimming in FAI surgery or performing acetabular osteotomies. PMID:19130159

  12. Female Sex Is a Risk Factor for Failure of Hip Arthroscopy Performed for Acetabular Retroversion

    PubMed Central

    Poehling-Monaghan, Kirsten L.; Krych, Aaron J.; Levy, Bruce A.; Trousdale, Robert T.; Sierra, Rafael J.

    2017-01-01

    significantly different between the success and failure groups included patient sex, with males being more likely than females to have a successful outcome (P < .02), as well as undergoing femoral osteoplasty (P < .02). Intraoperative variables that were associated with worse outcome included isolated labral debridement (P < .002). In a subgroup analysis, males were more likely than their female counterparts to have a successful outcome with both isolated cam and combined cam-pincer resection (P < .05). Level of crossover correction on postoperative radiographs had no correlation with outcome. Conclusion: Acetabular retroversion remains a challenging pathoanatomy to treat arthroscopically. If hip arthroscopy is to be considered in select cases, we recommend labral preservation when possible. Male patients with correction of cam deformities did well, while females with significant retroversion appeared to be at greater risk for failure of arthroscopic treatment. PMID:29164164

  13. [IMAGING ANALYSIS OF ACETABULAR CUP POSITIONS IN TOTAL HIP ARTHROPLASTY FOR ADULTS WITH ACETABULAR DYSPLASIA].

    PubMed

    Sun, Hong; Fang, Shuying; Yang, Zibo; Zhang, Zhiqi; Kang, Yan; Zhang, Ziji; Liao, Weiming; Fu, Ming; Wu, Peihui

    2016-11-08

    To investigate the influence of the degree of acetabular deformity and the learning-curve on the acetabular cup positions in total hip arthroplasty (THA) for adults with developmental dysplasia of hip (DDH). Between January 2008 and December 2015, 130 patients (144 hips) with DDH underwent primary THA, and the clinical data were analyzed retrospectively. Fifty-three patients (59 hips) were admitted before 2012, and 77 patients (85 hips) were treated after 2012. There were 32 males and 98 females, aged from 31 to 83 years (mean, 61). Unilateral replacement was performed in 116 cases and bilateral replacement in 14 cases. Of 144 hips, 48 hips were rated as Crowe type I, 57 hips as type II, and 39 hips as type of III/IV. The standard pelvic radiograph was taken within 1 week after operation. The mediCAD software was adopted to measure the angle of anteversion and abduction, bony coverage, and the distance between true rotating center and optimal rotating center to the connection of teardrops and the horizontal distance between two centers to evaluate the qualified rate of acetabular cup positions. Compared with the patients with the same type in 2013-2015 group, the anteversion angle and qualified rate of acetabular cup position significantly decreased in patients with Crowe I ( P <0.05); the horizontal distance significantly increased and qualified rate of acetabular cup position significantly decreased in patients with Crowe II ( P <0.05); and the anteversion angle significantly decreased and the horizontal distance significantly increased in patients with Crowe III/IV ( P <0.05) in 2008-2012 group. But no significant difference was shown in the other indexes ( P >0.05). In all Crowe types, the vertical distance between the true rotating center and the optimal rotating center increased with the degree of acetabular deformity in both 2008-2012 group and 2013-2015 group, showing significant difference ( P <0.05), but no significant difference was found in the other

  14. The jumbo acetabular component for acetabular revision: Curtain Calls and Caveats.

    PubMed

    Lachiewicz, P F; Watters, T S

    2016-01-01

    The 'jumbo' acetabular component is now commonly used in acetabular revision surgery where there is extensive bone loss. It offers high surface contact, permits weight bearing over a large area of the pelvis, the need for bone grafting is reduced and it is usually possible to restore centre of rotation of the hip. Disadvantages of its use include a technique in which bone structure may not be restored, a risk of excessive posterior bone loss during reaming, an obligation to employ screw fixation, limited bone ingrowth with late failure and high hip centre, leading to increased risk of dislocation. Contraindications include unaddressed pelvic dissociation, inability to implant the component with a rim fit, and an inability to achieve screw fixation. Use in acetabulae with < 50% bone stock has also been questioned. Published results have been encouraging in the first decade, with late failures predominantly because of polyethylene wear and aseptic loosening. Dislocation is the most common complication of jumbo acetabular revisions, with an incidence of approximately 10%, and often mandates revision. Based on published results, a hemispherical component with an enhanced porous coating, highly cross-linked polyethylene, and a large femoral head appears to represent the optimum tribology for jumbo acetabular revisions. ©2016 The British Editorial Society of Bone & Joint Surgery.

  15. Internal impingement in the etiology of rotator cuff tendinosis revisited.

    PubMed

    Budoff, Jeffrey E; Nirschl, Robert P; Ilahi, Omer A; Rodin, Dennis M

    2003-10-01

    The theory of internal impingement holds that, in overhead athletes, repeated contact between the undersurface of the rotator cuff and the posterosuperior glenoid rim leads to articular-sided partial-thickness rotator cuff tears and superior labral lesions. However, we have noted this same constellation of lesions in our general patient population. These recreational athletic patients do not routinely assume the position of extreme abduction and external rotation, and thus are unlikely to experience significant internal impingement forces. The goal of this study was to document the prevalence of superior labral lesions in patients being treated for partial-thickness undersurface rotator cuff tears. Retrospective case series. We retrospectively reviewed the records of 75 shoulders arthroscopically treated for partial-thickness articular-sided rotator cuff tears. With the exception of one professional tennis player, no patients were playing sports at a professional or major college level. No professional or collegiate throwing athletes were included. The prevalence of these lesions and their association with recreational athletics was noted. We found that 55 of 75 (73.3%) shoulders with articular-sided partial-thickness rotator cuff tears also had superior labral lesions. A statistically significant increased prevalence of superior labral lesions in the dominant shoulder was seen (P =.03). In addition, our patients who engaged in overhand throwing had significantly fewer superior labral lesions in the dominant shoulders than did nonthrowers (P =.017). The "kissing lesions" of undersurface rotator cuff tears and posterosuperior labral damage may be explained by mechanisms other than "internal impingement."

  16. [Application of three-dimensional printing personalized acetabular wing-plate in treatment of complex acetabular fractures via lateral-rectus approach].

    PubMed

    Mai, J G; Gu, C; Lin, X Z; Li, T; Huang, W Q; Wang, H; Tan, X Y; Lin, H; Wang, Y M; Yang, Y Q; Jin, D D; Fan, S C

    2017-03-01

    Objective: To investigate reduction and fixation of complex acetabular fractures using three-dimensional (3D) printing technique and personalized acetabular wing-plate via lateral-rectus approach. Methods: From March to July 2016, 8 patients with complex acetabular fractures were surgically managed through 3D printing personalized acetabular wing-plate via lateral-rectus approach at Department of Orthopedics, the Third Affiliated Hospital of Southern Medical University. There were 4 male patients and 4 female patients, with an average age of 57 years (ranging from 31 to 76 years). According to Letournel-Judet classification, there were 2 anterior+ posterior hemitransverse fractures and 6 both-column fractures, without posterior wall fracture or contralateral pelvic fracture. The CT data files of acetabular fracture were imported into the computer and 3D printing technique was used to print the fractures models after reduction by digital orthopedic technique. The acetabular wing-plate was designed and printed with titanium. All fractures were treated via the lateral-rectus approach in a horizontal position after general anesthesia. The anterior column and the quadrilateral surface fractures were fixed by 3D printing personalized acetabular wing-plate, and the posterior column fractures were reduction and fixed by antegrade lag screws under direct vision. Results: All the 8 cases underwent the operation successfully. Postoperative X-ray and CT examination showed excellent or good reduction of anterior and posterior column, without any operation complications. Only 1 case with 75 years old was found screw loosening in the pubic bone with osteoporosis after 1 month's follow-up, who didn't accept any treatment because the patient didn't feel discomfort. According to the Matta radiological evaluation, the reduction of the acetabular fracture was rated as excellent in 3 cases, good in 4 cases and fair in 1 case. All patients were followed up for 3 to 6 months and all

  17. Acetabular fractures: anatomic and clinical considerations.

    PubMed

    Lawrence, David A; Menn, Kirsten; Baumgaertner, Michael; Haims, Andrew H

    2013-09-01

    Classifying acetabular fractures can be an intimidating topic. However, it is helpful to remember that there are only three basic types of acetabular fractures: column fractures, transverse fractures, and wall fractures. Within this framework, acetabular fractures are classified into two broad categories: elementary or associated fractures. We will review the osseous anatomy of the pelvis and provide systematic approaches for reviewing both radiographs and CT scans to effectively evaluate the acetabulum. Although acetabular fracture classification may seem intimidating, the descriptions and distinctions discussed and shown in this article hopefully make the topic simpler to understand. Approach the task by recalling that there are only three basic types of acetabular fractures: column fractures (coronally oriented on CT images), transverse fractures (sagittally oriented on CT images), and wall fractures (obliquely oriented on CT images). We have provided systematic approaches for reviewing both conventional radiographs and CT scans to effectively assess the acetabulum. The clinical implications of the different fracture patterns have also been reviewed because it is critically important to include pertinent information for our clinical colleagues to provide the most efficient and timely clinical care.

  18. Risk Factors for Revision Surgery After Superior Labral Anterior-Posterior Repair: A National Perspective.

    PubMed

    Taylor, Samuel A; Degen, Ryan M; White, Alexander E; McCarthy, Moira M; Gulotta, Lawrence V; O'Brien, Stephen J; Werner, Brian C

    2017-06-01

    Data regarding risk factors for revision surgery after superior labral anterior-posterior (SLAP) repair are limited to institutional series. To define risk factors for revision surgery after SLAP repair among patients in a large national database. Case-control study; Level of evidence, 3. A national insurance database was queried for patients undergoing arthroscopic SLAP repair (Current Procedural Terminology [CPT] code 29807) for the diagnosis of a SLAP tear. Patients without a CPT modifier for laterality were excluded. Revision surgery was defined as (1) subsequent ipsilateral SLAP repair (CPT 29807), (2) ipsilateral arthroscopic debridement for the diagnosis of a SLAP tear (CPT 29822 or 29823, with diagnosis code 840.7), (3) subsequent ipsilateral arthroscopic biceps tenodesis (CPT 29828), (4) subsequent ipsilateral open biceps tenodesis (CPT 23430), and (5) subsequent biceps tenotomy (CPT 23405). Multivariable binomial logistic regression analysis was performed to identify risk factors for revision surgery after SLAP repair, including patient demographics/comorbidities, concomitant diagnoses, and concomitant procedures performed. Odds ratios (ORs), 95% CIs, and P values were calculated. The estimated financial impact of revision surgery was also calculated. There were 4751 patients who met inclusion and exclusion criteria. Overall, 121 patients (2.5%) required revision surgery after SLAP repair. Regression analysis identified numerous risk factors for revision surgery, including age >40 years (OR, 1.5; 95% CI, 1.2-1.8; P = .045), female sex (OR, 1.5; 95% CI, 1.3-1.8; P = .010), obesity (OR, 1.8; 95% CI, 1.5-2.2; P = .001), smoking (OR, 2.0; 95% CI, 1.6-2.4; P < .0001), and diagnosis of biceps tendinitis (OR, 3.5; 95% CI, 3.0-4.2; P < .0001) or long head of the biceps tearing (OR, 5.1; 95% CI, 4.1-6.3; P < .0001) at or before the time of surgery. Concomitant rotator cuff repair and distal clavicle excision were not significant risk factors for revision surgery

  19. Return to Preinjury Levels of Participation After Superior Labral Repair in Overhead Athletes: A Systematic Review

    PubMed Central

    Sciascia, Aaron; Myers, Natalie; Kibler, W. Ben; Uhl, Timothy L.

    2015-01-01

    Context Athletes often preoperatively weigh the risks and benefits of electing to undergo an orthopaedic procedure to repair damaged tissue. A common concern for athletes is being able to return to their maximum levels of competition after shoulder surgery, whereas clinicians struggle with the ability to provide a consistent prognosis of successful return to participation after surgery. The variation in study details and rates of return in the existing literature have not supplied clinicians with enough evidence to give overhead athletes adequate information regarding successful return to participation when deciding to undergo shoulder surgery. Objective To investigate the odds of overhead athletes returning to preinjury levels of participation after arthroscopic superior labral repair. Data Sources The CINAHL, MEDLINE, and SPORTDiscus databases from 1972 to 2013. Study Selection The criteria for article selection were (1) The study was written in English. (2) The study reported surgical repair of an isolated superior labral injury or a superior labral injury with soft tissue debridement. (3) The study involved overhead athletes equal to or less than 40 years of age. (4) The study assessed return to the preinjury level of participation. Data Extraction We critically reviewed articles for quality and bias and calculated and compared odds ratios for return to full participation for dichotomous populations or surgical procedures. Data Synthesis Of 215 identified articles, 11 were retained: 5 articles about isolated superior labral repair and 6 articles about labral repair with soft tissue debridement. The quality range was 11 to 17 (42% to 70%) of a possible 24 points. Odds ratios could be generated for 8 of 11 studies. Nonbaseball, nonoverhead, and nonthrowing athletes had a 2.3 to 5.8 times greater chance of full return to participation than overhead/throwing athletes after isolated superior labral repair. Similarly, nonoverhead athletes had 1.5 to 3.5 times greater

  20. The role of arthroscopy in the dysplastic hip—a systematic review of the intra-articular findings, and the outcomes utilizing hip arthroscopic surgery

    PubMed Central

    Jo, Suenghwan; Lee, Sang Hong; Wang, Sung Il; Smith, Bjorn; O’Donnell, John

    2016-01-01

    Acetabular dysplasia is one of the most common sources of hip arthritis. With the recent innovation in hip arthroscopy, the question has been raised whether arthroscopy can be used to treat dysplastic hip conditions. The purposes of this systematic review are (i) describe the prevalence of intra-articular pathologies and (ii) report the outcomes of dysplastic hip treatment with hip arthroscopy as a sole treatment. Medical databases were searched for articles including arthroscopic findings and treatment of dysplastic hip with predetermined criteria. PubMed, Ovid database and CINAHL (Cumulative Index to Nursing and Allied Health Literature) were searched up until 7 January 2015. Two reviewers independently assess the eligibility of retrieved studies using titles, abstracts and full-text articles. Thirteen studies were eligible to be included for the systematic review. Overall, labral tear was the most common pathology with a prevalence rate of 77.3%. All of the four studies describing arthroscopic treatment for only borderline dysplasia reported favorable outcome. With regard to more severely dysplastic hips, two out of three studies reported acceptable outcomes while one study reported negative results. This review indicates that intra-articular pathology is commonly observed in symptomatic dysplastic hips with a labral tear being the most common pathology. Arthroscopic treatment of borderline dysplasia could provide benefits whereas treatment of more dysplastic hips is controversial. Nevertheless, there is a lack of evidence for using arthroscopy alone in hips with a center edge angle <20°. Level IV, systematic review of Level IV studies. PMID:27583155

  1. Sensitivity and specificity of noncontrast magnetic resonance imaging reports in the diagnosis of type-II superior labral anterior-posterior lesions in the community setting.

    PubMed

    Connolly, Keith P; Schwartzberg, Randy S; Reuss, Bryan; Crumbie, David; Homan, Brad M

    2013-02-20

    Magnetic resonance imaging (MRI) has been suggested to be of high accuracy at academic institutions in the identification of superior labral tears; however, many Type-II superior labral anterior-posterior (SLAP) lesions encountered during arthroscopy have not been previously diagnosed with noncontrast images. This study evaluated the accuracy of diagnosing Type-II SLAP lesions in a community setting with use of noncontrast MRI and analyzed the effect that radiologist training and the scanner type or magnet strength had on sensitivity and specificity. One hundred and forty-four patients requiring repair of an arthroscopically confirmed Type-II SLAP lesion who had a noncontrast MRI examination performed within twelve months before the procedure were included in the sensitivity analysis. An additional 100 patients with arthroscopically confirmed, normal superior labral anatomy were identified for specificity analysis. The transcribed interpretations of the images by the radiologists were used to document the diagnosis of a SLAP lesion and were compared with the operative report. The magnet strength, type of MRI system (open or closed), and whether the radiologist had completed a musculoskeletal fellowship were also recorded. Noncontrast MRI identified SLAP lesions in fifty-four of 144 shoulders, yielding an overall sensitivity of 38% (95% confidence interval [CI] = 30%, 46%). Specificity was 94% (95% CI = 87%, 98%), with six SLAP lesions diagnosed in 100 shoulders that did not contain the lesion. Musculoskeletal fellowship-trained radiologists performed with higher sensitivity than those who had not completed the fellowship (46% versus 19%; p = 0.009). Our results demonstrate a low sensitivity and high specificity in the diagnosis of Type-II SLAP lesions with noncontrast MRI in this community setting. Musculoskeletal fellowship-trained radiologists had significantly higher sensitivities in accurately diagnosing the lesion than did radiologists without such training

  2. Outcomes of isolated glenoid labral injuries in professional baseball pitchers.

    PubMed

    Cerynik, Douglas L; Ewald, Timothy J; Sastry, Akhilesh; Amin, Nirav H; Liao, Jason G; Tom, James A

    2008-05-01

    Major League Baseball (MLB) pitchers who return to competition after labral surgery show a decline in their pitching performance. Retrospective cohort. Tertiary institution. MLB starting or relief pitchers with isolated glenoid labral injuries. Open or arthroscopic surgical repair of isolated glenoid labral injuries. Individual statistics were reviewed for 42 MLB pitchers who underwent surgical repair of isolated glenoid labral injuries of their throwing shoulder between 1998 and 2003. Pertinent statistical data, including earned run average (ERA), innings pitched (IP), and walks plus hits per inning pitched (WHIP), were obtained for all players and compared before and after surgery. These statistics were evaluated for an association with demographic factors, pitching role, and rehabilitation time. A total of 42 MLB pitchers (26 starters, 16 relievers) were included in the study with an average age of 27.5 years for starters and 29.9 years for relievers at injury time. There were 30 right-handed pitchers and 12 left-handed pitchers. In all, 69% of pitchers returned postoperatively to MLB for at least one season; 29% pitched for three seasons or more. For both relievers and starters, there was no statistically significant postoperative change in ERA or WHIP at 1 and 3 years. Starters had significantly decreased IP at 1 year, but not at 3 years. Relievers had no significant change in IP at 1 year postoperatively, but IP were significantly decreased at 3 years. Relievers missed less time after surgery than did starters (11.4 vs. 18.4 months). Most pitchers who were able to return to competition after surgery showed insignificant changes in ERA and WHIP and significant decreases in IP. Age, MLB experience, and pitching role as a reliever were the most significant factors related to a successful return after surgery.

  3. The Diagnostic Value of the Vacuum Phenomenon during Hip Arthroscopy

    PubMed Central

    Rath, Ehud; Gortzak, Yair; Schwarzkopf, Ran; Benkovich, Vadim; Cohen, Eugene; Atar, Dan

    2011-01-01

    The diagnostic value of the vacuum phenomenon between the femoral head and the acetabulum, and time frame of its occurrence after application of traction is an important clinical question. The resulting arthrogram may outline the shape, location, and extent of cartilage lesions prior to arthroscopy of the hip joint. The presence, duration, and diagnostic information of the vacuum phenomenon were evaluated in 24 hips that underwent arthroscopy. The operative diagnosis was compared to the results of imaging studies and to findings obtained during a traction trial prior to arthroscopy. Indications for arthroscopy included avascular necrosis, labral tears, loose bodies, osteoarthrosis, and intractable hip pain. In 22 hips the vacuum phenomenon developed within 30 seconds after application of traction. The most important data obtained from the vacuum phenomenon was the location and extent of femoral head articular cartilage detachment and the presence of nonossified loose bodies. The vacuum phenomenon did not reveal labral or acetabular cartilage pathology in any of these patients. The vacuum phenomenon obtained during the trial of traction can add valuable information prior to hip arthroscopy. Femoral head articular cartilage detachment was best documented by this method. The hip arthroscopist should utilize this diagnostic window routinely prior to hip arthroscopy. PMID:24977068

  4. The Diagnostic Value of the Vacuum Phenomenon during Hip Arthroscopy.

    PubMed

    Rath, Ehud; Gortzak, Yair; Schwarzkopf, Ran; Benkovich, Vadim; Cohen, Eugene; Atar, Dan

    2011-01-01

    The diagnostic value of the vacuum phenomenon between the femoral head and the acetabulum, and time frame of its occurrence after application of traction is an important clinical question. The resulting arthrogram may outline the shape, location, and extent of cartilage lesions prior to arthroscopy of the hip joint. The presence, duration, and diagnostic information of the vacuum phenomenon were evaluated in 24 hips that underwent arthroscopy. The operative diagnosis was compared to the results of imaging studies and to findings obtained during a traction trial prior to arthroscopy. Indications for arthroscopy included avascular necrosis, labral tears, loose bodies, osteoarthrosis, and intractable hip pain. In 22 hips the vacuum phenomenon developed within 30 seconds after application of traction. The most important data obtained from the vacuum phenomenon was the location and extent of femoral head articular cartilage detachment and the presence of nonossified loose bodies. The vacuum phenomenon did not reveal labral or acetabular cartilage pathology in any of these patients. The vacuum phenomenon obtained during the trial of traction can add valuable information prior to hip arthroscopy. Femoral head articular cartilage detachment was best documented by this method. The hip arthroscopist should utilize this diagnostic window routinely prior to hip arthroscopy.

  5. A novel electromagnetic navigation tool for acetabular surgery.

    PubMed

    Lehmann, Wolfgang; Rueger, Johannes M; Nuechtern, Jakob; Grossterlinden, Lars; Kammal, Michael; Hoffmann, Michael

    2015-10-01

    Acetabular fracture surgery is demanding and screw placement along narrow bony corridors remains challenging. It necessitates x-ray radiation for fluoroscopically assisted screw insertion. The purpose of this cadaver study was to evaluate the feasibility, accuracy and operation time of a novel electromagnetic navigation system for screw insertion along predefined acetabular corridors. A controlled laboratory study with a total of 24 electromagnetically navigated screw insertions was performed on 8 cadaveric acetabula. 3 peri-acetabular bony corridors (QSS, Quadrilateral Surface Screw; IAS, Infra-Acetabular Screw; PCS, Posterior Column Screw) were defined and screws were placed in a defined order without fluoroscopy. Operation time was documented. Postoperative CT scans were performed to analyse accuracy of screw placement. Mean cadaver age was 70.4 ± 11.7. Successful screw placement was accomplished in 22 out of 24 (91.7%) cases. The overall mean time for all 3 acetabular screws was 576.6 ± 75.9s. All 3 complications occurred during the placement of the IAS due to an impassable narrow bony corridor. QSS mean length was 50 ± 5mm, IAS mean length was 85 ± 10mm and PCS mean length was 120 ± 5mm. In this cadaver study the novel electromagnetic navigation system was feasible to allow accurate screw placement without fluoroscopy in defined narrow peri-acetabular bony corridors. Copyright © 2015 Elsevier Ltd. All rights reserved.

  6. Influence of rotator cuff tears on glenohumeral stability during abduction tasks.

    PubMed

    Hölscher, Thomas; Weber, Tim; Lazarev, Igor; Englert, Carsten; Dendorfer, Sebastian

    2016-09-01

    One of the main goals in reconstructing rotator cuff tears is the restoration of glenohumeral joint stability, which is subsequently of utmost importance in order to prevent degenerative damage such as superior labral anterior posterior (SLAP) lesion, arthrosis, and malfunction. The goal of the current study was to facilitate musculoskeletal models in order to estimate glenohumeral instability introduced by muscle weakness due to cuff lesions. Inverse dynamics simulations were used to compute joint reaction forces for several static abduction tasks with different muscle weakness. Results were compared with the existing literature in order to ensure the model validity. Further arm positions taken from activities of daily living, requiring the rotator cuff muscles were modeled and their contribution to joint kinetics computed. Weakness of the superior rotator cuff muscles (supraspinatus; infraspinatus) leads to a deviation of the joint reaction force to the cranial dorsal rim of the glenoid. Massive rotator cuff defects showed higher potential for glenohumeral instability in contrast to single muscle ruptures. The teres minor muscle seems to substitute lost joint torque during several simulated muscle tears to maintain joint stability. Joint instability increases with cuff tear size. Weakness of the upper part of the rotator cuff leads to a joint reaction force closer to the upper glenoid rim. This indicates the comorbidity of cuff tears with SLAP lesions. The teres minor is crucial for maintaining joint stability in case of massive cuff defects and should be uprated in clinical decision-making. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1628-1635, 2016. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  7. Effect of acetabular reinforcement ring with hook for acetabular dysplasia clarified by three-dimensional finite element analysis.

    PubMed

    Zhao, Xin; Chosa, Etsuo; Yamako, Go; Watanabe, Shinji; Deng, Gang; Totoribe, Koji

    2013-12-01

    The objective of this study was to biomechanically determine the effect of the severity of acetabular dysplasia, number and positions of screws and type of bone graft material used on the initial fixation strength of the acetabular reinforcement ring with hook (Ganz ring) using the finite element method. Relative micromotion increased as the severity of acetabular dysplasia increased and tended to decrease as the number of screws increased, but varied according to screw placement position. Increased strength of the bone graft material led to decreased relative micromotion. Biomechanically, the Ganz ring can be placed securely using 3 screws in patients with Crowe 1 dysplasia. However, in patients with Crowe 2 or higher dysplasia, it is necessary to spread at least 4 screws across an area of good host bone. © 2013.

  8. The diagnostic accuracy of a clinical examination in determining intra-articular hip pain for potential hip arthroscopy candidates.

    PubMed

    Martin, RobRoy L; Irrgang, James J; Sekiya, Jon K

    2008-09-01

    One purpose of this study was to determine whether signs and symptoms could identify when a majority of the hip pain was originating from intra-articular sources in potential arthroscopic surgery candidates. The second purpose was to quantify pain reduction after an anesthetic intra-articular injection in those with potential labral pathology. Subjects with hip pain being evaluated by an orthopaedic surgeon specializing in hip arthroscopy were prospectively enrolled in the study. Clinical examination results were recorded. Sensitivity, specificity, and likelihood ratios were calculated to determine their accuracy in identifying those who would have greater than 50% pain relief from those with 50% pain relief or less. We enrolled 105 subjects in this study. An anesthetic intra-articular injection was performed in 49 potential candidates for arthroscopic surgery (47%). The mean age in these 49 subjects was 42 years (SD, 15 years; range, 18 to 68 years), with 25 men (51%) and 24 women (49%). According to magnetic resonance imaging (MRI) arthrogram, 18 individuals had a definite labral tear, 29 had a possible tear, and 2 had no labral tears. In those with definite tears or possible tears, 39% (n = 7) and 45% (n = 13), respectively, did not achieve a greater than 50% reduction of pain. Groin pain, clicking, pinching pain with sitting, lateral thigh pain, flexion abduction external rotation test, flexion-internal rotation-adduction test, and trochanteric tenderness were not useful in identifying those with greater than 50% pain relief from those with 50% relief or less. The symptoms and signs investigated in this study did not accurately or consistently identify subjects with primary intra-articular pain sources. Furthermore, candidates for hip arthroscopy with a labral tear identified on MRI arthrogram had varied responses to anesthetic intra-articular injection. Therefore all labral tears identified on MRI arthrogram may not be a major contributor to patients' pain

  9. Reconstruction of failed acetabular component in the presence of severe acetabular bone loss: a systematic review.

    PubMed

    Volpin, A; Konan, S; Biz, C; Tansey, R J; Haddad, F S

    2018-04-13

    Acetabular revision especially in the presence of severe bone loss is challenging. There is a paucity of literature critiquing contemporary techniques of revision acetabular reconstruction and their outcomes. The purpose of this study was to systematically review the literature and to report clinical outcomes and survival of contemporary acetabular revision arthroplasty techniques (tantalum metal shells, uncemented revision jumbo shells, reinforced cages and rings, oblong shells and custom-made triflange constructs). Full-text papers and those with an abstract in English published from January 2001 to January 2016 were identified through international databases. A total of 50 papers of level IV scientific evidence, comprising 2811 hips in total, fulfilled the inclusion criteria and were included. Overall, patients had improved outcomes irrespective of the technique of reconstruction as documented by postoperative hip scores. Our pooled analysis suggests that oblong cups components had a lower failure rate compared with other different materials considered in this review. Custom-made triflange cups had one of highest failure rates. However, this may reflect the complexity of revisions and severity of bone loss. The most common postoperative complication reported in all groups was dislocation. This review confirms successful acetabular reconstructions using diverse techniques depending on the type of bone loss and highlights key features and outcomes of different techniques. In particular, oblong cups and tantalum shells have successful survivorship.

  10. [Contact characteristics research of acetabular weight-bearing area with different internal fixation methods after compression fracture of acetabular dome].

    PubMed

    Xu, Bowen; Zhang, Qingsong; An, Siqi; Pei, Baorui; Wu, Xiaobo

    2017-08-01

    To establish the model of compression fracture of acetabular dome, and to measure the contact characteristics of acetabular weight-bearing area of acetabulum after 3 kinds of internal fixation. Sixteen fresh adult half pelvis specimens were randomly divided into 4 groups, 4 specimens each group. Group D was the complete acetabulum (control group), and the remaining 3 groups were prepared acetabular dome compression fracture model. The fractures were fixed with reconstruction plate in group A, antegrade raft screws in group B, and retrograde raft screws in group C. The pressure sensitive films were attached to the femoral head, and the axial compression test was carried out on the inverted single leg standing position. The weight-bearing area, average stress, and peak stress were measured in each group. Under the loading of 500 N, the acetabular weight-bearing area was significantly higher in group D than in other 3 groups ( P <0.05), and the average stress and peak stress were significantly lower than in other 3 groups ( P <0.05). The acetabular weight-bearing area were significantly higher in group B and group C than in group A, and the average stress and peak stress were significantly lower than in group A ( P <0.05). There was no significant difference in the above indexes between group B and group C ( P >0.05). For the compression fracture of the acetabular dome, the contact characteristics of the weight-bearing area can not restore to the normal level, even if the anatomical reduction and rigid internal fixation were performed; compared with the reconstruction plate fixation, antegrade and retrograde raft screws fixations can increase the weight-bearing area, reduce the average stress and peak stress, and reduce the incidence of traumatic arthritis.

  11. Acetabular-epiphyseal angle and hip dislocation in cerebral palsy: a preliminary study.

    PubMed

    Alí-Morell, O J; Zurita-Ortega, F; Davó-Jiménez, I; Segura-Biedma, S

    To relate, in non-ambulatory subjects with palsy, Reimers' migration percentage with standardized radiological measurements, including the acetabular-epiphyseal angle. Descriptive, observational and transversal study of 15 individuals with cerebral palsy at levels IV and V of the Gross Motor Function Classification System, aged between 3 and 9 years. Radiological measurements of the acetabular index, Hilgenreiner's epiphyseal angle, acetabular-epiphyseal angle, neck-shaft angle and Reimers' migration percentage of each of the hips were performed. Correlations between acetabular index, epiphyseal angle and acetabular-epiphyseal angle were obtained with respect to the Reimers migration percentage. For hips with a migration rate of 15% or less, a positive correlation was observed between acetabular and epiphyseal angles. In our population, the measurement between acetabular and epiphyseal inclination represents the highest association with the hip migration percentage. Copyright © 2018 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

  12. Polyethylene wear debris in modular acetabular prostheses.

    PubMed

    Chen, P C; Mead, E H; Pinto, J G; Colwell, C W

    1995-08-01

    The longevity of total hip arthroplasty has brought forth the recognition of aseptic loosening of prosthetic components as the leading cause of implant failure. Modularity of implants, although a significant improvement in versatility, may increase debris formation, a recognized cause of implant failure. This study was designed to measure the relative motion, and to assess the polyethylene wear debris production at the interface between the metal acetabular shell and the back side of the polyethylene liner, in modular hip prostheses. Five models from 4 manufacturers with different locking mechanisms and acetabular shell surface treatments were tested under long-term simultaneous sinusoidal and static loading (10(7) cycles at 3 Hz with +/- 2.5 Nmeter and 220 N static load). Results showed that there were marked differences in the security of the acetabular shell and polyethylene liner locking mechanism, wear pattern, damage sites, and amount of polyethylene debris on the acetabular shell and polyethylene liner surfaces. The range of polyethylene liner motion observed among the 5 models during 1 cycle of testing varied from an average of 0.96 degrees to movement too small to be detected by the test machines. Image and scanning electron microscopy analysis showed different wear patterns and a wide range in the average polyethylene liner surface wear area (0.26 cm2-4.61 cm2). In general, a stable locking mechanism and a smooth acetabular shell surface are essential in minimizing polyethylene liner wear and polyethylene debris production.

  13. [Quantification of acetabular coverage in normal adult].

    PubMed

    Lin, R M; Yang, C Y; Yu, C Y; Yang, C R; Chang, G L; Chou, Y L

    1991-03-01

    Quantification of acetabular coverage is important and can be expressed by superimposition of cartilage tracings on the maximum cross-sectional area of the femoral head. A practical Autolisp program on PC AutoCAD has been developed by us to quantify the acetabular coverage through numerical expression of the images of computed tomography. Thirty adults (60 hips) with normal center-edge angle and acetabular index in plain X ray were randomly selected for serial drops. These slices were prepared with a fixed coordination and in continuous sections of 5 mm in thickness. The contours of the cartilage of each section were digitized into a PC computer and processed by AutoCAD programs to quantify and characterize the acetabular coverage of normal and dysplastic adult hips. We found that a total coverage ratio of greater than 80%, an anterior coverage ratio of greater than 75% and a posterior coverage ratio of greater than 80% can be categorized in a normal group. Polar edge distance is a good indicator for the evaluation of preoperative and postoperative coverage conditions. For standardization and evaluation of acetabular coverage, the most suitable parameters are the total coverage ratio, anterior coverage ratio, posterior coverage ratio and polar edge distance. However, medial coverage and lateral coverage ratios are indispensable in cases of dysplastic hip because variations between them are so great that acetabuloplasty may be impossible. This program can also be used to classify precisely the type of dysplastic hip.

  14. Simulated type II superior labral anterior posterior lesions do not alter the path of glenohumeral articulation: a cadaveric biomechanical study.

    PubMed

    Youm, Thomas; Tibone, James E; ElAttrache, Neal S; McGarry, Michelle H; Lee, Thay Q

    2008-04-01

    Previous studies have demonstrated increased glenohumeral translations with simulated type II superior labral anterior posterior lesions, which may explain the sensation of instability in the overhead-throwing athlete. It is unknown whether this amount of increased translation alters glenohumeral kinematics. To determine whether type II superior labral anterior posterior lesions significantly alter glenohumeral kinematics as defined by path of glenohumeral articulation in a simulated cadaveric model of the throwing shoulder. Controlled laboratory study. Six cadaveric shoulders were tested for glenohumeral rotational range of motion and translation using a custom shoulder testing system and the Microscribe 3DLX. The path of glenohumeral articulation was measured by calculating the humeral head center with respect to the glenoid articular surface at maximal internal rotation, 30 degrees, 60 degrees, 90 degrees, and maximal external rotation. Data were recorded for vented intact shoulders, shoulders with arthroscopically created type II superior labral anterior posterior lesions, and shoulders with arthroscopically repaired superior labral anterior posterior lesions. A subtle but significant increase in external rotation (2.7 degrees) was seen after creating a type II lesion. Small increases in glenohumeral translation were found in the anterior (0.9 mm) and inferior (0.9 mm) directions with application of a 15-N force in the superior labral anterior posterior group. Increases in glenohumeral rotation and translation were restored to the intact state after repair of the lesion. No significant differences were found in the path of glenohumeral articulation for the superior labral anterior posterior condition compared with the intact shoulder. The small amounts of increased external rotation and translation found with arthroscopically created type II superior labral anterior posterior lesions do not significantly affect glenohumeral kinematics in this passive motion

  15. Return to play after treatment of superior labral tears in professional baseball players.

    PubMed

    Fedoriw, Wasyl W; Ramkumar, Prem; McCulloch, Patrick C; Lintner, David M

    2014-05-01

    The published return-to-play (RTP) rates for athletes who have undergone surgical repair of superior labrum anterior-posterior (SLAP) tears vary widely and are generally accepted to be lower in the subset of competitive throwers. The efficacy of nonsurgical treatment for this group is unknown. Nonsurgical treatment of SLAP tears in professional baseball players leads to RTP before consideration of surgical treatment. Incorporating performance statistics and level of competition will result in lower calculated RTP rates than have been previously reported. Case series; Level of evidence, 4. A retrospective review of 119 consecutive patients in a single professional baseball organization with persistent shoulder pain that limited the ability to compete was performed. Sixty-eight patients had magnetic resonance imaging-documented SLAP lesions. All patients had failed 1 attempt at rehabilitation but had continued with supervised physical therapy. Treatment was according to an algorithm focusing on the correction of scapular dyskinesia and posterior capsular contracture with glenohumeral internal rotation deficit (GIRD), followed by pain-free return to throwing. Those who failed 2 cycles of nonsurgical treatment were treated surgically. Success was defined by 2 different standards: (1) RTP, in accordance with previous studies; and (2) a more stringent standard of return to the same level/quality of professional competition (A, AA, AAA, etc) with the incorporation of a return to preinjury individual performance statistics (earned run average, walks plus hits per inning pitched), termed "return to prior performance" (RPP). Sixty-eight athletes were identified with SLAP lesions. Twenty-one pitchers successfully completed the nonsurgical algorithm and attempted a return. Their RTP rate was 40%, and their RPP rate was 22%. The RTP rate for 27 pitchers who underwent 30 procedures was 48%, and the RPP rate was 7%. For 10 position players treated nonsurgically, the RTP rate was

  16. Evaluation of the three-dimensional bony coverage before and after rotational acetabular osteotomy.

    PubMed

    Tanaka, Takeyuki; Moro, Toru; Takatori, Yoshio; Oshima, Hirofumi; Ito, Hideya; Sugita, Naohiko; Mitsuishi, Mamoru; Tanaka, Sakae

    2018-02-26

    Rotational acetabular osteotomy is a type of pelvic osteotomy that involves rotation of the acetabular bone to improve the bony coverage of the femoral head for patients with acetabular dysplasia. Favourable post-operative long-term outcomes have been reported in previous studies. However, there is a paucity of published data regarding three-dimensional bony coverage. The present study investigated the three-dimensional bony coverage of the acetabulum covering the femoral head in hips before and after rotational acetabular osteotomy and in normal hips. The computed tomography data of 40 hip joints (12 joints before and after rotational acetabular osteotomy; 16 normal joints) were analyzed. The three-dimensional bony coverage of each joint was evaluated using original software. The post-operative bony coverage improved significantly compared with pre-operative values. In particular, the anterolateral aspect of the acetabulum tended to be dysplastic in patients with acetabular dysplasia compared to those with normal hip joints. However, greater bony coverage at the anterolateral aspect was obtained after rotational acetabular osteotomy. Meanwhile, the results of the present study may indicate that the bony coverage in the anterior aspect may be excessive. Three-dimensional analysis indicated that rotational acetabular osteotomy achieved favorable bony coverage. Further investigations are necessary to determine the ideal bony coverage after rotational acetabular osteotomy.

  17. Combat-related acetabular fractures: Outcomes of open versus closed injuries.

    PubMed

    Purcell, Richard L; Donohue, Michael A; Saxena, Sameer K; Gordon, Wade T; Lewandowski, Louis L

    2018-02-01

    Since the onset of the Global War on Terror close to 50,000 United States service members have been injured in combat, many of these injuries would have previously been fatal. Among these injuries, open acetabular fractures are at an increased number due to the high percentage of penetrating injuries such as high velocity gunshot wounds and blast injuries. These injuries lead to a greater degree of contamination, and more severe associated injuries. There is a significantly smaller proportion of the classic blunt trauma mechanism typically seen in civilian trauma. We performed a retrospective review of the Department of Defense Trauma Registry into which all US combat-injured patients are enrolled, as well as reviewed local patient medical records, and radiologic studies from March 2003 to April 2012. Eighty seven (87) acetabular fractures were identified with 32 classified as open fractures. Information regarding mechanism of injury, fracture pattern, transfusion requirements, Injury Severity Score (ISS), and presence of lower extremity amputations was analyzed. The mechanism of injury was an explosive device in 59% (n=19) of patients with an open acetabular fracture; the remaining 40% (n=13) were secondary to ballistic injury. In contrast, in the closed acetabular fracture cohort 38% (21/55) of fractures were due to explosive devices, and all remaining (n=34) were secondary to blunt trauma such as falls, motor vehicle collisions, or aircraft crashes. Patients with open acetabular fractures required a median of 17units of PRBC within the first 24h after injury. The mean ISS was 32 in the open group compared with 22 in the closed group (p=0.003). In the open fracture group nine patients (28%) sustained bilateral lower extremity amputations, and 10 patients (31%) ultimately underwent a hip disarticulation or hemi-pelvectomy as their final amputation level. Open acetabular fractures represent a significant challenge in the management of combat-related injuries. High

  18. Acetabular inclination and anteversion in infants using 3D MR imaging.

    PubMed

    Falliner, A; Muhle, C; Brossmann, J

    2002-03-01

    To establish if 3D MR imaging could be used for measurements of acetabular inclination and anteversion in infants specimens. 3D MR data of 3 pelvic preparations of 6-week- to 10-month-old infant specimens was gathered. MR imaging in transaxial and frontal planes was carried out to measure the acetabular inclination and anteversion: a method to determine the MR planes for measurements is described. It was oriented on anatomical landmarks of the pelvis and therefore allowed adjustment of the frontal and transaxial planes, independent of the pelvis position. The mean acetabular inclination angle was 48 degrees, and the mean acetabular anteversion was 23 degrees. Because of the low number of cases the results can only be assessed as a tendency, but MR imaging seems to be suitable for measurements of acetabular inclination and anteversion.

  19. A novel method to assess primary stability of press-fit acetabular cups.

    PubMed

    Crosnier, Emilie A; Keogh, Patrick S; Miles, Anthony W

    2014-11-01

    Initial stability is an essential prerequisite to achieve osseointegration of press-fit acetabular cups in total hip replacements. Most in vitro methods that assess cup stability do not reproduce physiological loading conditions and use simplified acetabular models with a spherical cavity. The aim of this study was to investigate the effect of bone density and acetabular geometry on cup stability using a novel method for measuring acetabular cup micromotion. A press-fit cup was inserted into Sawbones(®) foam blocks having different densities to simulate normal and osteoporotic bone variations and different acetabular geometries. The stability of the cup was assessed in two ways: (a) measurement of micromotion of the cup in 6 degrees of freedom under physiological loading and (b) uniaxial push-out tests. The results indicate that changes in bone substrate density and acetabular geometry affect the stability of press-fit acetabular cups. They also suggest that cups implanted into weaker, for example, osteoporotic, bone are subjected to higher levels of micromotion and are therefore more prone to loosening. The decrease in stability of the cup in the physiological model suggests that using simplified spherical cavities to model the acetabulum over-estimates the initial stability of press-fit cups. This novel testing method should provide the basis for a more representative protocol for future pre-clinical evaluation of new acetabular cup designs. © IMechE 2014.

  20. 21 CFR 888.3370 - Hip joint (hemi-hip) acetabular metal cemented prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Hip joint (hemi-hip) acetabular metal cemented... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3370 Hip joint (hemi-hip) acetabular metal cemented prosthesis. (a) Identification. A hip joint (hemi-hip) acetabular...

  1. A Novel Approach for Treatment of Acetabular Fractures

    PubMed Central

    Xue, Zichao; Qin, Hui; Ding, Haoliang; An, Zhiquan

    2016-01-01

    Background There is no single approach that provides adequate exposure for treatment of all types of acetabular fractures. We describe our experience with an easier, relatively less invasive pubic symphysis approach (PSA) for the treatment of acetabular fractures. Material/Methods Between March 2011 and March 2012, fifteen patients with acetabular fracture underwent surgery using the PSA technique. Fracture reduction and treatment outcomes were assessed by clinical and radiological examination. Operation time, intraoperative blood loss and postoperative complications were documented. Results Mean operative time was 222±78 minutes. Average blood loss was 993±361 mL. Anatomical reduction was achieved in all patients. Minimum follow-up period was 31 months. Postoperative hypoesthesia in the area of innervation of the lateral femoral cutaneous nerve was reported in one patient, with spontaneous recovery at one month after surgery. No complications were reported during the follow-up period. At the most recent follow up, clinical outcomes were graded as “excellent” in six patients, “good” in eight patients and “fair” in one patient based on the modified Merle d’Aubigné-Postel score. Conclusions PSA appears to be a timesaving and safe approach for treatment of acetabular fractures that affords good visual access and allows for excellent fracture reduction. Our preliminary results revealed a much lower incidence of complications than traditional approaches, suggesting PSA is an alternative for treatment of acetabular fractures. PMID:27734825

  2. 21 CFR 888.3370 - Hip joint (hemi-hip) acetabular metal cemented prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Hip joint (hemi-hip) acetabular metal cemented... (hemi-hip) acetabular metal cemented prosthesis. (a) Identification. A hip joint (hemi-hip) acetabular metal cemented prosthesis is a device intended to be implanted to replace a portion of the hip joint...

  3. Safe surgical technique for associated acetabular fractures

    PubMed Central

    2013-01-01

    Associated acetabular fractures are challenging injuries to manage. The complex surgical approaches and the technical difficulty in achieving anatomical reduction imply that the learning curve to achieve high-quality care of patients with such challenging injuries is extremely steep. This first article in the Journal’s “Safe Surgical Technique” section presents the standard surgical care, in conjunction with intraoperative tips and tricks, for the safe management of all subgroups of associated acetabular fractures. PMID:23414782

  4. Problems With Large Joints: Shoulder Conditions.

    PubMed

    Campbell, Michael

    2016-07-01

    The shoulder is the most mobile joint in the body. It requires an extensive support system to create mobility while providing stability. Although there are many etiologies of shoulder pain, weakness, and instability, most injuries in the shoulder are due to overuse. Rotator cuff tears, labral tears, calcific tendinopathy, and impingement often result from chronic overuse injuries. Acute injuries include dislocations that can cause labral tears or other complications. Frozen shoulder refers to a typically benign condition of restricted range of motion that may spontaneously resolve but can cause prolonged pain and discomfort. The history combined with specific shoulder examination techniques can help family physicians successfully diagnose shoulder conditions. X-ray imaging typically is sufficient to rule out more serious etiologies when evaluating patients with shoulder conditions. However, imaging with magnetic resonance imaging (MRI) study or ultrasonography for rotator cuff tears, and MRI study with intra-articular contrast for labral tears, is needed to confirm these diagnoses. Corticosteroid injections and physical therapy are first-line treatments for most shoulder conditions. Surgical options typically are reserved for patients for whom conservative treatments are ineffective, and typically are performed arthroscopically. Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.

  5. Editorial Commentary: Hip Labral Revision Reconstruction in a Fellowship Training Center: A Report From the Mountains.

    PubMed

    Martin, Hal David

    2018-04-01

    Hip labral reconstruction has proven to be a successful technique in restoring normal labrum function. However, sometimes revision surgery is required. A recent, well-designed prospective study provides significant support for revision labral reconstruction, showing how it leads to improved hip mechanics and reduction in pain. The success of the study design and this report is a testament to an educational institution dedicated to fellowship training. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  6. Intraoperative fluoroscopic evaluation of screw placement during pelvic and acetabular surgery.

    PubMed

    Yi, Chengla; Burns, Sean; Hak, David J

    2014-01-01

    The surgical treatment of pelvic and acetabular fractures can be technically challenging. Various techniques are available for the reconstruction of pelvic and acetabular fractures. Less invasive percutaneous fracture stabilization techniques, with closed reduction or limited open reduction, have been developed and are gaining popularity in the management of pelvic and acetabular fractures. These techniques require knowledge and interpretation of various fluoroscopic images to ensure appropriate and safe screw placement. Given the anatomic complexity of the intrapelvic structures and the 2-dimensional nature of standard fluoroscopy, multiple images oriented in different planes are needed to assess the accuracy of guide wire and screw placement. This article reviews the fluoroscopic imaging of common screw orientations during pelvic and acetabular surgery.

  7. Hip morphology in elite golfers: asymmetry between lead and trail hips.

    PubMed

    Dickenson, Edward; O'Connor, Philip; Robinson, Philip; Campbell, Robert; Ahmed, Imran; Fernandez, Miguel; Hawkes, Roger; Charles, Hutchinson; Griffin, Damian

    2016-09-01

    During a golf swing, the lead hip (left hip in a right-handed player) rotates rapidly from external to internal rotation, while the opposite occurs in the trail hip. This study assessed the morphology and pathology of golfers' hips comparing lead and trail hips. A cohort of elite golfers were invited to undergo MRI of their hips. Hip morphology was evaluated by measuring acetabular depth (pincer shape=negative measure), femoral neck antetorsion (retrotorsion=negative measure) and α angles (cam morphology defined as α angle >55° anteriorly) around the axis of the femoral neck. Consultant musculoskeletal radiologists determined the presence of intra-articular pathology. 55 players (mean age 28 years, 52 left hip lead) underwent MRI. No player had pincer morphology, 2 (3.6%) had femoral retrotorsion and 9 (16%) had cam morphology. 7 trail hips and 2 lead hips had cam morphology (p=0.026). Lead hip femoral neck antetorsion was 16.7° compared with 13.0° in the trail hip (p<0.001). The α angles around the femoral neck were significantly lower in the lead compared with trail hips (p<0.001), with the greatest difference noted in the anterosuperior portion of the head neck junction; 53° vs 58° (p<0.001) and 43° vs 47° (p<0.001). 37% of trail and 16% of lead hips (p=0.038) had labral tears. Golfers' lead and trail hips have different morphology. This is the first time side-to-side asymmetry of cam prevalence has been reported. The trail hip exhibited a higher prevalence of labral tears. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  8. Validation of a Dry Model for Assessing the Performance of Arthroscopic Hip Labral Repair.

    PubMed

    Phillips, Lisa; Cheung, Jeffrey J H; Whelan, Daniel B; Murnaghan, Michael Lucas; Chahal, Jas; Theodoropoulos, John; Ogilvie-Harris, Darrell; Macniven, Ian; Dwyer, Tim

    2017-07-01

    Arthroscopic hip labral repair is a technically challenging and demanding surgical technique with a steep learning curve. Arthroscopic simulation allows trainees to develop these skills in a safe environment. The purpose of this study was to evaluate the use of a combination of assessment ratings for the performance of arthroscopic hip labral repair on a dry model. Cross-sectional study; Level of evidence, 3. A total of 47 participants including orthopaedic surgery residents (n = 37), sports medicine fellows (n = 5), and staff surgeons (n = 5) performed arthroscopic hip labral repair on a dry model. Prior arthroscopic experience was noted. Participants were evaluated by 2 orthopaedic surgeons using a task-specific checklist, the Arthroscopic Surgical Skill Evaluation Tool (ASSET), task completion time, and a final global rating scale. All procedures were video-recorded and scored by an orthopaedic fellow blinded to the level of training of each participant. The internal consistency/reliability (Cronbach alpha) using the total ASSET score for the procedure was high (intraclass correlation coefficient > 0.9). One-way analysis of variance for the total ASSET score demonstrated a difference between participants based on the level of training ( F 3,43 = 27.8, P < .001). A good correlation was seen between the ASSET score and previous exposure to arthroscopic procedures ( r = 0.52-0.73, P < .001). The interrater reliability for the ASSET score was excellent (>0.9). The results of this study demonstrate that the use of dry models to assess the performance of arthroscopic hip labral repair by trainees is both valid and reliable. Further research will be required to demonstrate a correlation with performance on cadaveric specimens or in the operating room.

  9. Proximal Rectus Femoris Avulsion: Ultrasonic Diagnosis and Nonoperative Management

    PubMed Central

    Esser, Stephan; Jantz, David; Hurdle, Mark F.; Taylor, Walter

    2015-01-01

    Objective To present a case of ultrasonic diagnosis and nonoperative management of a complete proximal rectus femoris avulsion in a National Collegiate Athletic Association Division 1 soccer goalkeeper. Background While delivering a goal kick, a previously uninjured 24-year-old collegiate soccer goalkeeper had the sudden onset of right anterior thigh pain. He underwent rehabilitation with rapid resolution of his presenting pain but frequent intermittent recurrence of anterior thigh pain. After he was provided a definitive diagnosis with musculoskeletal ultrasound, he underwent an extended period of rehabilitation and eventually experienced complete recovery without recurrence. Differential Diagnosis Rectus femoris avulsion, rectus femoris strain or partial tear, inguinal hernia, or acetabular labral tear. Treatment Operative and nonoperative options were discussed. In view of the player's recovery, nonoperative options were pursued with a good result. Uniqueness Complete proximal rectus femoris avulsions are rare. Our case contributes to the debate on whether elite-level kicking and running athletes can return to full on-field performance without surgery. Conclusions Complete proximal rectus femoris avulsions can be treated effectively using nonoperative measures with good preservation of function even in the elite-level athlete. In addition, musculoskeletal ultrasound is an excellent tool for on-site evaluation and may help guide prognosis and management. PMID:25978099

  10. Validation of a new radiographic measurement of acetabular version: the transverse axis distance (TAD).

    PubMed

    Nitschke, Ashley; Lambert, Jeffery R; Glueck, Deborah H; Jesse, Mary Kristen; Mei-Dan, Omer; Strickland, Colin; Petersen, Brian

    2015-11-01

    This study has three aims: (1) validate a new radiographic measure of acetabular version, the transverse axis distance (TAD) by showing equivalent TAD accuracy in predicting CT equatorial acetabular version when compared to a previously validated, but more cumbersome, radiographic measure, the p/a ratio; (2) establish predictive equations of CT acetabular version from TAD; (3) calculate a sensitive and specific cut point for predicting excessive CT acetabular anteversion using TAD. A 14-month retrospective review was performed of patients who had undergone a dedicated MSK CT pelvis study and who also had a technically adequate AP pelvis radiograph. Two trained observers measured the radiographic p/a ratio, TAD, and CT acetabular equatorial version for 110 hips on a PACS workstation. Mixed model analysis was used to find prediction equations, and ROC analysis was used to evaluate the diagnostic accuracy of p/a ratio and TAD. CT equatorial acetabular version can accurately be predicted from either p/a ratio (p < 0.001) or TAD (p < 0.001). The diagnostic accuracies of p/a ratio and TAD are comparable (p =0.46). Patients whose TAD is higher than 17 mm may have excessive acetabular anteversion. For that cutpoint, the sensitivity of TAD is 0.73, with specificity of 0.82. TAD is an accurate radiographic predictor of CT acetabular anteversion and provides an easy-to-use and intuitive point-of-care assessment of acetabular version in patients with hip pain.

  11. Three-dimensional finite analysis of acetabular contact pressure and contact area during normal walking.

    PubMed

    Wang, Guangye; Huang, Wenjun; Song, Qi; Liang, Jinfeng

    2017-11-01

    This study aims to analyze the contact areas and pressure distributions between the femoral head and mortar during normal walking using a three-dimensional finite element model (3D-FEM). Computed tomography (CT) scanning technology and a computer image processing system were used to establish the 3D-FEM. The acetabular mortar model was used to simulate the pressures during 32 consecutive normal walking phases and the contact areas at different phases were calculated. The distribution of the pressure peak values during the 32 consecutive normal walking phases was bimodal, which reached the peak (4.2 Mpa) at the initial phase where the contact area was significantly higher than that at the stepping phase. The sites that always kept contact were concentrated on the acetabular top and leaned inwards, while the anterior and posterior acetabular horns had no pressure concentration. The pressure distributions of acetabular cartilage at different phases were significantly different, the zone of increased pressure at the support phase distributed at the acetabular top area, while that at the stepping phase distributed in the inside of acetabular cartilage. The zones of increased contact pressure and the distributions of acetabular contact areas had important significance towards clinical researches, and could indicate the inductive factors of acetabular osteoarthritis. Copyright © 2016. Published by Elsevier Taiwan.

  12. Debonding of porous coating of a threaded acetabular component: retrieval analysis.

    PubMed

    Łapaj, Łukasz; Markuszewski, Jacek; Rybak, Tomasz; Wierusz-Kozłowska, Małgorzata

    2013-01-01

    This report presents a case of debonding of plasma sprayed porous titanium coating from a threaded acetabular component which caused aseptic loosening of the implant. Weight bearing after delamination caused abrasive damage of the acetabular shell, and particles of the coating embedded in the acetabular liner. Microscopic examination of periprosthetic tissues showed presence of metal particles and macrophage infiltration. Despite microscopic examination of the retrieved component the cause of debonding remains unclear. Copyright © 2012 Elsevier Ltd. All rights reserved.

  13. Return to Play and Prior Performance in Major League Baseball Pitchers After Repair of Superior Labral Anterior-Posterior Tears.

    PubMed

    Smith, Ryan; Lombardo, Daniel J; Petersen-Fitts, Graysen R; Frank, Charles; Tenbrunsel, Troy; Curtis, Gannon; Whaley, James; Sabesan, Vani J

    2016-12-01

    The published return-to-play (RTP) rates for Major League Baseball (MLB) pitchers who have undergone surgical repair of superior labrum anterior-posterior (SLAP) tears vary widely and are generally accepted to be lower in the subset of competitive throwers. The efficacy of surgical treatment for MLB players is largely unknown. To examine the RTP rate and performance of MLB pitchers who have undergone SLAP tear repair between 2003 and 2010. Descriptive epidemiological study. A retrospective review of MLB pitchers undergoing SLAP repair was performed using the MLB disabled list. Data collected included the following player statistics: earned run average (ERA), walks plus hits per inning pitched (WHIP), and innings pitched (IP). The mean values for performance variables both before and after surgery were compared. A definition of return to prior performance (RTPP) was established as an ERA within 2.00 and WHIP within 0.500 of preoperative values. Twenty-four MLB players met inclusion criteria, of which 62.5% were able to RTP at the MLB level after SLAP repair surgery. Of those able to RTP, 86.7% were able to RTPP. However, the overall rate of RTPP, including those unable to RTP, was 54.2%. Mean performance analysis of the RTP group revealed a statistically significant decrease in IP for MLB pitchers throwing a mean 101.8 innings before injury and 65.53 innings after injury ( P = .004). Of those pitchers able to RTP, chances of a full recovery were good (86.7%). Our results indicate the need for future research aimed at proper surgical selection of who will return to play, as they will likely achieve full recovery. We believe this information can help surgeons advise high-level overhead-throwing athletes about expected outcomes for surgical treatment of SLAP tears.

  14. Bone preserving techniques for explanting the well-fixed cemented acetabular component.

    PubMed

    Stevens, Jarrad; Macpherson, Gavin; Howie, Colin

    2018-06-01

    Removal of a well-fixed, cemented acetabular component at the time of revision hip surgery can be complex. It is essential to remove the implant and cement mantle in a timely fashion while preserving bone stock and osseous integrity. The biomechanical properties of polymethylmethacrylate cement and polyethylene can be utilised to aid with the removal of well cemented implants which are often harder than the surrounding bone. While removal of loose components may be relatively straightforward, the challenge for the revision arthroplasty surgeon often involves the removal of well-fixed implants. Here, we present three established techniques for the removal of a well-fixed cemented acetabular component and one novel modification we have described before. We collate and review four techniques for removing well-fixed cemented acetabular implants that utilise the different biomechanical properties of bone cement and polyethylene. These techniques are illustrated with a photographic series utilising saw bones. A step-by-step approach to our new technique is shown in photographs, both in the clinical setting and with a "Sawbone". This is accompanied by a clinical video that details the surgical technique in its entirety. These techniques utilise different biomechanical principles to extract the acetabular component. Each technique has advantages and disadvantages. Our new technique is a simplification of a previously published extraction manoeuvre that utilises tensile force between cement and the implant to remove the polyethylene cup. This is a safe and reproducible technique in patients with a well-fixed cemented acetabular implant. Understanding the biomechanical properties of polymethylmethacrylate bone cement and polyethylene can aid in the safe removal of a well-fixed cemented acetabular component in revision hip surgery. The optimal technique for removal of a cemented acetabular component varies depending on a number of patient and implant factors. This summary of

  15. Arthroscopic repair of a chondrolabral lesion associated with anterior glenohumeral dislocation.

    PubMed

    Page, Richard; Bhatia, Deepak N

    2010-12-01

    Chondrolabral lesions are uncommon after anteroinferior glenohumeral dislocations. This report describes a new dual-lesion complex that involved an avulsion of the anteroinferior glenoid labrum and a flap tear of the adjacent articular cartilage [glenoid labral tear and articular cartilage flap (GLAF) lesion]. The chondral component involved a large undermined region of the anterior half of the lower glenoid articular cartilage, and the labral component involved an avulsion from the 2.30-6 o'clock position on the glenoid. The labral tear was reconstructed with 3 suture anchors to form a neo-labrum in an attempt to overlap and stabilize the periphery of the chondral flap. A meniscal repair device was used to place a mattress stitch in the cartilage periphery to further stabilize the flap. This technique resulted in a secure repair without any chondral damage, and this remained intact on an MRI performed at a 3-month follow-up. A final 12-month follow-up showed complete recovery, as assessed by the Oxford shoulder instability score and Rowe score, and by a return to the pre-injury sporting level.

  16. Sham surgery versus labral repair or biceps tenodesis for type II SLAP lesions of the shoulder: a three-armed randomised clinical trial.

    PubMed

    Schrøder, Cecilie Piene; Skare, Øystein; Reikerås, Olav; Mowinckel, Petter; Brox, Jens Ivar

    2017-12-01

    Labral repair and biceps tenodesis are routine operations for superior labrum anterior posterior (SLAP) lesion of the shoulder, but evidence of their efficacy is lacking. We evaluated the effect of labral repair, biceps tenodesis and sham surgery on SLAP lesions. A double-blind, sham-controlled trial was conducted with 118 surgical candidates (mean age 40 years), with patient history, clinical symptoms and MRI arthrography indicating an isolated type II SLAP lesion. Patients were randomly assigned to either labral repair (n=40), biceps tenodesis (n=39) or sham surgery (n=39) if arthroscopy revealed an isolated SLAP II lesion. Primary outcomes at 6 and 24 months were clinical Rowe score ranging from 0 to 100 (best possible) and Western Ontario Shoulder Instability Index (WOSI) ranging from 0 (best possible) to 2100. Secondary outcomes were Oxford Instability Shoulder Score, change in main symptoms, EuroQol (EQ-5D and EQ-VAS), patient satisfaction and complications. There were no significant between-group differences at any follow-up in any outcome. Between-group differences in Rowe scores at 2 years were: biceps tenodesis versus labral repair: 1.0 (95% CI -5.4 to 7.4), p=0.76; biceps tenodesis versus sham surgery: 1.6 (95% CI -5.0 to 8.1), p=0.64; and labral repair versus sham surgery: 0.6 (95% CI -5.9 to 7.0), p=0.86. Similar results-no differences between groups-were found for WOSI scores. Postoperative stiffness occurred in five patients after labral repair and in four patients after tenodesis. Neither labral repair nor biceps tenodesis had any significant clinical benefit over sham surgery for patients with SLAP II lesions in the population studied. ClinicalTrials.gov identifier: NCT00586742. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  17. Correlation of clinical and magnetic resonance imaging findings in hips of elite female ballet dancers.

    PubMed

    Duthon, Victoria B; Charbonnier, Caecilia; Kolo, Frank C; Magnenat-Thalmann, Nadia; Becker, Christophe D; Bouvet, Cindy; Coppens, Elia; Hoffmeyer, Pierre; Menetrey, Jacques

    2013-03-01

    To understand why professional female ballet dancers often complain of inguinal pain and experience early hip osteoarthritis (OA). Goals were to examine clinical and advanced imaging findings in the hips of dancers compared with those in a matched cohort of nondancers and to assess the femoral head translation in the forward split position using magnetic resonance imaging (MRI). Twenty professional female ballet dancers and 14 active healthy female individuals matched for age (control group) completed a questionnaire on hip pain and underwent hip examination with impingement tests and measurement of passive hip range of motion (ROM). All had a pelvic 1.5 T MRI in the back-lying position to assess femoroacetabular morphologic features and lesions. For the dancers, additional MR images were acquired in the split position to evaluate femoroacetabular congruency. Twelve of 20 dancers complained of groin pain only while dancing; controls were asymptomatic. Dancers' passive hip ROM was normal. No differences in α neck angle, acetabular depth, acetabular version, and femoral neck anteversion were found between dancers and controls. MRI of dancers while performing splits showed a mean femoral head subluxation of 2.05 mm. MRI of dancers' hips showed labral tears, cartilage thinning, and herniation pits, located in superior and posterosuperior positions. Lesions were the same for symptomatic and asymptomatic dancers. Controls had proportionally the same number of labral lesions but in an anterosuperior position. They also had 2 to 3 times fewer cartilage lesions and pits than did dancers. The results of our study are consistent with our hypothesis that repetitive extreme movements can cause femoral head subluxations and femoroacetabular abutments in female ballet dancers with normal hip morphologic features, which could result in early OA. Pathologic changes seen on MRI were symptomatic in less than two thirds of the dancers. Level IV, therapeutic case series. Copyright

  18. Controversies in Treatment of Acetabular Fracture

    PubMed Central

    Grubor, Predrag; Krupic, Ferid; Biscevic, Mirza; Grubor, Milan

    2015-01-01

    Introduction: Acetabular fractures treatment represents a great controversy, challenge and dilemma for an orthopedic surgeon. Aim: The aim of the paper was to present the results of treatment of 96 acetabular fractures in the Clinic of Traumatology Banja Luka, in the period from 2003 to 2013, as well as to raise awareness regarding the controversy in the methods of choice in treating acetabulum fractures. Material and methods: The series consists of 96 patients, 82 males and 14 females, average age 40.5 years. Traffic trauma was the cause of fractures in 79 patients (85%), and in 17 patients (15%) fractures occurred due to falls from height. Polytrauma was present in 31 patients (32%). According to the classification of Judet and Letournel, representation of acetabular fractures was as follows: posterior wall in 32 patients, posterior column in 28, anterior wall in 4, anterior column in 2, transverse fractures in 8, posterior wall and posterior column in 10, anterior and posterior wall in 6, both- column in 4 and transversal fracture and posterior wall in 2 patients. 14 patients were treated with traction, that is, 6 patients with femoral traction and 8 patients with both lateral and femoral traction. 82 patients (86.4%) were surgically treated. Kocher-Langenbeck approach was applied in the treatment of 78 patients. In two patients from the Kocher-Langenbeck’s approach, the Ollier’s approach had to be applied as well. Two acetabular were primarily treated with Ollier’s approach. Extended Smith- Peterson’s approach was applied 4 times, and Emile Letournel’s (ilioinguinal) approach 14 times. Results: Functional outcome (after follow-up of 18 months), according to the Harris hip score of surgical treatment in 82 patients, was as follows: good 46 (56%), satisfactory 32 (39%) and poor 4 (5%). Results of acetabulum fractures treated with traction were: good 8 (57%), satisfactory 4 (28%) and poor 2 (15%). According to the Brook’s classification of heterotopic

  19. Does a cemented cage improve revision THA for severe acetabular defects?

    PubMed

    Hansen, Erik; Shearer, David; Ries, Michael D

    2011-02-01

    Evidence suggests a growing incidence of revision total hip arthroplasty (THA) including a subset with large acetabular defects. Revision THA for severe acetabular bone loss is associated with a relatively high rate of mechanical failure. We questioned whether cementing a cage to the reconstructed acetabular defect and pelvis would improve the rate of mechanical failure for patients with Type 3 defects (Paprosky et al.) with and without pelvic discontinuity in comparison to historical controls. We retrospectively collected data on 33 patients who underwent 35 revision THAs using an acetabular reconstruction cage cemented to morselized allograft and either structural allograft or trabecular metal augmentation for Type 3 defects in the presence (n = 13) and absence (n = 22) of pelvic discontinuity at a mean followup of 59 months (range, 24-92 months). The primary outcome was mechanical failure, defined as revision of the acetabular reconstruction for aseptic loosening. Revision surgery for mechanical failure occurred in four of the 13 patients with pelvic discontinuity and two of the 22 patients without discontinuity. Radiographic loosening occurred in one patient with and one patient without pelvic discontinuity. Seven of the 35 revisions were subsequently revised for deep infection all in patients who were immunocompromised. Cementing the cage to the pelvis can offer an advantage for treating severe acetabular defects. Trabecular metal augmentation appears to provide better initial mechanical stability than a structural allograft, but successful allograft reconstruction may restore bone stock. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

  20. Structure and microanalysis of tear film ferning of camel tears, human tears, and Refresh Plus.

    PubMed

    Am, Masmali; Ra, Fagehi; El-Naggar, Ahmad H; Tm, Almubrad

    2018-01-01

    This study aimed to investigate the tear ferning pattern and chemical elements of the tear film of camel tears compared with human tears and Refresh Plus eye lubricant. Refresh Plus was used as a control because it provides a healthy ferning pattern, due to the presence of an optimum ratio of carboxymethylcellulose (CMC) sodium and electrolytes. The main research focus is elucidating the viability of camel tear film in the dry, harsh environment of the desert. The tears were collected from five camels, five male desert workers (20-25 years old) at a small village located 100 km from Riyadh, Saudi Arabia, and five male subjects (20-25 years old) from Riyadh. A small drop (1 μl) of tears was dried on a glass slide and observed under a light (Olympus BX1) and scanning electron microscope (Inspect S50, Field Electron and Ion Company [FEI]). Energy-dispersive X-ray spectroscopy (EDS) of the tear film and Refresh Plus were investigated with a JEOL 1400 scanning transmission electron microscope. The camel tear film pattern was surrounded by thick, peripheral, homogenous layers containing small oily droplets, particles, and tiny branches in the tear ferning. The tear ferning of the camel was grade 0-1, whereas the tear ferning of human tears and Refresh Plus was grade 1-2. The mass percentage of chloride was highest in the camel tears. The mass percentage of potassium in the camel tears was greater than that in the human tears, but it was less than that in the Refresh Plus lubricant. Camel tears exhibit a better quality than human tears and Refresh Plus lubricant do. The presence of oily droplet-like structures at the periphery of tear ferning suggests that camel tear film may have a higher quality and quantity of minerals and lubricants, which may help the animal to avoid eye dryness. Future work is required to investigate the identification of the elements present in the peripheral and central part of the tear ferning.

  1. Meniscal tears missed on MR imaging: relationship to meniscal tear patterns and anterior cruciate ligament tears.

    PubMed

    De Smet, A A; Graf, B K

    1994-04-01

    MR imaging of the knee is a valuable technique for diagnosing meniscal tears, but some tears found at arthroscopy are not shown on MR imaging. The purpose of this study was to determine whether or not tears were more frequently missed in the presence of an anterior cruciate ligament tear or when tears had certain locations or configurations. We reviewed the original MR reports and surgical records of 400 patients who had both an MR examination and arthroscopy of the knee. Using chi 2 analysis, we examined how the sensitivity for detecting meniscal tears varied with the presence of a tear of the anterior cruciate ligament, with the location of the tear within the meniscus, and among six configurations of meniscal tears. We also studied whether sensitivity decreased with an increasing delay between MR examination and arthroscopy. In the presence of a tear of the anterior cruciate ligament, the sensitivity decreased from 0.97 to 0.88 (p = .016) for medial meniscal tears and from 0.94 to 0.69 (p = .0005) for lateral tears. The overall sensitivity for lateral meniscal tears was significantly less for posterior (p = .001) and peripheral (p = .005) tears than for other tear locations or configurations. The sensitivities did not significantly differ between tear locations and configurations in the medial meniscus or with an increasing delay until arthroscopy. Patients with a torn anterior cruciate ligament were more likely to have peripheral tears of the medial meniscus (p = .00004) and posterior (p = .0004) and peripheral (p = .04) tears of the lateral meniscus. Because of their location and configuration, meniscal tears associated with an anterior cruciate ligament injury are more difficult to detect on MR images than are tears in knees with an intact ligament. If a tear of the anterior cruciate ligament is detected, special attention should be given to the subtle peripheral tears that may be present in either meniscus, but most commonly in the posterior horn of the

  2. Computer assisted surgery in preoperative planning of acetabular fracture surgery: state of the art.

    PubMed

    Boudissa, Mehdi; Courvoisier, Aurélien; Chabanas, Matthieu; Tonetti, Jérôme

    2018-01-01

    The development of imaging modalities and computer technology provides a new approach in acetabular surgery. Areas covered: This review describes the role of computer-assisted surgery (CAS) in understanding of the fracture patterns, in the virtual preoperative planning of the surgery and in the use of custom-made plates in acetabular fractures with or without 3D printing technologies. A Pubmed internet research of the English literature of the last 20 years was carried out about studies concerning computer-assisted surgery in acetabular fractures. The several steps for CAS in acetabular fracture surgery are presented and commented by the main author regarding to his personal experience. Expert commentary: Computer-assisted surgery in acetabular fractures is still initial experiences with promising results. Patient-specific biomechanical models considering soft tissues should be developed to allow a more realistic planning.

  3. The tear turnover and tear clearance tests - a review.

    PubMed

    Garaszczuk, Izabela K; Montes Mico, Robert; Iskander, D Robert; Expósito, Alejandro Cerviño

    2018-03-01

    The aim is to provide a summary of methods available for the assessment of tear turnover and tear clearance rates. The review defines tear clearance and tear turnover and describes their implication for ocular surface health. Additionally, it describes main types of techniques for measuring tear turnover, including fluorescein tear clearance tests, techniques utilizing electromagnetic spectrum and tracer molecule and novel experimental techniques utilizing optical coherence tomography and fluorescein profilometry. Areas covered: Internet databases (PubMed, Science Direct, Google Scholar) and most frequently cited references were used as a principal resource of information on tear turnover rate and tear clearance rate, presenting methodologies and equipment, as well as their definition and implications for the anterior eye surface health and function. Keywords used for data-search were as follows: tear turnover, tear clearance, fluorescein clearance, scintigraphy, fluorophotometry, tear flow, drainage, tear meniscus dynamics, Krehbiel flow and lacrimal functional unit. Expert commentary: After decades, the topic of tear turnover assessment has been reintroduced. Recently, new techniques have been developed to propose less invasive, less time consuming and simpler methodologies for the assessment of tear dynamics that have the potential to be utilized in clinical practice.

  4. Decreased Lumbar Lordosis and Deficient Acetabular Coverage Are Risk Factors for Subchondral Insufficiency Fracture.

    PubMed

    Jo, Woo Lam; Lee, Woo Suk; Chae, Dong Sik; Yang, Ick Hwan; Lee, Kyoung Min; Koo, Kyung Hoi

    2016-10-01

    Subchondral insufficiency fracture (SIF) of the femoral head occurs in the elderly and recipients of organ transplantation. Osteoporosis and deficient lateral coverage of the acetabulum are known risk factors for SIF. There has been no study about relation between spinopelvic alignment and anterior acetabular coverage with SIF. We therefore asked whether a decrease of lumbar lordosis and a deficiency in the anterior acetabular coverage are risk factors. We investigated 37 patients with SIF. There were 33 women and 4 men, and their mean age was 71.5 years (59-85 years). These 37 patients were matched with 37 controls for gender, age, height, weight, body mass index and bone mineral density. We compared the lumbar lordosis, pelvic incidence, pelvic tilt, sacral slope, acetabular index, acetabular roof angle, acetabular head index, anterior center-edge angle and lateral center-edge angle. Lumbar lordosis, pelvic tilt, sacral slope, lateral center edge angle, anterior center edge angle, acetabular index and acetabular head index were significantly different between SIF group and control group. Lumbar lordosis (OR = 1.11), lateral center edge angle (OR = 1.30) and anterior center edge angle (OR = 1.27) had significant associations in multivariate analysis. Decreased lumbar lordosis and deficient anterior coverage of the acetabulum are risk factors for SIF as well as decreased lateral coverage of the acetabulum.

  5. Intraoperative CT in the assessment of posterior wall acetabular fracture stability.

    PubMed

    Cunningham, Brian; Jackson, Kelly; Ortega, Gil

    2014-04-01

    Posterior wall acetabular fractures that involve 10% to 40% of the posterior wall may or may not require an open reduction and internal fixation. Dynamic stress examination of the acetabular fracture under fluoroscopy has been used as an intraoperative method to assess joint stability. The aim of this study was to demonstrate the value of intraoperative ISO computed tomography (CT) examination using the Siemens ISO-C imaging system (Siemens Corp, Malvern, Pennsylvania) in the assessment of posterior wall acetabular fracture stability during stress examination under anesthesia. In 5 posterior wall acetabular fractures, standard fluoroscopic images (including anteroposterior pelvis and Judet radiographs) with dynamic stress examinations were compared with the ISO-C CT imaging system to assess posterior wall fracture stability during stress examination. After review of standard intraoperative fluoroscopic images under dynamic stress examination, all 5 cases appeared to demonstrate posterior wall stability; however, when the intraoperative images from the ISO-C CT imaging system demonstrated that 1 case showed fracture instability of the posterior wall segment during stress examination, open reduction and internal fixation was performed. The use of intraoperative ISO CT imaging has shown an initial improvement in the surgeon's ability to assess the intraoperative stability of posterior wall acetabular fractures during stress examination when compared with standard fluoroscopic images. Copyright 2014, SLACK Incorporated.

  6. Validity and reliability of the Paprosky acetabular defect classification.

    PubMed

    Yu, Raymond; Hofstaetter, Jochen G; Sullivan, Thomas; Costi, Kerry; Howie, Donald W; Solomon, Lucian B

    2013-07-01

    The Paprosky acetabular defect classification is widely used but has not been appropriately validated. Reliability of the Paprosky system has not been evaluated in combination with standardized techniques of measurement and scoring. This study evaluated the reliability, teachability, and validity of the Paprosky acetabular defect classification. Preoperative radiographs from a random sample of 83 patients undergoing 85 acetabular revisions were classified by four observers, and their classifications were compared with quantitative intraoperative measurements. Teachability of the classification scheme was tested by dividing the four observers into two groups. The observers in Group 1 underwent three teaching sessions; those in Group 2 underwent one session and the influence of teaching on the accuracy of their classifications was ascertained. Radiographic evaluation showed statistically significant relationships with intraoperative measurements of anterior, medial, and superior acetabular defect sizes. Interobserver reliability improved substantially after teaching and did not improve without it. The weighted kappa coefficient went from 0.56 at Occasion 1 to 0.79 after three teaching sessions in Group 1 observers, and from 0.49 to 0.65 after one teaching session in Group 2 observers. The Paprosky system is valid and shows good reliability when combined with standardized definitions of radiographic landmarks and a structured analysis. Level II, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.

  7. Arthroscopic labral repair of the hip, using a through-labral double-stranded single-pass suture technique.

    PubMed

    Ye, Ken; Singh, Parminder J

    2014-10-01

    The normal labrum is crucial to the biomechanical function of the hip joint, not only increasing the surface area and depth of the acetabulum but also maintaining a suction seal to assist in normal synovial fluid flow from the peripheral to the central compartment. Simple loop suture repairs of the labrum may evert the labrum, thus losing the optimal seal, as well as causing abrasion of the articular cartilage. Vertical mattress suture and labral base fixation techniques aim to leave the free edge of the labrum intact and undisturbed, therefore improving the contact of the labrum to the femoral head and neck to improve the seal of the acetabulum. We aim to describe a double-stranded single-pass vertical mattress suture technique that may allow greater versatility to the surgeon in repairing thinner labrums while still achieving a free and continuous free edge.

  8. The Transverse Acetabular Ligament as an Intraoperative Guide to Cup Abduction.

    PubMed

    Hiddema, Willem B; van der Merwe, Johan F; van der Merwe, Werner

    2016-07-01

    The success of a total hip arthroplasty relies on optimal acetabular cup placement to ensure mating of the femoral head and acetabular cup throughout all positions of the hip joint. Poor cup placement is associated with dislocation, impingement, microseparation, component loosening, and accelerated wear due to rim loading. This study examined a novel method of using the transverse acetabular ligament (TAL) to guide cup inclination during primary total hip arthroplasty. A descriptive study using 16 hips from 9 cadavers. A computer navigation system measured inclination and version of the acetabular component in 3 positions with the lower edge of cup: (1) flush with, (2) 5 mm proximal to, and (3) 5 mm distal to free border of the TAL. The median inclination angles were 44° in position (1), 30° in position (2), and 64° in position (3). The median anteversion angle for all positions was 19°. Cup inclination was acceptable when the lower edge of the cup was flush or within 5 mm proximal to the TAL. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Sacroiliac joint dysfunction as a reason for the development of acetabular retroversion: a new theory.

    PubMed

    Cibulka, Michael T

    2014-05-01

    Acetabular retroversion has been recently implicated as an important factor in the development of femoral acetabular impingement and hip osteoarthritis. The proper function of the hip joint requires that the anatomic features of the acetabulum and femoral head complement one another. In acetabular retroversion, the alignment of the acetabulum is altered where it opens in a posterolaterally instead of anterior direction. Changes in acetabular orientation can occur with alterations in pelvic tilt (anterior/posterior), and pelvic rotation (left/right). An overlooked problem that alters pelvic tilt and rotation, often seen by physical therapists, is sacroiliac joint dysfunction. A unique feature that develops in patients with sacroiliac joint dysfunction (SIJD) is asymmetry between the left and right innominate bones that can alter pelvic tilt and rotation. This article puts forth a theory suggesting that acetabular retroversion may be produced by sacroiliac joint dysfunction.

  10. Is anatomic acetabular orientation related to pelvic morphology? CT analysis of 150 healthy pelvises.

    PubMed

    Sautet, P; Giorgi, H; Chabrand, P; Tropiano, P; Argenson, J-N; Parratte, S; Blondel, B

    2018-05-01

    Links between sagittal spinal alignment and acetabular orientation attract considerable research attention with the goal of optimising prosthetic cup position. However, whether pelvic incidence (PI) is related to anatomic acetabular orientation remains unknown. We therefore conducted a radiological study with the following objectives: to look for correlations between PI and anatomic acetabular parameters; to describe the sacro-pubic angle (SPA), defined by fixed bony pelvic landmarks, and its relations with acetabular anteversion; and to determine whether anatomical parameters (PI and SPA) correlate with demographic characteristics. PI correlates with anatomical acetabular parameters. We conducted a computed tomography (CT) study of the pelvises of 150 patients free of degenerative disease. Three parameters were measured: anatomic acetabular orientation in the Lewinnek reference plane, PI, and the SPA subtended by the line connecting the midpoint of the sacral endplate to the pubic symphysis and the anterior pelvic plane. Statistical tests were performed to look for correlations among these parameters. Intra-observer and inter-observer reproducibility was considered highly satisfactory (inter-class correlation coefficient, >86% and >82%, respectively). Mean PI was 58.6°±10.2° (range, 32.8°-97.6°), with no significant differences between genders or across age groups. Mean SPA was 34.7°±5.5° (range, 18.3°-49.8°). Mean anatomic acetabular anteversion (AAA) was greater in females (23.4°; range, 11.5°-34.5°) than in males (20°; range, 7.5°-34.5°) (P<0.001). PI did not correlate with any of the acetabular parameters (PI/AAA, r=0.8 and P=0.33; PI/acetabular inclination on the horizontal, r=-0.96 and P=0.24). SPA correlated significantly with both PI (r=0.33 and P<0.001) and AAA (r=0.33 and P<0.001). This CT study of normal pelvises showed that AAA was significantly greater in females and that SPA correlated significantly with both PI and acetabular

  11. Acetabular cartilage defects cause altered hip and knee joint coordination variability during gait.

    PubMed

    Samaan, Michael A; Teng, Hsiang-Ling; Kumar, Deepak; Lee, Sonia; Link, Thomas M; Majumdar, Sharmila; Souza, Richard B

    2015-12-01

    Patients with acetabular cartilage defects reported increased pain and disability compared to those without acetabular cartilage defects. The specific effects of acetabular cartilage defects on lower extremity coordination patterns are unclear. The purpose of this study was to determine hip and knee joint coordination variability during gait in those with and without acetabular cartilage defects. A combined approach, consisting of a semi-quantitative MRI-based quantification method and vector coding, was used to assess hip and knee joint coordination variability during gait in those with and without acetabular cartilage lesions. The coordination variability of the hip flexion-extension/knee rotation, hip abduction-adduction/knee rotation, and hip rotation/knee rotation joint couplings were reduced in the acetabular lesion group compared to the control group during loading response of the gait cycle. The lesion group demonstrated increased variability in the hip flexion-extension/knee rotation and hip abduction-adduction/knee rotation joint couplings, compared to the control group, during the terminal stance/pre-swing phase of gait. Reduced variability during loading response in the lesion group may suggest reduced movement strategies and a possible compensation mechanism for lower extremity instability during this phase of the gait cycle. During terminal stance/pre-swing, a larger variability in the lesion group may suggest increased movement strategies and represent a compensation or pain avoidance mechanism caused by the load applied to the hip joint. Copyright © 2015 Elsevier Ltd. All rights reserved.

  12. Reconstruction of the pelvic brim and its role in the reduction accuracy of displaced T-shaped acetabular fracture.

    PubMed

    Harnroongroj, T; Asavamongkolkul, A; Chareancholvanich, K

    2000-05-01

    Open reduction of the displaced T-shaped acetabular fracture has a problem of accuracy of the fracture reduction. This study was carried out to demonstrate that the reconstruction of the pelvic brim by approaching the pubo-acetabular fragment plays a role in the accuracy of the reduction of displaced T-shaped acetabular fractures. From 1975 to 1990, a retrospective study was carried out of 22 patients who sustained a displaced T-shaped acetabular fracture. The patients were operated on by open reduction and internal fixation of the ischio-acetabular fragment to the posterior column without restoration of the pelvic brim. Radiographs of the pelvis were reviewed. The result showed that there was displacement of the pubo-acetabular fragment including the medial wall in all cases. As the result of this study, a prospective study between 1990 and 1997 was carried out of 15 patients who sustained displaced T-shaped acetabular fractures including 3 cases with medial displacement of the femoral head. The pubo-acetabular fragment was anatomically reduced and fixed to the anterior column of the acetabulumn as the first approach to restore a disrupted pelvic brim. There, patterns of the acetabular fracture were subsequently re-evaluated especially the ischio-acetabular fragment including the position of the femoral head by using an intraoperative portable X-ray technique. The stability of the hip joint was assessed by hip flexion. The intraoperative radiograph appearances of the ischio-acetabular fragment were visually confirmed by a second surgical exposure. The results showed that the intraoperative radiographs gave spontaneous reduction of the ischio-acetabular fragment in all patients except one. There was a reduction of the displaced femoral head into the hip socket in the three patients. The hip joints were stable in all patients. The second surgical exposure showed that there was good spontaneous reduction of the ischio-acetabular fragment to the posterior column by

  13. Extreme hip motion in professional ballet dancers: dynamic and morphological evaluation based on magnetic resonance imaging.

    PubMed

    Kolo, Frank C; Charbonnier, Caecilia; Pfirrmann, Christian W A; Duc, Sylvain R; Lubbeke, Anne; Duthon, Victoria B; Magnenat-Thalmann, Nadia; Hoffmeyer, Pierre; Menetrey, Jacques; Becker, Christoph D

    2013-05-01

    To determine the prevalence of femoroacetabular impingement (FAI) of the cam or pincer type based on magnetic resonance imaging (MRI) in a group of adult female professional ballet dancers, and to quantify, in vivo, the range of motion (ROM) and congruence of the hip joint in the splits position. Institutional review board approval and informed consent from each volunteer were obtained. Thirty symptomatic or asymptomatic adult female professional ballet dancers (59 hips) and 14 asymptomatic non-dancer adult women (28 hips, control group) were included in the present study. All subjects underwent MRI in the supine position, while, for the dancers, additional images were acquired in the splits position. Labral abnormalities, cartilage lesions, and osseous abnormalities of the acetabular rim were assessed at six positions around the acetabulum. A morphological analysis, consisting of the measurement of the α angle, acetabular depth, and acetabular version, was performed. For the dancers, ROM and congruency of the hip joint in the splits position were measured. Acetabular cartilage lesions greater than 5 mm were significantly more frequent in dancer's hips than in control hips (28.8 vs 7.1%, p = 0.026), and were mostly present at the superior position in dancers. Distribution of labral lesions between the dancers and the control group showed substantially more pronounced labral lesions at the superior, posterosuperior, and anterosuperior positions in dancers (54 lesions in 28 dancer's hips vs 10 lesions in 8 control hips). Herniation pits were found significantly more often (p = 0.002) in dancer's hips (n = 31, 52.5%), 25 of them being located in a superior position. A cam-type morphology was found for one dancer and a retroverted hip was noted for one control. Femoroacetabular subluxations were observed in the splits position (mean: 2.05 mm). The prevalence of typical FAI of the cam or pincer type was low in this selected population of professional ballet

  14. Comparative study of comminuted posterior acetabular wall fracture treated with the Acetabular Tridimensional Memory Fixation System.

    PubMed

    Zhang, Yuntong; Zhao, Xue; Tang, Yang; Zhang, Chuncai; Xu, Shuogui; Xie, Yang

    2014-04-01

    Posterior wall fractures are one of the most common acetabular fractures. However, only 30% of these fractures involve a single large fragment, and comminuted acetabular posterior wall fractures pose a particular surgical challenge. The purpose of this study was to compare outcomes between patients who received fixation for comminuted posterior wall fracture using the Acetabular Tridimensional Memory Fixation System (ATMFS) and patients who underwent fixation with conventional screws and buttress plates (Plates group). Between April 2003 and May 2007, 196 consecutive patients who sustained a comminuted posterior wall fracture of acetabulum were treated with ATMFS or conventional screws and buttress plates. Operative time, fluoroscopy time, blood loss, and any intra-operative complications were recorded. Plain AP and lateral radiographs were obtained at all visits (Matta's criteria). Modified Merle d' Aubigne-Postel score, and Mos SF-36 score were compared between groups. Fifty patients were included in the analysis with 26 in the ATMFS group and 24 in the Plates group. The mean follow-up time was 57.5 months, ranging from 31 to 69 months. All patients had fully healed fractures at the final follow-up. There was no difference in clinical outcomes or radiological evaluations between groups. Patients with comminuted posterior wall fractures of the acetabulum treated with the ATMFS or conventional screws and buttress plate techniques achieve a good surgical result. Both techniques are safe, reliable, and practical. Use of the ATMFS technique may reduce blood loss and improve rigid support to marginal bone impaction. The use ATMFS may need additional support when fractures involve the superior roof. Copyright © 2013 Elsevier Ltd. All rights reserved.

  15. Cement-in-cement acetabular revision with a constrained tripolar component.

    PubMed

    Leonidou, Andreas; Pagkalos, Joseph; Luscombe, Jonathan

    2012-02-17

    Dislocation of a total hip replacement (THR) is common following total hip arthroplasty (THA). When nonoperative management fails to maintain reduction, revision surgery is considered. The use of constrained acetabular liners has been extensively described. Complete removal of the old cement mantle during revision THA can be challenging and is associated with significant complications. Cement-in-cement revision is an established technique. However, the available clinical and experimental studies focus on femoral stem revision. The purpose of this study was to present a case of cement-in-cement acetabular revision with a constrained component for recurrent dislocations and to investigate the current best evidence for this technique. This article describes the case of a 74-year-old woman who underwent revision of a Charnley THR for recurrent low-energy dislocations. A tripolar constrained acetabular component was cemented over the primary cement mantle following removal of the original liner by reaming, roughening the surface, and thoroughly irrigating and drying the primary cement. Clinical and radiological results were good, with the Oxford Hip Score improving from 11 preoperatively to 24 at 6 months postoperatively. The good short-term results of this case and the current clinical and biomechanical data encourage the use of the cement-in-cement technique for acetabular revision. Careful irrigation, drying, and roughening of the primary surface are necessary. Copyright 2012, SLACK Incorporated.

  16. Calcification of the acetabular labrum of the hip: prevalence in the general population and relation to hip articular cartilage and fibrocartilage degeneration.

    PubMed

    Hawellek, Thelonius; Hubert, Jan; Hischke, Sandra; Krause, Matthias; Bertrand, Jessica; Schmidt, Burkhard C; Kronz, Andreas; Püschel, Klaus; Rüther, Wolfgang; Niemeier, Andreas

    2018-05-30

    Meniscal calcification is considered to play a relevant role in the pathogenesis of osteoarthritis of the knee. Little is known about the biology of acetabular labral disease and its importance in hip pathology. Here, we analyze for the first time the calcification of the acetabular labrum of the hip (ALH) and its relation to hip cartilage degeneration. In this cross-sectional post-mortem study of an unselected sample of the general population, 170 ALH specimens and 170 femoral heads from 85 donors (38 female, 47 male; mean age 62.1 years) were analyzed by high-resolution digital contact radiography (DCR) and histological degeneration grade. The medial menisci (MM) from the same 85 donors served as an intra-individual reference for cartilage calcification (CC). Scanning electron microscopy (SEM), energy dispersive analysis (ED) and Raman spectroscopy were performed for characterization of ALH CC. The prevalence of CC in the ALH was 100% and that in the articular cartilage of the hip (ACH) was 96.5%. Quantitative analysis revealed that the amount of ALH CC was higher than that in the ACH (factor 3.0, p < 0.001) and in the MM (factor 1.3, p < 0.001). There was significant correlation between the amount of CC in the fibrocartilage of the left and right ALH (r = 0.70, p < 0.001). Independent of age, the amount of ALH CC correlated with histological degeneration of the ALH (Krenn score) (r = 0.55; p < 0.001) and the ACH (Osteoarthritis Research Society International (OARSI), r = 0.69; p < 0.001). Calcification of the ALH was characterized as calcium pyrophosphate dihydrate deposition. The finding that ALH fibrocartilage is a strongly calcifying tissue is unexpected and novel. The fact that ALH calcification correlates with cartilage degeneration independent of age is suggestive of an important role of ALH calcification in osteoarthritis of the hip and renders it a potential target for the prevention and treatment of hip joint degeneration.

  17. Pelvic incidence: a predictive factor for three-dimensional acetabular orientation-a preliminary study.

    PubMed

    Boulay, Christophe; Bollini, Gérard; Legaye, Jean; Tardieu, Christine; Prat-Pradal, Dominique; Chabrol, Brigitte; Jouve, Jean-Luc; Duval-Beaupère, Ginette; Pélissier, Jacques

    2014-01-01

    Acetabular cup orientation (inclination and anteversion) is a fundamental topic in orthopaedics and depends on pelvis tilt (positional parameter) emphasising the notion of a safe range of pelvis tilt. The hypothesis was that pelvic incidence (morphologic parameter) could yield a more accurate and reliable assessment than pelvis tilt. The aim was to find out a predictive equation of acetabular 3D orientation parameters which were determined by pelvic incidence to include in the model. The second aim was to consider the asymmetry between the right and left acetabulae. Twelve pelvic anatomic specimens were measured with an electromagnetic Fastrak system (Polhemus Society) providing 3D position of anatomical landmarks to allow measurement of acetabular and pelvic parameters. Acetabulum and pelvis data were correlated by a Spearman matrix. A robust linear regression analysis provided prediction of acetabulum axes. The orientation of each acetabulum could be predicted by the incidence. The incidence is correlated with the morphology of acetabula. The asymmetry of the acetabular roof was correlated with pelvic incidence. This study allowed analysis of relationships of acetabular orientation and pelvic incidence. Pelvic incidence (morphologic parameter) could determine the safe range of pelvis tilt (positional parameter) for an individual and not a group.

  18. Pelvic Incidence: A Predictive Factor for Three-Dimensional Acetabular Orientation—A Preliminary Study

    PubMed Central

    Bollini, Gérard; Legaye, Jean; Tardieu, Christine; Prat-Pradal, Dominique; Chabrol, Brigitte; Jouve, Jean-Luc; Duval-Beaupère, Ginette; Pélissier, Jacques

    2014-01-01

    Acetabular cup orientation (inclination and anteversion) is a fundamental topic in orthopaedics and depends on pelvis tilt (positional parameter) emphasising the notion of a safe range of pelvis tilt. The hypothesis was that pelvic incidence (morphologic parameter) could yield a more accurate and reliable assessment than pelvis tilt. The aim was to find out a predictive equation of acetabular 3D orientation parameters which were determined by pelvic incidence to include in the model. The second aim was to consider the asymmetry between the right and left acetabulae. Twelve pelvic anatomic specimens were measured with an electromagnetic Fastrak system (Polhemus Society) providing 3D position of anatomical landmarks to allow measurement of acetabular and pelvic parameters. Acetabulum and pelvis data were correlated by a Spearman matrix. A robust linear regression analysis provided prediction of acetabulum axes. The orientation of each acetabulum could be predicted by the incidence. The incidence is correlated with the morphology of acetabula. The asymmetry of the acetabular roof was correlated with pelvic incidence. This study allowed analysis of relationships of acetabular orientation and pelvic incidence. Pelvic incidence (morphologic parameter) could determine the safe range of pelvis tilt (positional parameter) for an individual and not a group. PMID:25006461

  19. Acetabular rim and surface segmentation for hip surgery planning and dysplasia evaluation

    NASA Astrophysics Data System (ADS)

    Tan, Sovira; Yao, Jianhua; Yao, Lawrence; Summers, Ronald M.; Ward, Michael M.

    2008-03-01

    Knowledge of the acetabular rim and surface can be invaluable for hip surgery planning and dysplasia evaluation. The acetabular rim can also be used as a landmark for registration purposes. At the present time acetabular features are mostly extracted manually at great cost of time and human labor. Using a recent level set algorithm that can evolve on the surface of a 3D object represented by a triangular mesh we automatically extracted rims and surfaces of acetabulae. The level set is guided by curvature features on the mesh. It can segment portions of a surface that are bounded by a line of extremal curvature (ridgeline or crestline). The rim of the acetabulum is such an extremal curvature line. Our material consists of eight hemi-pelvis surfaces. The algorithm is initiated by putting a small circle (level set seed) at the center of the acetabular surface. Because this surface distinctively has the form of a cup we were able to use the Shape Index feature to automatically extract an approximate center. The circle then expands and deforms so as to take the shape of the acetabular rim. The results were visually inspected. Only minor errors were detected. The algorithm also proved to be robust. Seed placement was satisfactory for the eight hemi-pelvis surfaces without changing any parameters. For the level set evolution we were able to use a single set of parameters for seven out of eight surfaces.

  20. THE RECOGNITION AND TREATMENT OF SUPERIOR LABRAL (SLAP) LESIONS IN THE OVERHEAD ATHLETE

    PubMed Central

    Macrina, Leonard C.; Cain, E. Lyle; Dugas, Jeffrey R.; Andrews, James R.

    2013-01-01

    The overhead athlete presents with a unique profile that may predispose them to specific pathology. Injury to the superior aspect of the glenoid labrum (SLAP lesions) poses a significant challenge to the rehabilitation specialist due to the complex nature and wide variety of etiological factors associated with these lesions. A thorough clinical evaluation and proper identification of the extent of labral injury is important in order to determine the most appropriate non‐operative and/or surgical management. Postoperative rehabilitation is based on the specific surgical procedure that has been performed, as well as the extent, location, and mechanism of labral pathology and associated lesions. Emphasis is placed on protecting the healing labrum while gradually restoring range of motion, strength, and dynamic stability of the glenohumeral joint. The purpose of this paper is to provide an overview of the anatomy and pathomechanics of SLAP lesions and review specific clinical examination techniques used to identify these lesions in the overhead athlete. Furthermore, a review of the current surgical management and postoperative rehabilitation guidelines is provided. Level of Evidence: 5 PMID:24175139

  1. Evaluation of shoulder pathology: three-dimensional enhanced T1 high-resolution isotropic volume excitation MR vs two-dimensional fast spin echo T2 fat saturation MR.

    PubMed

    Park, H J; Lee, S Y; Kim, M S; Choi, S H; Chung, E C; Kook, S H; Kim, E

    2015-03-01

    To evaluate the diagnostic accuracy of three-dimensional (3D) enhanced T1 high-resolution isotropic volume excitation (eTHRIVE) shoulder MR for the detection of rotator cuff tears, labral lesions and calcific tendonitis of the rotator cuff in comparison with two-dimensional (2D) fast spin echo T2 fat saturation (FS) MR. This retrospective study included 73 patients who underwent shoulder MRI using the eTHRIVE technique. Shoulder MR images were interpreted separately by two radiologists. They evaluated anatomic identification and image quality of the shoulder joint on routine MRI sequences (axial and oblique coronal T2 FS images) and compared them with the reformatted eTHRIVE images. The images were scored on a four-point scale (0, poor; 1, questionable; 2, adequate; 3, excellent) according to the degree of homogeneous and sufficient fat saturation to penetrate bone and soft tissue, visualization of the glenoid labrum and distinction of the supraspinatus tendon (SST). The diagnostic accuracy of eTHRIVE images compared with routine MRI sequences was evaluated in the setting of rotator cuff tears, glenoid labral injuries and calcific tendonitis of the SST. Fat saturation scores for eTHRIVE were significantly higher than those of the T2 FS for both radiologists. The sensitivity and accuracy of the T2 FS in diagnosing rotor cuff tears were >90%, whereas sensitivity and accuracy of the eTHRIVE method were significantly lower. The sensitivity, specificity and accuracy of both images in diagnosing labral injuries and calcific tendonitis were similar and showed no significant differences. The specificity of both images for the diagnosis of labral injuries and calcific tendonitis was higher than the sensitivities. The accuracy of 3D eTHRIVE imaging was comparable to that of 2D FSE T2 FS for the diagnosis of glenoid labral injury and calcific tendonitis of SST. The 3D eTHRIVE technique was superior to 2D FSE T2 FS in terms of fat saturation. Overall, 3D eTHRIVE was inferior

  2. The effect of acetabular cup size on the short-term stability of revision hip arthroplasty: a finite element investigation.

    PubMed

    Phillips, A T M; Pankaj; Usmani, A S; Howie, C R

    2004-01-01

    The study uses idealized two-dimensional finite element models to examine the behaviour of the acetabular construct following revision hip arthroplasty, carried out using the Slooff-Ling impaction grafting technique. The behaviour of bone graft was considered in detail, with non-linear elasticity and non-associated plasticity being adopted. Load was applied to the acetabular construct through a femoral head using smooth sliding surfaces. In particular, four models were subjected to two idealized cyclic load cases to investigate the effect of acetabular cup size on the short-term stability of the acetabular construct. The study suggests that benefits may be gained by using the largest practical size of acetabular cup.

  3. Variability and Comprehensiveness of North American Online Available Physical Therapy Protocols Following Hip Arthroscopy for Femoroacetabular Impingement and Labral Repair.

    PubMed

    Cvetanovich, Gregory L; Lizzio, Vincent; Meta, Fabien; Chan, Derek; Zaltz, Ira; Nho, Shane J; Makhni, Eric C

    2017-11-01

    To assess comprehensiveness and variability of postoperative physical therapy protocols published online following hip arthroscopy for femoroacetabular impingement (FAI) and/or labral repair. Surgeons were identified by the International Society for Hip Arthroscopy "Find a Surgeon" feature in North America (http://www.isha.net/members/, search August 10, 2016). Exclusion criteria included nonsurgeons and protocols for conditions other than hip arthroscopy for FAI and/or labral tear. Protocols were identified by review of surgeons' personal and departmental websites and evaluated for postoperative restrictions, rehabilitation components, and the time points for ending restrictions and initiating activities. Of 111 surgeons available online, 31 (27.9%) had postoperative hip arthroscopy physical therapy protocols available online. Bracing was used in 54.8% (17/31) of protocols for median 2-week duration (range, 1-6 weeks). Most protocols specified the initial postoperative weight-bearing status (29/31, 93.5%), most frequently partial weight-bearing with 20 pounds foot flat (20/29, 69.0%). The duration of weight-bearing restriction was median 3 weeks (range, 2-6) for FAI and median 6 weeks (range, 3-8) for microfracture. The majority of protocols specified initial range of motion limitations (26/31, 83.9%) for median 3 weeks (range, 1.5-12). There was substantial variation in the rehabilitation activities and time points for initiating activities. Time to return to running was specified by 20/31 (64.5%) protocols at median 12 weeks (range, 6-19), and return to sport timing was specified by 13/31 (41.9%) protocols at median 15.5 weeks (range, 9-23). There is considerable variability in postoperative physical therapy protocols available online following hip arthroscopy for FAI, including postoperative restrictions, rehabilitation activities, and time points for activities. This information offers residents, fellows, and established hip arthroscopists a centralized

  4. [Effects of Surgically Treated Pelvic Ring and Acetabular Fractures on Postural Control].

    PubMed

    Lang, P; Schnegelberger, A; Riesner, H-J; Stuby, F; Friemert, B; Palm, H-G

    2016-04-01

    The aim of surgical treatment of pelvic ring and acetabular fractures is to allow rapid mobilisation of patients in order to restore stance and gait stability (postural control), as this significantly correlates with a positive outcome. The regulation of postural stability is mainly controlled by transmission of proprioceptive stimuli. In addition, the pelvis serves as a connection between the legs and the spine and thus is also of great importance for mechanical stabilisation. It remains unclear whether surgical treatment of pelvic ring and acetabular fractures affects the regulation of postural control. Therefore, the aim of this study was to examine the impact of surgically treated pelvic ring and acetabular fractures on postural stability by means of computerised dynamic posturography (CDP) after a mean of 35 months and to compare the results with a healthy control group. A retrospective case control study of 38 patients with surgically treated pelvic ring and acetabular fractures and 38 healthy volunteers was carried out using CDP. The average time of follow-up was 35 (12-78) months. The most important outcome parameter in this investigation was the overall stability index (OSI). Hip joint mobility, the health-related quality of life (SF-12) and pain were supplementary outcome parameters. It was found that surgically treated pelvic ring and acetabular fractures had no influence on postural stability. The OSI was 2.1 ° in the patient group and 1.9 ° in the control group. There was no significant difference between the groups in hip joint mobility. A total of 52 % of patients showed no or only mild pain. Mean health-related quality of life was the same as in the total population. Surgically treated pelvic ring and acetabular fractures do not lead to deterioration in postural control in the mid term. This is of high prognostic importance for rapid mobilisation of the patients. Therefore no increase in the risk of falling is expected after successfully

  5. High-precision measurements of cementless acetabular components using model-based RSA: an experimental study.

    PubMed

    Baad-Hansen, Thomas; Kold, Søren; Kaptein, Bart L; Søballe, Kjeld

    2007-08-01

    In RSA, tantalum markers attached to metal-backed acetabular cups are often difficult to detect on stereo radiographs due to the high density of the metal shell. This results in occlusion of the prosthesis markers and may lead to inconclusive migration results. Within the last few years, new software systems have been developed to solve this problem. We compared the precision of 3 RSA systems in migration analysis of the acetabular component. A hemispherical and a non-hemispherical acetabular component were mounted in a phantom. Both acetabular components underwent migration analyses with 3 different RSA systems: conventional RSA using tantalum markers, an RSA system using a hemispherical cup algorithm, and a novel model-based RSA system. We found narrow confidence intervals, indicating high precision of the conventional marker system and model-based RSA with regard to migration and rotation. The confidence intervals of conventional RSA and model-based RSA were narrower than those of the hemispherical cup algorithm-based system regarding cup migration and rotation. The model-based RSA software combines the precision of the conventional RSA software with the convenience of the hemispherical cup algorithm-based system. Based on our findings, we believe that these new tools offer an improvement in the measurement of acetabular component migration.

  6. Imaging of Sports-Related Hip and Groin Injuries

    PubMed Central

    Lischuk, Andrew W.; Dorantes, Thomas M.; Wong, William; Haims, Andrew H.

    2010-01-01

    A normally functioning hip joint is imperative for athletes who use their lower extremities with running, jumping, or kicking activities. Sports-related injuries of the hip and groin are far less frequent than injuries to the more distal aspect of the extremity, accounting for less than 10% of lower extremity injuries. Despite the lower incidence, hip and groin injuries can lead to significant clinical and diagnostic challenges related to the complex anatomy and biomechanical considerations of this region. Loads up to 8 times normal body weight have been documented in the joint in common daily activities, such as jogging, with significantly greater force expected during competitive athletics. Additionally, treatment for hip and groin injuries can obviate the participation of medical and surgical specialties, with a multidisciplinary approach frequently required. Delay in diagnosis and triage of these injuries may cause loss of time from competition and, potentially, early onset of degenerative changes. Magnetic resonance imaging (MRI) of the hip has proven to be the gold standard for the diagnosis of sports-related hip and groin injuries in the setting of negative radiographs. With its exquisite soft tissue contrast, multiplanar capabilities, and lack of ionizing radiation, MRI is unmatched in the noninvasive diagnosis of intra-articular and extra-articular pathology, as well as intraosseous processes. This review focuses on MRI of common athletic injuries of the hip and groin, including acetabular labral tears, femoral acetabular impingement syndrome, muscle injuries around the hip and groin (including athletic pubalgia), and athletic osseous injuries. PMID:23015946

  7. Imaging of sports-related hip and groin injuries.

    PubMed

    Lischuk, Andrew W; Dorantes, Thomas M; Wong, William; Haims, Andrew H

    2010-05-01

    A normally functioning hip joint is imperative for athletes who use their lower extremities with running, jumping, or kicking activities. Sports-related injuries of the hip and groin are far less frequent than injuries to the more distal aspect of the extremity, accounting for less than 10% of lower extremity injuries. Despite the lower incidence, hip and groin injuries can lead to significant clinical and diagnostic challenges related to the complex anatomy and biomechanical considerations of this region. Loads up to 8 times normal body weight have been documented in the joint in common daily activities, such as jogging, with significantly greater force expected during competitive athletics. Additionally, treatment for hip and groin injuries can obviate the participation of medical and surgical specialties, with a multidisciplinary approach frequently required. Delay in diagnosis and triage of these injuries may cause loss of time from competition and, potentially, early onset of degenerative changes. Magnetic resonance imaging (MRI) of the hip has proven to be the gold standard for the diagnosis of sports-related hip and groin injuries in the setting of negative radiographs. With its exquisite soft tissue contrast, multiplanar capabilities, and lack of ionizing radiation, MRI is unmatched in the noninvasive diagnosis of intra-articular and extra-articular pathology, as well as intraosseous processes. This review focuses on MRI of common athletic injuries of the hip and groin, including acetabular labral tears, femoral acetabular impingement syndrome, muscle injuries around the hip and groin (including athletic pubalgia), and athletic osseous injuries.

  8. Mass spectrometric identification of phospholipids in human tears and tear lipocalin.

    PubMed

    Dean, Austin W; Glasgow, Ben J

    2012-04-02

    The purpose of this article was to identify by mass spectrometry phosphocholine lipids in stimulated human tears and determine the molecules bound to tear lipocalin or other proteins. Tear proteins were separated isocratically from pooled stimulated human tears by gel filtration fast performance liquid chromatography. Separation of tear lipocalin was confirmed by SDS tricine gradient PAGE. Protein fractions were extracted with chloroform/methanol and analyzed with electrospray ionization MS/MS triple quadrupole mass spectrometry in precursor ion scan mode for select leaving groups. For quantification, integrated ion counts were derived from standard curves of authentic compounds of phosphatidylcholine (PC) and phosphatidylserine. Linear approximation was possible from integration of the mass spectrometrically obtained ion peaks at 760 Da for the PC standard. Tears contained 194 ng/mL of the major intact PC (34:2), m/z 758.6. Ten other monoisotopic phosphocholines were found in tears. A peak at 703.3 Da was assigned as a sphingomyelin. Four lysophosphatidylcholines (m/z 490-540) accounted for about 80% of the total integrated ion count. The [M+H](+) compound, m/z 496.3, accounted for 60% of the signal intensity. Only the tear lipocalin-bearing fractions showed phosphocholines (104 ng/mL). Although the intact phospholipids bound to tear lipocalin corresponded precisely in mass and relative signal intensity to that found in tears, we did not identify phosphocholines between m/z 490 and 540 in any of the gel-filtration fractions. Phospholipids, predominantly lysophospholipids, are present in tears. The higher mass intact PCs in tears are native ligands of tear lipocalin.

  9. The prevalence of acetabular anomalies associated with pistol-grip-deformity in osteoarthritic hips.

    PubMed

    Ipach, I; Mittag, F; Walter, C; Syha, R; Wolf, P; Kluba, T

    2013-02-01

    Acetabular retroversion, excessive acetabular coverage and abnormal head-neck-junction with a so-called "pistol-grip-deformity" were added to the classical description of hip dysplasia to describe pathological hip morphology. The aim of the current study was the detection of pathological acetabular geometry in patients with an abnormal head-neck-junction. Femoroacetabular impingement and hip dysplasia features are frequent in patients with end-stage osteoarthritis before 60 years of age. We analysed our data bank retrospectively for all patients who received a Total Hip Arthroplasty (THA) due to end-stage osteoarthritis before the age of 60 years. The pelvic-views and the Dunn-view of these patients were screened for an abnormal head-neck-junction by measuring the head-ratio and the alpha-angle. An orthopaedic surgeon and a radiologist did this independently. These radiographies were measured for signs of acetabular dysplasia, excessive acetabular coverage and crossing sign. A consecutive series of 135 total hip arthroplasties were performed in patients aged less or equal to 60 years because of end-stage osteoarthritis. From these, 81 patients were classified as having an abnormal head-neck-junction. The mean head-ratio in these 81 patients was 1.52±0.35, the mean alpha-angle was 62.5°±9.3°. The mean CE-angle of these 81 patients was 35.8°±10.4°, the mean CA-angle was 36.7°±5.7°, the mean depth-width ratio was 49.1±10, the mean extrusion index was 19.1±9.2 and the mean CCD-angle was 131.7°±7.3°. Of these 81hips, 14 had isolated pistol-grip-deformity, while 11 hips had associated dysplasia, 38 had excessive acetabular coverage, and 14 had crossing sign. In addition, a crossing sign was identified in four of the 11 dysplastic hips and 19 of the 38 of the hips having excessive acetabular coverage. There was no statistically significant difference in regard to the age between the four groups (P=0.087). In contrast, the hips that had excessive acetabular

  10. Cemented total hip replacement cable debris and acetabular construct durability.

    PubMed

    Altenburg, Aaron J; Callaghan, John J; Yehyawi, Tameem M; Pedersen, Douglas R; Liu, Steve S; Leinen, Jessica A; Dahl, Kevin A; Goetz, Devon D; Brown, Thomas D; Johnston, Richard C

    2009-07-01

    Third-body wear can adversely affect the outcome of total hip arthroplasty by causing increased polyethylene wear, osteolysis, and component loosening. We hypothesized that there would be greater generation and migration of metal debris to the bearing surfaces in hips in which cobalt-chromium cables were used to reattach the osteotomized greater trochanter when compared with hips in which stainless steel wires were used. Between June 1981 and December 1983, 196 consecutive total hip arthroplasties were performed with use of an Iowa stem and a titanium-backed cemented acetabular component, with cobalt-chromium cable trochanteric reattachment. After nineteen to twenty years of follow-up, the patients were evaluated with regard to the depth of head penetration into the polyethylene (as a surrogate for wear), osteolysis, loosening, and the need for revision. The results were compared with those for a series of 304 total hip arthroplasties that were performed by the same surgeon from January 1984 to December 1985 with use of the same components and the same surgical technique, but with stainless steel wire trochanteric reattachment. The two groups had a comparable nineteen to twenty-year follow-up. All living patients (fifty-nine hips in the cable group and ninety-two hips in the wire group) had minimum ten-year follow-up radiographs. The polyethylene wear rate was 0.101 mm/yr for the cable group and 0.082 mm/yr for the wire group (p = 0.039). For the living patients, the rate of revision of the acetabular component because of aseptic loosening was 37.3% (twenty-two hips) for the cable group and 20.7% (nineteen hips) for the wire group (p = 0.025). The rate of acetabular osteolysis was 44% (twenty-six hips) for the cable group and 26% (twenty-four hips) for the wire group (p = 0.022). Kaplan-Meier analysis with revision of the acetabular component because of aseptic loosening as the end point demonstrated survival rates of 73.7% +/- 9% and 83% +/- 7% for the cable and

  11. Mass Spectrometric Identification of Phospholipids in Human Tears and Tear Lipocalin

    PubMed Central

    Dean, Austin W.; Glasgow, Ben J.

    2012-01-01

    Purpose. The purpose of this article was to identify by mass spectrometry phosphocholine lipids in stimulated human tears and determine the molecules bound to tear lipocalin or other proteins. Methods. Tear proteins were separated isocratically from pooled stimulated human tears by gel filtration fast performance liquid chromatography. Separation of tear lipocalin was confirmed by SDS tricine gradient PAGE. Protein fractions were extracted with chloroform/methanol and analyzed with electrospray ionization MS/MS triple quadrupole mass spectrometry in precursor ion scan mode for select leaving groups. For quantification, integrated ion counts were derived from standard curves of authentic compounds of phosphatidylcholine (PC) and phosphatidylserine. Results. Linear approximation was possible from integration of the mass spectrometrically obtained ion peaks at 760 Da for the PC standard. Tears contained 194 ng/mL of the major intact PC (34:2), m/z 758.6. Ten other monoisotopic phosphocholines were found in tears. A peak at 703.3 Da was assigned as a sphingomyelin. Four lysophosphatidylcholines (m/z 490–540) accounted for about 80% of the total integrated ion count. The [M+H]+ compound, m/z 496.3, accounted for 60% of the signal intensity. Only the tear lipocalin–bearing fractions showed phosphocholines (104 ng/mL). Although the intact phospholipids bound to tear lipocalin corresponded precisely in mass and relative signal intensity to that found in tears, we did not identify phosphocholines between m/z 490 and 540 in any of the gel-filtration fractions. Conclusions. Phospholipids, predominantly lysophospholipids, are present in tears. The higher mass intact PCs in tears are native ligands of tear lipocalin. PMID:22395887

  12. Optimal acetabular component orientation estimated using edge-loading and impingement risk in patients with metal-on-metal hip resurfacing arthroplasty.

    PubMed

    Mellon, Stephen J; Grammatopoulos, George; Andersen, Michael S; Pandit, Hemant G; Gill, Harinderjit S; Murray, David W

    2015-01-21

    Edge-loading in patients with metal-on-metal resurfaced hips can cause high serum metal ion levels, the development of soft-tissue reactions local to the joint called pseudotumours and ultimately, failure of the implant. Primary edge-loading is where contact between the femoral and acetabular components occurs at the edge/rim of the acetabular component whereas impingement of the femoral neck on the acetabular component's edge causes secondary or contrecoup edge-loading. Although the relationship between the orientation of the acetabular component and primary edge-loading has been identified, the contribution of acetabular component orientation to impingement and secondary edge-loading is less clear. Our aim was to estimate the optimal acetabular component orientation for 16 metal-on-metal hip resurfacing arthroplasty (MoMHRA) subjects with known serum metal ion levels. Data from motion analysis, subject-specific musculoskeletal modelling and Computed Tomography (CT) measurements were used to calculate the dynamic contact patch to rim (CPR) distance and impingement risk for 3416 different acetabular component orientations during gait, sit-to-stand, stair descent and static standing. For each subject, safe zones free from impingement and edge-loading (CPR <10%) were defined and, consequently, an optimal acetabular component orientation was determined (mean inclination 39.7° (SD 6.6°) mean anteversion 14.9° (SD 9.0°)). The results of this study suggest that the optimal acetabular component orientation can be determined from a patient's motion and anatomy. However, 'safe' zones of acetabular component orientation associated with reduced risk of dislocation and pseudotumour are also associated with a reduced risk of edge-loading and impingement. Copyright © 2014 Elsevier Ltd. All rights reserved.

  13. Endoscopic resection of acetabular screw tip to decompress sciatic nerve following total hip arthroplasty.

    PubMed

    Yoon, Sun-Jung; Park, Myung-Sik; Matsuda, Dean K; Choi, Yun Ho

    2018-06-04

    Sciatic nerve injuries following total hip arthroplasty are disabling complications. Although degrees of injury are variable from neuropraxia to neurotmesis, mechanical irritation of sciatic nerve might be occurred by protruding hardware. This case shows endoscopic decompression for protruded acetabular screw irritating sciatic nerve, the techniques described herein may permit broader arthroscopic/endoscopic applications for management of complications after reconstructive hip surgery. An 80-year-old man complained of severe pain and paresthesias following acetabular component revision surgery. Physical findings included right buttock pain with radiating pain to lower extremity. Radiographs and computed tomography imaging showed that the sharp end of protruded screw invaded greater sciatic foramen anterior to posterior and distal to proximal direction at sciatic notch level. A protruding tip of the acetabular screw at the sciatic notch was decompressed by use of techniques gained from experience performing endoscopic sciatic nerve decompression. The pre-operative pain and paresthesias resolved post-operatively after recovering from anesthesia. This case report describes the first documented endoscopic resection of the tip of the acetabular screw irritating sciatic nerve after total hip arthroplasty. If endoscopic resection of an offending acetabular screw can be performed in a safe and minimally invasive manner, one can envision a future expansion of the role of hip arthroscopic surgery in several complications management after total hip arthroplasty.

  14. Referral Patterns for Chronic Groin Pain and Athletic Pubalgia/Sports Hernia: Magnetic Resonance Imaging Findings, Treatment, and Outcomes.

    PubMed

    Zoland, Mark P; Maeder, Matthew E; Iraci, Joseph C; Klein, Devon A

    Chronic groin pain is a common problem and has been well-described in high-performance athletes. Its presentation in the recreational athlete has been less frequently described. We present the experience of a tertiary group of physicians specializing in groin pain and athletic pubalgia. Dynamic magnetic resonance imaging (MRI) protocol was employed. Surgery was performed in patients failing non-surgical management. A retrospective review was performed. Of 117 mostly non-professional athletes, there were 79 MRI-positive cases of athletic pubalgia (68%). Other common findings were acetabular labral tear (57%) and inguinal hernia (35%). Employment of a dynamic MRI protocol increased sensitivity for certain pathologies. Of positive athletic pubalgia cases, 49% went on to have surgical repair. The satisfaction rate in the surgical group was 90% at follow up. Advances in MRI have increased our ability to characterize and diagnose specific injuries causing groin pain. We present our diagnostic algorithm, including an MRI protocol that not only evaluates the groin, but has increased sensitivity for additional findings such as inguinal hernia and abdominal wall deficiencies. A targeted work-up and subsequent surgical treatment in the appropriate patient, even in the recreational athletic population, has yielded a 90% satisfaction rate.

  15. The Morscher Press-Fit Acetabular Component: An Independent Long-Term Review at 18-22 Years.

    PubMed

    Gwynne-Jones, David P; Lash, Heath W R; James, Andrew W; Iosua, Ella E; Matheson, John A

    2017-08-01

    There are relatively few 20-year results of uncemented acetabular components, and most of these are modular designs. This study reports the 20-year results of a monoblock press-fit acetabular component. A total of 122 total hip arthroplasties (111 patients) using the Morscher cup were reviewed at a mean of 19.7 years. The average age at implantation was 57.3 years (range, 36-74 years), and 81 (66%) were men. Twenty-two patients (25 hips) had died. Seven hips were revised, including 5 acetabular revisions. Six patients (6 hips) declined to participate but were known not to have been revised. The mean Oxford hip score was 41.1 (range, 22-48), and the mean reduced Western Ontario and McMaster Universities Osteoarthritis Index score was 5.7/48 (range, 0-24). Eccentric wear was seen in 13 (15.7%) and major osteolysis in 14 (17%) of 82 surviving hips with radiographs. The all-cause revision rate was 0.32 per 100 observed component years (95% confidence interval [CI], 0.13-0.66). The 20-year Kaplan-Meier survival was 93.4% (CI, 86.6-96.8) for all-cause revisions, 95.5% (CI, 89.4-98.1) for any acetabular revision, and 97.1% (CI, 91.2-99.1) for acetabular aseptic loosening, wear, or osteolysis. The Morscher acetabular component has continued to perform well at 20 years despite using conventional polyethylene with results that match or surpass other cementless acetabulae. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Comparison between Conventional MR Arthrograhphy and Abduction and External Rotation MR Arthrography in Revealing Tears of the Antero-Inferior Glenoid Labrum

    PubMed Central

    Choi, Jung-Ah; Suh, Sang-il; Kim, Baek Hyun; Cha, Sang Hoon; Lee, Ki Yeol; Lee, Chang Hee

    2001-01-01

    Objective To compare, in terms of their demonstration of tears of the anterior glenoid labrum, oblique axial MR arthrography obtained with the patient's shoulder in the abduction and external rotation (ABER) position, with conventional axial MR arthrography obtained with the patient's arm in the neutral position. Materials and Methods MR arthrography of the shoulder, including additional oblique axial sequences with the patient in the ABER position, was performed in 30 patients with a clinical history of recurrent anterior shoulder dislocation. The degree of anterior glenoid labral tear or defect was evaluated in both the conventional axial and the ABER position by two radiologists. Decisions were reached by consensus, and a three-point scale was used: grade 1=normal; grade 2=probable tear, diagnosed when subtle increased signal intensity in the labrum was apparent; grade 3=definite tear/defect, when a contrast material-filled gap between the labrum and the glenoid rim or deficient labrum was present. The scores for each imaging sequence were averaged and to compare conventional axial and ABER position scans, Student's t test was performed. Results In 21 (70%) of 30 patients, the same degree of anterior instability was revealed by both imaging sequences. Eight (27%) had a lower grade in the axial position than in the ABER position, while one (3%) had a higher grade in the axial position. Three whose axial scan was grade 1 showed only equivocal evidence of tearing, but their ABER-position scan, in which a contrast material-filled gap between the labrum and the glenoid rim was present, was grade 3. The average grade was 2.5 (SD=0.73) for axial scans and 2.8 (SD=0.46) for the ABER position. The difference between axial and ABER-position scans was statistically significant (p<0.05). Conclusion MR arthrography with the patient's shoulder in the ABER position is more efficient than conventional axial scanning in revealing the degree of tear or defect of the anterior

  17. Biochemical and Cellular Assessment of Acetabular Chondral Flaps Identified During Hip Arthroscopy.

    PubMed

    Hariri, Sanaz; Truntzer, Jeremy; Smith, Robert Lane; Safran, Marc R

    2015-06-01

    To analyze chondral flaps debrided during hip arthroscopy to determine their biochemical and cellular composition. Thirty-one full-thickness acetabular chondral flaps were collected during hip arthroscopy. Biochemical analysis was undertaken in 21 flaps from 20 patients, and cellular viability was determined in 10 flaps from 10 patients. Biochemical analysis included concentrations of (1) DNA (an indicator of chondrocyte content), (2) hydroxyproline (an indicator of collagen content), and (3) glycosaminoglycan (an indicator of chondrocyte biosynthesis). Higher values for these parameters indicated more healthy tissue. The flaps were examined to determine the percentage of viable chondrocytes. The percentage of acetabular chondral flap specimens that had concentrations within 1 SD of the mean values reported in previous normal cartilage studies was 38% for DNA, 0% for glycosaminoglycan, and 43% for hydroxyproline. The average cellular viability of our acetabular chondral flap specimens was 39% (SD, 14%). Only 2 of the 10 specimens had more than half the cells still viable. There was no correlation between (1) the gross examination of the joint or knowledge of the patient's demographic characteristics and symptoms and (2) biochemical properties and cell viability of the flap, with one exception: a degenerative appearance of the surrounding cartilage correlated with a higher hydroxyproline concentration. Although full-thickness acetabular chondral flaps can appear normal grossly, the biochemical properties and percentage of live chondrocytes in full-thickness chondral flaps encountered in hip arthroscopy show that this tissue is not normal. There has been recent interest in repairing chondral flaps encountered during hip arthroscopy. These data suggest that acetabular chondral flaps are not biochemically and cellularly normal. Although these flaps may still be valuable mechanically and/or as a scaffold in some conductive or inductive capacity, further study is

  18. The boiled-egg technique: a new method for obtaining femoral head autograft used in acetabular defect reconstruction.

    PubMed

    Bucknall, Vittoria; Mehdi, Ali

    2013-09-01

    Primary total hip arthroplasty can be complicated by acetabular bony defects, threatening the biomechanical integrity of the prosthesis. Traditionally, when autologous bone is used to pack these defects, it is obtained from thin slices of femoral head in addition to acetabular reamings. We report a novel technique for the acquisition of autologous femoral head bone graft used in the reconstruction of acetabular defects during primary total hip arthroplasty. Copyright © 2013 Elsevier Inc. All rights reserved.

  19. MR arthrography of the hip: diagnostic performance and image quality of 3D-steady state free precession versus 2D turbo spin echo sequences.

    PubMed

    Kraus, Mareen Sarah; Notohamiprodjo, Mike; Partovi, Sasan; Sobieh, Ahmed; Baur-Melnyk, Andrea; Hausdorf, Joerg; Grosse, Ulrich

    2018-06-01

    To retrospectively compare the diagnostic performance of isotropic 3D steady-state free precession (3D-SSFP) sequences with 2D turbo spin-echo proton density-weighted fat-saturated (2D-TSE-PD fs) images in hip magnetic resonance arthrography; arthroscopy was a standard of reference. Eighty-one patients with suspected labral tears who underwent hip MR arthrography (3-T scanner) were included. 2D-TSE-PD fs sequences were acquired in three planes and a singular sagittal 3D-SSFP. Labral tears, cartilage pathology and bone marrow were independently assessed by two blinded radiologists using a 5-point Likert scale. Accuracy was determined in 39 patients using invasive arthroscopy. Diagnostic confidence of labral and cartilaginous pathologies based on image quality was rated higher for 3D-SSFP (4.5 ± 0.8; 4.35 ± 0.7; p < 0.0001), but inferior for bone marrow pathology (3.9 ± 0.7; 4.0 ± 0.7; p < 0.0001). In the arthroscopy patients, similar sensitivity (85.9%) but higher specificity (74.4vs.42.9%) and higher positive and negative predictive values were found in 3D-SSFP of labral and cartilage pathologies. 3D-SSFP in hip magnetic resonance arthrography offers increased accuracy in detecting labral and cartilage pathologies compared with 2D-TSE-PD, while reducing the acquisition time. A drawback of 3D-SSFP was the inferior diagnostic confidence for bone marrow evaluation; thus, 3D-SSFP should be combined with conventional 2D-TSE sequences.

  20. Impaction grafted bone chip size effect on initial stability in an acetabular model: Mechanical evaluation.

    PubMed

    Holton, Colin; Bobak, Peter; Wilcox, Ruth; Jin, Zhongmin

    2013-01-01

    Acetabular bone defect reconstruction is an increasing problem for surgeons with patients undergoing complex primary or revision total hip replacement surgery. Impaction bone grafting is one technique that has favourable long-term clinical outcome results for patients who undergo this reconstruction method for acetabular bone defects. Creating initial mechanical stability of the impaction bone graft in this technique is known to be the key factor in achieving a favourable implant survival rate. Different sizes of bone chips were used in this technique to investigate if the size of bone chips used affected initial mechanical stability of a reconstructed acetabulum. Twenty acetabular models were created in total. Five control models were created with a cemented cup in a normal acetabulum. Then five models in three different groups of bone chip size were constructed. The three groups had an acetabular protrusion defect reconstructed using either; 2-4 mm(3), 10 mm(3) or 20 mm(3) bone chip size for impaction grafting reconstruction. The models underwent compression loading up to 9500 N and displacement within the acetabular model was measured indicating the initial mechanical stability. This study reveals that, although not statistically significant, the largest (20 mm(3)) bone chip size grafted models have an inferior maximum stiffness compared to the medium (10 mm(3)) bone chip size. Our study suggests that 10 mm(3) size of bone chips provide better initial mechanical stability compared to smaller or larger bone chips. We dismissed the previously held opinion that the biggest practically possible graft is best for acetabular bone graft impaction.

  1. Cemented Total Hip Replacement Cable Debris and Acetabular Construct Durability

    PubMed Central

    Altenburg, Aaron J.; Callaghan, John J.; Yehyawi, Tameem M.; Pedersen, Douglas R.; Liu, Steve S.; Leinen, Jessica A.; Dahl, Kevin A.; Goetz, Devon D.; Brown, Thomas D.; Johnston, Richard C.

    2009-01-01

    Background: Third-body wear can adversely affect the outcome of total hip arthroplasty by causing increased polyethylene wear, osteolysis, and component loosening. We hypothesized that there would be greater generation and migration of metal debris to the bearing surfaces in hips in which cobalt-chromium cables were used to reattach the osteotomized greater trochanter when compared with hips in which stainless steel wires were used. Methods: Between June 1981 and December 1983, 196 consecutive total hip arthroplasties were performed with use of an Iowa stem and a titanium-backed cemented acetabular component, with cobalt-chromium cable trochanteric reattachment. After nineteen to twenty years of follow-up, the patients were evaluated with regard to the depth of head penetration into the polyethylene (as a surrogate for wear), osteolysis, loosening, and the need for revision. The results were compared with those for a series of 304 total hip arthroplasties that were performed by the same surgeon from January 1984 to December 1985 with use of the same components and the same surgical technique, but with stainless steel wire trochanteric reattachment. The two groups had a comparable nineteen to twenty-year follow-up. All living patients (fifty-nine hips in the cable group and ninety-two hips in the wire group) had minimum ten-year follow-up radiographs. Results: The polyethylene wear rate was 0.101 mm/yr for the cable group and 0.082 mm/yr for the wire group (p = 0.039). For the living patients, the rate of revision of the acetabular component because of aseptic loosening was 37.3% (twenty-two hips) for the cable group and 20.7% (nineteen hips) for the wire group (p = 0.025). The rate of acetabular osteolysis was 44% (twenty-six hips) for the cable group and 26% (twenty-four hips) for the wire group (p = 0.022). Kaplan-Meier analysis with revision of the acetabular component because of aseptic loosening as the end point demonstrated survival rates of 73.7% ± 9% and

  2. Acetabular overcoverage in the horizontal plane: an underdiagnosed trigger of early hip arthritis. A CT scan study in young adults.

    PubMed

    Valera, Màrius; Ibáñez, Natalia; Sancho, Rogelio; Llauger, Jaume; Gich, Ignasi

    2018-01-01

    Acetabular overcoverage promotes hip osteoarthritis causing a pincer-type femoroacetabular impingement. Acetabular coverage in the horizontal plane is usually poorly defined in imaging studies and may be misdiagnosed. The goal of this study was to analyze the role of acetabular overcoverage measured in the frontal plane and in the horizontal plane by CT scan and to determine its relationship with other anatomic features in the onset of hip arthritis in young adults. We compared prospectively CT scans from two groups of adults of 55 years or younger: the patient group (n = 30) consisted of subjects with diagnosis of early hip arthritis (Tönnis Grade I or II) and the control group (n = 31) consisted of subjects with healthy hips. Two independent observers analyzed centre edge angle (CEA), acetabular anteversion angle (AAA), anterior sector acetabular angle (AASA), posterior sector acetabular angle (PASA), horizontal acetabular sector angle (HASA), femoral anteversion angle (FAVA), alpha angle (AA), and Mckibbin Instability Index (MI). Angles measuring the acetabular coverage on the horizontal plane (AASA, PASA and, HASA) were significantly higher in the patient group (p < 0.001, p = 0.03 and p < 0.001, respectively). Pearson's correlation coefficient showed a positive correlation between CEA and HASA in patients (r = 0.628) and in controls (r = 0.660). However, a high CEA (> 35º) was strongly associated with a high HASA (> 160º) in patients (p = 0.024) but not in controls (p = 0.21), suggesting that pincer should be simultaneously present in the horizontal and frontal plane to trigger hip degeneration. No significant association was detected between a high alpha angle (> 60º) and a high CEA (> 35º suggesting that a mixed pincer-cam aetiology was not prevalent in our series. Multivariate regression analysis showed the most significant predictors of degenerative joint disease were HASA (p = 0.008), AA (p = 0.048) and ASAA (p = 0

  3. Improving the accuracy of acetabular cup implantation using a bulls-eye spirit level.

    PubMed

    Macdonald, Duncan; Gupta, Sanjay; Ohly, Nicholas E; Patil, Sanjeev; Meek, R; Mohammed, Aslam

    2011-01-01

    Acetabular introducers have a built-in inclination of 45 degrees to the handle shaft. With patients in the lateral position, surgeons aim to align the introducer shaft vertical to the floor to implant the acetabulum at 45 degrees. We aimed to determine if a bulls-eye spirit level attached to an introducer improved the accuracy of implantation. A small circular bulls-eye spirit level was attached to the handle of an acetabular introducer. A saw bone hemipelvis was fixed to a horizontal, flat surface. A cement substitute was placed in the acetabulum and subjects were asked to implant a polyethylene cup, aiming to obtain an angle of inclination of 45 degrees. Two attempts were made with the spirit level masked and two with it unmasked. The distance of the air bubble from the spirit level's center was recorded by a single assessor. The angle of inclination of the acetabular component was then calculated. Subjects included both orthopedic consultants and trainees. Twenty-five subjects completed the study. Accuracy of acetabular implantation when using the unmasked spirit level improved significantly in all grades of surgeon. With the spirit level masked, 12 out of 50 attempts were accurate at 45 degrees inclination; 11 out of 50 attempts were "open," with greater than 45 degrees of inclination, and 27 were "closed," with less than 45 degrees. With the spirit level visible, all subjects achieved an inclination angle of exactly 45 degrees. A simple device attached to the handle of an acetabular introducer can significantly improve the accuracy of implantation of a cemented cup into a saw bone pelvis in the lateral position.

  4. Pelvic Incidence and Acetabular Version in Slipped Capital Femoral Epiphysis.

    PubMed

    Gebhart, Jeremy J; Bohl, Michael S; Weinberg, Douglas S; Cooperman, Daniel R; Liu, Raymond W

    2015-09-01

    The etiology of slipped capital femoral epiphysis (SCFE) is multifactorial, but the role of sagittal balance of the pelvis as a contributing factor to its development has not been well studied. Our primary purpose was to determine whether a smaller pelvic incidence (PI), a position-independent anatomic parameter that regulates pelvic orientation, could be a factor that increases shear stress in the epiphyseal growth plate and potentially contributes to the development of SCFE. We also set out to determine whether acetabular retroversion was associated with SCFE. We obtained 14 cadaveric pelvi from the Hamann-Todd Osteological Collection whose femurs showed evidence of post-SCFE deformity. Two hundred age-matched, sex-matched, and race-matched pelvi were used as controls. PI and acetabular version were measured using standardized lateral photographs and goniometers, respectively. T tests were performed to evaluate for differences in measured parameters between groups. The mean PI was 40.6±6.1 degrees for SCFE specimens and 47.4±9.9 degrees for normal specimens (P=0.01). The mean version of SCFE and normal acetabula was 15±7 and 17±6 degrees, respectively (P=0.39). There was also no significant difference in version between SCFE acetabula and the contralateral, uninvolved acetabular of the same specimen (15±7 vs. 17±8 degrees, P=0.33). Specimens with SCFE deformity demonstrated a smaller PI than a large cohort of normal control specimens. We found no significant difference between acetabular version of specimens with and without SCFE deformity. Contralateral or unaffected acetabuli of SCFE specimens were not more retroverted than the affected side of the same specimen. Sagittal balance of the pelvis, and particularly decreased PI, may play an important role in the development of SCFE. The influence of mechanical factors beyond the hip joint in the development of SCFE should be considered by clinicians.

  5. Does Increased Coefficient of Friction of Highly Porous Metal Increase Initial Stability at the Acetabular Interface?

    PubMed

    Goldman, Ashton H; Armstrong, Lucas C; Owen, John R; Wayne, Jennifer S; Jiranek, William A

    2016-03-01

    Highly porous metal acetabular components illustrate a decreased rate of aseptic loosening in short-term follow-up compared with previous registry data. This study compared the effect of component surface roughness at the bone-implant interface and the quality of the bone on initial pressfit stability. The null hypothesis is that a standard porous coated acetabular cup would show no difference in initial stability as compared with a highly porous acetabular cup when subjected to a bending moment. Second, would bone mineral density (BMD) be a significant variable under these test conditions. In a cadaveric model, acetabular cup micromotion was measured during a 1-time cantilever bending moment applied to 2 generations of pressfit acetabular components. BMD data were also obtained from the femoral necks available for associated specimen. The mean bending moment at 150 μm was not found to be significantly different for Gription (24.6 ± 14.0 N m) cups vs Porocoat (25 ± 10.2 N m; P > .84). The peak bending moment tolerated by Gription cups (33.9 ± 20.3 N m) was not found to be significantly different from Porocoat (33.5 ± 12.2 N m; P > .92). No correlation between BMD and bending moment at 150 μm of displacement could be identified. The coefficient of friction provided by highly porous metal acetabular shells used in this study did not provide better resistance to migration under bending load when compared with a standard porous coated component. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. A comparison of basal and eye-flush tears for the analysis of cat tear proteins.

    PubMed

    Petznick, Andrea; Evans, Margaret D M; Madigan, Michele C; Markoulli, Maria; Garrett, Qian; Sweeney, Deborah F

    2011-02-01

    To identify a rapid and effective tear collection method providing sufficient tear volume and total protein content (TPC) for analysis of individual proteins in cats. Domestic adult short-haired cats (12-37 months; 2.7-6.6 kg) were used in the study. Basal tears without stimulation and eye-flush tears after instillation of saline (10 μl) were collected using microcapillary tubes from animal eyes either unwounded control or wounded with 9-mm central epithelial debridement giving four groups with n = 3. Tear comparisons were based on total time and rate for tear collection, TPC using micro bicinchoninic acid (BCA), tear immunoglobulin A (IgA), total matrix-metalloproteinase (MMP)-9 concentration using sandwich enzyme-linked immunosorbent assay (ELISA) and MMP-9 activity. Eye-flush tears were collected significantly faster than basal tears in wounded eyes with higher rates for tear collection in unwounded control and wounded eyes. TPC was significantly lower in eye-flush tears compared to basal tears. The relative proportion of tear IgA normalized to TPC (% IgA of TPC) was not significantly different between basal and eye-flush tears. In unwounded control eyes, MMP-9 was slightly higher in eye-flush than in basal tears; activity of MMP-9 in both tear types was similar. In wounded eyes, eye-flush tears showed highest MMP-9 levels and activity on Day 1, which subsequently decreased to Day 7. MMP-9 activity in basal tears from wounded eyes did not display changes in expression. Eye-flush tears can be collected rapidly providing sufficient tear volume and TPC. This study also indicates that eye-flush tears may be more suitable than basal tears for the analysis of MMPs following corneal wounding. © 2011 The Authors. Acta Ophthalmologica © 2011 Acta Ophthalmologica Scandinavica Foundation.

  7. Blocked Tear Duct

    MedlinePlus

    ... of the nose (lacrimal sac). From there tears travel down a duct (the nasolacrimal duct) draining into your nose. Once in the nose, tears are reabsorbed. A blockage can occur at any point in the tear drainage system, from the puncta ...

  8. Analysis of acetabular orientation and femoral anteversion using images of three-dimensional reconstructed bone models.

    PubMed

    Park, Jaeyeong; Kim, Jun-Young; Kim, Hyun Deok; Kim, Young Cheol; Seo, Anna; Je, Minkyu; Mun, Jong Uk; Kim, Bia; Park, Il Hyung; Kim, Shin-Yoon

    2017-05-01

    Radiographic measurements using two-dimensional (2D) plain radiographs or planes from computed tomography (CT) scans have several drawbacks, while measurements using images of three-dimensional (3D) reconstructed bone models can provide more consistent anthropometric information. We compared the consistency of results using measurements based on images of 3D reconstructed bone models (3D measurements) with those using planes from CT scans (measurements using 2D slice images). Ninety-six of 561 patients who had undergone deep vein thrombosis-CT between January 2013 and November 2014 were randomly selected. We evaluated measurements using 2D slice images and 3D measurements. The images used for 3D reconstruction of bone models were obtained and measured using [Formula: see text] and [Formula: see text] (Materialize, Leuven, Belgium). The mean acetabular inclination, acetabular anteversion and femoral anteversion values on 2D slice images were 42.01[Formula: see text], 18.64[Formula: see text] and 14.44[Formula: see text], respectively, while those using images of 3D reconstructed bone models were 52.80[Formula: see text], 14.98[Formula: see text] and 17.26[Formula: see text]. Intra-rater reliabilities for acetabular inclination, acetabular anteversion, and femoral anteversion on 2D slice images were 0.55, 0.81, and 0.85, respectively, while those for 3D measurements were 0.98, 0.99, and 0.98. Inter-rater reliabilities for acetabular inclination, acetabular anteversion and femoral anteversion on 2D slice images were 0.48, 0.86, and 0.84, respectively, while those for 3D measurements were 0.97, 0.99, and 0.97. The differences between the two measurements are explained by the use of different tools. However, more consistent measurements were possible using the images of 3D reconstructed bone models. Therefore, 3D measurement can be a good alternative to measurement using 2D slice images.

  9. Increased Mortality in Elderly Patients with Sarcopenia and Acetabular Fractures.

    PubMed

    Deren, Matthew E; Babu, Jacob; Cohen, Eric M; Machan, Jason; Born, Christopher T; Hayda, Roman

    2017-02-01

    Sarcopenia is a condition of clinically relevant loss of muscle mass and function. Acetabular fractures in elderly patients are common and difficult to treat. This study aimed to determine if sarcopenia is common in elderly patients with acetabular fractures and correlates with lower-energy mechanisms of injury, higher rates of complications, and higher mortality than patients with normal muscle mass. The Rhode Island Hospital Trauma Database was queried for patients who were ≥60 years of age from 2005 to 2014 using the International Classification of Diseases, Ninth Revision, code for closed acetabular fracture, 808.0. Charts were retrospectively reviewed for demographic data, operative intervention, mechanism of injury, mortality, comorbidities, and other factors. Computed tomography (CT) was used to determine the muscle cross-sectional area and to calculate the skeletal muscle index. The database revealed 192 patients coded for acetabular fracture; of these, 181 were correctly diagnosed. Ninety-nine patients had recorded body mass index (BMI) and adequate CT scans to measure the skeletal muscle index. Forty-two patients (42.4%) had sarcopenia, and 57 patients (57.6%) did not have sarcopenia. There were no significant differences in demographic characteristics between the groups with the exception of BMI and sex. BMI was higher in patients who did not have sarcopenia (31.7 kg/m) than it was in patients with sarcopenia (23.6 kg/m) (p < 0.001). Male sex was significantly greater (p = 0.0104) in patients with sarcopenia at 76.2% (32 of 42 patients) than in patients without sarcopenia at 50.9% (29 of 57 patients). Fractures in patients without sarcopenia were associated with a higher-energy mechanism of injury in 78.9% of cases compared with 52.4% of cases of patients with sarcopenia (p = 0.005). Sarcopenia was significantly associated (p = 0.0419) with increased 1-year mortality (28.6%) compared with the absence of sarcopenia (12.3%). This association was even

  10. Stabilization of an acetabular fracture with cables for acute total hip arthroplasty.

    PubMed

    Mears, D C; Shirahama, M

    1998-01-01

    A critical stage of total hip arthroplasty for an acute acetabular fracture where extensive comminution, impaction, and osteopenia thwart the application of conventional open or closed methods, especially in the elderly, is stable fixation of the acetabulum. The use of 2-mm braided cables permits effective immobilization of the fracture for use in conjunction with a hybrid arthroplasty. The method is consistent with the use of a conventional arthroplastic incision and is suitable for other applications including the fixation of periprosthetic fractures, bulk allografts, and conventional acetabular fractures.

  11. Complications Are Not Increased With Acetabular Revision of Metal-on-metal Total Hip Arthroplasty.

    PubMed

    Penrose, Colin T; Seyler, Thorsten M; Wellman, Samuel S; Bolognesi, Michael P; Lachiewicz, Paul F

    2016-10-01

    Isolated revision of the acetabular component in the setting of total hip arthroplasty has an increased risk of dislocation. With local soft tissue destruction frequently associated with failed metal-on-metal (MoM) bearings, it is presumed that acetabular revision of these hips will have even greater risk of complications. However, no study directly compares the complications of MoM with metal-on-polyethylene (MoP) acetabular revisions. In the context of a large database analysis, we asked the following questions: (1) Are there differences in early medical or wound complications after isolated acetabular revision of MoM and MoP bearing surfaces? (2) Are there differences in the frequency of dislocation, deep infection, and rerevision based on the bearing surface of the original implant? A review of the 100% Medicare database from 2005 to 2012 was performed using International Classification of Diseases, 9th Revision and Current Procedural Terminology codes. We identified 451 patients with a MoM bearing and 628 patients with a MoP bearing who had an isolated acetabular revision and a minimum followup of 2 years. The incidence, odds ratios, and 95% confidence intervals for early medical or wound complications were calculated using a univariate analysis at 30 days with patient sex and age group-adjusted analysis for blood transfusion. The incidence, odds ratio, and 95% confidence intervals for dislocation, deep infection, and rerevision were calculated using a univariate analysis at 30 day, 90 days, 1 year, and 2 years using a subgroup analysis with the Cochran-Mantel-Haenszel test to adjust for patient gender and age groups. There were no differences between the MoM and MoP isolated acetabular revisions in the incidence of 30-day local complications. There was a greater risk of transfusion in the MoP group than the MoM group (134 of 451 [30%] versus 230 of 628 [37%]; odds ratio [OR], 0.731; 95% confidence interval [CI], 0.565-0.948; p = 0.018). There were no

  12. Tear-Film Evaporation Rate from Simultaneous Ocular-Surface Temperature and Tear-Breakup Area.

    PubMed

    Dursch, Thomas J; Li, Wing; Taraz, Baseem; Lin, Meng C; Radke, Clayton J

    2018-01-01

    A corneal heat-transfer model is presented to quantify simultaneous measurements of fluorescein tear-breakup area (TBA) and ocular-surface temperature (OST). By accounting for disruption of the tear-film lipid layer (TFLL), we report evaporation rates through lipid-covered tear. The modified heat-transfer model provides new insights into evaporative dry eye. A quantitative analysis is presented to assess human aqueous tear evaporation rate (TER) through intact TFLLs from simultaneous in vivo measurement of time-dependent infrared OST and fluorescein TBA. We interpret simultaneous OST and TBA measurements using an extended heat-transfer model. We hypothesize that TBAs are ineffectively insulated by the TFLL and therefore exhibit higher TER than does that for a well-insulting TFLL-covered tear. As time proceeds, TBAs increase in number and size, thereby increasing the cornea area-averaged TER and decreasing OST. Tear-breakup areas were assessed from image analysis of fluorescein tear-film-breakup video recordings and are included in the heat-transfer description of OST. Model-predicted OSTs agree well with clinical experiments. Percent reductions in TER of lipid-covered tear range from 50 to 95% of that for pure water, in good agreement with literature. The physical picture of noninsulating or ruptured TFLL spots followed by enhanced evaporation from underlying cooler tear-film ruptures is consistent with the evaporative-driven mechanism for local tear rupture. A quantitative analysis is presented of in vivo TER from simultaneous clinical measurement of transient OST and TBA. The new heat-transfer model accounts for increased TER through expanding TBAs. Tear evaporation rate varies strongly across the cornea because lipid is effectively missing over tear-rupture troughs. The result is local faster evaporation compared with nonruptured, thick lipid-covered tear. Evaporative-driven tear-film ruptures deepen to a thickness where fluorescein quenching commences and local

  13. 21 CFR 888.3320 - Hip joint metal/metal semi-constrained, with a cemented acetabular component, prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Hip joint metal/metal semi-constrained, with a... Devices § 888.3320 Hip joint metal/metal semi-constrained, with a cemented acetabular component, prosthesis. (a) Identification. A hip joint metal/metal semi-constrained, with a cemented acetabular...

  14. 21 CFR 888.3320 - Hip joint metal/metal semi-constrained, with a cemented acetabular component, prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Hip joint metal/metal semi-constrained, with a... Devices § 888.3320 Hip joint metal/metal semi-constrained, with a cemented acetabular component, prosthesis. (a) Identification. A hip joint metal/metal semi-constrained, with a cemented acetabular...

  15. Evaluation of Shoulder-Stabilizing Braces: Can We Prevent Shoulder Labrum Injury in Collegiate Offensive Linemen?

    PubMed

    Baker, Hayden P; Tjong, Vehniah K; Dunne, Kevin F; Lindley, Tory R; Terry, Michael A

    2016-12-01

    Shoulder injuries remain one of the most common injuries among collegiate football athletes. Offensive linemen in particular are prone to posterior labral pathology. To evaluate the efficacy of shoulder bracing in collegiate offensive linemen with respect to injury prevention, severity, and lost playing time. Cohort study; Level of evidence, 3. Offensive linemen at a single collegiate institution wore bilateral shoulder-stabilizing braces for every contact practice and game beginning in the spring of 2013. Between spring of 2007 and fall of 2012, offensive linemen did not wear any shoulder braces. Player injury data were collected for all contact practices and games throughout these time periods to highlight differences with brace use. Forty-five offensive linemen (90 shoulders) participated in spring and fall college football seasons between 2007 and 2015. There were 145 complete offensive linemen seasons over the course of the study. Offensive linemen not wearing shoulder braces completed 87 seasons; offensive linemen wearing shoulder braces completed 58 seasons. Posterior labral tear injury rates were calculated for players who wore the shoulder braces (0.71 per 1000 athlete-exposures) compared with shoulders of players who did not wear the braces (1.90 per 1000 athlete-exposures). The risk ratio was 0.46 (95% CI, 0.16-1.30; P = .14). Mean time (contact practices and games) missed due to injury was significant, favoring less time missed by players who used braces (8.7 vs 36.60 contact practices and games missed due to injury; P = .0019). No significant difference in shoulder labral tears requiring surgery was found for brace use compared with no brace use. Shoulder-stabilizing braces were shown not to prevent posterior labral tears among collegiate offensive lineman, although they were associated with less time lost to injury. The results of this study have clinical significance, indicating that wearing a shoulder brace provides a protective factor for offensive

  16. Assessment of acetabular retroversion following long term review of Salter's osteotomy.

    PubMed

    Robb, Curtis A; Datta, Amit; Nayeemuddin, Mohammed; Bache, Christopher E

    2009-01-01

    Salter's innominate osteotomy may predispose to anterior over-coverage of the acetabulum. Over cover or retroversion has been demonstrated to be a cause of hip pain, impingement and subsequent osteoarthritis. We reviewed the long-term follow up of seventeen skeletally mature hips in sixteen patients who had previously undergone a Salter's osteotomy in childhood. The Salter pelvic osteotomy was performed at a mean average age of 5 years and follow up at a mean average age of 20 years. Patients were assessed by clinical examination for signs of impingement, Harris Hip Score and pelvic radiograph. Acetabular version was evaluated by the relationship between anterior and posterior walls of the acetabulum using templates applied to the pelvic radiograph as described by Hefti. The median acetabular cover averaged 17 degrees of anteversion with 2 patients (12%) demonstrating retroversion, neither of whom, had signs of impingement on examination. The mean average Harris Hip Score was 85 indicating a good outcome at long-term follow-up. We believe acetabular remodelling may occur with age after Salter's innominate osteotomy and have found good results in patients after skeletal maturation. Fears of long-term anterior over-coverage and retroversion with this operation may be unfounded.

  17. Computed tomography assessment of hip joints in asymptomatic individuals in relation to femoroacetabular impingement.

    PubMed

    Kang, Alan C L; Gooding, Andrew J; Coates, Mark H; Goh, Tony D; Armour, Paul; Rietveld, John

    2010-06-01

    Femoroacetabular impingement has become a well-recognized entity predisposing to acetabular labral tears and chondral damage, and subsequently development of osteoarthritis of the hip joint. In the authors' experience, it is common to see bony abnormalities predisposing to femoroacetabular impingement in the contralateral asymptomatic hips in patients with unilateral femoroacetabular impingement. This study was undertaken to investigate the prevalence of bony abnormalities predisposing to femoroacetabular impingement in asymptomatic individuals without exposing study participants to unnecessary radiation. Cross-sectional study; Level of evidence, 4. Fifty individuals (100 hip joints), ranging from 15 to 40 years of age, who were seen at a local hospital between March and August 2008 with abdominal trauma or nonspecific abdominal pain in whom abdominal computed tomography was performed to aid diagnosis were prospectively studied. These patients were not known to have any history of hip-related problems. Raw data from the abdominal computed tomography scan, performed on a 64-slice multidetector computed tomography scanner, were reformatted using bone algorithm into several different planes. Several measurements and observations of the hip joints were made in relation to femoroacetabular impingement. The 100 hip joints from 50 patients with no history of hip problems demonstrated that 39% of the joints (31% of female, 48% of male joints) have at least 1 morphologic aspect predisposing to femoroacetabular impingement. The majority (66% to 100% ) of the findings were bilateral; 33% of female and 52% of male asymptomatic participants in our study had at least 1 predisposing factor for femoroacetabular impingement in 1 or both of their hip joints. Based on the data collected from this study, the acetabular crossover sign had a 71% sensitivity and 88% specificity for detecting acetabular retroversion. Nonquantitative assessment of the femoral head at the anterior

  18. Initial stability of press-fit acetabular components under rotational forces.

    PubMed

    Fehring, Keith A; Owen, John R; Kurdin, Anton A; Wayne, Jennifer S; Jiranek, William A

    2014-05-01

    The primary goal of this study was to determine the initial press-fit stability in acetabular components without screw fixation. Mechanical testing was performed with the implantation of press-fit acetabular components in cadaveric specimens. No significant difference was found in load to failure testing between 1 and 2 mm of under-reaming. However, there was significant variability in bending forces required to create 150 μm of micromotion ranging from 49.3 N to 214.4 N. This study shows that cups implanted in a press-fit fashion, which are felt to be clinically stable, have high degrees of variability in resisting load and may be at risk for loosening. There is a need for more objective intra-operative techniques to test cup stability. © 2014.

  19. The influence of acetabular bone cracks in the press-fit hip replacement: Numerical and experimental analysis.

    PubMed

    Ramos, A; Duarte, R J; Relvas, C; Completo, A; Simões, J A

    2013-07-01

    The press-fit hip acetabular prosthesis implantation can cause crack formation in the thin regions surrounding the acetabular. As a consequence the presence of cracks in this region can lead to poor fixation and fibrous tissue formation. Numerical and experimental models of commercial press-fit hip replacements were developed to compare the behavior between the intact and implanted joints. Numerical models with an artificial crack and without crack were considered. The iliac and the femur were created through 3D geometry acquisition based on composite human replicas and 3D-Finite Element models were generated. The mechanical behavior was assessed numerically and experimentally considering the principal strains. The comparison between Finite Element model predictions and experimental measurements revealed a maximum difference of 9%. Similar distribution of the principal strains around the acetabular cavity was obtained for the intact and implanted models. When comparing the Von Mises stresses, it is possible to observe that the intact model is the one that presents the highest stress values in the entire acetabular cavity surface. The crack in the posterior side changes significantly the principal strain distribution, suggesting bone loss after hip replacement. Relatively to micromotions, these were higher on the superior side of the acetabular cavity and can change the implant stability and bone ingrowth. Copyright © 2013 Elsevier Ltd. All rights reserved.

  20. A Pilot Study of Augmented Reality Technology Applied to the Acetabular Cup Placement During Total Hip Arthroplasty.

    PubMed

    Ogawa, Hiroyuki; Hasegawa, Seiichirou; Tsukada, Sachiyuki; Matsubara, Masaaki

    2018-06-01

    We developed an acetabular cup placement device, the AR-HIP system, using augmented reality (AR). The AR-HIP system allows the surgeon to view an acetabular cup image superimposed in the surgical field through a smartphone. The smartphone also shows the placement angle of the acetabular cup. This preliminary study was performed to assess the accuracy of the AR-HIP system for acetabular cup placement during total hip arthroplasty (THA). We prospectively measured the placement angles using both a goniometer and AR-HIP system in 56 hips of 54 patients undergoing primary THA. We randomly determined the order of intraoperative measurement using the 2 devices. At 3 months after THA, the placement angle of the acetabular cup was measured on computed tomography images. The primary outcome was the absolute value of the difference between intraoperative and postoperative computed tomography measurements. The measurement angle using AR-HIP was significantly more accurate in terms of radiographic anteversion than that using a goniometer (2.7° vs 6.8°, respectively; mean difference 4.1°; 95% confidence interval, 3.0-5.2; P < .0001). There was no statistically significant difference in terms of radiographic inclination (2.1° vs 2.6°; mean difference 0.5°; 95% confidence interval, -1.1 to 0.1; P = .13). In this pilot study, the AR-HIP system provided more accurate information regarding acetabular cup placement angle than the conventional method. Further studies are required to confirm the utility of the AR-HIP system as a navigation tool. Copyright © 2018 Elsevier Inc. All rights reserved.

  1. An unusual mode of failure of a tripolar constrained acetabular liner: a case report.

    PubMed

    Banks, Louisa N; McElwain, John P

    2010-04-01

    Dislocation after primary total hip arthroplasty (THA) is the most commonly encountered complication and is unpleasant for both the patient and the surgeon. Constrained acetabular components can be used to treat or prevent instability after primary total hip arthroplasty. We present the case of a 42-year-old female with a BMI of 41. At 18 months post-primary THA the patient underwent further revision hip surgery after numerous (more than 20) dislocations. She had a tripolar Trident acetabular cup (Stryker-Howmedica-Osteonics, Rutherford, New Jersey) inserted. Shortly afterwards the unusual mode of failure of the constrained acetabular liner was noted from radiographs in that the inner liner had dissociated from the outer. The reinforcing ring remained intact and in place. We believe that the patient's weight, combined with poor abductor musculature caused excessive demand on the device leading to failure at this interface when the patient flexed forward. Constrained acetabular components are useful implants to treat instability but have been shown to have up to 42% long-term failure rates with problems such as dissociated inserts, dissociated constraining rings and dissociated femoral rings being sited. Sometimes they may be the only option left in difficult cases such as illustrated here, but still unfortunately have the capacity to fail in unusual ways.

  2. Theo van Rens Prize. Arthroscopic assessment of the unstable shoulder.

    PubMed

    Hintermann, B; Gächter, A

    1994-01-01

    The purpose of this study was to evaluate prospectively the findings during shoulder arthroscopy in patients with recurrent anterior instability of the glenohumeral joint. One hundred and seventy-eight patients who fulfilled the criteria of having had at least one documented shoulder dislocation were included in the study. The pathological findings most frequently noted at arthroscopy were: anterior glenoid labral tears (85%), ventral capsule insufficiency (80%), Hill-Sachs compression fractures (67%), glenohumeral ligament insufficiency (55%), rotator cuff tears (20%), posterior glenoid labral tears (8%), and SLAP lesions (5%). Abnormalities were noted more frequently than expected, and there were significant differences between preoperative and postoperative diagnoses. Our study has taught us that a multiplicity of morphological changes are associated with instability of the glenohumeral joint, and that there is no single cause. The labrum and rim of the anterior inferior glenoid, for instance, showed typical abnormalities corresponding to different entities of anterior instability. In practice, this is very important, as the abnormalities visualized by imaging methods determine the surgical treatment.

  3. Arthroscopic findings after shoulder dislocation.

    PubMed

    Hintermann, B; Gächter, A

    1995-01-01

    The purpose of this study was to evaluate prospectively the arthroscopic findings of the unstable shoulder, to provide insights into the causes and mechanisms of shoulder instability, and to establish a rationale for using special surgical procedures. Arthroscopic examination was performed on 212 patients who had at least 1 documented shoulder dislocation. Of these 212 patients, 184 (87%) patients had anterior glenoid labral tears, 168 (79%) patients had ventral capsule insufficiency, 144 (68%) patients had Hill-Sachs compression fractures, 116 (55%) patients had glenohumeral ligament insufficiency, 30 (14%) patients had complete rotator cuff tendon tears, 26 (12%) patients had posterior glenoid labral tears, 14 (7%) patients had superior labrum anterior and inferior lesions. As this prospective study shows, multiple morphologic changes are associated with instability of the glenohumeral joint; there is no single cause for an unstable shoulder. Arthroscopic examination of the shoulder before surgery revealed a significant amount of information that would have been undetected without the aid of expensive diagnostic tools. For instance, the labrum and rim of the anteroinferior glenoid showed typical abnormalities corresponding to different entities of anterior instability.

  4. Divalent cations in tears, and their influence on tear film stability in humans and rabbits.

    PubMed

    Wei, Xiaojia Eric; Markoulli, Maria; Millar, Thomas J; Willcox, Mark D P; Zhao, Zhenjun

    2012-06-05

    Reduced tear film stability is reported to contribute to dry eye. Rabbits are known to have a more stable tear film than humans. Thus, we sought to examine the tears of rabbits and humans for metal cations, and to test how they influence tear film stability. Tears were collected from 10 healthy humans and 6 rabbits. Tear osmolality was measured by vapor pressure osmometer, and metals analyzed using inductively coupled plasma (ICP) mass spectrometry or ICP atomic emission spectroscopy. The influence of divalent cations on tears was analyzed by measuring surface tension using the Langmuir trough in vitro, using different concentrations of cations in the subphase, and grading the tear break-up in rabbits in vivo after instillation of chelating agents. Rabbit tears had a higher osmolality compared to humans. Major metals did not differ between species; however, rabbits had higher levels of Mg(2+) (1.13 vs. 0.39 mM) and Ca(2+) (0.75 vs. 0.36 mM). In rabbit tears in vitro, diminishing divalent cations resulted in a decrease in the maximum surface pressure from 37 to 30 mN/m. In vivo, an increase in the amount of tear film that was broken-up was found. In contrast, when changing divalent cation concentrations in human tears, the maximum surface pressure remained at 26 mN/m. The normal osmolality of rabbit tears is significantly higher than that in humans. While divalent cations had little influence on human tears, they appear to have an important role in maintaining tear film stability in rabbits.

  5. Radial tears associated with cleavage tears of the medial meniscus in athletes.

    PubMed

    Kidron, Amos; Thein, Rafael

    2002-03-01

    To evaluate the significance of a small radial tear in the root of the posterior horn of the medial meniscus in an otherwise normal-looking meniscus in individuals who play vigorous sports. Retrospective review. Arthroscopy was performed in 1,270 patients; 11 patients (0.86%) had a small radial tear in the root of the medial meniscus. Trimming of the tear revealed a large horizontal cleavage tear of the posterior horn and body of the meniscus. The average age of the affected patients was 29.6 years (range, 21 to 45 years), and all were active in sports. Magnetic resonance imaging was of dubious diagnostic value. Three patients had undergone previous arthroscopy at which time the small radial root tear had been noted but was not thought to warrant treatment. All 11 patients returned to their former levels of activity after adequate surgery. When a radial root tear in the medial meniscus is found in an athletic patient, the edges of the tear should be trimmed, the root of the medial meniscus examined, and any additional torn cartilage resected.

  6. The influence of the acetabular labrum seal, intact articular superficial zone and synovial fluid thixotropy on squeeze-film lubrication of a spherical synovial joint.

    PubMed

    Hlavácek, M

    2002-10-01

    A model of synovial fluid (SF) filtration by articular cartilage (AC) in a step-loaded spherical synovial joint at rest is presented. The effects of joint pathology (such as a depleted acetabular labrum, a depleted cartilage superficial zone consistent with early osteoarthritis and an inflammatory SF) on the squeezed synovial film are also investigated. Biphasic mixture models for AC (ideal fluid and elastic porous transversely isotropic two-layer matrix) and for SF (ideal and thixotropic fluids) are applied and the following results are obtained. If the acetabular labrum is able to seal the pressurised SF between the articular surfaces (as in the normal hip joint), the fluid in the synovial film and in the cartilage within the labral ring is homogeneously pressurised. The articular surfaces remain separated by a fluid film for minutes. If the labrum is destroyed or absent and the SF can escape across the contact edge, the fluid pressure is non-homogeneous and with a small jump at the articular surface at the very moment of load application. The ensuing synovial film filtration by porous cartilage is lower for the normal cartilage (with the intact superficial zone) than if this zone is already depleted or rubbed off as in the early stage of primary osteoarthritis. Compared with the inflammatory (Newtonian) SF, the normal (thixotropic) fluid applies favourably in the squeezed film near the contact centre only, yielding a thicker SF film there, but not affecting the minimum thickness in the fluid film profile at a fixed time. For all that, in the unsealed case for both the normal and pathological joint, the macromolecular concentration of the hyaluronic acid-protein complex in the synovial film quickly increases due to the filtration in the greater part of the contact. A stable synovial gel film, thick on the order of 10(-7)m, protecting the articular surfaces from the intimate contact, is formed within a couple of seconds. Boundary lubrication by the synovial gel is

  7. [A simulative biomechanical experiment on different position of none-cement acetabular components influencing the load distribution around acetabulum].

    PubMed

    Li, Dongsong; Liu, Jianguo; Li, Shuqiang; Fan, Honghui; Guan, Jikui

    2008-02-01

    In the present study, a three dimensional finite-element model of the human pelvic was reconstructed, and then, under different acetabular component position (the abduction angle ranges from 30 degrees to 70 degrees and the anteversion ranges from 5 degrees to 30degrees) the load distribution around the acetabular was evaluated by the computer biomechanical analysis program (Solidworks). Through the obtained load distribution results, the most even and reasonable range of the distribution was selected; therefore the safe range of the acetabular component implantation can be validated from the biomechanics aspect.

  8. Can acetabular orientation be restored by lumbar pedicle subtraction osteotomy in ankylosing spondylitis patients with thoracolumbar kyphosis?

    PubMed

    Hu, Jun; Qian, Bang-Ping; Qiu, Yong; Wang, Bin; Yu, Yang; Zhu, Ze-Zhang; Jiang, Jun; Mao, Sai-Hu; Qu, Zhe; Zhang, Yun-Peng

    2017-07-01

    To evaluate whether acetabular orientation (abduction and anteversion) can be restored by lumbar pedicle subtraction osteotomy (PSO) in ankylosing spondylitis (AS) patients with thoracolumbar kyphosis. A total of 33 consecutive AS patients with thoracolumbar kyphosis undergoing one-level lumbar PSO were retrospectively reviewed. Radiographical measurements included sagittal vertical axis, global kyphosis, thoracic kyphosis, local kyphosis, lumbar lordosis, pelvic incidence, sacral slope, and pelvic tilt. Acetabular abduction and anteversion were measured on CT scans of the pelvis before and after lumbar PSO. The preoperative and postoperative parameters were compared by the paired samples t test. Pearson's correlation analysis was conducted to determine the correlations between the changes in acetabular abduction and anteversion and the changes in sagittal spinopelvic parameters. After lumbar PSO, sagittal vertical axis, global kyphosis, and pelvic tilt were corrected from 15.7 ± 6.7 cm, 66.8° ± 17.5°, and 38.6° ± 9.0° to 2.9 ± 4.9 cm, 21.3° ± 8.2°, and 23.2° ± 8.2°, respectively (p < 0.001). Of note, acetabular abduction and anteversion decreased from 59.6° ± 4.6° to 31.4° ± 6.5° before surgery to 51.4° ± 6.5° and 20.2° ± 4.4° after surgery, respectively (p < 0.001). Moreover, the changes in acetabular abduction and anteversion were observed significantly correlated with the change in pelvic tilt (r = 0.527, p = 0.002; r = 0.586, p < 0.001). Abnormal acetabular abduction and anteversion could be corrected by lumbar PSO in AS patients with thoracolumbar kyphosis. Consequently, a relatively normal acetabular orientation could be achieved after lumbar PSO, which might decrease the potential risk of dislocation in AS patients with spine and hip deformities requiring subsequent THR surgery.

  9. The Evolution of the Cup-Cage Technique for Major Acetabular Defects: Full and Half Cup-Cage Reconstruction.

    PubMed

    Sculco, Peter K; Ledford, Cameron K; Hanssen, Arlen D; Abdel, Matthew P; Lewallen, David G

    2017-07-05

    Complex acetabular reconstruction for major bone loss can require advanced methods such as the use of a cup-cage construct. The purpose of this study was to review outcomes after the initial development of the cup-cage technique and the subsequent evolution to the use of a half cup-cage construct. We performed a retrospective, single-center review of 57 patients treated with cup-cage reconstruction for major acetabular bone loss. All patients had major acetabular defects graded as Paprosky Type 2B through 3B, with 34 (60%) having an associated pelvic discontinuity. Thirty patients received a full cup-cage construct and 27, a half cup-cage construct. The mean follow-up was 5 years. Both the full and half cup-cage cohorts demonstrated significantly improved Harris hip score (HHS) values, from 36 to 72 at a minimum of 2 years of follow-up (p < 0.05). Early construct migration occurred in 4 patients, with stabilization prior to 2-year follow-up in all but 1 patient. Incomplete, zone-3, nonprogressive acetabular radiolucencies were observed in 2 (7%) of the full cup-cage constructs and 6 (22%) of the half cup-cage constructs. One patient with a full cup-cage construct underwent re-revision of the acetabular component for progressive migration and aseptic loosening. Short-term survivorship free from re-revision for any cause or reoperation was 89% (83% and 96% for full and half cup-cage cohorts, respectively). Both full and half cup-cage constructs demonstrated successful clinical outcomes and survivorship in the treatment of major acetabular defects and pelvic discontinuity. Each method is utilized on the basis of individual intraoperative findings, including the extent and pattern of bone loss, the quality and location of host bone remaining after preparation, and the presence of pelvic discontinuity. Longer-term follow-up is required to understand the durability of these constructs in treating major acetabular defects and pelvic discontinuity. Therapeutic Level III

  10. Symptomatic rotator cuff tears show higher radioisotope uptake on bone scintigraphy compared with asymptomatic tears.

    PubMed

    Koike, Yoichi; Sano, Hirotaka; Kita, Atushi; Itoi, Eiji

    2013-09-01

    Some patients with rotator cuff tears complain of pain, whereas others are asymptomatic. Previous studies have pointed out the presence of active bone metabolism in the painful shoulder, identified with increased radioisotope uptake during bone scintigraphy. Shoulders with symptomatic rotator cuff tears will demonstrate higher radioisotope uptake than shoulders with asymptomatic tears with bone scintigraphy, reflecting active bone metabolism in symptomatic tears. Cross-sectional study; Level of evidence, 3. The study consisted of 3 groups: patients with symptomatic tears (symptomatic group), patients with asymptomatic tears (asymptomatic group), and controls (no tear group). The symptomatic group consisted of 28 shoulders from 28 patients with symptomatic rotator cuff tears (pain score ≤4 on the University of California, Los Angeles [UCLA] shoulder evaluation form) who underwent bone scintigraphy followed by rotator cuff repair. Of 70 volunteers who had previously undergone bone scintigraphy for diseases unrelated to their shoulder, 34 were selected for the asymptomatic group (pain score ≥8 on the UCLA shoulder form), and 32 were selected for the no tear group. The mean radioisotope uptake in the symptomatic group was significantly higher than that in the asymptomatic group (P = .02) and the no tear group (P = .02). Ten of 28 shoulders (36%) in the symptomatic group showed increased radioisotope uptake exceeding 2 standard deviations from the mean of the no tear group. This percentage was significantly higher when compared with the asymptomatic group (0%) (P < .01). Shoulders with a symptomatic rotator cuff tear showed higher radioisotope uptake on bone scintigraphy than those with an asymptomatic tear. The radioisotope uptake in shoulders with an asymptomatic tear was comparable with that in shoulders without a tear. Positive radioisotope uptake may be associated with pain in a subgroup of patients with rotator cuff tears.

  11. Long-term results with the Atlas IIIp elastic cementless acetabular component in total hip replacement.

    PubMed

    Lee, Paul Yuh Feng; Rachala, Madhu; Teoh, Kar Ho; Woodnutt, David John

    2016-09-01

    Modular cementless elastic acetabular systems have advantages over cemented and hard shell cementless acetabular systems. There are few reports on the medium-term and long-term follow up of this particular type of implant. This study describes our experience with the Atlas IIIp modular acetabular system, which is a thin shell cementless elastic acetabular implant for total hip replacement commercialized under this name in many countries. We prospectively followed 244 patients treated with Atlas IIIp acetabular system between 2001 and 2004. Minimum ten year follow up was available for 148 hips (139 patients) from the original cohort of 263 hips (244 patients). One hundred five patients had died from unrelated causes and were excluded from the results. Post-operative and follow up radiographs of patients were assessed; and Harris hip scores were used as clinical outcome. Revision for any reason was defined as the end point for survivorship analysis. The mean pre-operative Harris hip score was 48 (S.D. 16) and the average post-operative score was 82 (S.D. 12). The mean follow up in our series was 11.5 years, ranging from ten to 13.5 years. Thirteen hips required further surgery in our cohort; of which ten cases required cup revision. The 13-years cumulative implant survival was 91.2 % and the risk of implant revision was 8.8 % at 13 years in 148 hips (139 patients). Kaplan-Meier analysis showed the implant survival rate of 95.2 % at ten years for revision for any reason and 99.4 % for aseptic loosening. Our clinical experience with this acetabular cup suggests good long-term survival rates that are similar to other cups on the market. The clinical experience in this study shows long-term survival rates that are consistent, acceptable and good results achieved with a low revision rate. Therapeutic III; therapeutic study.

  12. Risk Factors for Tear Progression in Symptomatic Rotator Cuff Tears: A Prospective Study of 174 Shoulders.

    PubMed

    Yamamoto, Nobuyuki; Mineta, Mitsuyoshi; Kawakami, Jun; Sano, Hirotaka; Itoi, Eiji

    2017-09-01

    The risk factors for tear progression in symptomatic rotator cuff tears have not been clarified yet. It is important for orthopaedic surgeons to know the natural course of tear progression when nonoperative management is to be chosen. Tears in younger patients, high-activity patients, or heavy laborers would progress in size more than those in older patients, low-activity patients, or light laborers. Case-control study; Level of evidence, 3. Two hundred twenty-five consecutive patients with symptomatic rotator cuff tears visited our institute between 2009 and 2015. Of these, 174 shoulders of 171 patients (mean age, 66.9 years) who underwent at least 2 magnetic resonance imaging (MRI) examinations were prospectively enrolled. The mean follow-up was 19 months. Tear progression was defined as positive when the tear size increased by ≥2 mm. The demographic factors that were analyzed by multivariate analysis included age, sex, hand dominance, smoking, alcohol drinking, hypercholesterolemia, sports participation, job type, tear size, and tear type (full or partial thickness). Of the 174 shoulders, 82 shoulders (47%) showed tear progression. The mean (±SD) tear length and width in the progression group on final MRI were 23.1 ± 12.5 mm and 17.3 ± 9.6 mm, respectively; the tear size progressed by a mean 5.8 ± 5.6 mm in length and 3.1 ± 5.2 mm in width. The mean propagation speed was 3.8 mm/y in length and 2.0 mm/y in width. The size of full-thickness tears significantly increased compared with that of articular-sided partial-thickness tears ( P = .0215). The size of medium tears significantly increased compared with that of other tears ( P < .0001). According to the logistic regression analysis, smoking was significantly correlated with tear progression ( P = .026). Subgroup analyses showed that male sex, hand dominance, and trauma were correlated with tear progression. Age, alcohol drinking, hypercholesterolemia, sports participation, and job type did not show any

  13. Sex assessment from the acetabular rim by means of image analysis.

    PubMed

    Benazzi, S; Maestri, C; Parisini, S; Vecchi, F; Gruppioni, G

    2008-08-25

    Determining sex from skeletal remains is one of the most important steps in archaeological and forensic anthropology. The present study considers the diagnostic value of the acetabulum based on its planar image and related metric data. For this purpose, 83 adult os coxae of known age were examined. Digital photos of the acetabular area were taken, with each bone in a standardized orientation. Technical drawing software was used to trace the acetabular rim and to measure the related dimensions (area, perimeter, longitudinal and transverse maximum width). The measurements were subjected to SPSS discriminant and classification function analysis. There were significant differences (p

  14. A novel approach for determining three-dimensional acetabular orientation: results from two hundred subjects.

    PubMed

    Higgins, Sean W; Spratley, E Meade; Boe, Richard A; Hayes, Curtis W; Jiranek, William A; Wayne, Jennifer S

    2014-11-05

    The inherently complex three-dimensional morphology of both the pelvis and acetabulum create difficulties in accurately determining acetabular orientation. Our objectives were to develop a reliable and accurate methodology for determining three-dimensional acetabular orientation and to utilize it to describe relevant characteristics of a large population of subjects without apparent hip pathology. High-resolution computed tomography studies of 200 patients previously receiving pelvic scans for indications not related to orthopaedic conditions were selected from our institution's database. Three-dimensional models of each osseous pelvis were generated to extract specific anatomical data sets. A novel computational method was developed to determine standard measures of three-dimensional acetabular orientation within an automatically identified anterior pelvic plane reference frame. Automatically selected points on the osseous ridge of the acetabulum were used to generate a best-fit plane for describing acetabular orientation. Our method showed excellent interobserver and intraobserver agreement (an intraclass correlation coefficient [ICC] of >0.999) and achieved high levels of accuracy. A significant difference between males and females in both anteversion (average, 3.5°; 95% confidence interval [CI], 1.9° to 5.1° across all angular definitions; p < 0.0001) and inclination (1.4°; 95% CI, 0.6° to 2.3° for anatomic angular definition; p < 0.002) was observed. Intrapatient asymmetry in anatomic measures showed bilateral differences in anteversion (maximum, 12.1°) and in inclination (maximum, 10.9°). Significant differences in acetabular orientation between the sexes can be detected only with accurate measurements that account for the entire acetabulum. While a wide range of interpatient acetabular orientations was observed, the majority of subjects had acetabula that were relatively symmetrical in both inclination and anteversion. A highly accurate and

  15. Direct hip joint distraction during acetabular fracture surgery using the AO universal manipulator.

    PubMed

    Calafi, L Afshin; Routt, M L Chip

    2010-02-01

    Certain acetabular fractures may necessitate distraction of the hip joint for removal of intra-articular debris and assessment of reduction. Distraction can be accomplished by manual traction, using a traction table or an AO universal manipulator (UM). The UM is a relatively simple and an inexpensive device that can provide focal distraction in a controlled manner without the risks associated with the use of a traction table. We describe a technique using the UM for hip joint distraction during acetabular fracture surgery through a Kocher-Langenbeck surgical exposure.

  16. [APPLICATION AND EFFECTIVENESS OF BIOLOGICAL TYPE ACETABULAR CUP IN ADULT Crowe TYPE IV DEVELOPMENTAL DYSPLASIA OF THE HIP].

    PubMed

    Xu, Ning; Sun, Junying; Zhao, Xijiang; Wang, Tao

    2016-01-01

    To investigate the application and effectiveness of the biological type acetabular cup(diameter < 44 mm) in adult Crowe type IV developmental dysplasia of the hip (DDH). Between April 2001 andAugust 2013, biological type acetabular cup was used in total hip arthroplasty for the treatment of Crowe type IV DDH in16 cases (20 hips). There were 3 males and 13 females, aged 31-69 years (mean, 49 years). Unilateral hip was involved in 12cases, and bilateral hips in 4 cases. The patients showed pain of the hip joint and inequality of lower limb (shortening ofaffected limb 1.8-6.0 cm in length, 3.5 cm on average). Acetabular deformity, the relationship and the severity of femoralhead dislocation were comfirmed on the X-ray films. The preoperative Harris score was 34.0 ± 6.9. All patientsachieved healing of incision by first intention, with no complication of infection or neurovascular injury. Sixteen caseswere followed up 4-12 years (mean, 7.5 years). At 2 weeks after operation, dislocation occurred in 2 cases, and were fixedwith plaster for 3 weeks after reduction of the hip. Postoperative X-ray films showed complete reduction of femoral head;the average acetabular coverage of the cup of the weight-bearing area was 98.5% (range, 98.2%-99.1%). The cup from theRanawat triangle was 4.6-7.0 mm (mean, 5.8 mm) in medial shifting, and was 4.5-7.9 mm (mean, 6.2 mm) in elevation,it located at cup lateral surface area inside the iliopectineal line and the Kohler line (< 40%); the cup abduction angle was(45 ± 5)degrees, and the anteversion angle was (10 ± 5)degrees. The other patients had no prosthesis loosening except 1 patient havingextensive acetabular prosthesis loosening because of acetabular osteolysis at 12 years after operation. The hip Harris scorewas significantly improved to 85.0 ± 7.5 at 1 year after operation (t = 14.34, P = 0.01). The acetabular grindingprocess to retain enough bone combined with a small cup of-biological prosthesis treating adult Crowe type IV DDH

  17. Mastering the Physical Examination of the Athlete's Hip.

    PubMed

    Trofa, David P; Mayeux, Sophie E; Parisien, Robert L; Ahmad, Christopher S; Lynch, T Sean

    In this review, we describe precise methods for evaluating the athlete's hip or groin with an emphasis on recognizing the most common extra-articular and intra-articular pathologies, including adductor strains, athletic pubalgia, osteitis pubis, and femoroacetabular impingement with labral tears.

  18. Antimicrobial Compounds in Tears

    PubMed Central

    McDermott, Alison M.

    2013-01-01

    The tear film coats the cornea and conjunctiva and serves several important functions. It provides lubrication, prevents drying of the ocular surface epithelia, helps provide a smooth surface for refracting light, supplies oxygen and is an important component of the innate defense system of the eye providing protection against a range of potential pathogens. This review describes both classic antimicrobial compounds found in tears such as lysozyme and some more recently identified such as members of the cationic antimicrobial peptide family and surfactant protein-D as well as potential new candidate molecules that may contribute to antimicrobial protection. As is readily evident from the literature review herein, tears, like all mucosal fluids, contain a plethora of molecules with known antimicrobial effects. That all of these are active in vivo is debatable as many are present in low concentrations, may be influenced by other tear components such as the ionic environment, and antimicrobial action may be only one of several activities ascribed to the molecule. However, there are many studies showing synergistic/additive interactions between several of the tear antimicrobials and it is highly likely that cooperativity between molecules is the primary way tears are able to afford significant antimicrobial protection to the ocular surface in vivo. In addition to effects on pathogen growth and survival some tear components prevent epithelial cell invasion and promote the epithelial expression of innate defense molecules. Given the protective role of tears a number of scenarios can be envisaged that may affect the amount and/or activity of tear antimicrobials and hence compromise tear immunity. Two such situations, dry eye disease and contact lens wear, are discussed here. PMID:23880529

  19. Well-fixed acetabular component retention or replacement: the whys and the wherefores.

    PubMed

    Blaha, J David

    2002-06-01

    Occasionally the adult reconstructive surgeon is faced with a well-fixed acetabular component that is associated with an arthroplasty problem that ordinarily would require removal and replacement of the cup. Removal of a well-fixed cup is associated with considerable morbidity in bone loss, particularly in the medial wall of the acetabulum. In such a situation, retention of the cup with exchange only of the polyethylene liner may be possible. As preparation for a prospective study, I informally reviewed my experience of cup retention or replacement in revision total hip arthroplasty. An algorithm for retaining or revising a well-fixed acetabular component is presented here. Copyright 2002, Elsevier Science (USA).

  20. Early failure mechanisms of constrained tripolar acetabular sockets used in revision total hip arthroplasty.

    PubMed

    Cooke, Christopher C; Hozack, William; Lavernia, Carlos; Sharkey, Peter; Shastri, Shani; Rothman, Richard H

    2003-10-01

    Fifty-eight patients received an Osteonics constrained acetabular implant for recurrent instability (46), girdlestone reimplant (8), correction of leg lengthening (3), and periprosthetic fracture (1). The constrained liner was inserted into a cementless shell (49), cemented into a pre-existing cementless shell (6), cemented into a cage (2), and cemented directly into the acetabular bone (1). Eight patients (13.8%) required reoperation for failure of the constrained implant. Type I failure (bone-prosthesis interface) occurred in 3 cases. Two cementless shells became loose, and in 1 patient, the constrained liner was cemented into an acetabular cage, which then failed by pivoting laterally about the superior fixation screws. Type II failure (liner locking mechanism) occurred in 2 cases. Type III failure (femoral head locking mechanism) occurred in 3 patients. Seven of the 8 failures occurred in patients with recurrent instability. Constrained liners are an effective method for treatment during revision total hip arthroplasty but should be used in select cases only.

  1. A new method for the measurement of anteversion of the acetabular cup after total hip arthroplasty.

    PubMed

    Aydogan, Mehmet; Burç, Halil; Saka, Gursel

    2014-08-01

    Many methods of determining the anteversion of the acetabular cup have been described in the literature. The advantages and disadvantages of each of these methods are discussed in this paper. We present a new method of measuring the acetabular anteversion at the anteroposterior hip. The formula designed by the authors was anteversion angle (α) = arc sin |PK|/√ |AK| × |BK|. The formula was tested using the AutoCAD software, and an experimental study was conducted to evaluate the accuracy. Three groups were created, and 16 X-ray images were taken and coded. Ten orthopaedic surgeons measured the acetabular anteversion from these X-rays using our formula. The results in Group 1 were closer to the actual value; in contrast, the results in Group 2 differed from the actual values. The results in Group 3 were as close to the actual anteversion values as were those in Group 1. Developments in technology often bring an increase in complications. Despite newly developed surgical methods and technology, the position of the acetabular cup is still used to determine the results of a total hip arthroplasty. Our method is simple, cost-effective and achieves almost 100 % accuracy.

  2. Restoration of Neuromuscular Control During The Pitch After Operative Treatment Of Slap Tears

    PubMed Central

    Chalmers, Peter Nissen; Cip, Johannes; Trombley, Robert; Monson, Brett; Wimmer, Markus; Cole, Brian J.; Verma, Nikhil N.; Romeo, Anthony A.

    2014-01-01

    Objectives: Superior labral anterior-posterior (SLAP) tears are a common cause of shoulder pain and dysfunction in overhead throwers. Treatment outcomes remain unpredictable with a large percentage of atheletes unable to return to sport. Persistent pain from the LHB (long head biceps) has been postulated as etiology of failure following repair. Previous authors have hypothesized that maximal stress is placed upon the biceps anchor during the cocking phase and that SLAP tears likely occur during this phase. We hypothesized that operative treatment of SLAP tears with repair or tenodesis would result in persistent alterations in neuromuscular control of the biceps during the overhand pitch post-operatively. Methods: We evaluated the activity of the biceps muscle in the overhand pitching motion and correlate this activity with throwing phase in healthy collegiate and semi-professional pitchers, collegiate pitchers status-post SLAP repair, and collegiate pitchers status-post biceps tenodesis. Patients were at least one year post-operative and had returned to pitching with a painless shoulder. Subjects pitched from a regulation-sized mound while surface electrodes collected electromyographic (sEMG) signals at 1500 Hz from the long- and short-heads of the biceps (LHBM and SHBM respectively), the deltoid, the infraspinatus, and the latissimus dorsi. Motion analysis data was captured at 120 Hz with a 14-camera three-dimensional markerless motion analysis system. At least five pitches were performed by each subject. sEMG data was then normalized to maximal manual muscle testing and then divided into previously described pitching phases (wind-up, stride, cocking, acceleration, deceleration, follow-through). Results: Eighteen pitchers participated: 7 normals, 6 status-post SLAP repair, and 5 status-post tenodesis. While no significant differences were observed in mean LHBM, SHBM, deltoid, infraspinatus, or latissimus activity between normals, pitchers status-post SLAP repair

  3. Tear progression of symptomatic full-thickness and partial-thickness rotator cuff tears as measured by repeated MRI.

    PubMed

    Kim, Yang-Soo; Kim, Sung-Eun; Bae, Sung-Ho; Lee, Hyo-Jin; Jee, Won-Hee; Park, Chang Kyun

    2017-07-01

    The purpose of this study was to analyse the natural course of symptomatic full-thickness and partial-thickness rotator cuff tears treated non-operatively and to identify risk factors affecting tear enlargement. One hundred and twenty-two patients who received non-surgical treatment for a partial- or full-thickness supraspinatus tear were included in this study. All rotator cuff tears were diagnosed with magnetic resonance imaging (MRI), and the same modality was used for follow-up studies. Follow-up MRI was performed after at least a 6-month interval. We evaluated the correlation between tear enlargement and follow-up duration. Eleven risk factors were analysed by both univariate and multivariate analyses to identify factors that affect enlargement of rotator cuff tears. The mean follow-up period was 24.4 ± 19.5 months. Out of 122 patients, 34 (27.9%) patients had an initial full-thickness tear and 88 (72.1%) patients had a partial-thickness tear. Considering all patients together, tear size increased in 51/122 (41.8%) patients, was unchanged in 65/122 (53.3%) patients, and decreased in 6/122 (4.9%) patients. Tear size increased for 28/34 (82.4%) patients with full-thickness tears and 23/88 (26.1%) patients with partial-thickness tears. From the two groups which were followed over 12 months, a higher rate of enlargement was observed in full-thickness tears than in partial-thickness tears (6-12 months, n.s.; 12-24 months, P = 0.002; over 24 months, P < 0.001). Logistic regression revealed that having a full-thickness tear was the most reliable risk factor for tear progression (P < 0.001). This study found that 28/34 (82.4%) of symptomatic full-thickness rotator cuff tears and 23/88 (26.1%) of symptomatic partial-thickness tears increased in size over a follow-up period of 6-100 months. Full-thickness tears showed a higher rate of enlargement than partial-thickness tears regardless of the follow-up duration. Univariate and multivariate analyses

  4. Computer-assisted virtual preoperative planning in orthopedic surgery for acetabular fractures based on actual computed tomography data.

    PubMed

    Wang, Guang-Ye; Huang, Wen-Jun; Song, Qi; Qin, Yun-Tian; Liang, Jin-Feng

    2016-12-01

    Acetabular fractures have always been very challenging for orthopedic surgeons; therefore, appropriate preoperative evaluation and planning are particularly important. This study aimed to explore the application methods and clinical value of preoperative computer simulation (PCS) in treating pelvic and acetabular fractures. Spiral computed tomography (CT) was performed on 13 patients with pelvic and acetabular fractures, and Digital Imaging and Communications in Medicine (DICOM) data were then input into Mimics software to reconstruct three-dimensional (3D) models of actual pelvic and acetabular fractures for preoperative simulative reduction and fixation, and to simulate each surgical procedure. The times needed for virtual surgical modeling and reduction and fixation were also recorded. The average fracture-modeling time was 45 min (30-70 min), and the average time for bone reduction and fixation was 28 min (16-45 min). Among the surgical approaches planned for these 13 patients, 12 were finally adopted; 12 cases used the simulated surgical fixation, and only 1 case used a partial planned fixation method. PCS can provide accurate surgical plans and data support for actual surgeries.

  5. Human tears contain a chemosignal.

    PubMed

    Gelstein, Shani; Yeshurun, Yaara; Rozenkrantz, Liron; Shushan, Sagit; Frumin, Idan; Roth, Yehudah; Sobel, Noam

    2011-01-14

    Emotional tearing is a poorly understood behavior that is considered uniquely human. In mice, tears serve as a chemosignal. We therefore hypothesized that human tears may similarly serve a chemosignaling function. We found that merely sniffing negative-emotion-related odorless tears obtained from women donors induced reductions in sexual appeal attributed by men to pictures of women's faces. Moreover, after sniffing such tears, men experienced reduced self-rated sexual arousal, reduced physiological measures of arousal, and reduced levels of testosterone. Finally, functional magnetic resonance imaging revealed that sniffing women's tears selectively reduced activity in brain substrates of sexual arousal in men.

  6. Subscapularis tendon tears

    PubMed Central

    Lenart, Brett A.; Ticker, Jonathan B.

    2017-01-01

    Tears of the subscapularis tendon have been under-recognised until recently. Therefore, a high index of suspicion is essential for diagnosis. A directed physical examination, including the lift-off, belly-press and increased passive external rotation can help identify tears of the subscapularis. All planes on MR imaging should be carefully evaluated to identify tears of the subscapularis, retraction, atrophy and biceps pathology. Due to the tendency of the tendon to retract medially, acute and traumatic full-thickness tears should be repaired. Chronic tears without significant degeneration should be considered for repair if no contraindication exists. Arthroscopic repair can be performed using a 30-degree arthroscope and a laterally-based single row repair; one anchor for full thickness tears ⩽ 50% of tendon length and two anchors for those ⩾ 50% of tendon length. Biceps pathology, which is invariably present, should be addressed by tenotomy or tenodesis. Timing of post-operative rehabilitation is dictated by the size of the repair and the security of the repair construct. The stages of rehabilitation typically involve a period of immobilisation followed by range of movement exercises, with a delay in active internal rotation (IR) and strengthening in IR. Cite this article: EFORT Open Rev 2017;2:484–495. DOI: 10.1302/2058-5241.2.170015 PMID:29387471

  7. Antimicrobial compounds in tears.

    PubMed

    McDermott, Alison M

    2013-12-01

    The tear film coats the cornea and conjunctiva and serves several important functions. It provides lubrication, prevents drying of the ocular surface epithelia, helps provide a smooth surface for refracting light, supplies oxygen and is an important component of the innate defense system of the eye providing protection against a range of potential pathogens. This review describes both classic antimicrobial compounds found in tears such as lysozyme and some more recently identified such as members of the cationic antimicrobial peptide family and surfactant protein-D as well as potential new candidate molecules that may contribute to antimicrobial protection. As is readily evident from the literature review herein, tears, like all mucosal fluids, contain a plethora of molecules with known antimicrobial effects. That all of these are active in vivo is debatable as many are present in low concentrations, may be influenced by other tear components such as the ionic environment, and antimicrobial action may be only one of several activities ascribed to the molecule. However, there are many studies showing synergistic/additive interactions between several of the tear antimicrobials and it is highly likely that cooperativity between molecules is the primary way tears are able to afford significant antimicrobial protection to the ocular surface in vivo. In addition to effects on pathogen growth and survival some tear components prevent epithelial cell invasion and promote the epithelial expression of innate defense molecules. Given the protective role of tears a number of scenarios can be envisaged that may affect the amount and/or activity of tear antimicrobials and hence compromise tear immunity. Two such situations, dry eye disease and contact lens wear, are discussed here. Copyright © 2013 Elsevier Ltd. All rights reserved.

  8. Acetabular Global Insufficiency in Patients with Down Syndrome and Hip-Related Symptoms: A Matched-Cohort Study.

    PubMed

    Bulat, Evgeny; Maranho, Daniel A; Kalish, Leslie A; Millis, Michael B; Kim, Young-Jo; Novais, Eduardo N

    2017-10-18

    The etiology of hip instability in Down syndrome is not completely understood. We investigated the morphology of the acetabulum and femur in patients with Down syndrome and compared measurements of the hips with those of matched controls. Computed tomography (CT) images of the pelvis of 42 patients with Down syndrome and hip symptoms were compared with those of 42 age and sex-matched subjects without Down syndrome or history of hip disease who had undergone CT for abdominal pain. Each of the cohorts had 23 male and 19 female subjects. The mean age (and standard deviation) in each cohort was 11.3 ± 5.3 years. The lateral center-edge angle (LCEA), acetabular inclination angle (IA), acetabular depth-width ratio (ADR), acetabular version, and anterior and posterior acetabular sector angles (AASA and PASA) were compared. The neck-shaft angle and femoral version were measured in the patients with Down syndrome only. The hips of the patients with Down syndrome were further categorized as stable (n = 21) or unstable (n = 63) for secondary analysis. The hips in the Down syndrome group had a smaller LCEA (mean, 10.8° ± 12.6° compared with 25.6° ± 4.6°; p < 0.0001), a larger IA (mean, 17.4° ± 10.3° compared with 10.9° ± 4.8°; p < 0.0001), a lower ADR (mean, 231.9 ± 56.2 compared with 306.8 ± 31.0; p < 0.0001), a more retroverted acetabulum (mean acetabular version as measured at the level of the centers of the femoral heads [AVC], 7.8° ± 5.1° compared with 14.0° ± 4.5°; p < 0.0001), a smaller AASA (mean, 55.0° ± 9.9° compared with 59.7° ± 7.8°; p = 0.005), and a smaller PASA (mean, 67.1° ± 10.4° compared with 85.2° ± 6.8°; p < 0.0001). Within the Down syndrome cohort, the unstable hips showed greater femoral anteversion (mean, 32.7° ± 14.6° compared with 23.6° ± 10.6°; p = 0.002) and worse global acetabular insufficiency compared with the stable hips. No differences between the unstable and stable hips were found with respect to

  9. Morphometric analysis of acetabular dysplasia in cerebral palsy: three-dimensional CT study.

    PubMed

    Gose, Shinichi; Sakai, Takashi; Shibata, Toru; Murase, Tsuyoshi; Yoshikawa, Hideki; Sugamoto, Kazuomi

    2009-12-01

    Three-dimensional computed tomography (3D-CT) eliminates the positioning errors and allows the clinician to more accurately assess the radiographic parameters present. To elucidate the 3D geometry of the acetabulum and the extent of hip subluxation/dislocation in patients with cerebral palsy (CP), quantitative morphometric analysis was performed using 3D-CT data. We evaluated 150 hips in 75 patients with bilateral spastic CP. The mean age of the patients was 5.4 years (range: 2.7 to 6.9 y). The fitting plane of the ilium was projected onto the coronal plane and then onto the sagittal plane, and then the angle formed with a horizontal line was defined as CTalpha (the lateral opening angle) and CTbeta (the sagittal inclination angle), respectively. The center of the acetabulum and the femoral head were defined, and the distance between these centers was divided by the femoral head diameter, defined as CT migration percentage (CTMP, %). In 123 (82%) of the 150 hips, the femoral head center was located posteriorly, superiorly, and laterally relative to the acetabular center. Large CTalpha cases tended to show large CTMP. CTalpha and CTMP were significantly larger in the cases with Gross Motor Functional Classification System (GMFCS) level IV/V and spastic quadriplegia, than in the cases with GMFCS level II/III and spastic diplegia. CTbeta showed significant correlation with the acetabular defect on the lateral 3D reconstructed images. Three-dimensional acetabular geometry and migration percentage in CP patients can be analyzed quantitatively using 3D-CT regardless of the abnormal spastic posture. The extent of acetabular dysplasia and subluxation is more severe in patients with GMFCS level IV/V and spastic quadriplesia. Level 4.

  10. The Bimetric cementless total hip replacement: 7-18 year follow-up assessing the influence of acetabular design on survivorship.

    PubMed

    Russell, R C; Ghassemi, A; Dorrell, J H; Powles, D P

    2009-08-01

    The purpose of this study was to evaluate the mid- to long-term survivorship of Bimetric cementless total hip replacement and assess how it is affected by the acetabular design. This was a retrospective analysis of 127 Bimetric cementless total hip replacements in 110 patients with a follow-up of 7-18 years. A single design stem and three different cementless metal-backed acetabular designs were used. Patients were assessed clinically using the Harris hip score and radiologically by independent review of current hip radiographs. There was only one case of aseptic loosening of the femoral stem. The earliest acetabular design showed a high failure rate whilst the latter two designs showed a 96% survivorship at a mean of 9.5 years. We conclude that a combination of the bimetric stem with either of the latter acetabular cup designs has a good mid- to long-term performance.

  11. Accuracy of templating the acetabular cup size in Total Hip Replacement using conventional acetate templates on digital radiographs.

    PubMed

    Krishnamoorthy, Vignesh P; Perumal, Rajamani; Daniel, Alfred J; Poonnoose, Pradeep M

    2015-12-01

    Templating of the acetabular cup size in Total Hip Replacement (THR) is normally done using conventional radiographs. As these are being replaced by digital radiographs, it has become essential to create a technique of templating using digital films. We describe a technique that involves templating the digital films using the universally available acetate templates for THR without the use of special software. Preoperative digital radiographs of the pelvis were taken with a 30 mm diameter spherical metal ball strapped over the greater trochanter. Using standard acetate templates provided by the implant company on magnified digital radiographs, the size of the metal ball (X mm) and acetabular cup (Y mm) were determined. The size of the acetabular cup to be implanted was estimated using the formula 30*Y/X. The estimated size was compared with the actual size of the cup used at surgery. Using this technique, it was possible to accurately predict the acetabular cup size in 28/40 (70%) of the hips. When the accuracy to within one size was considered, templating was correct in 90% (36/40). When assessed by two independent observers, there was good intra-observer and inter-observer reliability with intra-class correlation coefficient values greater than 0.8. It was possible to accurately and reliably predict the size of the acetabular cup, using acetate templates on digital films, without any digital templates.

  12. A Controlled Study on the Correlation between Tear Film Volume and Tear Film Stability in Diabetic Patients.

    PubMed

    Eissa, Iman M; Khalil, Noha M; El-Gendy, Heba A

    2016-01-01

    Purpose. To assess the tear film quantity and correlate it with the quality and stability of the tear film in diabetics and compare them to age matched controls. Introduction. Diabetes affects tear film parameters in multiple ways. Poor metabolic control and neuropathy are postulated factors. To further understand how diabetes affects tear film parameters this study was conducted. Subjects and Methods. Tear meniscus height was measured by anterior segment OCT, along with tear thinning time, a subtype of noninvasive tear break-up time, and blinking rate per minute which were all recorded for 22 diabetic patients. Correlations between these tear film parameters were studied and then compared to 16 age matched controls. Results. A statistically significant difference was found in blinking rate between the diabetic and the control group (P = 0.002), with higher blinking rate among diabetics. All tear film parameters were negatively correlated with duration of diabetes. A positive correlation was found between tear film volume and stability. Conclusion. Diabetes affects the tear film in various ways. Diabetics should be examined for dry eye signs even in absence of symptoms which may be masked by associated neuropathy. Duration of diabetes has an impact on tear film status.

  13. TFOS DEWS II Tear Film Report.

    PubMed

    Willcox, Mark D P; Argüeso, Pablo; Georgiev, Georgi A; Holopainen, Juha M; Laurie, Gordon W; Millar, Tom J; Papas, Eric B; Rolland, Jannick P; Schmidt, Tannin A; Stahl, Ulrike; Suarez, Tatiana; Subbaraman, Lakshman N; Uçakhan, Omür Ö; Jones, Lyndon

    2017-07-01

    The members of the Tear Film Subcommittee reviewed the role of the tear film in dry eye disease (DED). The Subcommittee reviewed biophysical and biochemical aspects of tears and how these change in DED. Clinically, DED is characterized by loss of tear volume, more rapid breakup of the tear film and increased evaporation of tears from the ocular surface. The tear film is composed of many substances including lipids, proteins, mucins and electrolytes. All of these contribute to the integrity of the tear film but exactly how they interact is still an area of active research. Tear film osmolarity increases in DED. Changes to other components such as proteins and mucins can be used as biomarkers for DED. The Subcommittee recommended areas for future research to advance our understanding of the tear film and how this changes with DED. The final report was written after review by all Subcommittee members and the entire TFOS DEWS II membership. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Validation of a 3D CT method for measurement of linear wear of acetabular cups.

    PubMed

    Jedenmalm, Anneli; Nilsson, Fritjof; Noz, Marilyn E; Green, Douglas D; Gedde, Ulf W; Clarke, Ian C; Stark, Andreas; Maguire, Gerald Q; Zeleznik, Michael P; Olivecrona, Henrik

    2011-02-01

    We evaluated the accuracy and repeatability of a 3D method for polyethylene acetabular cup wear measurements using computed tomography (CT). We propose that the method be used for clinical in vivo assessment of wear in acetabular cups. Ultra-high molecular weight polyethylene cups with a titanium mesh molded on the outside were subjected to wear using a hip simulator. Before and after wear, they were (1) imaged with a CT scanner using a phantom model device, (2) measured using a coordinate measurement machine (CMM), and (3) weighed. CMM was used as the reference method for measurement of femoral head penetration into the cup and for comparison with CT, and gravimetric measurements were used as a reference for both CT and CMM. Femoral head penetration and wear vector angle were studied. The head diameters were also measured with both CMM and CT. The repeatability of the method proposed was evaluated with two repeated measurements using different positions of the phantom in the CT scanner. The accuracy of the 3D CT method for evaluation of linear wear was 0.51 mm and the repeatability was 0.39 mm. Repeatability for wear vector angle was 17°. This study of metal-meshed hip-simulated acetabular cups shows that CT has the capacity for reliable measurement of linear wear of acetabular cups at a clinically relevant level of accuracy.

  15. Tear dynamics in healthy and dry eyes.

    PubMed

    Cerretani, Colin F; Radke, C J

    2014-06-01

    Dry-eye disease, an increasingly prevalent ocular-surface disorder, significantly alters tear physiology. Understanding the basic physics of tear dynamics in healthy and dry eyes benefits both diagnosis and treatment of dry eye. We present a physiological-based model to describe tear dynamics during blinking. Tears are compartmentalized over the ocular surface; the blink cycle is divided into three repeating phases. Conservation laws quantify the tear volume and tear osmolarity of each compartment during each blink phase. Lacrimal-supply and tear-evaporation rates are varied to reveal the dependence of tear dynamics on dry-eye conditions, specifically tear osmolarity, tear volume, tear-turnover rate (TTR), and osmotic water flow. Predicted periodic-steady tear-meniscus osmolarity is 309 and 321 mOsM in normal and dry eyes, respectively. Tear osmolarity, volume, and TTR all match available clinical measurements. Osmotic water flow through the cornea and conjunctiva contribute 10 and 50% to the total tear supply in healthy and dry-eye conditions, respectively. TTR in aqueous-deficient dry eye (ADDE) is only half that in evaporative dry eye (EDE). The compartmental periodic-steady tear-dynamics model accurately predicts tear behavior in normal and dry eyes. Inclusion of osmotic water flow is crucial to match measured tear osmolarity. Tear-dynamics predictions corroborate the use of TTR as a clinical discriminator between ADDE and EDE. The proposed model is readily extended to predict the dynamics of aqueous solutes such as drugs or fluorescent tags.

  16. Early Versus Late Weight-Bearing Protocols for Surgically Managed Posterior Wall Acetabular Fractures.

    PubMed

    Heare, Austin; Kramer, Nicholas; Salib, Christopher; Mauffrey, Cyril

    2017-07-01

    Despite overall improved outcomes with open reduction and internal fixation of acetabular fractures, posterior wall fractures show disproportionately poor results. The effect of weight bearing on outcomes of fracture management has been investigated in many lower extremity fractures, but evidence-based recommendations in posterior wall acetabular fractures are lacking. The authors systematically reviewed the current literature to determine if a difference in outcome exists between early and late postoperative weight-bearing protocols for surgically managed posterior wall acetabular fractures. PubMed and MEDLINE were searched for posterior wall acetabular fracture studies that included weight-bearing protocols and Merle d'Aubigné functional scores. Twelve studies were identified. Each study was classified as either early or late weight bearing. Early weight bearing was defined as full, unrestricted weight bearing at or before 12 weeks postoperatively. Late weight bearing was defined as restricted weight bearing for greater than 12 weeks postoperatively. The 2 categories were then compared by functional score using a 2-tailed t test and by complication rate using chi-square analysis. Six studies (152 fractures) were placed in the early weight-bearing category. Six studies (302 fractures) were placed in the late weight-bearing category. No significant difference in Merle d'Aubigné functional scores was found between the 2 groups. No difference was found regarding heterotopic ossification, avascular necrosis, superficial infections, total infections, or osteoarthritis. This systematic review found no difference in functional outcome scores or complication rates between early and late weight-bearing protocols for surgically treated posterior wall fractures. [Orthopedics. 2017: 40(4):e652-e657.]. Copyright 2017, SLACK Incorporated.

  17. Characteristics of radial tears in the posterior horn of the medial meniscus compared to horizontal tears.

    PubMed

    Choi, Chul-Jun; Choi, Yun-Jin; Song, In-Bum; Choi, Chong-Hyuk

    2011-06-01

    The clinical and radiologic features of radial tears of the medial meniscus posterior horn were compared with those of horizontal tears. From January 2007 to December 2008, 387 consecutive cases of medial meniscal tears were treated arthroscopically. Among these, 91 were radial tears in the medial meniscus posterior horn, and 95 were horizontal tears in the posterior segment of the medial meniscus. The patients' data (age, gender, duration of symptom, body mass index, and injury history), radiographic findings (Kellgren and Lawrence score, posterior tibial slope, and femorotibial angle), and chondral lesions were recorded. The patient factors of age, gender, and body mass index were related to radial tears of the medial meniscus posterior horn. Radial tears were significantly correlated with Kellgren and Lawrence score, varus alignment, posterior tibial slope, and severity of the chondral lesion. Radial tears of the medial meniscus posterior horn are a unique clinical entity that are associated with older age, females and obesity, and are strongly associated with an increased incidence and severity of cartilage degeneration compared to horizontal tears.

  18. Glenohumeral internal rotation deficit in throwing athletes: current perspectives

    PubMed Central

    Rose, Michael B; Noonan, Thomas

    2018-01-01

    Glenohumeral internal rotation deficit (GIRD) is an adaptive process in which the throwing shoulder experiences a loss of internal rotation (IR). GIRD has most commonly been defined by a loss of >20° of IR compared to the contralateral shoulder. Total rotational motion of the shoulder is the sum of internal and external rotation and may be more important than the absolute value of IR loss. Pathologic GIRD has been defined as a loss of IR combined with a loss of total rotational motion. The leading pathologic process in GIRD is posterior capsular and rotator-cuff tightness, due to the repetitive cocking that occurs with the overhead throwing motion. GIRD has been associated with numerous pathologic conditions, including posterior superior labral tears, partial articular-sided rotator-cuff tears, and superior labral anterior-to-posterior tears. The mainstay of treatment for patients with GIRD is posterior capsular stretching and strengthening to improve scapular mechanics. In patients who fail nonoperative therapy, shoulder arthroscopy can be performed. Arthroscopic surgery in the high-level throwing athlete should be to restore them to their functional baseline with the minimum amount of intervention possible. PMID:29593438

  19. Robotic-arm assisted total hip arthroplasty results in smaller acetabular cup size in relation to the femoral head size: a matched-pair controlled study.

    PubMed

    Suarez-Ahedo, Carlos; Gui, Chengcheng; Martin, Timothy J; Chandrasekaran, Sivashankar; Lodhia, Parth; Domb, Benjamin G

    2017-03-31

    To compare the acetabular component size relative to the patient's native femoral head size between conventional THA (CTHA) approach and robotic-arm assisted THA (RTHA) to infer which of these techniques preserved more acetabular bone. Patients were included if they had primary osteoarthritis (OA) and underwent total hip replacement between June 2008 and March 2014. Patients were excluded if they had missing or rotated postoperative anteroposterior radiographs. RTHA patients were matched to a control group of CTHA patients, in terms of preoperative native femoral head size, age, gender, body mass index (BMI) and approach. Acetabular cup size relative to femoral head size was used as a surrogate for amount of bone resected. We compared the groups according to 2 measures describing acetabular cup diameter (c) in relation to femoral head diameter (f): (i) c-f, the difference between cup diameter and femoral head diameter and (ii) (c-f)/f, the same difference as a fraction of femoral head diameter. 57 matched pairs were included in each group. There were no significant differences between groups for demographic measures, femoral head diameter, or acetabular cup diameter (p>0.05). However, measures (i) and (ii) did differ significantly between the groups, with lower values in the RTHA group (p<0.02). Using acetabular cup size relative to femoral head size as an approximate surrogate measure of acetabular bone resection may suggest greater preservation of bone stock using RTHA compared to CTHA. Further studies are needed to validate the relationship between acetabular cup size and bone loss in THA.

  20. Tear analysis in contact lens wearers.

    PubMed Central

    Farris, R L

    1985-01-01

    Tear analysis in contact lens wearers was compared with tear analysis in aphakics without contact lens wear and normal phakic patients. Subjects were divided into five groups: group 1, aphakic without contact lens; group 2, phakic with daily-wear hard contact lens; group 3, phakic with daily-wear soft contact lens; group 4, phakic with extended-wear soft contact lens; and group 5, aphakic with extended-wear soft contact lens. The experimental groups were compared with age- and sex-matched control groups for statistical analysis of tear variables by means of the Student's t-test. The variables measured were tear osmolarity, tear albumin, and lysozyme and lactoferrin concentrations in basal and reflex tears. Highly significant elevations of tear osmolarity were found in aphakic subjects without contact lenses. Less significant differences in tear osmolarity were found in phakic subjects with hard daily-wear lenses or with extended-wear soft lenses. Tear albumin, lysozyme, and lactoferrin in basal and reflex tears were not significantly different in the different groups of contact lens wearers or in the group of aphakic subjects without contact lenses compared with their control groups. Individual variations in tear albumin, lysozyme, and lactoferrin appeared to be responsible for the inability to demonstrate significant differences in tear composition in association with the wearing of different types of contact lenses. Older and aphakic patients demonstrated a tendency to have increased concentrations of proteins in the tears compared with younger, phakic contact lens wearers and normal controls without contact lenses. PMID:3914131

  1. Quantitative analysis of tear film fluorescence and discomfort during tear film instability and thinning.

    PubMed

    Begley, Carolyn; Simpson, Trefford; Liu, Haixia; Salvo, Eliza; Wu, Ziwei; Bradley, Arthur; Situ, Ping

    2013-04-12

    The purpose of this study was to test the association between tear film fluorescence changes during tear break-up (TBU) or thinning and the concurrent ocular sensory response. Sixteen subjects kept one eye open as long as possible (MBI), indicated their discomfort level continuously, and rated ocular sensations of irritation, stinging, burning, pricking, and cooling using visual analog scales (VAS). Fluorescence of the tear film was quantified by a pixel-based analysis of the median pixel intensity (PI), TBU, and percentage of dark pixels (DarkPix) over time. A cutoff of 5% TBU was used to divide subjects into either break-up (BU) or minimal break-up (BUmin) groups. Tear film fluorescence decreased (median PI) and the percentage of TBU and DarkPix increased in all trials, with the rate significantly greater in the BU than the BUmin group (Mann-Whitney U test, P < 0.05). The rate of increasing discomfort during trials was highly correlated with the rate of decrease in median PI and developing TBU (Spearman's, r ≥ 0.70). Significant correlations were found between corneal fluorescence, MBI, and sensory measures. Concentration quenching of fluorescein dye with tear film thinning best explains decreasing tear film fluorescence during trials. This was highly correlated with increasing ocular discomfort, suggesting that both tear film thinning and TBU stimulate underlying corneal nerves, although TBU produced more rapid stimulation. Slow increases in tear film hyperosmolarity may cause the gradual increase in discomfort during slow tear film thinning, whereas the sharp increases in discomfort during TBU suggest a more complex stimulus.

  2. Classification of ulnar triangular fibrocartilage complex tears. A treatment algorithm for Palmer type IB tears.

    PubMed

    Atzei, A; Luchetti, R; Garagnani, L

    2017-05-01

    The classical definition of 'Palmer Type IB' triangular fibrocartilage complex tear, includes a spectrum of clinical conditions. This review highlights the clinical and arthroscopic criteria that enable us to categorize five classes on a treatment-oriented classification system of triangular fibrocartilage complex peripheral tears. Class 1 lesions represent isolated tears of the distal triangular fibrocartilage complex without distal radio-ulnar joint instability and are amenable to arthroscopic suture. Class 2 tears include rupture of both the distal triangular fibrocartilage complex and proximal attachments of the triangular fibrocartilage complex to the fovea. Class 3 tears constitute isolated ruptures of the proximal attachment of the triangular fibrocartilage complex to the fovea; they are not visible at radio-carpal arthroscopy. Both Class 2 and Class 3 tears are diagnosed with a positive hook test and are typically associated with distal radio-ulnar joint instability. If required, treatment is through reattachment of the distal radio-ulnar ligament insertions to the fovea. Class 4 lesions are irreparable tears due to the size of the defect or to poor tissue quality and, if required, treatment is through distal radio-ulnar ligament reconstruction with tendon graft. Class 5 tears are associated with distal radio-ulnar joint arthritis and can only be treated with salvage procedures. This subdivision of type IB triangular fibrocartilage complex tear provides more insights in the pathomechanics and treatment strategies. II.

  3. Partial articular-sided rotator cuff tears: in situ repair versus tear completion prior to repair.

    PubMed

    Sethi, Paul M; Rajaram, Arun; Obopilwe, Elifho; Mazzocca, Augustus D

    2013-06-01

    Uncertainty exists over the ideal surgical treatment method for partial articular-sided rotator cuff tears, with options ranging from debridement to in situ repair to tear completion prior to repair. The purpose of this study was to determine whether in situ repair was a viable biomechanical treatment option compared with tear completion prior to repair of partial articular-sided rotator cuff tears. Fourteen fresh-frozen cadaveric shoulders were dissected. Partial articular-sided tears were created and repaired using in situ repair or tear completion prior to the repair. Strain and displacement were measured at 45°, 60°, and 90° of glenohumeral abduction. Testing was performed with a load of 100 N applied for 30 cycles. Data from the biomechanical testing displayed 4 conditions that showed improved characteristics of in situ repair over completion and repair: bursal-sided strain anteriorly at 45°, bursal-sided strain anteriorly at 90°, bursal-sided displacement anteriorly at 45°, and bursal-sided displacement anteriorly at 90°. The data indicate that in situ repair is a viable biomechanical treatment option compared with tear completion prior to repair of partial articular-sided rotator cuff tears. When clinically appropriate, the in situ repair may offer some biomechanical advantages, with lower strain and displacement observed on the bursal side compared with tear completion prior to repair. Copyright 2013, SLACK Incorporated.

  4. Tear-Duct Obstruction and Surgery

    MedlinePlus

    ... Staying Safe Videos for Educators Search English Español Tear-Duct Obstruction and Surgery KidsHealth / For Parents / Tear- ... year old with little or no treatment. About Tear Ducts Our eyes are continually exposed to dust, ...

  5. Saline magnetic resonance arthrography in the evaluation of glenohumeral instability.

    PubMed

    Tirman, P F; Stauffer, A E; Crues, J V; Turner, R M; Nottage, W M; Schobert, W E; Rubin, B D; Janzen, D L; Linares, R C

    1993-01-01

    Sixty-five patients underwent magnetic resonance (MR) shoulder arthrography. Forty-eight of these patients underwent examination under anesthesia (EUA). MR images were retrospectively evaluated for signs felt to be imaging indicators of shoulder instability, including evaluation of various capsular measurements and the presence of glenoid labral tears, as well as Hill-Sachs fractures. Statistical analysis of the results showed that no correlation between capsular indicators with EUA-documented instability was found. However, there was a statistically significant correlation between the presence of a Bankart cartilaginous deformity (p = 0.000) and Hill-Sachs fractures (p = 0.022) with EUA-documented instability. Sensitivity to labral tears was 89% and specificity was 98%, whereas Hill-Sachs fracture detection was 69% and 87%, respectively. We believe that MR saline arthrography is of benefit in the evaluation of the anterior labrum when unenhanced MR imaging is inconclusive, and we speculate on the role of MR arthrography as a primary investigative tool.

  6. Validation of a 3D CT method for measurement of linear wear of acetabular cups

    PubMed Central

    2011-01-01

    Background We evaluated the accuracy and repeatability of a 3D method for polyethylene acetabular cup wear measurements using computed tomography (CT). We propose that the method be used for clinical in vivo assessment of wear in acetabular cups. Material and methods Ultra-high molecular weight polyethylene cups with a titanium mesh molded on the outside were subjected to wear using a hip simulator. Before and after wear, they were (1) imaged with a CT scanner using a phantom model device, (2) measured using a coordinate measurement machine (CMM), and (3) weighed. CMM was used as the reference method for measurement of femoral head penetration into the cup and for comparison with CT, and gravimetric measurements were used as a reference for both CT and CMM. Femoral head penetration and wear vector angle were studied. The head diameters were also measured with both CMM and CT. The repeatability of the method proposed was evaluated with two repeated measurements using different positions of the phantom in the CT scanner. Results The accuracy of the 3D CT method for evaluation of linear wear was 0.51 mm and the repeatability was 0.39 mm. Repeatability for wear vector angle was 17°. Interpretation This study of metal-meshed hip-simulated acetabular cups shows that CT has the capacity for reliable measurement of linear wear of acetabular cups at a clinically relevant level of accuracy. PMID:21281259

  7. Relationship Between Age at Onset of Symptoms and Intraoperative Findings in Hip Arthroscopic Surgery

    PubMed Central

    Suarez-Ahedo, Carlos; Gui, Chengcheng; Rabe, Stephanie M.; Walsh, John P.; Chandrasekaran, Sivashankar; Domb, Benjamin G.

    2017-01-01

    Background: Hip arthroscopic surgery is intended to treat multiple abnormalities in an effort to delay the progression to osteoarthritis, especially in young patients. However, the length of time in which patients experience joint pain before seeking a specialist for a diagnosis can delay hip preservation surgery and influence clinical outcomes. Purpose: To investigate the relationship between age at symptom onset and findings during hip arthroscopic surgery as well as outcomes after 2 years of clinical follow-up. Study Design: Cohort study; Level of evidence, 3. Methods: From February 2008 to March 2015, data were prospectively collected on all patients undergoing hip arthroscopic surgery at a single institution. Anatomic and pathological characteristics were recorded intraoperatively. The mean age at onset of symptoms was calculated and correlated with intraoperative findings using Pearson correlation and logistic regression. All patients were assessed preoperatively and postoperatively with 4 patient-reported outcome measures: the modified Harris Hip Score (mHHS), the Non-Arthritic Hip Score (NAHS), the Hip Outcome Score–Activities of Daily Living (HOS-ADL), and the Hip Outcome Score–Sport-Specific Subscale (HOS-SSS). Pain was estimated using a visual analog scale (VAS). Furthermore, patients with an age at onset of symptoms below the mean (34.6 years) were compared with those of an age at onset of symptoms above the mean. The 2 groups were compared using the Student t test and the chi-square test. P values <.05 were considered significant. Results: A total of 1697 patients met the inclusion criteria. Body mass index was weakly correlated with age (r = 0.3). Younger patients had a lower prevalence of combined Seldes type 1 and 2 labral tears; acetabular labrum articular disruption (ALAD) grade 2, 3, and 4 acetabular chondral lesions; and Outerbridge grade 2, 3, and 4 femoral head chondral lesions (P < .05 for all). More advanced age was correlated with wider

  8. Does partial tear repair of adjacent tendons improve the outcome of supraspinatus tendonfull-thickness tear reinsertion?

    PubMed

    Nich, C; Dhiaf, N; Di Schino, M; Augereau, B

    2014-11-01

    Partial tearing of the infraspinatus and/or subscapularis tendon(s) is frequently associated with supraspinatus full-thickness tears. However, limited data regarding its influence on supraspinatus surgical repair is available. Our aim was to assess the functional and anatomical outcomes of open repair of supraspinatus full-thickness tears combined with adjacent partial tearing, comparatively to a control. We retrospectively identified 22 patients (22 shoulders) with a partial tear, most of them being a delamination tear, of the infraspinatus and/or subscapularis tendons associated with a complete detachment of the supraspinatus tendon. Twenty-seven patients (27 shoulders) treated for an isolated complete detachment of the supraspinatus tendon by open repair served as controls. The mean age was 58 years. A proximalized trans-osseous reinsertion of the supraspinatus tendon was combined with a curettage-closure of the delamination tear. Patients were evaluated with standardized MRI at last follow-up. At a mean of 75-month follow-up, the presence of a partial tear of either infraspinatus or subscapularis, or both, did not influence function and healing rates of supraspinatus tendon repair. Conversely to the control, when a retear occurred, the functional score tended to worsen. Preoperatively, fatty muscular degeneration was more pronounced when a partial tear was present. Fatty degeneration worsened regardless of repair healing. Open reinsertion of a supraspinatus full-thickness tear associated with a thorough treatment of partial tear of adjacent tendons led to optimal functional and anatomical mid term outcomes. Our results suggest the presence of a partial tear of adjacent tendons could be associated with poorer function in case of supraspinatus tendon re-rupture. Level III case-control study. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  9. Results of arthroscopic repair of type II superior labral anterior posterior lesions in overhead athletes: assessment of return to preinjury playing level and satisfaction.

    PubMed

    Neuman, Brian J; Boisvert, C Brittany; Reiter, Brian; Lawson, Kevin; Ciccotti, Michael G; Cohen, Steven B

    2011-09-01

    The majority of the literature on surgical outcomes of superior labral anterior posterior (SLAP) repairs has focused on short-term follow-up of 1 to 2 years, not allowing adequate time for full rehabilitation and return to maximum level of competition for all types of athletes. Also, previous studies have concentrated on using questionnaires that primarily evaluate patients' activities of daily living, which do not focus on sport-specific performance. To determine the midterm results of type II SLAP repairs in overhead athletes, focusing primarily on athletic performance as well as activities of daily living. Case series; Level of evidence, 4. A retrospective review of 30 overhead athletes, who underwent an arthroscopic superior labral repair for a symptomatic type II SLAP tear between 2002 and 2007, was performed. Our study population included 22 male and 8 female patients with a mean age at the time of surgery of 24 years. Twenty-one patients participated in baseball or softball, and the remainder of patients were involved in javelin throwing or tennis. The average follow-up was 3.5 years. The outcome of treatment was evaluated using the American Shoulder and Elbow Society (ASES) scoring system, assessing activities of daily living, and the Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow (KJOC) score, assessing sport-specific performance. In addition, the length of time to return to sport and the degree of successful performance were evaluated. Repairs resulted in ASES scores comparable with those from prior published studies (average ASES score, 87.9). The KJOC score averaged 73.6. The athletes' perception was that they returned to approximately 84.1% of their preinjury level of function with a mean time to return to play of 11.7 months. There was a significant drop in the ASES to KJOC score for the baseball/softball players (87.9 ± 14.94 and 72 ± 19.24, respectively; P = .006). Patients reported an overall satisfaction rate of 93.3% with the procedure, with

  10. Clinical Assessment of Physical Examination Maneuvers for Superior Labral Anterior to Posterior Lesions.

    PubMed

    Somerville, Lyndsay E; Willits, Kevin; Johnson, Andrew M; Litchfield, Robert; LeBel, Marie-Eve; Moro, Jaydeep; Bryant, Dianne

    2017-10-01

    Purpose  Shoulder pain and disability pose a diagnostic challenge owing to the numerous etiologies and the potential for multiple disorders to exist simultaneously. The evidence to support the use of clinical tests for superior labral anterior to posterior complex (SLAP) is weak or absent. The purpose of this study is to determine the diagnostic validity of physical examination maneuvers for SLAP lesions by performing a methodologically rigorous, clinically applicable study. Methods  We recruited consecutive new shoulder patients reporting pain and/or disability. The physician took a history and indicated their certainty about each possible diagnosis ("certain the diagnosis is absent/present," or "uncertain requires further testing"). The clinician performed the physical tests for diagnoses where uncertainty remained. Magnetic resonance imaging arthrogram and arthroscopic examination were the gold standards. We calculated sensitivity, specificity, and likelihood ratios (LRs) and investigated whether combinations of the top tests provided stronger predictions. Results  Ninety-three patients underwent physical examination for SLAP lesions. When using the presence of a SLAP lesion (Types I-V) as disease positive, none of the tests was sensitive (10.3-33.3) although they were moderately specific (61.3-92.6). When disease positive was defined as repaired SLAP lesion (including biceps tenodesis or tenotomy), the sensitivity (10.5-38.7) and specificity (70.6-93.8) of tests improved although not by a substantial amount. None of the tests was found to be clinically useful for predicting repairable SLAP lesions with all LRs close to one. The compression rotation test had the best LR for both definitions of disease (SLAP tear present = 1.8 and SLAP repaired = 1.67). There was no optimal combination of tests for diagnosing repairable SLAP lesions, with at least two tests positive providing the best combination of measurement properties (sensitivity 46.1% and

  11. Hip arthroscopy protocol: expert opinions on post-operative weight bearing and return to sports guidelines.

    PubMed

    Rath, Ehud; Sharfman, Zachary T; Paret, Matan; Amar, Eyal; Drexler, Michael; Bonin, Nicolas

    2017-01-01

    The objectives of this study are to survey the weight-bearing limitation practices and delay for returning to running and impact sports of high volume hip arthroscopy orthopedic surgeons. The study was designed in the form of expert survey questionnaire. Evidence-based data are scares regarding hip arthroscopy post-operative weight-bearing protocols. An international cross-sectional anonymous Internet survey of 26 high-volume hip arthroscopy specialized surgeons was conducted to report their weight-bearing limitations and rehabilitation protocols after various arthroscopic hip procedures. The International Society of Hip Arthroscopy invited this study. The results were examined in the context of supporting literature to inform the studies suggestions. Four surgeons always allow immediate weight bearing and five never offer immediate weight bearing. Seventeen surgeons provide weight bearing depending on the procedures performed: 17 surgeons allowed immediate weight bearing after labral resection, 10 after labral repair and 8 after labral reconstruction. Sixteen surgeons allow immediate weight bearing after psoas tenotomy. Twenty-one respondents restrict weight bearing after microfracture procedures for 3-8 weeks post-operatively. Return to running and impact sports were shorter for labral procedures and bony procedures and longer for cartilaginous and capsular procedures. Marked variability exists in the post-operative weight-bearing practices of hip arthroscopy surgeons. This study suggests that most surgeons allow immediate weight bearing as tolerated after labral resection, acetabular osteoplasty, chondroplasty and psoas tenotomy. For cartilage defect procedures, 6 weeks or more non-weight bearing is suggested depending on the area of the defect and lateral central edge angle. Delayed return to sports activities is suggested after microfracture procedures. The level of evidence was Level V expert opinions.

  12. Hip arthroscopy protocol: expert opinions on post-operative weight bearing and return to sports guidelines

    PubMed Central

    Rath, Ehud; Paret, Matan; Amar, Eyal; Drexler, Michael; Bonin, Nicolas

    2017-01-01

    Abstract The objectives of this study are to survey the weight-bearing limitation practices and delay for returning to running and impact sports of high volume hip arthroscopy orthopedic surgeons. The study was designed in the form of expert survey questionnaire. Evidence-based data are scares regarding hip arthroscopy post-operative weight-bearing protocols. An international cross-sectional anonymous Internet survey of 26 high-volume hip arthroscopy specialized surgeons was conducted to report their weight-bearing limitations and rehabilitation protocols after various arthroscopic hip procedures. The International Society of Hip Arthroscopy invited this study. The results were examined in the context of supporting literature to inform the studies suggestions. Four surgeons always allow immediate weight bearing and five never offer immediate weight bearing. Seventeen surgeons provide weight bearing depending on the procedures performed: 17 surgeons allowed immediate weight bearing after labral resection, 10 after labral repair and 8 after labral reconstruction. Sixteen surgeons allow immediate weight bearing after psoas tenotomy. Twenty-one respondents restrict weight bearing after microfracture procedures for 3–8 weeks post-operatively. Return to running and impact sports were shorter for labral procedures and bony procedures and longer for cartilaginous and capsular procedures. Marked variability exists in the post-operative weight-bearing practices of hip arthroscopy surgeons. This study suggests that most surgeons allow immediate weight bearing as tolerated after labral resection, acetabular osteoplasty, chondroplasty and psoas tenotomy. For cartilage defect procedures, 6 weeks or more non-weight bearing is suggested depending on the area of the defect and lateral central edge angle. Delayed return to sports activities is suggested after microfracture procedures. The level of evidence was Level V expert opinions. PMID:28630722

  13. Artificial tears potpourri: a literature review

    PubMed Central

    Moshirfar, Majid; Pierson, Kasey; Hanamaikai, Kamalani; Santiago-Caban, Luis; Muthappan, Valliammai; Passi, Samuel F

    2014-01-01

    Numerous brands and types of artificial tears are available on the market for the treatment of dysfunctional tear syndrome. Past literature has focused on comparing the components of these products on patient’s clinical improvement. The wide array of products on the market presents challenges to both clinicians and patients when trying to choose between available tear replacement therapies. Different formulations affect patients based on etiology and severity of disease. In order to provide an unbiased comparison between available tear replacement therapies, we conducted a literature review of existing studies and National Institutes of Health clinical trials on commercially available, brand name artificial tears. Outcomes evaluated in each study, as well as the percent of patients showing clinical and symptomatic improvement, were analyzed. Fifty-one studies evaluating different brands of artificial tears, and their efficacy were identified. Out of the 51 studies, 18 were comparison studies testing brand name artificial tears directly against each other. Nearly all formulations of artificial tears provided significant benefit to patients with dysfunctional tear syndrome, but some proved superior to others. From the study data, a recommended treatment flowchart was derived. PMID:25114502

  14. [Aseptic, simultaneous and bilateral mobilisation due to an acetabular shell fracture in a 43 year-old patient].

    PubMed

    Ceretti, M; Fanelli, M; Pappalardo, S

    2014-01-01

    The acetabular shell mobilization is the main long-term complication in total hip replacement. Metal-back fracture has also to be considered among the possible causes of shell mobilization. A case is presented of bilateral acetabular shell mobilization due to the trabecular covering de-soldering from the metal-back in a 43 year-old patient, 13-14 years after the first surgery. Copyright © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

  15. 49 CFR 178.1070 - Tear test.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 3 2013-10-01 2013-10-01 false Tear test. 178.1070 Section 178.1070... Containers § 178.1070 Tear test. (a) General. The tear test must be conducted for the qualification of all of Flexible Bulk Containers design types. (b) Special preparation for the tear test. Flexible Bulk Container...

  16. Effects of Menthol-Containing Artificial Tears on Tear Stimulation and Ocular Surface Integrity in Normal and Dry Eye Rat Models.

    PubMed

    Ahn, Somin; Eom, Youngsub; Kang, Boram; Park, Jungboung; Lee, Hyung Keun; Kim, Hyo Myung; Song, Jong Suk

    2018-05-01

    To evaluate the effects of menthol-containing artificial tears on tear stimulation and ocular surface integrity in normal and dry eye rat models. A total of 54 male Lewis rats were used. The levels of tear secretion and tear MUC5AC concentrations were compared between the menthol-containing artificial tear-treated group (menthol group) and the vehicle-treated group (vehicle group). The groups were compared after a single instillation to evaluate the immediate effects, and after repeated instillation (five times a day for 5 days) to evaluate the longer-term effects. Tear lactate dehydrogenase (LDH) activity was measured to evaluate eye drop instillation-induced ocular surface damage. The effects of menthol-containing artificial tears were also evaluated in a dry eye rat model. After a single instillation of menthol-containing artificial tears, tear secretion increased from 4.37 (±0.75) mm at baseline to 7.37 (±1.60) mm. However, after repeated instillations, the effects of tear stimulation decreased. The tear MUC5AC concentration was significantly lower in the menthol group than in the vehicle group after a single instillation, but not after repeated instillation. However, the tear LDH concentration was significantly increased in the menthol group after repeated instillation. In the dry eye rat model, the extent of menthol-induced tear stimulation was reduced. Menthol-containing artificial tears increased tear secretion, but lowered the tear MUC5AC concentration. Menthol-induced tear stimulation was reduced after repeated instillation for 5 days and in the dry eye rat model. Conversely, repeated instillation of menthol-induced ocular surface damage, resulting in increased tear LDH activity.

  17. 49 CFR 178.818 - Tear test.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 3 2013-10-01 2013-10-01 false Tear test. 178.818 Section 178.818 Transportation... Tear test. (a) General. The tear test must be conducted for the qualification of all flexible IBC design types. (b) Special preparation for the tear test. The flexible IBC must be filled to not less than...

  18. 49 CFR 178.818 - Tear test.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 2 2010-10-01 2010-10-01 false Tear test. 178.818 Section 178.818 Transportation... § 178.818 Tear test. (a) General. The tear test must be conducted for the qualification of all flexible IBC design types. (b) Special preparation for the tear test. The flexible IBC must be filled to not...

  19. Inversion of the acetabular labrum triggers rapidly destructive osteoarthritis of the hip: representative case report and proposed etiology.

    PubMed

    Fukui, Kiyokazu; Kaneuji, Ayumi; Fukushima, Mana; Matsumoto, Tadami

    2014-12-01

    The pathophysiology of rapidly destructive osteoarthritis (OA) of the hip is unknown. This study documented cases of inversion of the acetabular labrum, which has clinicoradiologic features similar to those of initial-stage rapidly destructive hip OA. Our study was based on a prospective review of data for 9 patients with rapidly destructive hip OA. Intraoperative findings showed that the anterosuperior portion of the acetabular labrum had inverted into the articular space, along with many fragments of articular cartilage, in all patients. Subchondral insufficiency fractures of the femoral heads were seen just under the inverted labra in 8 of the 9 patients. Inversion of the acetabular labrum may be involved in rapid joint-space narrowing and subchondral insufficiency fracture in rapidly destructive hip OA. Copyright © 2014 Elsevier Inc. All rights reserved.

  20. Effects of topical cyclosporine a plus artificial tears versus artificial tears treatment on conjunctival goblet cell density in dysfunctional tear syndrome.

    PubMed

    Demiryay, Elvan; Yaylali, Volkan; Cetin, Ebru Nevin; Yildirim, Cem

    2011-09-01

    The aim was to compare the effects of topical cyclosporine A and artificial tears combination with artificial tears alone in patients with dysfunctional tear syndrome (DTS). Forty-two eyes of 42 patients with DTS were enrolled in the study. The inclusion criteria for the study were Schirmer I (without anesthesia) scores below 10 mm/5 min and tear film break-up time (BUT) below 10 sec. The patients were randomly divided into two groups. The study group (22 patients) underwent 0.05% cyclosporine A treatment twice a day and preservative-free artificial tears for four times a day for 4 months. The control group (20 patients) was administered only preservative-free artificial tears four times a day for 4 months. The BUT, Schirmer test scores, corneal fluorescein staining, conjunctival lissamine green staining, and goblet cell density derived by impression cytology were recorded before and after treatment in each group. In the study group, all parameters improved statistically significantly after treatment at the 4-month follow-up compared with the pretreatment values (P<0.001 for all). In the control group, corneal fluorescein staining (P<0.001) and conjunctival lissamine green staining (P=0.014) improved, but BUT and Schirmer scores did not change significantly after treatment. At the end of the 4-month follow-up, the study group demonstrated statistically significantly better BUT (P=0.020), Schirmer scores (P=0.002), goblet cell density (P=0.006), corneal fluorescein staining (P=0.003), and conjunctival lissamine green staining (P=0.017) scores than did the control group. Topical cyclosporine A and artificial tears treatment significantly increases goblet cell density, decreases the signs of DTS, and improves ocular surface health.

  1. Anterior Segment Optical Coherence Tomography for Tear Meniscus Evaluation and its Correlation with other Tear Variables in Healthy Individuals

    PubMed Central

    Dhasmana, Renu; Nagpal, Ramesh Chander

    2016-01-01

    Introduction Dry eye is one of the most common ocular diseases in this cyber era. Despite availability of multiple tests, no single test is accurate for the diagnosis of dry eye. Anterior segment optical coherence tomography is the recent tool which can be added in the armentarium of dry eye tests. Aim To evaluate tear meniscus with anterior segment optical coherence tomography and its correlation with other tear variables in normal healthy individuals. Materials and Methods In this prospective cross-sectional observational study, right eye of 203 consecutive patients were studied. All the patients were divided into three groups Group 1, 2 and 3 according to their age ≤20 years, 21-40 years and >40 years respectively. All patients underwent routine ophthalmologic examinations along with slit-lamp bio-microscopy for tear meniscus height measurement, tear film break up time, Schirmer’s I test (with anaesthesia) and optical coherence tomography imaging of inferior tear meniscus height. After focusing of the instrument with a Cross Line (CL) centered on lower tear meniscus at 6’0 clock of cornea, a 6 mm long scan was obtained. The tear meniscus height (μm) and tear meniscus area (mm2) were measured manually with help of callipers by joining upper corneo-meniscus junction to the lower lid-meniscus junction and tear meniscus height and area within the plotted line respectively and calculated by using the integrated analysis available in the custom software. Results There was significant decrease in the all tear variables with the increase in the age. According to age groups in group 1, the mean Schirmer’s (24.0±4.9)mm, tear film break up time (11.1±1.9) sec, tear meniscus height on slit lamp (600.2±167.3)mm were higher but decreased in group 2 (21.5±5.4,10.8±1.4, 597.5±186.3) and group 3 (19.8 ± 5.1, 10.2 ± 1.6, 485.6 ± 157.7) respectively. Schirmer’s test values and tear film break up time were similar in both sexes (p=0.1 and p= 0.9). Tear meniscus

  2. A cemented cup with acetabular impaction bone grafting is more cost-effective than an uncemented cup in patients under 50 years.

    PubMed

    Busch, Vincent J J F; Verschueren, Joost; Adang, Eddy M; Lie, Stein A; Havelin, Leif I; Schreurs, Berend W

    2016-01-01

    Acetabular deficiencies in young patients can be restored in several ways during total hip arthroplasty. Currently, cementless cups are most frequently used. Impaction bone grafting of acetabular defects is a more biological approach, but is it cost-effective in young patients on the long term? We designed a decision model for a cost-utility analysis of a cemented cup with acetabular impaction bone grafting versus an uncemented cup, in terms of cost per quality-adjusted life year (QALY) for the young adult with acetabular bone deficiency, in need for a primary total hip arthroplasty. Outcome probabilities and effectiveness were derived from the Radboud University Nijmegen Medical Centre and the Norwegian Hip Register. Multiple sensitivity analyses were used to assess the contribution of the included variables in the model's outcome. Cemented cups with impaction bone grafting were more cost-effective compared to the uncemented option in terms of costs per QALY. A scenario suggesting equal primary survival rates of both cemented and uncemented cups still showed an effect gain of the cemented cup with impaction bone grafting, but at higher costs. Based on this model, the first choice of treatment of the acetabular bone deficient osteoarthritic hip in a young patient is reconstruction with impaction bone grafting and a cemented cup.

  3. Hot tearing studies in AA5182

    NASA Astrophysics Data System (ADS)

    van Haaften, W. M.; Kool, W. H.; Katgerman, L.

    2002-10-01

    One of the major problems during direct chill (DC) casting is hot tearing. These tears initiate during solidification of the alloy and may run through the entire ingot. To study the hot tearing mechanism, tensile tests were carried out in semisolid state and at low strain rates, and crack propagation was studied in situ by scanning electron microscopy (SEM). These experimentally induced cracks were compared with hot tears developed in an AA5182 ingot during a casting trial in an industrial research facility. Similarities in the microstructure of the tensile test specimens and the hot tears indicate that hot tearing can be simulated by performing tensile tests at semisolid temperatures. The experimental data were compared with existing hot tearing models and it was concluded that the latter are restricted to relatively high liquid fractions because they do not take into account the existence of solid bridges in the crack.

  4. Controversies In The Surgical Management Of Shoulder Instability: Associated Soft Tissue Procedures.

    PubMed

    Marco, Santos Moros; Lafuente, José Luis Ávila; Ibán, Miguel Angel Ruiz; Heredia, Jorge Diaz

    2017-01-01

    The glenohumeral joint is a ball-and-socket joint that is inherently unstable and thus, susceptible to dislocation. The traditional and most common anatomic finding is the Bankart lesion (anterior-inferior capsule labral complex avulsion), but there is a wide variety of anatomic alterations that can cause shoulder instability or may be present as a concomitant injury or in combination, including bone loss (glenoid or humeral head), complex capsule-labral tears, rotator cuff tears, Kim´s lesions (injuries to the posterior-inferior labrum) and rotator interval pathology. A review of articles related to shoulder anatomy and soft tissue procedures that are performed during shoulder instability arthroscopic management was conducted by querying the Pubmed database and conclusions and controversies regarding this injury were exposed. Due to the complex anatomy of the shoulder and the large range of movement of this joint, a wide variety of anatomic injuries and conditions can lead to shoulder instability, specially present in young population. Recognizing and treating all of them including Bankart repair, capsule-labral plicatures, SLAP repair, circumferential approach to pan-labral lesions, rotator interval closure, rotator cuff injuries and HAGL lesion repair is crucial to achieve the goal of a stable, full range of movement and not painful joint. Physicians must be familiarized with all the lesions involved in shoulder instability, and should be able to recognize and subsequently treat them to achieve the goal of a stable non-painful shoulder. Unrecognized or not treated lesions may result in recurrence of instability episodes and pain while overuse of some of the techniques previously described can lead to stiffness, thus the importance of an accurate diagnosis and treatment when facing a shoulder instability.

  5. Bilateral non-traumatic acetabular and femoral neck fractures due to pregnancy-associated osteoporosis.

    PubMed

    Aynaci, Osman; Kerimoglu, Servet; Ozturk, Cagatay; Saracoglu, Metehan

    2008-03-01

    Pregnancy-associated osteoporosis is a rare disorder and its pathophysiology remains unknown. We report a case of pregnancy-associated osteoporosis in a 27-year-old primiparous patient who revealed bilateral hip pain during early postnatal period. The plain radiographs and computerized tomography showed bilateral femoral neck and acetabular fractures. The diagnosis of osteoporosis was established by bone mineral density. Diagnostic work-up excluded a secondary osteoporosis. The case was treated successfully by bilateral cementless total hip arthroplasty. Bone mineral density increased after 2 years of treatment with calcium-vitamin D, calcitriol and alendronate. Diagnosis of pregnancy-associated osteoporosis should be suspected when hip pain occurs during pregnancy or in the post-partum period as it can lead to acetabular and femoral neck fractures.

  6. The Bimetric cementless total hip replacement: 7–18 year follow-up assessing the influence of acetabular design on survivorship

    PubMed Central

    Ghassemi, A.; Dorrell, J. H.; Powles, D. P.

    2008-01-01

    The purpose of this study was to evaluate the mid- to long-term survivorship of Bimetric cementless total hip replacement and assess how it is affected by the acetabular design. This was a retrospective analysis of 127 Bimetric cementless total hip replacements in 110 patients with a follow-up of 7–18 years. A single design stem and three different cementless metal-backed acetabular designs were used. Patients were assessed clinically using the Harris hip score and radiologically by independent review of current hip radiographs. There was only one case of aseptic loosening of the femoral stem. The earliest acetabular design showed a high failure rate whilst the latter two designs showed a 96% survivorship at a mean of 9.5 years. We conclude that a combination of the bimetric stem with either of the latter acetabular cup designs has a good mid- to long-term performance. PMID:18551293

  7. Ultrasound determination of rotator cuff tear repairability

    PubMed Central

    Tse, Andrew K; Lam, Patrick H; Walton, Judie R; Hackett, Lisa

    2015-01-01

    Background Rotator cuff repair aims to reattach the torn tendon to the greater tuberosity footprint with suture anchors. The present study aimed to assess the diagnostic accuracy of ultrasound in predicting rotator cuff tear repairability and to assess which sonographic and pre-operative features are strongest in predicting repairability. Methods The study was a retrospective analysis of measurements made prospectively in a cohort of 373 patients who had ultrasounds of their shoulder and underwent rotator cuff repair. Measurements of rotator cuff tear size and muscle atrophy were made pre-operatively by ultrasound to enable prediction of rotator cuff repairability. Tears were classified following ultrasound as repairable or irreparable, and were correlated with intra-operative repairability. Results Ultrasound assessment of rotator cuff tear repairability has a sensitivity of 86% (p < 0.0001) and a specificity of 67% (p < 0.0001). The strongest predictors of rotator cuff repairability were tear size (p < 0.001) and age (p = 0.004). Sonographic assessments of tear size ≥4 cm2 or anteroposterior tear length ≥25 mm indicated an irreparable rotator cuff tear. Conclusions Ultrasound assessment is accurate in predicting rotator cuff tear repairability. Tear size or anteroposterior tear length and age were the best predictors of repairability. PMID:27582996

  8. Plasminogen activator activity in tears of pregnant women.

    PubMed

    Csutak, Adrienne; Steiber, Zita; Tőzsér, József; Jakab, Attila; Berta, András; Silver, David M

    2017-01-01

    Plasminogen activator activity (PAA) in tears of pregnant women was investigated at various gestation times to assess the availability of plasminogen activator for aiding potential corneal wound healing processes during pregnancy. PAA was measured by a spectrophotometric method. The analysis used 91 tear samples from pregnant and non-pregnant women, supplemented with 10 additional tear PAA measurements from non-pregnant women obtained in a previous study. Tear levels of PAA in pregnant women formed a bimodal distribution. Either the tear PAA level was zero or non-zero during pregnancy. When non-zero, the tear PAA level was dissociated from gestation time and not different than non-pregnant and post-pregnant levels. The frequency of occurrence of zero level tear PAA increased with gestation: 16%, 17% and 46% had zero tear PAA in samples taken from women in the first, second and third trimester, respectively. Overall, of the tear samples taken from women during pregnancy, a total of 26% were at zero tear PAA. The remaining tear samples had non-zero tear PAA values throughout gestation equivalent to non-pregnant tear PAA values, suggesting local control of the source of PAA in tears. Given the importance of the plasminogen activator system in tears to wound healing in the cornea, and the high occurrence of zero tear PAA in our sample of pregnant women, elective corneal surgery would be contraindicated. If corneal surgery is nevertheless necessary, the tear PAA level would be worth checking and patients with low level should be closely observed during the postoperative period.

  9. Athlete shoulder injuries: CT arthrographic findings.

    PubMed

    Rafii, M; Firooznia, H; Bonamo, J J; Minkoff, J; Golimbu, C

    1987-02-01

    Forty-three professional and amateur athletes with persistent shoulder pain that interfered with their sports activities were evaluated by computed tomographic (CT) arthrography. In 19 patients, glenohumeral instability (14 anterior, two posterior, three multidirectional) was diagnosed with CT arthrography based on the simultaneous presence of labral and capsular lesions. The findings were crucial in establishing the diagnosis of instability in six patients in whom the condition was not suggested or could not be confirmed clinically. Another significant injury consisted of labral lesions not associated with glenohumeral instability. These tears often involved the anterior and parasuperior segments of this structure. Other, less frequently detected lesions included segmental labral enlargement and several labra with abnormal orientation (everted labrum). Early onset of degenerative disease was present in many athletes, especially those with a long history of sports activity. CT arthrographic findings were correlated with arthroscopic or surgical results in 19 patients.

  10. The use of an Ossis custom 3D-printed tri-flanged acetabular implant for major bone loss: minimum 2-year follow-up: Short title: Ossis custom 3D-Printed tri-flanged acetabular implant.

    PubMed

    Kieser, David C; Ailabouni, Ramez; Kieser, Sandra C J; Wyatt, Michael C; Armour, Paul C; Coates, Mark H; Hooper, Gary J

    2018-05-01

    Custom 3D-printed acetabular implants are a new technology used in hip surgery with ever-increasing frequency. They offer patient-specific implants to optimise filling of bone defects and implant-bone contact, without the need for excessive bone resection. This is a retrospective cohort study of 46 consecutive patients who underwent an Ossis unilateral custom 3D-printed acetabular implant. Clinical (Oxford Hip Score OHS-60), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Harris Hip Score (HHS) and radiological (restoration of biomechanical hip centre, osteointegration, wear, heterotrophic ossification) results were assessed. Patient mean age was 68 years and follow-up was 38 months (minimum 24 months). 10 patients were excluded from the outcome analysis; 2 patients died, 1 required revision for deep infection and 7 were lost to follow-up. Of the 36 patients included, 21 had severe osteolysis. 7 were revised for infection, 3 for tumoural defects, 3 for metallosis, 1 for dysplasia and 1 for trauma (Paprosky 2a [n=6], 2b [n=2], 2c [n=5], 3a [n=6], 3b [n=11], pelvic dissociation [n=6]). OHS significantly improved postoperatively (16-8-48.4 p=0.027). Postoperative functional scores were good (WOMAC 98; HHS 79). The biomechanical hip centre was restored in all patients. 1 patient had early implant migration with subsequent stabilisation. 2 patients had radiographs concerning for failure of osteointegration. 1 patient had recurrent dislocations. The mid-term results of the Ossis custom 3D-printed tri-flanged acetabular implant for the management of severe acetabular defects are encouraging. The improvement in functional scores and radiographic outcomes are comparable to similar designs. In addition, no cases have required revision for aseptic loosening.

  11. [Use of the Omega plate for stabilisation of acetabular fractures: first experience].

    PubMed

    Šrám, J; Taller, S; Lukáš, R; Endrych, L

    2013-01-01

    The aim of our study is to solve the problem of insufficient fixation of comminuted fractures of the quadrilateral plane and the iliopectineal line. These fixation problems occur while using the standard narrow 3.5 mm fixation plate applied from a modified Stoppa approach. A new plate developed by the authors--the Omega plate--fulfils the requirements. In the period 2010-2012, we performed 156 stabilisations of pelvic ring fractures and acetabular fractures. We used the modified Stoppa approach applying the standard fixation plate in 24 patients and the Omega plate in 15 patients. The patient group with the Omega plate included 10 male and five female patients with the average age of 61 years (range, 30-72). Only 11 patients were followed up, with an average period of 13.3 months, because one patient was lost to followup and three patients were shortly after surgery. The surgical technique of Omega plate application is described in detail. The clinical evaluation of post-operative results was based on the Harris Hip Score; the graphical results were rated using the Matta and Pohlemann criteria. The Stoppa approach alone was used in four patients, combination of two approaches (Stoppa and Kocher-Langenbeck approach) was used in six cases and three approaches were employed in five patients. No adverse intra- or post-operative events were recorded. Excellent or satisfactory graphical results were obtained in 12 patients and an unsatisfactory graphical outcome was recorded in three cases. In the follow-up period ranging from 8 to 22 months, 11 patients healed. Late complications included avascular femoral head necrosis in two and severe post-traumatic coxarthrosis in three patients. Due to these complications, all five patients underwent total hip arthroplasty without previous Omega plate removal at an average interval of 15 months from the primary pelvic surgery. They were not included in the follow-up evaluation. The remaining six patients had an average Harris Hip

  12. A combination of three-dimensional printing and computer-assisted virtual surgical procedure for preoperative planning of acetabular fracture reduction.

    PubMed

    Zeng, Canjun; Xing, Weirong; Wu, Zhanglin; Huang, Huajun; Huang, Wenhua

    2016-10-01

    Treatment of acetabular fractures remains one of the most challenging tasks that orthopaedic surgeons face. An accurate assessment of the injuries and preoperative planning are essential for an excellent reduction. The purpose of this study was to evaluate the feasibility, accuracy and effectiveness of performing 3D printing technology and computer-assisted virtual surgical procedures for preoperative planning in acetabular fractures. We hypothesised that more accurate preoperative planning using 3D printing models will reduce the operation time and significantly improve the outcome of acetabular fracture repair. Ten patients with acetabular fractures were recruited prospectively and examined by CT scanning. A 3-D model of each acetabular fracture was reconstructed with MIMICS14.0 software from the DICOM file of the CT data. Bone fragments were moved and rotated to simulate fracture reduction and restore the pelvic integrity with virtual fixation. The computer-assisted 3D image of the reduced acetabula was printed for surgery simulation and plate pre-bending. The postoperative CT scan was performed to compare the consistency of the preoperative planning with the surgical implants by 3D-superimposition in MIMICS14.0, and evaluated by Matta's method. Computer-based pre-operations were precisely mimicked and consistent with the actual operations in all cases. The pre-bent fixation plates had an anatomical shape specifically fit to the individual pelvis without further bending or adjustment at the time of surgery and fracture reductions were significantly improved. Seven out of 10 patients had a displacement of fracture reduction of less than 1mm; 3 cases had a displacement of fracture reduction between 1 and 2mm. The 3D printing technology combined with virtual surgery for acetabular fractures is feasible, accurate, and effective leading to improved patient-specific preoperative planning and outcome of real surgery. The results provide useful technical tips in

  13. Preservation of the Acetabular Cup During Revision Total Hip Arthroplasty Using a Novel Mini-navigation Tool: A Case Report.

    PubMed

    Vincent, John; Alshaygy, Ibrahim; Muir, Jeffrey M; Kuzyk, Paul

    2018-01-01

    While intraoperative navigation systems have been shown to improve outcomes in primary total hip arthroplasty (THA), their use in the context of revision has been largely overlooked. This case report presents the first documented use of an imageless navigation tool in the context of revision THA, and an unexpected benefit to the surgical procedure as a result. An 84-year-old female patient presented following five episodes of dislocation of the left hip and with pain in the left buttock, groin, and posterior aspect of her hip. Relevant surgical history included primary hip arthroplasty in 1999 and the first revision in 2014. Preoperative analysis revealed a constrained liner that had become disengaged and migrated inferiorly, lodging at the distal aspect of the femoral neck. Acetabular protrusion was also noted. The pre-operative plan included the replacement of the fragmented liner and likely of the acetabular cup due to hardware failure. Intraoperative assessment, however, revealed that the cup was in good condition and would be difficult to remove due to substantial bony ingrowth. With the assistance of imageless navigation, the orientation of the acetabular cup was determined and a new constrained liner was cemented into the preexisting acetabular component at an altered orientation, correcting anteversion by 7°. In revision hip arthroplasty cases, image-based navigation is limited by the presence of existing implants and corresponding metal artefact. This case demonstrates the successful use of an imageless navigation tool for revision surgery. Use of navigation led to the unexpected intraoperative discovery that the acetabular cup was in an acceptable state, and allowed the surgical team to correct the position of the cup using a constrained liner, thus preserving the cup. This significantly benefitted patient outcome, due to the risks associated with the removal of a firmly fixated acetabular cup. While more extensive research is required, this case

  14. Press-fit acetabular cup fixation: principles and testing.

    PubMed

    Macdonald, W; Carlsson, L V; Charnley, G J; Jacobsson, C M

    1999-01-01

    Pre-clinical testing of the fixation of press-fit acetabular components of total hip prostheses relies on cadaver or synthetic bone, but the properties and geometry of bone models differ from those of physiological bone. Cup designs use varied mechanisms for initial stability in bone; therefore, using different analogues and tests is appropriate. Press-fit cup stability was tested in the following: firstly, polyurethane (PU) foam modelling cancellous support; secondly, glass-fibre reinforced epoxide (GFRE) tubes modelling acetabular cortical support; thirdly, cadaveric acetabula. Three commercial cups [Harris-Galante II (H-G-II), Zimmer; Optifix, Smith & Nephew, Richards; porous coated anatomic (PCA), Howmedica] and an experimental cup with enhanced rim fixation were tested in three modes: direct pull-out, lever-out and axial torque. The fixation stabilities measured in the PU and the GFRE models showed trends consistent with those in cadaver bone, differing in the oversizing and cup geometry. The experimental cup was significantly more secure in most modes than other cups; the H-G II and Optifix cups showed similar stabilities, lower than that of the experimental cup but greater than that of the PCA cup (analysis of variance and Tukey's highly significant test; p < 0.001). The stabilities measured in cadaver bone more closely approximated those in GFRE. The use of several bone analogues enables separation of fixation mechanisms, allowing more accurate prediction of in vivo performance.

  15. Outcomes of Hip Arthroscopy in the Older Adult: A Systematic Review of the Literature.

    PubMed

    Griffin, Daniel W; Kinnard, Matthew J; Formby, Peter M; McCabe, Michael P; Anderson, Terrence D

    2017-07-01

    The indications for hip preservation surgery have expanded to include treatment of hip pathology in older adults. While several studies have examined the efficacy of hip arthroscopy in the setting of osteoarthritis, there has been no review of outcomes in older adults. To review the outcomes of hip arthroscopy in older adults and identify factors associated with treatment failures. Systematic review. PubMed, EMBASE, and the Cochrane Library were searched through March 2016 for studies reporting outcomes of primary hip arthroscopy in patients older than 40 years. Inclusion in the review was based on age, patient-reported outcome (PRO) measures, and duration of follow-up. Two authors screened the results and extracted data for use in this review. Standardized mean difference was calculated to estimate effect size for PRO scores within studies. Eight studies with 401 total patients undergoing hip arthroscopy for femoroacetabular impingement (FAI) or labral tears were included in this review. Seven of the 8 studies reported favorable PRO scores and significant postoperative improvement with moderate to large effect size. The included studies demonstrated a trend toward higher effect sizes with an increasing percentage of labral repair compared to isolated labral debridement. The complication rate was comparable to that of previous reports involving younger patients; however, the overall reoperation rate was 20.8%. Conversion to hip arthroplasty ranged from 0% to 30%, with an overall conversion rate of 18.5% at a mean time of 17.5 months following arthroscopy. The most common risk factors for conversion to arthroplasty were low preoperative PRO scores and advanced arthritis. Hip arthroscopy appears to be a safe and efficacious treatment for labral tears and FAI in older patients who do not have significant underlying degenerative changes. However, in this population, there is a significant proportion of patients who eventually require hip arthroplasty. Outcomes may be

  16. [The correlations between corneal sensation, tear meniscus volume, and tear film osmolarity after femtosecond laser-assisted LASIK].

    PubMed

    Zhang, Luyan; Sun, Xiyu; Yu, Ye; Xiong, Yan; Cui, Yuxin; Wang, Qinmei; Hu, Liang

    2016-01-01

    To investigate the correlations between corneal sensation, tear meniscus volume, and tear film osmolarity after femtosecond laser-assisted LASIK (FS-LASIK) surgery. In this prospective clinical study, 31 patients undergoing FS-LASIK for myopia were recruited. The upper and lower tear meniscus volumes (UTMV and LTMV) were measured by customized anterior segment optical coherence tomography, tear film osmolarity was measured by a TearLab Osmolarity test device, central corneal sensation was measured by a Cochet-Bonner esthesiometer preoperatively, at 1 week, 1 and 3 months postoperatively. Repeated measures analysis of variance was used to evaluate whether the tear film osmolarity, tear meniscus volume, and corneal sensation were changed after surgery. The correlations between these variables were analyzed by the Pearson correlation analysis. The tear film osmolarity was (310.03 ± 16.48) mOsms/L preoperatively, (323.51 ± 15.92) mOsms/L at 1 week, (319.93 ± 14.27) mOsms/L at 1 month, and (314.97±12.91) mOsms/L at 3 months. The UTMV was (0.42±0.15), (0.25± 0.09), (0.30±0.11), and (0.35±0.09) μL, respectively; the LTMV was (0.60±0.21),(0.37±0.08), (0.44± 0.14), and (0.52±0.17) μL, respectively. The tear film osmolarity was significantly higher at 1 week and 1 month postoperatively compared with the baseline (P=0.001, 0.004), and reduced to the preoperative level at 3 months (P=0.573). The UTMV, LTMV, and corneal sensation values presented significant decreases at all postoperative time points (all P<0.05). The Pearson correlation analysis showed the postoperative UTMV had a weak relationship with corneal sensation at 1 week after surgery (r=0.356,P=0.005). There were significant correlations between the preoperative LTMV and corneal sensation at 1 week, 1 and 3 months (respectively, r=0.422, 0.366, 0.352;P=0.001, 0.004, 0.006). No significant correlations were found between the tear film osmolarity, tear meniscus volume, and corneal sensation after surgery

  17. Acetabular revisions using porous tantalum components: A retrospective study with 5-10 years follow-up

    PubMed Central

    Evola, Francesco Roberto; Costarella, Luciano; Evola, Giuseppe; Barchitta, Martina; Agodi, Antonella; Sessa, Giuseppe

    2017-01-01

    AIM To evaluate the clinical and X-ray results of acetabular components and tantalum augments in prosthetic hip revisions. METHODS Fifty-eight hip prostheses with primary failure of the acetabular component were reviewed with tantalum implants. The clinical records and X-rays of these cases were retrospectively reviewed. Bone defect evaluations were based on preoperative CT scans and classified according to Paprosky criteria of Radiolucent lines and periprosthetic gaps; implant mobilization and osteolysis were evaluated by X-ray. An ad hoc database was created and statistical analyses were performed with SPSS software (IBM SPSS Statistics for Windows, version 23.0). Statistical analyses were carried out using the Student’s t test for independent and paired samples. A P value of < 0.05 was considered statistically significant and cumulative survival was calculated by the Kaplan-Meier method. RESULTS The mean follow-up was 87.6 ± 25.6 mo (range 3-120 mo). 25 cases (43.1%) were classified as minor defects, and 33 cases (56.9%) as major defects. The preoperative HHS rating improved significantly from a mean of 40.7 ± 6.1 (range: 29-53) before revision, to a mean of 85.8 ± 6.1 (range: 70-94) at the end of the follow-up (Student’s t test for paired samples: P < 0.001). Considering HHS only at the end of follow-up, no statistically significant difference was observed between patients with a major or minor defect (Student’s t test for independent samples: P > 0.05). Radiolucent lines were found in 4 implants (6.9%). Postoperative acetabular gaps were observed in 5 hips (8.6%). No signs of implant mobilization or areas of periprosthetic osteolysis were found in the x-rays at the final follow-up. Only 3 implants failed: 1 case of infection and 2 cases of instability. Defined as the end-point, cumulative survival at 10 years was 95% (for all reasons) and 100% for aseptic loosening of the acetabular component. CONCLUSION The medium-term use of prosthetic tantalum

  18. Acetabular revisions using porous tantalum components: A retrospective study with 5-10 years follow-up.

    PubMed

    Evola, Francesco Roberto; Costarella, Luciano; Evola, Giuseppe; Barchitta, Martina; Agodi, Antonella; Sessa, Giuseppe

    2017-07-18

    To evaluate the clinical and X-ray results of acetabular components and tantalum augments in prosthetic hip revisions. Fifty-eight hip prostheses with primary failure of the acetabular component were reviewed with tantalum implants. The clinical records and X-rays of these cases were retrospectively reviewed. Bone defect evaluations were based on preoperative CT scans and classified according to Paprosky criteria of Radiolucent lines and periprosthetic gaps; implant mobilization and osteolysis were evaluated by X-ray. An ad hoc database was created and statistical analyses were performed with SPSS software (IBM SPSS Statistics for Windows, version 23.0). Statistical analyses were carried out using the Student's t test for independent and paired samples. A P value of < 0.05 was considered statistically significant and cumulative survival was calculated by the Kaplan-Meier method. The mean follow-up was 87.6 ± 25.6 mo (range 3-120 mo). 25 cases (43.1%) were classified as minor defects, and 33 cases (56.9%) as major defects. The preoperative HHS rating improved significantly from a mean of 40.7 ± 6.1 (range: 29-53) before revision, to a mean of 85.8 ± 6.1 (range: 70-94) at the end of the follow-up (Student's t test for paired samples: P < 0.001). Considering HHS only at the end of follow-up, no statistically significant difference was observed between patients with a major or minor defect (Student's t test for independent samples: P > 0.05). Radiolucent lines were found in 4 implants (6.9%). Postoperative acetabular gaps were observed in 5 hips (8.6%). No signs of implant mobilization or areas of periprosthetic osteolysis were found in the x-rays at the final follow-up. Only 3 implants failed: 1 case of infection and 2 cases of instability. Defined as the end-point, cumulative survival at 10 years was 95% (for all reasons) and 100% for aseptic loosening of the acetabular component. The medium-term use of prosthetic tantalum components in prosthetic hip revisions is

  19. Reduced survival for uncemented compared to cemented total hip arthroplasty after operatively treated acetabular fractures.

    PubMed

    Clarke-Jenssen, John; Westberg, Marianne; Røise, Olav; Storeggen, Stein Arne Øvre; Bere, Tone; Silberg, Ingunn; Madsen, Jan Erik

    2017-11-01

    Post traumatic arthritis and avascular necrosis of the femoral head are common complications after operatively treated acetabular fractures. This may cause severe disabilities for the patient, necessitating a total hip arthroplasty. Even though an arthroplasty may provide good symptomatic relief, the long-term results are more uncertain and no consensus exists according to preferred prosthetic designs. With this cohort study, we aimed to investigate the medium to long term arthroplasty survival and clinical results of total hip arthroplasty after operatively treated acetabular fractures. We included 52 patients treated with a secondary total hip arthroplasty at a median of 2.4 (0.1-14.1) years after an operatively treated acetabular fracture. The median age was 54 (11-82) years. Cemented arthroplasty was used for 33 patients, 10 patients had an uncemented arthroplasty and 9 patients received a hybrid arthroplasty. Average follow up was 8.0 (SD 5.0) years. Ten-year revision free arthroplasty survival was 79%. Uncemented arthroplasties had a significantly worse 10-year survival of 57%. Arthroplasties performed at a centre without a pelvic fracture service also had a significantly worse 10-years survival of 51%. Cox regression showed similar results with an 8-fold increase in risk of revision for both uncemented arthroplasties and operations performed at a non-pelvic trauma centre. Total hip arthroplasty secondary to an operatively treated acetabular fracture provides good symptomatic relief. These patients are, however, complex cases and are probably best treated at specialist centres with both pelvic trauma surgeons and arthroplasty surgeons proficient in complex revisions present. Copyright © 2017 Elsevier Ltd. All rights reserved.

  20. Tears of Wine

    NASA Astrophysics Data System (ADS)

    Rathore, Prerana; Sharma, Vivek

    `Tears of wine' refer to the rows of wine-drops that spontaneously emerge within a glass of strong wine. Evaporation-driven Marangoni flows near the meniscus of water-alcohol mixtures drive liquid upward forming a thin liquid film, and a rim or ridge forms near the moving contact line. Eventually the rim undergoes an instability forming drops, that roll back into bulk reservoir forming so called tears or legs of wine. Most studies in literature argue the evaporation of more volatile, lower surface tension component (alcohol) results in a concentration-dependent surface tension gradient that drives the climbing flow within the thin film. Though it is well-known that evaporative cooling can create temperature gradients that could provide additional contribution to the climbing flows, the role of thermocapillary flows is less well-understood. Furthermore, the patterns, flows and instabilities that occur near the rim, and determine the size and periodicity of tears, are not well-studied. Using experiments and theory, we visualize and analyze the formation and growth of tears of wine. The sliding drops, released from the rim towards the bulk reservoir, show oscillations and a cascade of fascinating flows that are analyzed for the first time.

  1. Tear exchange and contact lenses: A review

    PubMed Central

    Muntz, Alex; Subbaraman, Lakshman N.; Sorbara, Luigina; Jones, Lyndon

    2015-01-01

    Tear exchange beneath a contact lens facilitates ongoing fluid replenishment between the ocular surface and the lens. This exchange is considerably lower during the wear of soft lenses compared with rigid lenses. As a result, the accumulation of tear film debris and metabolic by-products between the cornea and a soft contact lens increases, potentially leading to complications. Lens design innovations have been proposed, but no substantial improvement in soft lens tear exchange has been reported. Researchers have determined post-lens tear exchange using several methods, notably fluorophotometry. However, due to technological limitations, little remains known about tear hydrodynamics around the lens and, to-date, true tear exchange with contact lenses has not been shown. Further knowledge regarding tear exchange could be vital in aiding better contact lens design, with the prospect of alleviating certain adverse ocular responses. This article reviews the literature to-date on the significance, implications and measurement of tear exchange with contact lenses. PMID:25575892

  2. Electronic enhancement of tear secretion

    NASA Astrophysics Data System (ADS)

    Brinton, Mark; Lim Chung, Jae; Kossler, Andrea; Kook, Koung Hoon; Loudin, Jim; Franke, Manfred; Palanker, Daniel

    2016-02-01

    Objective. To study electrical stimulation of the lacrimal gland and afferent nerves for enhanced tear secretion, as a potential treatment for dry eye disease. We investigate the response pathways and electrical parameters to safely maximize tear secretion. Approach. We evaluated the tear response to electrical stimulation of the lacrimal gland and afferent nerves in isofluorane-anesthetized rabbits. In acute studies, electrical stimulation was performed using bipolar platinum foil electrodes, implanted beneath the inferior lacrimal gland, and a monopolar electrode placed near the afferent ethmoid nerve. Wireless microstimulators with bipolar electrodes were implanted beneath the lacrimal gland for chronic studies. To identify the response pathways, we applied various pharmacological inhibitors. To optimize the stimulus, we measured tear secretion rate (Schirmer test) as a function of pulse amplitude (1.5-12 mA), duration (0.1-1 ms) and repetition rate (10-100 Hz). Main results. Stimulation of the lacrimal gland increased tear secretion by engaging efferent parasympathetic nerves. Tearing increased with stimulation amplitude, pulse duration and repetition rate, up to 70 Hz. Stimulation with 3 mA, 500 μs pulses at 70 Hz provided a 4.5 mm (125%) increase in Schirmer score. Modulating duty cycle further increased tearing up to 57%, compared to continuous stimulation in chronically implanted animals (36%). Ethmoid (afferent) nerve stimulation increased tearing similar to gland stimulation (3.6 mm) via a reflex pathway. In animals with chronically implanted stimulators, a nearly 6 mm increase (57%) was achieved with 12-fold less charge density per pulse (0.06-0.3 μC mm-2 with 170-680 μs pulses) than the damage threshold (3.5 μC mm-2 with 1 ms pulses). Significance. Electrical stimulation of the lacrimal gland or afferent nerves may be used as a treatment for dry eye disease. Clinical trials should validate this approach in patients with aqueous tear deficiency, and

  3. Primary stability of a cementless acetabular cup in a cohort of patient-specific finite element models.

    PubMed

    O'Rourke, Dermot; Al-Dirini, Rami Ma; Taylor, Mark

    2018-03-01

    The primary stability achieved during total hip arthroplasty determines the long-term success of cementless acetabular cups. Pre-clinical finite element testing of cups typically use a model of a single patient and assume the results can be extrapolated to the general population. This study explored the variability in predicted primary stability of a Pinnacle ® cementless acetabular cup in 103 patient-specific finite element models of the hemipelvis and examined the association between patient-related factors and the observed variability. Cups were inserted by displacement-control into the FE models and then a loading configuration simulating a complete level gait cycle was applied. The cohort showed a range of polar gap of 284-1112 μm and 95th percentile composite peak micromotion (CPM) of 18-624 μm. Regression analysis was not conclusive on the relationship between patient-related factors and primary stability. No relationship was found between polar gap and micromotion. However, when the patient-related factors were categorised into quartile groups, trends suggested higher polar gaps occurred in subjects with small and shallow acetabular geometries and cup motion during gait was affected most by low elastic modulus and high bodyweight. The variation in primary stability in the cohort for an acetabular cup with a proven clinical track record may provide benchmark data when evaluating new cup designs. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1012-1023, 2018. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  4. Study of the three-dimensional orientation of the labrum: its relations with the osseous acetabular rim

    PubMed Central

    Bonneau, Noémie; Bouhallier, July; Baylac, Michel; Tardieu, Christine; Gagey, Olivier

    2012-01-01

    Understanding the three-dimensional orientation of the coxo-femoral joint remains a challenge as an accurate three-dimensional orientation ensure an efficient bipedal gait and posture. The quantification of the orientation of the acetabulum can be performed using the three-dimensional axis perpendicular to the plane that passes along the edge of the acetabular rim. However, the acetabular rim is not regular as an important indentation in the anterior rim was observed. An innovative cadaver study of the labrum was developed to shed light on the proper quantification of the three-dimensional orientation of the acetabulum. Dissections on 17 non-embalmed corpses were performed. Our results suggest that the acetabular rim is better represented by an anterior plane and a posterior plane rather than a single plane along the entire rim as it is currently assumed. The development of the socket from the Y-shaped cartilage was suggested to explain the different orientations in these anterior and posterior planes. The labrum forms a plane that takes an orientation in between the anterior and posterior parts of the acetabular rim, filling up inequalities of the bony rim. The vectors VL, VA2 and VP, representing the three-dimensional orientation of the labrum, the anterior rim and the posterior rim, are situated in a unique plane that appears biomechanically dependent. The three-dimensional orientation of the acetabulum is a fundamental parameter to understand the hip joint mechanism. Important applications for hip surgery and rehabilitation, as well as for physical anthropology, were discussed. PMID:22360458

  5. Dynamic interfacial properties of human tear-lipid films and their interactions with model-tear proteins in vitro.

    PubMed

    Svitova, Tatyana F; Lin, Meng C

    2016-07-01

    This review summarizes the current state of knowledge regarding interfacial properties of very complex biological colloids, specifically, human meibum and tear lipids, and their interactions with proteins similar to the proteins found in aqueous part of human tears. Tear lipids spread as thin films over the surface of tear-film aqueous and play crucial roles in tear-film stability and overall ocular-surface health. The vast majority of papers published to date report interfacial properties of meibum-lipid monolayers spread on various aqueous sub-phases, often containing model proteins, in Langmuir trough. However, it is well established that natural human ocular tear lipids exist as multilayered films with a thickness between 30 and 100nm, that is very much disparate from 1 to 2nm thick meibum monolayers. We employed sessile-bubble tensiometry to study the dynamic interfacial and rheological properties of reconstituted multilayered human tear-lipid films. Small amounts (0.5-1μg) of human tear lipids were deposited on an air-bubble surface to produce tear-lipid films in thickness range 30-100nm corresponding to ocular lipid films. Thus, we were able to overcome major Langmuir-trough method limitations because ocular tear lipids can be safely harvested only in minute, sub-milligram quantities, insufficient for Langmuir through studies. Sessile-bubble method is demonstrated to be a versatile tool for assessing conventional synthetic surfactants adsorption/desorption dynamics at an air-aqueous solution interface. (Svitova T., Weatherbee M., Radke C.J. Dynamics of surfactant sorption at the air/water interface: continuous-flow tensiometry. J. Colloid Interf. Sci. 2003;261:1170-179). The augmented flow-sessile-bubble setup, with step-strain relaxation module for dynamic interfacial rheological properties and high-precision syringe pump to generate larger and slow interfacial area expansions-contractions, was developed and employed in our studies. We established that

  6. Comparison of low-abundance biomarker levels in capillary-collected nonstimulated tears and washout tears of aqueous-deficient and normal patients.

    PubMed

    Guyette, Nicole; Williams, Larezia; Tran, My-Tho; Than, Tammy; Bradley, John; Kehinde, Lucy; Edwards, Clara; Beasley, Mark; Fullard, Roderick

    2013-05-01

    Low tear volume limits the use of nonstimulated (NS) microcapillary tear collection in aqueous-deficient (AD) patients. Adding a small amount of "washout" fluid to the eye prior to tear collection is a potentially viable alternative method for abundant proteins, but is relatively untested for low-abundance biomarkers. This study determined the feasibility of the washout (WO) method as an NS alternative for low-abundance biomarkers. NS and WO biomarker profiles were compared between AD patients and non-AD controls to determine if the two methods identify the same intergroup differences. Matching NS and WO tears were collected from 48 patients by micropipette, the WO sample after instillation of 10 μL saline. Tear cytokine levels were measured by 27-Plex Bio-Rad assay. Bland-Altman analyses for each biomarker determined the agreement between tear sample types. Patients were grouped as AD or non-AD based on Schirmer score to determine if NS profile between-group differences were preserved in WO tears. Bland-Altman plots showed good biomarker level agreement between NS and WO tears for most cytokines. Five biomarkers, among those most often cited as differing in AD dry eye, differed significantly between non-AD and AD groups in both tear types. Additional biomarker differences were seen in NS tears only. The WO tear collection method is a viable alternative to NS tears for many low-abundance biomarkers and is able to replicate major NS tear differences between dry eye groups. More subtle intergroup differences are lost in WO samples because of reduced statistical power.

  7. Change in Acetabular Cup Orientation From Supine to Standing Position and Its Effect on Wear of Highly Crosslinked Polyethylene.

    PubMed

    Teeter, Matthew G; Goyal, Prateek; Yuan, Xunhua; Howard, James L; Lanting, Brent A

    2018-01-01

    The purpose of this study is to measure acetabular cup position and wear of the highly crosslinked polyethylene liner in the supine and standing position for patients at a minimum of 10 years after the operation. A total of 38 patients were recruited at a mean of 12.5 years after the operation. All patients received a single acetabular cup design with a highly crosslinked liner and a 28-mm cobalt-chromium femoral head. Patients underwent supine and standing radiostereometric examinations in which the X-ray sources and detectors were positioned to obtain an anterior-posterior and cross-table lateral radiograph. Acetabular cup position and the three-dimensional wear rate were measured from the radiographs, and outcome scores were recorded for each patient. Anteversion significantly increased (P < .0001) a mean of 12° from supine (15.1° ± 10.4°) to standing (27.2° ± 10.5°) position. Inclination also significantly increased (P = .001) a mean of 2° from supine (44.4° ± 6.8°) to standing (46.3° ± 7.7°) position. There was no difference (P = .093) in wear rate between supine (0.067 ± 0.070 mm/y) and standing (0.073 ± 0.074 mm/y) positions. There were no correlations between cup orientation and wear rate in either position. Highly crosslinked polyethylene is a forgiving bearing material. Although adherence to the traditional acetabular position target zone is recommended, ensuring hip stability and consideration of the patient's functional position are also important objectives to consider for the acetabular position. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Warm and touching tears: tearful individuals are perceived as warmer because we assume they feel moved and touched.

    PubMed

    Zickfeld, Janis H; Schubert, Thomas W

    2018-01-31

    Recent work investigated the inter-individual functions of emotional tears in depth. In one study (Van de Ven, N., Meijs, M. H. J., & Vingerhoets, A. (2017). What emotional tears convey: Tearful individuals are seen as warmer, but also as less competent. British Journal of Social Psychology, 56(1), 146-160. Https://doi.org/10.1111/bjso.12162) tearful individuals were rated as warmer, and participants expressed more intentions to approach and help such individuals. Simultaneously, tearful individuals were rated as less competent, and participants expressed less intention to work with the depicted targets. While tearful individuals were perceived as sadder, perceived sadness mediated only the effect on competence, but not on warmth. We argue that tearful individuals might be perceived as warm because they are perceived as feeling moved and touched. We ran a pre-registered extended replication of Van de Ven et al. Results replicate the warmth and helping findings, but not the competence and work effects. The increase in warmth ratings was completely mediated by perceiving feeling moved and touched. Possible functions of feeling moved and touched with regard to emotional tears are discussed.

  9. Assay of mucins in human tear fluid.

    PubMed

    Spurr-Michaud, Sandra; Argüeso, Pablo; Gipson, Ilene

    2007-05-01

    Mucin genes, both secreted (MUC2, MUC5AC, MUC5B, MUC7) and membrane associated (MUC1, MUC4, MUC16), have been reported to be expressed by ocular surface epithelia. The purpose of this study was to comprehensively assay the mucin content of human tear fluid using multiple antibodies for each mucin and to develop a sensitive, semi-quantitative method for the assay of mucins in tears. Tear washes were obtained by instillation of saline onto the ocular surface, followed by collection from the inferior fornix. Tear proteins were separated in 1% agarose gels, transferred to nitrocellulose membrane by vacuum blotting and probed with multiple antibodies recognizing MUC1, MUC2, MUC4, MUC5AC, MUC5B, MUC7 and MUC16. Binding was detected using chemiluminescence, and quantity was determined by densitometry. Serial dilutions of pooled tears from normal individuals were assayed to determine the linear range of detectability. MUC1, MUC4, MUC16, MUC5AC and low levels of MUC2 were consistently detected in human tear fluid, while MUC5B and MUC7 were not. Use of several antibodies recognizing different epitopes on the same mucin confirmed these findings. The antibodies to mucins bound to serial dilutions of tears in a linear fashion (r2 > 0.9), indicating the feasibility of semi-quantitation. MUC5AC in tear fluid had an increased electrophoretic mobility compared to MUC5AC isolated from conjunctival tissue. This study provides clear evidence that the mucin component of tears is a mixture of secreted and shed membrane-associated mucins, and for the first time demonstrates MUC16 in tear fluid. Immunoblots of tears using agarose gel electrophoresis and chemiluminescence detection provide a semi-quantitative assay for mucin protein that will be useful for comparisons with tears from diseased eyes or after pharmacological intervention.

  10. Assay of Mucins in Human Tear Fluid

    PubMed Central

    Spurr-Michaud, Sandra; Argüeso, Pablo; Gipson, Ilene

    2007-01-01

    Mucin genes, both secreted (MUC2, MUC5AC, MUC5B, MUC7) and membrane associated (MUC1, MUC4, MUC16), have been reported to be expressed by ocular surface epithelia. The purpose of this study was to comprehensively assay the mucin content of human tear fluid using multiple antibodies for each mucin and to develop a sensitive, semi-quantitative method for the assay of mucins in tears. Tear washes were obtained by instillation of saline onto the ocular surface, followed by collection from the inferior fornix. Tear proteins were separated in 1% agarose gels, transferred to nitrocellulose membrane by vacuum blotting and probed with multiple antibodies recognizing MUC1, MUC2, MUC4, MUC5AC, MUC5B, MUC7 and MUC16. Binding was detected using chemiluminescence, and quantity was determined by densitometry. Serial dilutions of pooled tears from normal individuals were assayed to determine the linear range of detectability. MUC1, MUC4, MUC16, MUC5AC and low levels of MUC2 were consistently detected in human tear fluid, while MUC5B and MUC7 were not. Use of several antibodies recognizing different epitopes on the same mucin confirmed these findings. The antibodies to mucins bound to serial dilutions of tears in a linear fashion (r2 >0.9), indicating the feasibility of semi-quantitation. MUC5AC in tear fluid had an increased electrophoretic mobility compared to MUC5AC isolated from conjunctival tissue. This study provides clear evidence that the mucin component of tears is a mixture of secreted and shed membrane-associated mucins, and for the first time demonstrates MUC16 in tear fluid. Immunoblots of tears using agarose gel electrophoresis and chemiluminescence detection provide a semi-quantitative assay for mucin protein that will be useful for comparisons with tears from diseased eyes or after pharmacological intervention. PMID:17399701

  11. Tear exchange and contact lenses: a review.

    PubMed

    Muntz, Alex; Subbaraman, Lakshman N; Sorbara, Luigina; Jones, Lyndon

    2015-01-01

    Tear exchange beneath a contact lens facilitates ongoing fluid replenishment between the ocular surface and the lens. This exchange is considerably lower during the wear of soft lenses compared with rigid lenses. As a result, the accumulation of tear film debris and metabolic by-products between the cornea and a soft contact lens increases, potentially leading to complications. Lens design innovations have been proposed, but no substantial improvement in soft lens tear exchange has been reported. Researchers have determined post-lens tear exchange using several methods, notably fluorophotometry. However, due to technological limitations, little remains known about tear hydrodynamics around the lens and, to-date, true tear exchange with contact lenses has not been shown. Further knowledge regarding tear exchange could be vital in aiding better contact lens design, with the prospect of alleviating certain adverse ocular responses. This article reviews the literature to-date on the significance, implications and measurement of tear exchange with contact lenses. Copyright © 2014 Spanish General Council of Optometry. Published by Elsevier Espana. All rights reserved.

  12. The relationship between operative and radiographic acetabular component orientation: which factors influence resultant cup orientation?

    PubMed

    Grammatopoulos, G; Pandit, H G; da Assunção, R; McLardy-Smith, P; De Smet, K A; Gill, H S; Murray, D W

    2014-10-01

    There is great variability in acetabular component orientation following hip replacement. The aims of this study were to compare the component orientation at impaction with the orientation measured on post-operative radiographs and identify factors that influence the difference between the two. A total of 67 hip replacements (52 total hip replacements and 15 hip resurfacings) were prospectively studied. Intra-operatively, the orientation of the acetabular component after impaction relative to the operating table was measured using a validated stereo-photogrammetry protocol. Post-operatively, the radiographic orientation was measured; the mean inclination/anteversion was 43° (sd 6°)/ 19° (sd 7°). A simulated radiographic orientation was calculated based on how the orientation would have appeared had an on-table radiograph been taken intra-operatively. The mean difference between radiographic and intra-operative inclination/anteversion was 5° (sd 5°)/ -8° (sd 8°). The mean difference between simulated radiographic and intra-operative inclination/anteversion, which quantifies the effect of the different way acetabular orientation is measured, was 3°/-6° (sd 2°). The mean difference between radiographic and simulated radiographic orientation inclination/anteversion, which is a manifestation of the change in pelvic position between component impaction and radiograph, was 1°/-2° (sd 7°). This study demonstrated that in order to achieve a specific radiographic orientation target, surgeons should implant the acetabular component 5° less inclined and 8° more anteverted than their target. Great variability (2 sd about ± 15°) in the post-operative radiographic cup orientation was seen. The two equally contributing causes for this are variability in the orientation at which the cup is implanted, and the change in pelvic position between impaction and post-operative radiograph. ©2014 The British Editorial Society of Bone & Joint Surgery.

  13. Application of an innovative computerized virtual planning system in acetabular fracture surgery: A feasibility study.

    PubMed

    Wang, Huixiang; Wang, Fang; Newman, Simon; Lin, Yanping; Chen, Xiaojun; Xu, Lu; Wang, Qiugen

    2016-08-01

    Acetabular fracture surgery is amongst the most challenging tasks in the field of trauma surgery and careful preoperative planning is crucial for success. The aim of this paper is to describe the preliminary outcome of the utilization of an innovative computerized virtual planning system for acetabular fractures. 3D models of acetabular fractures and surrounding soft tissues from six patients were constructed from preoperative CT scans. A novel highly-automatic segmentation technique was performed on the 3D model to separate each fracture fragment, then 3D virtual reduction was performed. Additionally, the models were used to assess potential surgical approaches with reference to both the fracture and the surrounding soft tissues. The time required for virtual planning was recorded. After surgery, the virtual plan was compared to the real surgery with respect to surgical approach and reduction sequence. A Likert scale questionnaire was completed by the surgeons to evaluate their satisfaction with the system. Virtual planning was successfully completed in all cases. The planned surgical approach was followed in all cases with the planned reduction sequence followed completely in five cases and partially in one. The mean time required for virtual planning was 38.7min (range 21-57, SD=15.5). The mean time required for planning of B-type fractures was 25.0min (range 21-30, SD=4.6), of C-type fracture 52.3min (range 49-57, SD=4.2). The results of the questionnaire demonstrated a high level of satisfaction with the planning system. This study demonstrates that the virtual planning system is feasible in clinical settings with high satisfaction and acceptability from the surgeons. It provides a viable option for the planning of acetabular fracture surgery. Copyright © 2016 Elsevier Ltd. All rights reserved.

  14. Does semi-automatic bone-fragment segmentation improve the reproducibility of the Letournel acetabular fracture classification?

    PubMed

    Boudissa, M; Orfeuvre, B; Chabanas, M; Tonetti, J

    2017-09-01

    The Letournel classification of acetabular fracture shows poor reproducibility in inexperienced observers, despite the introduction of 3D imaging. We therefore developed a method of semi-automatic segmentation based on CT data. The present prospective study aimed to assess: (1) whether semi-automatic bone-fragment segmentation increased the rate of correct classification; (2) if so, in which fracture types; and (3) feasibility using the open-source itksnap 3.0 software package without incurring extra cost for users. Semi-automatic segmentation of acetabular fractures significantly increases the rate of correct classification by orthopedic surgery residents. Twelve orthopedic surgery residents classified 23 acetabular fractures. Six used conventional 3D reconstructions provided by the center's radiology department (conventional group) and 6 others used reconstructions obtained by semi-automatic segmentation using the open-source itksnap 3.0 software package (segmentation group). Bone fragments were identified by specific colors. Correct classification rates were compared between groups on Chi 2 test. Assessment was repeated 2 weeks later, to determine intra-observer reproducibility. Correct classification rates were significantly higher in the "segmentation" group: 114/138 (83%) versus 71/138 (52%); P<0.0001. The difference was greater for simple (36/36 (100%) versus 17/36 (47%); P<0.0001) than complex fractures (79/102 (77%) versus 54/102 (53%); P=0.0004). Mean segmentation time per fracture was 27±3min [range, 21-35min]. The segmentation group showed excellent intra-observer correlation coefficients, overall (ICC=0.88), and for simple (ICC=0.92) and complex fractures (ICC=0.84). Semi-automatic segmentation, identifying the various bone fragments, was effective in increasing the rate of correct acetabular fracture classification on the Letournel system by orthopedic surgery residents. It may be considered for routine use in education and training. III: prospective

  15. Reduced tear production in three canine endocrinopathies.

    PubMed

    Williams, D L; Pierce, V; Mellor, P; Heath, M F

    2007-05-01

    Previous reports have suggested that hypothyroid and diabetic patients can be predisposed to keratoconjunctivitis sicca. This study aimed to measure tear production in dogs with diabetes, hypothyroidism and hyperadrenocorticism using the Schirmer tear test and to compare these results with Schirmer tear test values for a group of normal dogs. Schirmer tear tests were performed on 16 dogs with hyperadrenocorticism, 18 with diabetes and 12 with hypothyroidism together with 100 control dogs. Corneal sensitivity was also measured in 12 of the 18 diabetic dogs with a Cochet Bonnet aesthesiometer and compared with age- and breed-matched normal dogs. Schirmer tear test values in dogs with hypothyroidism, hyperadrenocorticism and diabetes were 12.3+/-3.2, 14.0+/-4.0 and 12.3+/-5.3 mm/minutes, respectively. Schirmer tear test values were significantly lower than that for the control group (19.6+/-4.2 mm/minutes) in all dogs with an endocrinopathy. Only in two hypothyroid dogs and three diabetics, this was manifested as profound keratoconjunctivitis sicca with Schirmer tear test value lower than 5 mm/minutes. Diabetic dogs had significantly reduced corneal sensitivity compared with a matched set of control dogs. This study shows a significant reduction in tear production in animals with diabetes mellitus, hypothyroidism and hyperadrenocorticism. Further research is needed to elucidate the mechanisms by which this reduction in tear production occurs. Assessment of tear production should be undertaken in animals diagnosed with these endocrinopathies, as these animals may progress to clinical keratoconjunctivitis sicca.

  16. Perioperative and acute care outcomes in morbidly obese patients with acetabular fractures at a Level 1 trauma center

    PubMed Central

    Vincent, Heather K.; Haupt, Edward; Tang, Sonya; Egwuatu, Adaeze; Vlasak, Richard; Horodyski, MaryBeth; Carden, Donna; Sadisivan, Kalia K.

    2014-01-01

    Background Controversy exists regarding obesity-related injury severity and clinical outcomes after orthopedic trauma. Purpose The purposes of this study were to expand our understanding of the effect of morbid obesity on perioperative and acute care outcomes after acetabular fracture. Methods This was a retrospective review of patients with acetabular fracture after trauma. Non-morbidly obese (BMI < 35 kg/m2) and morbidly obese (BMI ≥ 35 kg/m2; N = 81). Injury severity scores and Glasgow Coma Scale scores (GCS) were collected. Perioperative and acute care outcomes were positioning and operative time, extra fractures, estimated blood loss, complications, hospital charges, ventilator days, transfusions, length of stay (LOS) and discharge destination. Positioning and operative times were longer in morbidly obese patients (p < 0.05). No other differences existed between groups. Conclusions Orthopedic trauma surgeons and care teams can expect similar acute care outcomes in morbidly obese and non-morbidly obese patients with acetabular fracture. PMID:25104886

  17. Interferometric characterization of tear film dynamics

    NASA Astrophysics Data System (ADS)

    Primeau, Brian Christopher

    The anterior refracting surface of the eye is the thin tear film that forms on the surface of the cornea. When a contact lens is on worn, the tear film covers the contact lens as it would a bare cornea, and is affected by the contact lens material properties. Tear film irregularity can cause both discomfort and vision quality degradation. Under normal conditions, the tear film is less than 10 microns thick and the thickness and topography change in the time between blinks. In order to both better understand the tear film, and to characterize how contact lenses affect tear film behavior, two interferometers were designed and built to separately measure tear film behavior in vitro and in vivo. An in vitro method of characterizing dynamic fluid layers applied to contact lenses mounted on mechanical substrates has been developed using a phase-shifting Twyman-Green interferometer. This interferometer continuously measures light reflected from the surface of the fluid layer, allowing precision analysis of the dynamic fluid layer. Movies showing this fluid layer behavior can be generated. The fluid behavior on the contact lens surface is measured, allowing quantitative analysis beyond what typical contact angle or visual inspection methods provide. The in vivo interferometer is a similar system, with additional modules included to provide capability for human testing. This tear film measurement allows analysis beyond capabilities of typical fluorescein visual inspection or videokeratometry and provides better sensitivity and resolution than shearing interferometry methods.

  18. Controversies In The Surgical Management Of Shoulder Instability: Associated Soft Tissue Procedures

    PubMed Central

    Moros Marco, Santos; Ávila Lafuente, José Luis; Ruiz Ibán, Miguel Angel; Diaz Heredia, Jorge

    2017-01-01

    Background: The glenohumeral joint is a ball-and-socket joint that is inherently unstable and thus, susceptible to dislocation. The traditional and most common anatomic finding is the Bankart lesion (anterior-inferior capsule labral complex avulsion), but there is a wide variety of anatomic alterations that can cause shoulder instability or may be present as a concomitant injury or in combination, including bone loss (glenoid or humeral head), complex capsule-labral tears, rotator cuff tears, Kim´s lesions (injuries to the posterior-inferior labrum) and rotator interval pathology. Methods: A review of articles related to shoulder anatomy and soft tissue procedures that are performed during shoulder instability arthroscopic management was conducted by querying the Pubmed database and conclusions and controversies regarding this injury were exposed. Results: Due to the complex anatomy of the shoulder and the large range of movement of this joint, a wide variety of anatomic injuries and conditions can lead to shoulder instability, specially present in young population. Recognizing and treating all of them including Bankart repair, capsule-labral plicatures, SLAP repair, circumferential approach to pan-labral lesions, rotator interval closure, rotator cuff injuries and HAGL lesion repair is crucial to achieve the goal of a stable, full range of movement and not painful joint. Conclusion: Physicians must be familiarized with all the lesions involved in shoulder instability, and should be able to recognize and subsequently treat them to achieve the goal of a stable non-painful shoulder. Unrecognized or not treated lesions may result in recurrence of instability episodes and pain while overuse of some of the techniques previously described can lead to stiffness, thus the importance of an accurate diagnosis and treatment when facing a shoulder instability. PMID:28979603

  19. Towards the optimal design of an uncemented acetabular component using genetic algorithms

    NASA Astrophysics Data System (ADS)

    Ghosh, Rajesh; Pratihar, Dilip Kumar; Gupta, Sanjay

    2015-12-01

    Aseptic loosening of the acetabular component (hemispherical socket of the pelvic bone) has been mainly attributed to bone resorption and excessive generation of wear particle debris. The aim of this study was to determine optimal design parameters for the acetabular component that would minimize bone resorption and volumetric wear. Three-dimensional finite element models of intact and implanted pelvises were developed using data from computed tomography scans. A multi-objective optimization problem was formulated and solved using a genetic algorithm. A combination of suitable implant material and corresponding set of optimal thicknesses of the component was obtained from the Pareto-optimal front of solutions. The ultra-high-molecular-weight polyethylene (UHMWPE) component generated considerably greater volumetric wear but lower bone density loss compared to carbon-fibre reinforced polyetheretherketone (CFR-PEEK) and ceramic. CFR-PEEK was located in the range between ceramic and UHMWPE. Although ceramic appeared to be a viable alternative to cobalt-chromium-molybdenum alloy, CFR-PEEK seems to be the most promising alternative material.

  20. Assessment of tear film osmolarity using the TearLab™ osmometer in normal dogs and dogs with keratoconjunctivitis sicca.

    PubMed

    Sebbag, Lionel; Park, Shin Ae; Kass, Philip H; Maggs, David J; Attar, Mayssa; Murphy, Christopher J

    2017-07-01

    To evaluate repeatability and reproducibility of tear osmolarity measured using the TearLab ™ osmometer in normal dogs and to assess its diagnostic potential in dogs with keratoconjunctivitis sicca (KCS). Beagle dogs; six normal and five with KCS. Tear osmolarity and Schirmer tear test-1 (STT-1) values were obtained at various times. Normal dogs were assessed for diurnal variation and repeatability and reproducibility of measurements. Dogs with KCS were evaluated before and after 5 months' topical twice-daily therapy with 2% cyclosporine. Mean ± SD tear osmolarity (mOsm/L) was significantly higher in normal dogs (337.4 ± 16.2) than in dogs with KCS before therapy (306.2 ± 18.0; P < 0.0001), but not following therapy with 2% cyclosporine (330.5 ± 13.7; P = 1.00). Osmolarity readings lower than 325.5 mOsm/L were suggestive of KCS (84.8% sensitivity and 87.1% specificity). In normal dogs, tear osmolarity readings were stable during the daytime (P = 0.99). Repeated measurements revealed high variability and typically poor-to-moderate repeatability and reproducibility, although this was improved by taking three successive measurements at each session. Considering combined data from all dogs, a positive correlation existed between STT-1 and tear osmolarity measurements (Pearson's correlation test, P = 0.04, r = 0.62). Canine tear osmolarity as determined by TearLab ™ osmometer was variable, required multiple readings to be informative, and differed from values reported for humans. Dogs with KCS had a lower tear osmolarity than did normal dogs, and this increased following cyclosporine therapy. © 2016 American College of Veterinary Ophthalmologists.

  1. T2* Mapping Provides Information That Is Statistically Comparable to an Arthroscopic Evaluation of Acetabular Cartilage.

    PubMed

    Morgan, Patrick; Nissi, Mikko J; Hughes, John; Mortazavi, Shabnam; Ellerman, Jutta

    2017-07-01

    Objectives The purpose of this study was to validate T2* mapping as an objective, noninvasive method for the prediction of acetabular cartilage damage. Methods This is the second step in the validation of T2*. In a previous study, we established a quantitative predictive model for identifying and grading acetabular cartilage damage. In this study, the model was applied to a second cohort of 27 consecutive hips to validate the model. A clinical 3.0-T imaging protocol with T2* mapping was used. Acetabular regions of interest (ROI) were identified on magnetic resonance and graded using the previously established model. Each ROI was then graded in a blinded fashion by arthroscopy. Accurate surgical location of ROIs was facilitated with a 2-dimensional map projection of the acetabulum. A total of 459 ROIs were studied. Results When T2* mapping and arthroscopic assessment were compared, 82% of ROIs were within 1 Beck group (of a total 6 possible) and 32% of ROIs were classified identically. Disease prediction based on receiver operating characteristic curve analysis demonstrated a sensitivity of 0.713 and a specificity of 0.804. Model stability evaluation required no significant changes to the predictive model produced in the initial study. Conclusions These results validate that T2* mapping provides statistically comparable information regarding acetabular cartilage when compared to arthroscopy. In contrast to arthroscopy, T2* mapping is quantitative, noninvasive, and can be used in follow-up. Unlike research quantitative magnetic resonance protocols, T2* takes little time and does not require a contrast agent. This may facilitate its use in the clinical sphere.

  2. Acetabular revision with impaction bone grafting and a cemented polyethylene acetabular component: comparison of the Kaplan-Meier analysis to the competing risk analysis in 62 revisions with 25 to 30 years follow-up.

    PubMed

    Te Stroet, M A J; Keurentjes, J C; Rijnen, W H C; Gardeniers, J W M; Verdonschot, N; Slooff, T J J H; Schreurs, B W

    2015-10-01

    We present the results of 62 consecutive acetabular revisions using impaction bone grafting and a cemented polyethylene acetabular component in 58 patients (13 men and 45 women) after a mean follow-up of 27 years (25 to 30). All patients were prospectively followed. The mean age at revision was 59.2 years (23 to 82). We performed Kaplan-Meier (KM) analysis and also a Competing Risk (CR) analysis because with long-term follow-up, the presence of a competing event (i.e. death) prevents the occurrence of the endpoint of re-revision. A total of 48 patients (52 hips) had died or had been re-revised at final review in March 2011. None of the deaths were related to the surgery. The mean Harris hip score of the ten surviving hips in ten patients was 76 points (45 to 99). The KM survivorship at 25 years for the endpoint 're-revision for any reason' was 58.0% (95% confidence interval (CI) 38 to 73) and for 're-revision for aseptic loosening' 72.1% (95% CI 51 to 85). With the CR analysis we calculated the KM analysis overestimates the failure rate with respectively 74% and 93% for these endpoints. The current study shows that acetabular impaction bone grafting revisions provide good clinical results at over 25 years. ©2015 The British Editorial Society of Bone & Joint Surgery.

  3. High complication rate in reconstruction of Paprosky type IIIa acetabular defects using an oblong implant with modular side plates and a hook.

    PubMed

    Babis, G C; Sakellariou, V I; Chatziantoniou, A N; Soucacos, P N; Megas, P

    2011-12-01

    We report the results of 62 hips in 62 patients (17 males, 45 females) with mean age of 62.4 years (37 to 81), who underwent revision of the acetabular component of a total hip replacement due to aseptic loosening between May 2003 and November 2007. All hips had a Paprosky type IIIa acetabular defect. Acetabular revision was undertaken using a Procotyl E cementless oblong implant with modular side plates and a hook combined with impaction allografting. At a mean follow-up of 60.5 months (36 to 94) with no patients lost to follow-up and one died due to unrelated illness, the complication rate was 38.7%. Complications included aseptic loosening (19 hips), deep infection (3 hips), broken hook and side plate (one hip) and a femoral nerve palsy (one hip). Further revision of the acetabular component was required in 18 hips (29.0%) and a further four hips (6.4%) are currently loose and awaiting revision. We observed unacceptably high rates of complication and failure in our group of patients and cannot recommend this implant or technique.

  4. Clinical Assessment of Physical Examination Maneuvers for Superior Labral Anterior to Posterior Lesions

    PubMed Central

    Somerville, Lyndsay E.; Willits, Kevin; Johnson, Andrew M.; Litchfield, Robert; LeBel, Marie-Eve; Moro, Jaydeep; Bryant, Dianne

    2017-01-01

    Purpose  Shoulder pain and disability pose a diagnostic challenge owing to the numerous etiologies and the potential for multiple disorders to exist simultaneously. The evidence to support the use of clinical tests for superior labral anterior to posterior complex (SLAP) is weak or absent. The purpose of this study is to determine the diagnostic validity of physical examination maneuvers for SLAP lesions by performing a methodologically rigorous, clinically applicable study. Methods  We recruited consecutive new shoulder patients reporting pain and/or disability. The physician took a history and indicated their certainty about each possible diagnosis (“certain the diagnosis is absent/present,” or “uncertain requires further testing”). The clinician performed the physical tests for diagnoses where uncertainty remained. Magnetic resonance imaging arthrogram and arthroscopic examination were the gold standards. We calculated sensitivity, specificity, and likelihood ratios (LRs) and investigated whether combinations of the top tests provided stronger predictions. Results  Ninety-three patients underwent physical examination for SLAP lesions. When using the presence of a SLAP lesion (Types I–V) as disease positive, none of the tests was sensitive (10.3–33.3) although they were moderately specific (61.3–92.6). When disease positive was defined as repaired SLAP lesion (including biceps tenodesis or tenotomy), the sensitivity (10.5–38.7) and specificity (70.6–93.8) of tests improved although not by a substantial amount. None of the tests was found to be clinically useful for predicting repairable SLAP lesions with all LRs close to one. The compression rotation test had the best LR for both definitions of disease (SLAP tear present = 1.8 and SLAP repaired = 1.67). There was no optimal combination of tests for diagnosing repairable SLAP lesions, with at least two tests positive providing the best combination of measurement properties

  5. [Shoulder instability and rotator cuff tear].

    PubMed

    Voigt, C; Lill, H

    2009-01-01

    A rotator cuff tear as a complication of anterior shoulder dislocation is well known in patients over 40 years old. The incidence of this accompanying injury correlates with the patient's age and the number of redislocations. The tear localization and dimension depend on the patient's age. To what extent these tears are a complication of shoulder dislocation is often unclear, as rotator cuff tears and glenohumeral instability interact. Reports on this combined injury pattern are rare, but based on the patient's age, activity level, and functional demand, therapeutic concepts have been devised. In active patients younger than 60 years and in cases of redislocation, both the rotator cuff tear and the capsule-labrum-ligament lesion should be reconstructed arthroscopically. In lesser active patients age 60 years or older, an isolated rotator cuff reconstruction is often sufficient to stabilize the glenohumeral joint. This treatment concept shows a predominantly good outcome.As a special form of anterior shoulder dislocation, a rotator cuff tear and a plexus brachialis lesion--the"terrible triad of the shoulder"--is described here.

  6. Managing acetabular fractures in the elderly with fixation and primary arthroplasty: aiming for early weightbearing.

    PubMed

    Rickman, Mark; Young, James; Trompeter, Alex; Pearce, Rachel; Hamilton, Mark

    2014-11-01

    Osteoporotic acetabular fractures in the elderly are becoming more common. Regardless of treatment, most patients are managed with a period of protected weightbearing, even if a THA has been performed. We have tried to treat these patients analogously to geriatric femoral neck fractures in a way that allows immediate full weightbearing. We determined return to mobility, length of hospital stay (LOS), radiographic outcomes, and complications in a series of elderly osteoporotic patients treated for acetabular fractures with early fracture fixation and simultaneous THA, allowing full weightbearing immediately postoperatively. Since 2009, one surgeon (MR) used a consistent approach for fracture fixation and THA with immediate weightbearing in all patients older than 65 years with acetabular fractures who were fit for surgery and whose injuries were deemed osteoporotic fractures (low-energy mechanisms) meeting particular radiographic criteria (significant marginal impaction or femoral head damage). Twenty-four patients met these criteria and were reviewed at a mean of 24 months (range, 8-38 months). Mean age was 77 years (range, 63-90 years), and eight patients were women. The surgical technique included plate stabilization of both acetabular columns plus simultaneous THA using a tantalum socket and a cemented femoral stem. Clinical and note reviews were conducted to ascertain return to mobility, LOS, and postoperative complications. Component migration and fracture healing were assessed on plain radiographs. All patients mobilized with full weightbearing by Day 7 postoperatively. Only one patient remained dependent on a frame to mobilize at discharge. At 6 weeks, two patients already required no walking aids. At 6 months, patients were using a single stick at home at most, and all patients had managed stairs. Mean LOS was 18 days (range, 10-36 days). Radiographically, no component migration was seen in any patient. Seventeen of 24 fractures (71%) healed

  7. Evaporation-driven instability of the precorneal tear film.

    PubMed

    Peng, Cheng-Chun; Cerretani, Colin; Braun, Richard J; Radke, C J

    2014-04-01

    Tear-film instability is widely believed to be a signature of eye health. When an interblink is prolonged, randomly distributed ruptures occur in the tear film. "Black spots" and/or "black streaks" appear in 15 to 40 s for normal individuals. For people who suffer from dry eye, tear-film breakup time (BUT) is typically less than a few seconds. To date, however, there is no satisfactory quantitative explanation for the origin of tear rupture. Recently, it was proposed that tear-film breakup is related to locally high evaporative thinning. A spatial variation in the thickness of the tear-film lipid layer (TFLL) may lead to locally elevated evaporation and subsequent tear-film breakup. We examine the local-evaporation-driven tear-film-rupture hypothesis in a one-dimensional (1-D) model for the evolution of a thin aqueous tear film overriding the cornea subject to locally elevated evaporation at its anterior surface and osmotic water influx at its posterior surface. Evaporation rate depends on mass transfer both through the coating lipid layer and through ambient air. We establish that evaporation-driven tear-film breakup can occur under normal conditions but only for higher aqueous evaporation rates. Predicted roles of environmental conditions, such as wind speed and relative humidity, on tear-film stability agree with clinical observations. More importantly, locally elevated evaporation leads to hyperosmolar spots in the tear film and, hence, vulnerability to epithelial irritation. In addition to evaporation rate, tear-film instability depends on the strength of healing flow from the neighboring region outside the breakup region, which is determined by the surface tension at the tear-film surface and by the repulsive thin-film disjoining pressure. This study provides a physically consistent and quantitative explanation for the formation of black streaks and spots in the human tear film during an interblink. Copyright © 2013 Elsevier B.V. All rights reserved.

  8. Use of iPhone technology in improving acetabular component position in total hip arthroplasty.

    PubMed

    Tay, Xiau Wei; Zhang, Benny Xu; Gayagay, George

    2017-09-01

    Improper acetabular cup positioning is associated with high risk of complications after total hip arthroplasty. The aim of our study is to objectively compare 3 methods, namely (1) free hand, (2) alignment jig (Sputnik), and (3) iPhone application to identify an easy, reproducible, and accurate method in improving acetabular cup placement. We designed a simple setup and carried out a simple experiment (see Method section). Using statistical analysis, the difference in inclination angles using iPhone application compared with the freehand method was found to be statistically significant ( F [2,51] = 4.17, P = .02) in the "untrained group". There is no statistical significance detected for the other groups. This suggests a potential role for iPhone applications in junior surgeons in overcoming the steep learning curve.

  9. Topical anaesthetic and tear film stability.

    PubMed

    Mengher, L S; Pandher, K S; Bron, A J

    1986-02-01

    The effect of unpreserved topical anaesthetic on tear film stability (0.4% oxybuprocaine hydrochloride) was investigated in a double masked randomised study in 12 healthy volunteers, using a noninvasive tear film break up technique (NIBUT). It was found that the topical anaesthetic did not reduce the pre-corneal tear film stability, contrary to the electron microscopic evidence.

  10. Bone Remodeling in Acetabular Reconstruction Using a Kerboull-Type Reinforcement Device and Structural Bone-Grafting in Total Hip Arthroplasty.

    PubMed

    Oe, Kenichi; Iida, Hirokazu; Tsuda, Kohei; Nakamura, Tomohisa; Okamoto, Naofumi; Ueda, Yusuke

    2017-03-01

    The purpose of this study was to identify the long-term durability of the Kerboull-type reinforcement device (KT plate) in acetabular reconstruction for massive bone defects, assessing the remodeling of structural bone grafts. This study retrospectively evaluated 106 hips that underwent acetabular reconstruction using a KT plate between November 2000 and December 2010. Thirty-eight primary total hip arthoplasties (THAs) and 68 revised THAs were performed, and the mean duration of clinical follow-up was 8 years (5-14 years). Regarding reconstructing the acetabular bone defects, autografts were used in 37 hips, allografts in 68 hips, and A-W glass ceramics in 2 hips. One hip exhibited radiological migration and no revision for aseptic loosening. The mean Merle d'Aubigné Clinical Score improved from 7.5 points (4-12 points) preoperatively to 10.9 points (9-18 points) at the last follow-up. The Kaplan-Meier survival rate for radiological migration of primary and revised THAs at 10 years was 100% and 97% (95% confidence interval: 96%-100%), respectively. Bone remodeling was evaluated using the radiological demarcation at the bone-to-bone interface, and an improvement of 100% in primary THAs and 94% in revised THAs was observed. For massive bone defects, acetabular reconstruction using the KT plate with a structural bone grafting can yield successful results. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Return to Sport and Clinical Outcomes After Hip Arthroscopic Labral Repair in Young Amateur Athletes: Minimum 2-Year Follow-Up.

    PubMed

    Mohan, Rohith; Johnson, Nick R; Hevesi, Mario; Gibbs, Christopher M; Levy, Bruce A; Krych, Aaron J

    2017-09-01

    To determine the rate of return of young amateur athletes to sport after hip arthroscopy, their clinical outcomes, and pathologic risk factors for worse outcomes 2 years after surgery. This study included all patients between age 13 and 23 who participated in a sport prior to surgery with intent to return who underwent hip arthroscopy after failure of comprehensive nonoperative management for whom 2-year outcome scores were available. Outcomes collected retrospectively included modified Harris Hip Score (mHHS) and the Hip Outcome Scores (HOS) subscales for activities of daily living (ADL) and sport (HOS Sport). In addition, sport played, return to sport rates, and Tegner Scores were measured preinjury and postoperatively. Descriptive statistics were used to present demographic data. A priori analysis was used to determine the sample size needed to show minimal clinically important differences for mHHS, HOS ADL, and HOS Sport. The study population included 50 patients with a mean age of 17.8 years. Athletes returned to sport at a rate of 92% (46/50). At a mean follow-up of 34 months, the mean mHHS, HOS ADL, and HOS Sport outcome scores were 85, 91, and 80 for the entire study group; 87, 92, and 84 for the group that returned to sport; and 67, 82, and 41 for the group that did not return to sport, respectively. Median preinjury and postoperative Tegner levels were 8 and 7, respectively. Labral takedown and reattachment was associated with lower HOS ADL (P = .01) and HOS Sport scores (P = .02). Athletes returned to sport at a high rate (92%; 46/50) after hip arthroscopy and perform activities at near preinjury levels. In this group of athletes, arthroscopic labral repair with chondrolabral preservation, which reflected less severe chondrolabral pathology, performed better than labral repair with takedown and reattachment. Level IV, therapeutic case series. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  12. Increased Tear Film Osmolarity in Systemic Lupus Erythematosus.

    PubMed

    Duru, Necati; Altinkaynak, Hasan; Uysal, Betul Seher; Duru, Zeynep; Can, Mehmet Erol; Erten, Sukran; Yuksel, Nilay; Kalkan Akcay, Emine

    2017-01-01

    To evaluate tear film osmolarity in patients with systemic lupus erythematosus (SLE). A total of 55 eyes from 55 patients with SLE and 47 eyes from 47 age- and gender-matched healthy individuals were included in this study. Tear film osmolarity was evaluated with a lab-on-a-chip technique (TearLab; TearLab Corporation, San Diego, CA) in SLE patients in comparison with healthy individuals, and results were correlated to clinically available diagnostic tests for dry eye, such as tear film break-up time (BUT), Schirmer's test, and Ocular Surface Disease Index (OSDI). The mean tear film osmolarity in the SLE patients and healthy individuals was 306.02 ± 13.27 mOsm/L and 300.74 ± 9.11 mOsm/L, respectively, which made for a statistically significant difference (p = 0.020). In the SLE group, tear film osmolarity was negatively correlated with the Schirmer's test score and the BUT value (r = -0.295 p = 0.029 and r = 0.347 p = 0.009, respectively), whereas tear film osmolarity was not correlated with OSDI score (r = -0.182 p = 0.183). This study revealed that tear film hyperosmolarity and abnormal tear film function are associated with SLE.

  13. 21 CFR 888.3370 - Hip joint (hemi-hip) acetabular metal cemented prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Hip joint (hemi-hip) acetabular metal cemented prosthesis. 888.3370 Section 888.3370 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3370 Hip joint...

  14. 21 CFR 888.3370 - Hip joint (hemi-hip) acetabular metal cemented prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Hip joint (hemi-hip) acetabular metal cemented prosthesis. 888.3370 Section 888.3370 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3370 Hip joint...

  15. 21 CFR 888.3370 - Hip joint (hemi-hip) acetabular metal cemented prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Hip joint (hemi-hip) acetabular metal cemented prosthesis. 888.3370 Section 888.3370 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3370 Hip joint...

  16. Tear gas: an epidemiological and mechanistic reassessment

    PubMed Central

    Rothenberg, Craig; Achanta, Satyanarayana; Svendsen, Erik R.

    2016-01-01

    Deployments of tear gas and pepper spray have rapidly increased worldwide. Large amounts of tear gas have been used in densely populated cities, including Cairo, Istanbul, Rio de Janeiro, Manama (Bahrain), and Hong Kong. In the United States, tear gas was used extensively during recent riots in Ferguson, Missouri. Whereas tear gas deployment systems have rapidly improved—with aerial drone systems tested and requested by law enforcement—epidemiological and mechanistic research have lagged behind and have received little attention. Case studies and recent epidemiological studies revealed that tear gas agents can cause lung, cutaneous, and ocular injuries, with individuals affected by chronic morbidities at high risk for complications. Mechanistic studies identified the ion channels TRPV1 and TRPA1 as targets of capsaicin in pepper spray, and of the tear gas agents chloroacetophenone, CS, and CR. TRPV1 and TRPA1 localize to pain‐sensing peripheral sensory neurons and have been linked to acute and chronic pain, cough, asthma, lung injury, dermatitis, itch, and neurodegeneration. In animal models, transient receptor potential inhibitors show promising effects as potential countermeasures against tear gas injuries. On the basis of the available data, a reassessment of the health risks of tear gas exposures in the civilian population is advised, and development of new countermeasures is proposed. PMID:27391380

  17. Combination acetabular radiofrequency ablation and cementoplasty using a navigational radiofrequency ablation device and ultrahigh viscosity cement: technical note.

    PubMed

    Wallace, Adam N; Huang, Ambrose J; Vaswani, Devin; Chang, Randy O; Jennings, Jack W

    2016-03-01

    Percutaneous radiofrequency ablation and cementoplasty is an alternative palliative therapy for painful metastases involving axial load-bearing bones. This technical report describes the use of a navigational radiofrequency probe to ablate acetabular metastases from an anterior approach followed by instillation of ultrahigh viscosity cement under CT-fluoroscopic guidance. The tumor ablation databases of two institutions were retrospectively reviewed to identify patients who underwent combination acetabular radiofrequency ablation and cementoplasty using the STAR Tumor Ablation and StabiliT Vertebral Augmentation Systems (DFINE; San Jose, CA). Pre-procedure acetabular tumor volume was measured on cross-sectional imaging. Pre- and post-procedure pain scores were measured using the Numeric Rating Scale (10-point scale) and compared. Partial pain improvement was categorically defined as ≥ 2-point pain score reduction. Patients were evaluated for evidence of immediate complications. Electronic medical records were reviewed for evidence of delayed complications. During the study period, 12 patients with acetabular metastases were treated. The median tumor volume was 54.3 mL (range, 28.3-109.8 mL). Pre- and post-procedure pain scores were obtained from 92% (11/12) of the cohort. The median pre-procedure pain score was 8 (range, 3-10). Post-procedure pain scores were obtained 7 days (82%; 9/11), 11 days (9.1%; 1/11) or 21 days (9.1%; 1/11) after treatment. The median post-treatment pain score was 3 (range, 1-8), a statistically significant difference compared with pre-treatment (P = 0.002). Categorically, 73% (8/11) of patients reported partial pain relief after treatment. No immediate symptomatic complications occurred. Three patients (25%; 3/12) were discharged to hospice within 1 week of treatment. No delayed complications occurred in the remaining 75% (9/12) of patients during median clinical follow-up of 62 days (range, 14-178 days). Palliative percutaneous

  18. 3D surgical printing and pre contoured plates for acetabular fractures.

    PubMed

    Chana-Rodríguez, Francisco; Mañanes, Rubén Pérez; Rojo-Manaute, José; Gil, Pablo; Martínez-Gómiz, José María; Vaquero-Martín, Javier

    2016-11-01

    We describe the methodical and possibilities of 3D surgical printing in preoperative planning of acetabular fractures showing a case of a 45-year-old with an associated transverse fracture of the left acetabulum with posterior wall fracture, with multiple fragments, and posterior ipsilateral hip dislocation, defending the do it your-self mode. Copyright © 2016 Elsevier Ltd. All rights reserved.

  19. Tear and decohesion of bovine pericardial tissue.

    PubMed

    Tobaruela, Almudena; Elices, Manuel; Bourges, Jean Yves; Rojo, Francisco Javier; Atienza, José Miguel; Guinea, Gustavo

    2016-10-01

    The aim of this study was to evaluate quantitatively the fracture-by tear and delamination-of bovine pericardium tissues which are usually employed for the manufacture of bioprosthetic valves. A large number of samples (77) were tested in root-to-apex and circumferential directions, according to a standardised tear test (ASTM D 1938). Before performing the tear test, some samples were subjected to 1000 cycles of fatigue to a maximum stress of 3MPa. Fracture toughness of tearing and delamination were computed by following a simple fracture model. The study showed significantly lower values of delamination toughness compared with tear delamination. Moreover, tear forces were different in each test direction, revealing a clear orthotropic behaviour. All these results, as well as the testing procedure, could be of value for future research in the physiological function of pericardium tissues and clinical applications. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. Photon correlation spectroscopy applied to tear analysis.

    PubMed

    Picarazzi, S; Lecchi, M; Pastori, V; D'Arienzo, M; Scotti, R; Tavazzi, S

    2017-09-01

    This study aims to deepen the knowledge on tear film properties by the development of a protocol for analyses of Photon Correlation Spectroscopy (PCS) on human tears and by the comparison between PCS results obtained on tears of contact lens wearers and non-wearers. Tears (5μL) were collected by a glass capillary. The analyses provide the hydrodynamic diameter of tear components by analyzing intensity fluctuations in time of scattered light. PCS appears a promising technique for studying tear features and for shedding light on specific eye conditions, such as on the clinical effects of CL wear. In fact, statistical difference (p<0.001) was found between the measured mean hydrodynamic diameter of tear components of wearers and non-wearers, the resulting value significantly higher for CL wearers. The scenario does not substantially change after (25±5)min from the CL removal. The difference is attributed to changes in the interactions between tear constituents due to CL wear. In order to get deeper insights on the influence of CL wear on aggregation and structure of tear components, a preliminary Electron Spin Resonance (ESR) investigation was performed, monitoring Fe 3+ species. ESR spectra on tears of both CL wearers and non-wearers showed the presence of intense signals, probably associated to iron (III) centers in proteins such as lactoferrin, and a weaker resonance attributable to Fe 3+ species interacting with S-S bridges of lysozyme. Differences in ESR spectra between CL wearers and non-wearers were detected and tentatively ascribed to changes in coordination or in local environment of Fe 3+ centers connected to aggregation phenomena induced by CL wear, which promote their interaction with other neighboring iron species. Copyright © 2017. Published by Elsevier B.V.

  1. Evaluating tear clearance rate with optical coherence tomography.

    PubMed

    Garaszczuk, Izabela K; Mousavi, Maryam; Cervino Exposito, Alejandro; Bartuzel, Maciej M; Montes-Micó, Robert; Iskander, D Robert

    2018-02-01

    To assess the early-phase of tear clearance rate (TCR) with anterior segment optical coherence tomography (OCT) and to determine the association between TCR and other clinical measures of the tear film in a group of young subjects with different levels of tear film quality. TCR was classified as the percentage decrease of subject's inferior tear meniscus height 30s after instillation of 5μl 0.9% saline solution. Fifty subjects (32F and 18M) aged (mean±standard deviation) 25.5±4.3 years volunteered for the study. It consisted of a review of medical history, Ocular Surface Disease Index (OSDI) questionnaire, tear film osmolarity measurements, slit lamp examination and TCR estimation based on dynamic measurements of the lower tear meniscus with OCT. Estimates of TCR were contrasted against subject age and tear film measures commonly used for dry eye diagnosis, which includes OSDI score, fluorescein tear film break-up time (FBUT), tear meniscus height (TMH), blinking frequency, tear film osmolarity and corneal staining. The group mean TCR was 29±13% and 36±19% respectively after 30 and 60s margin after saline solution instillation. Statistically significant correlations were found between TCR and FBUT (r 2 =0.319, p<0.001), blinking frequency (r 2 =0.138, p<0.01), tear film osmolarity (r 2 =0.133, p<0.01) and subject's age (r 2 =0.095, p<0.05). Anterior segment optical coherence tomography allows following changes of tear meniscus morphology post saline solution instillation and evaluating the TCR. OCT based TCR might be used as additional measure of the lacrimal functional unit. Copyright © 2017 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

  2. Hot Tearing in Aluminium — Copper Alloys

    NASA Astrophysics Data System (ADS)

    Viano, David; StJohn, David; Grandfield, John; Cáceres, Carlos

    For many aluminium alloys, hot tearing susceptibility follows a lambda curve relationship when hot tearing severity is plotted as a function of solute content. In the past, there has been some difficulty quantifying hot tearing. Traditional methods rely upon measuring electrical resistivity or the number and/or length of cracks in tests such as the ring test. In this experimental program, a hot tear test rig was used to investigate a series of binary Al-Cu alloys. This device measures the load imposed on the mushy zone during solidification. Hot tearing susceptibility was quantified in two ways. The first method involved measuring the load at the solidus temperature (548°C). The second method was to radiograph the hot spot and measure the image density of the cracks. Both methods had advantages and disadvantages. It was found that the results from the hot tear rig correlates with other published data using different experimental methods.

  3. Chemosignalling effects of human tears revisited: Does exposure to female tears decrease males' perception of female sexual attractiveness?

    PubMed

    Gračanin, Asmir; van Assen, Marcel A L M; Omrčen, Višnja; Koraj, Ivana; Vingerhoets, Ad J J M

    2017-01-01

    Gelstein et al. reported the results of three experiments suggesting a dampening influence of inhalation of female emotional tears on males' arousal and perception of female sexual attractiveness, specifically in non-sexual situations. This prompted the hypothesis that crying exerts its influence on others not only via the auditory and visual mode but also via chemosignals. In three studies, we attempted to replicate and extend Gelstein et al.'s findings by including an additional condition with irritant tears, by using pictures of sexually attractive women, and by testing related hypotheses on the pro-social effects of exposure to tears. All three studies, separately or combined in a meta-analysis, failed to replicate the original inhibitory effects of tears. In addition, sniffing tears did not affect measures of connectedness, aggression and pro-social behaviour. It is concluded that the effects of female tears on male arousal and perception of female sexual attractiveness, if any, are very weak at best. Rather, it seems that crying exerts its strong inter-personal effects through the visual and auditory sensory channels.

  4. Effect of screw fixation on acetabular component alignment change in total hip arthroplasty.

    PubMed

    Fujishiro, Takaaki; Hayashi, Shinya; Kanzaki, Noriyuki; Hashimoto, Shingo; Shibanuma, Nao; Kurosaka, Masahiro

    2014-06-01

    The use of screws can enhance immediate cup fixation, but the influence of screw insertion on cup position has not previously been measured. The purpose of this study was to quantitatively evaluate the effect of intra-operative screw fixation on acetabular component alignment that has been inserted with the use of a navigation system. We used a navigation system to measure cup alignment at the time of press-fit and after screw fixation in 144 hips undergoing total hip arthroplasty. We also compared those findings with factors measured from postoperative radiographs. The mean intra-operative change of cup position was 1.78° for inclination and 1.81° for anteversion. The intra-operative change of anteversion correlated with the number of screws. The intra-operative change of inclination also correlated with medial hip centre. The insertion of screws can induce changes in cup alignment, especially when multiple screws are used or if a more medial hip centre is required for rigid acetabular fixation.

  5. The development and nature of femoral head cam lesions following acetabular fractures.

    PubMed

    Berber, Onur; Foote, Julian; Sabharwal, Sanjeeve; Datta, Gorav; Bircher, Martin D

    2014-01-01

    The aim of acetabular fracture fixation is to restore joint congruity with restoration of the articular surface. Poor outcomes are seen where this has not been achieved. Letournel reported a collarette osteophyte seen postoperatively in a proportion of patients, which he suggested was an early precursor to the development of osteoarthritis. This is a retrospective study of patients treated at a tertiary referral unit who developed this lesion. The triangular index was measured in 48 of these patients and then correlated with their clinical findings, Oxford Hip Score and the presence of osteoarthritis. Length of follow-up, fracture classification, and joint congruency were also recorded. Results showed a statistically significant relationship between cam lesion size and the development of osteoarthritis (P = 0.008), cam lesion size and length of follow-up (P = 0.01), and between groin pain and postoperative joint congruency (LR = 0.035). These findings suggest that the appearance of a cam lesion is a poor long-term prognostic marker for the development of osteoarthritis in patients with an acetabular fracture.

  6. A new approach for assessment of wear in metal-backed acetabular cups using computed tomography: a phantom study with retrievals.

    PubMed

    Jedenmalm, Anneli; Noz, Marilyn E; Olivecrona, Henrik; Olivecrona, Lotta; Stark, Andre

    2008-04-01

    Polyethylene wear is an important cause of aseptic loosening in hip arthroplasty. Detection of significant wear usually happens late on, since available diagnostic techniques are either not sensitive enough or too complicated and expensive for routine use. This study evaluates a new approach for measurement of linear wear of metal-backed acetabular cups using CT as the intended clinically feasible method. 8 retrieved uncemented metal-backed acetabular cups were scanned twice ex vivo using CT. The linear penetration depth of the femoral head into the cup was measured in the CT volumes using dedicated software. Landmark points were placed on the CT images of cup and head, and also on a reference plane in order to calculate the wear vector magnitude and angle to one of the axes. A coordinate-measuring machine was used to test the accuracy of the proposed CT method. For this purpose, the head diameters were also measured by both methods. Accuracy of the CT method for linear wear measurements was 0.6 mm and wear vector angle was 27 degrees . No systematic difference was found between CT scans. This study on explanted acetabular cups shows that CT is capable of reliable measurement of linear wear in acetabular cups at a clinically relevant level of accuracy. It was also possible to use the method for assessment of direction of wear.

  7. 49 CFR 173.340 - Tear gas devices.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 2 2010-10-01 2010-10-01 false Tear gas devices. 173.340 Section 173.340... SHIPMENTS AND PACKAGINGS Gases; Preparation and Packaging § 173.340 Tear gas devices. (a) Packagings for tear gas devices must be approved prior to initial transportation by the Associate Administrator. (b...

  8. Tear clearance implications for ocular surface health.

    PubMed

    de Paiva, Cintia Sade; Pflugfelder, Stephen C

    2004-03-01

    Tear clearance/turnover provides a global assessment of the function of the lacrimal functional unit and of tear exchange on the ocular surface. It is an indirect measure of dry eye induced inflammation on the ocular surface. It shows better correlation with the severity of ocular irritation symptoms and corneal epithelial disease in dry eye than the Schirmer 1 test. Delayed tear clearance may prove to be the best measure for identifying patients with tear film disorders who may respond to anti-inflammatory therapy.

  9. Tear Film Osmolarity in Subjects with Acute Allergic Rhinoconjunctivitis

    PubMed Central

    NITODA, EIRINI; LAVARIS, ANASTASIOS; LAIOS, KONSTANTINOS; ANDROUDI, SOPHIA; KALOGEROPOULOS, CHRIS D; TSATSOS, MICHAEL; DAMASKOS, CHRISTOS; GARMPIS, NIKOLAOS; MOSCHOS, MARILITA M

    2018-01-01

    Background/Aim: Acute allergic rhinoconjuctivitis is the most common form of ocular allergies. The pathogenetic mechanisms are based on an immunoglobulin E (IgE)-mediated hypersensitivity reaction. On the other hand, tear osmolarity has been suggested to be an index of ocular surface damage and inflammation. These data were the motive to investigate the levels of tear osmolarity in subjects with acute allergic rhinoconjuctivitis, before and after administration of artificial tears. Patients and Methods: Forty-five subjects with acute allergic rhinoconjuctivitis were randomly divided into three groups, based on the type of artificial tears that they received: Group A (Thera tears), Group B (Wet therapy) and Group C (Tears Naturale free). The eye drops were administered six times a day for 60 days and all subjects underwent grading of subjective symptoms and clinical examination at baseline and at the end of the treatment. Results: The diagnosis of severe eye disease, which was based on ocular surface disease index (OSDI; Allergan, Inc, Irvine, CA, USA) and tear osmolarity values, concerned all patients at baseline. Although the administration of artificial tears significantly ameliorated the symptoms and the ocular variables in all groups, the results were better in the first group. Tear osmolarity was strongly and negatively correlated with tear film breakup time (BUT) and Schirmer I test at 2 months. Contrariwise, symptoms were eliminated, when tear osmolarity was decreased. Conclusion: Acute allergic rhinoconjuctivitis is characterized by tear hyperosmolarity, which can be rehabilitated with the administration of hypotonic artificial tears. PMID:29475928

  10. Tear Film Osmolarity in Subjects with Acute Allergic Rhinoconjunctivitis.

    PubMed

    Nitoda, Eirini; Lavaris, Anastasios; Laios, Konstantinos; Androudi, Sophia; Kalogeropoulos, Chris D; Tsatsos, Michael; Damaskos, Christos; Garmpis, Nikolaos; Moschos, Marilita M

    2018-01-01

    Acute allergic rhinoconjuctivitis is the most common form of ocular allergies. The pathogenetic mechanisms are based on an immunoglobulin E (IgE)-mediated hypersensitivity reaction. On the other hand, tear osmolarity has been suggested to be an index of ocular surface damage and inflammation. These data were the motive to investigate the levels of tear osmolarity in subjects with acute allergic rhinoconjuctivitis, before and after administration of artificial tears. Forty-five subjects with acute allergic rhinoconjuctivitis were randomly divided into three groups, based on the type of artificial tears that they received: Group A (Thera tears), Group B (Wet therapy) and Group C (Tears Naturale free). The eye drops were administered six times a day for 60 days and all subjects underwent grading of subjective symptoms and clinical examination at baseline and at the end of the treatment. The diagnosis of severe eye disease, which was based on ocular surface disease index (OSDI; Allergan, Inc, Irvine, CA, USA) and tear osmolarity values, concerned all patients at baseline. Although the administration of artificial tears significantly ameliorated the symptoms and the ocular variables in all groups, the results were better in the first group. Tear osmolarity was strongly and negatively correlated with tear film breakup time (BUT) and Schirmer I test at 2 months. Contrariwise, symptoms were eliminated, when tear osmolarity was decreased. Acute allergic rhinoconjuctivitis is characterized by tear hyperosmolarity, which can be rehabilitated with the administration of hypotonic artificial tears. Copyright© 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

  11. Corrosion on the acetabular liner taper from retrieved modular metal-on-metal total hip replacements.

    PubMed

    Gascoyne, Trevor C; Dyrkacz, Richard M; Turgeon, Thomas R; Burnell, Colin D; Wyss, Urs P; Brandt, Jan-M

    2014-10-01

    Eight retrieved metal-on-metal total hip replacements displayed corrosion damage along the cobalt-chromium alloy liner taper junction with the Ti alloy acetabular shell. Scanning electron microscopy indicated the primary mechanism of corrosion to be grain boundary and associated crevice corrosion, which was likely accelerated through mechanical micromotion and galvanic corrosion resulting from dissimilar alloys. Coordinate measurements revealed up to 4.3mm(3) of the cobalt-chromium alloy taper surface was removed due to corrosion, which is comparable to previous reports of corrosion damage on head-neck tapers. The acetabular liner-shell taper appears to be an additional source of metal corrosion products in modular total hip replacements. Patients with these prostheses should be closely monitored for signs of adverse reaction towards corrosion by-products. Copyright © 2014 Elsevier Inc. All rights reserved.

  12. Single-stage Acetabular Revision During Two-stage THA Revision for Infection is Effective in Selected Patients.

    PubMed

    Fink, Bernd; Schlumberger, Michael; Oremek, Damian

    2017-08-01

    The treatment of periprosthetic infections of hip arthroplasties typically involves use of either a single- or two-stage (with implantation of a temporary spacer) revision surgery. In patients with severe acetabular bone deficiencies, either already present or after component removal, spacers cannot be safely implanted. In such hips where it is impossible to use spacers and yet a two-stage revision of the prosthetic stem is recommended, we have combined a two-stage revision of the stem with a single revision of the cup. To our knowledge, this approach has not been reported before. (1) What proportion of patients treated with single-stage acetabular reconstruction as part of a two-stage revision for an infected THA remain free from infection at 2 or more years? (2) What are the Harris hip scores after the first stage and at 2 years or more after the definitive reimplantation? Between June 2009 and June 2014, we treated all patients undergoing surgical treatment for an infected THA using a single-stage acetabular revision as part of a two-stage THA exchange if the acetabular defect classification was Paprosky Types 2B, 2C, 3A, 3B, or pelvic discontinuity and a two-stage procedure was preferred for the femur. The procedure included removal of all components, joint débridement, definitive acetabular reconstruction (with a cage to bridge the defect, and a cemented socket), and a temporary cemented femoral component at the first stage; the second stage consisted of repeat joint and femoral débridement and exchange of the femoral component to a cementless device. During the period noted, 35 patients met those definitions and were treated with this approach. No patients were lost to followup before 2 years; mean followup was 42 months (range, 24-84 months). The clinical evaluation was performed with the Harris hip scores and resolution of infection was assessed by the absence of clinical signs of infection and a C-reactive protein level less than 10 mg/L. All

  13. Sarcopenia Is Predictive of 1-Year Mortality After Acetabular Fractures in Elderly Patients.

    PubMed

    Mitchell, Phillip M; Collinge, Cory A; OʼNeill, David E; Bible, Jesse E; Mir, Hassan R

    2018-06-01

    To determine whether sarcopenia is an independent predictor of mortality in geriatric acetabular fractures. Retrospective cohort. American College of Surgeons Level I trauma center. One hundred and forty-six patients over the age 60 with acetabular fractures treated at our institution over a 12-year period. The primary outcome was 1-year mortality, collected using the Social Security Death Index. We used the psoas:lumbar vertebral index (PLVI), calculated using the cross-sectional area of the L4 vertebral body and the left and right psoas muscles, to assess for sarcopenia. Using a multivariate logistic regression model, we found that low PLVI was associated with increased 1-year mortality (P = 0.046) when controlling for age, gender, Charlson Comorbidity Index, Injury Severity Score (ISS), smoking status, and associated pelvic ring injury. Increasing age and ISS also showed a relationship with 1-year mortality in this cohort (P < 0.001, P < 0.001, respectively). We defined sarcopenia as those patients in the lowest quartile of PLVI. The mortality rate of this cohort was 32.4%, compared with 11.0% in patients without sarcopenia (odds ratio 4.04; 95% confidence interval 1.62-10.1). Age >75 years, ISS >14, and sarcopenia had 1-year mortality rates of 37.1%, 30.9%, and 32.4%, respectively. In patients with all 3 factors, the mortality rate was 90%. Sarcopenia is an independent risk factor for 1-year mortality in elderly patients with acetabular fractures. This study highlights the importance of objective measures to assess frailty in elderly patients who have sustained fractures about the hip and pelvis. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

  14. Computed tomography image-guided surgery in complex acetabular fractures.

    PubMed

    Brown, G A; Willis, M C; Firoozbakhsh, K; Barmada, A; Tessman, C L; Montgomery, A

    2000-01-01

    Eleven complex acetabular fractures in 10 patients were treated by open reduction with internal fixation incorporating computed tomography image guided software intraoperatively. Each of the implants placed under image guidance was found to be accurate and without penetration of the pelvis or joint space. The setup time for the system was minimal. Accuracy in the range of 1 mm was found when registration was precise (eight cases) and was in the range of 3.5 mm when registration was only approximate (three cases). Added benefits included reduced intraoperative fluoroscopic time, less need for more extensive dissection, and obviation of additional surgical approaches in some cases. Compared with a series of similar fractures treated before this image guided series, the reduction in operative time was significant. For patients with complex anterior and posterior combined fractures, the average operation times with and without application of three-dimensional imaging technique were, respectively, 5 hours 15 minutes and 6 hours 14 minutes, revealing 16% less operative time for those who had surgery using image guidance. In the single column fracture group, the operation time for those with three-dimensional imaging application, was 2 hours 58 minutes and for those with traditional surgery, 3 hours 42 minutes, indicating 20% less operative time for those with imaging modality. Intraoperative computed tomography guided imagery was found to be an accurate and suitable method for use in the operative treatment of complex acetabular fractures with substantial displacement.

  15. Surgical Treatment of Combined Posterior Root Tears of the Lateral Meniscus and ACL Tears

    PubMed Central

    Pan, Fengyu; Hua, Shan; Ma, Zhuang

    2015-01-01

    Background The treatment of anterior cruciate ligament (ACL) rupture complicated with posterior lateral meniscus root (PLMR) tears remains controversial. The goal of this study was to evaluate clinical outcomes of PLMR tear refixation versus left untreated at the time of reconstruction. Material/Methods From August 2001 to January 2012, 31 patients who undergone repair of PLMR tears were evaluated and compared with a matched control group with untreated PLMR tears. Clinical evaluation consisted of the Lysholm scale, subjective International Knee Documentation Committee (IKDC) questionnaires, and radiographic evaluation with MRI. Results Regarding to the Lysholm score and the subjective questionnaire score, there were no statistical difference between the 2 groups. However, patients after operative treatment reach higher functional scores and lower rates of osteoarthritis (normal: group A, 80%, and group B, 48%, respectively) with statistical significance (P<0.05) compared to the matched control group. Conclusions Surgical and conservative treatment of the PLMR can both effectively improve knee function. However, a tendency towards higher functional scores and lower rates of osteoarthritis for patients with operative treatment was observed. PMID:25959903

  16. On the tear resistance of skin

    DOE PAGES

    Yang, Wen; Sherman, Vincent R.; Gludovatz, Bernd; ...

    2015-03-27

    Tear resistance is vitally important for the various functions of skin, especially protection from predatorial attack. Here, we mechanistically quantify the extreme tear resistance of skin and identify the underlying structural features, which lead to its sophisticated failure mechanisms. Here we explain why it is virtually impossible to propagate a tear in rabbit skin, chosen as a model material for the dermis of vertebrates. Finally, we express the deformation in terms of four mechanisms of collagen fibril activity in skin under tensile loading that virtually eliminate the possibility of tearing in pre-notched samples: fibril straightening, fibril reorientation towards the tensilemore » direction, elastic stretching and interfibrillar sliding, all of which contribute to the redistribution of the stresses at the notch tip.« less

  17. Diadenosine tetraphosphate contributes to carbachol-induced tear secretion.

    PubMed

    Fonseca, Begoña; Martínez-Águila, Alejandro; Díaz-Hernández, Miguel; Pintor, Jesús

    2015-03-01

    The purpose of this study is to investigate if the cholinergic stimulation by carbachol on tear secretion is a direct process or if it is also mediated by purinergic mechanisms. Experiments were performed in New Zealand male rabbits. The amount of tear secretion was measured with Schirmer's test and then analyzed by a HPLC protocol in order to study the nucleotide levels. Animal eyes were instilled with carbachol (a cholinergic agonist), pirenzepine, gallamine and 4-DAMP (muscarinic antagonists), PPADS, suramin and reactive blue 2 (purinergic antagonists), and a P2Y2 receptor small interfering RNA (siRNA). Tear secretion increased with the instillation of carbachol, approximately 84 % over control values 20 min after the instillation and so did Ap4A and ATP release. When we applied carbachol in the presence of muscarinic antagonists, tear volume only increased to 4 % with atropine, 12 % in the case of pirenzepine, 3 % with gallamine, and 8 % with 4-DAMP. In the presence of carbachol and purinergic antagonists, tear secretion was increased to 12 % (all values compared to basal tear secretion). By analyzing tear secretion induced with carbachol in presence of a P2Y2 receptor siRNA, we found that tear secretion was diminished to 60 %. The inhibition of tear secretion in the presence of carbachol and purinergic antagonists or P2Y2 siRNA occurred with no apparent change in the tear amount of Ap4A. These experiments demonstrated the participation of Ap4A in lacrimal secretion process.

  18. Impact of environmental adaptation on tear film assessments.

    PubMed

    Fagehi, R

    2018-03-01

    The purpose of this study was to investigate the effect of ocular environmental adaptation on clinical tear film assessment. Thirty subjects (male, mean age 23±2.5) participated in this study. A number of clinical tear film tests were applied, including: fluorescein tear break-up time (FTBUT), Schirmer test and tear prism height test (TPH). The tear physiology of each subject was evaluated twice, once immediately when they arrived from the external environment, and then after 30minutes adaptation in the exam room environment. The mean values were: Schirmer test A (22.1±2.99), Schirmer test B (24.2±2.63), FTBUT A (8.00±1.94), FTBUT B (9.13±2.04), TPH A (0.179±0.026) and TPH B* (0.187±0.023). Statistical testing using Wilcoxon-signed rank test showed a significant difference between the Schirmer test results measured at the different times (P=0.008). Also, the FTBUT and tear prism height test results showed significant differences between the two evaluation times, (P=0.001, 0.011, respectively) (A: tear assessed when the subject comes from the outside environment, B: tear film assessed after 30min adaptation in the clinical environment). This study showed a significant difference between the tear film test results evaluated when the subjects were assessed immediately from the outside environment and after an adaptation time in the clinic environment. Practitioners must consider the effect of differences between external and clinical environment adaptation on clinical tear film physiology. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

  19. [Alterations in tears aqueous layer during cytostatics treatment].

    PubMed

    Wojciechowska, Katarzyna; Wieckowska-Szakiel, Marzena; Rózalska, Barbara; Jurowski, Piotr

    2013-01-01

    The aim of the study was to evaluate tears secretion, pH and lysozyme activity in tears aqueous layer during chemotherapy in lung, breast and bowel cancer. 36 patients were enrolled to the study. Depending on the type of cancer and type of chemotherapy patients were divided into three groups. Group I (12 patients) diagnosed with non-small-cell lung cancer treated with PE schema (cisplatin, etoposide), Group II (12 patients) with breast cancer treated with FAC schema (fluorouracil, doxorubicin, cyclophosphamide), Group III (12 patients) with bowel cancer treated with FU/LV schema (fluorouracil, leucovorin). In all the patients: Schirmer's I test, pH measurements and lysozyme test were performed. Patients were examined before chemotherapy, after 2nd, 4th, 6th cycle. In group I and II lowering of tears secretion (p < 0.001) was revealed. In group III there was higher tears secretion (p < 0.001). PH was lowered after 2nd chemotherapy course in group I and II. In further treatment pH value were in the same lower level as after the second course. In group III there was higher pH--more alkaline (p < 0.001) after 2nd cycle of treatment and it was on the same level to the end of the examination process. Lowering of lysozyme activity in the tears film in all groups (p < 0.001) was established. The higher alterations of the lysozyme activity were observed in group treated with FAC schema. Cytostatic treatment has major influence on tears aqueous layer causing alterations of tears secretions. PH alterations depending on type of chemotherapy was observed. Lowering of lysozyme activity in tears was observed. All the deteriorations aggravate with duration of chemotherapy. Alterations of tears film parameters during chemotherapy may influence upon eye surface homeostasis and infectious complication. tears aqueous layer, Schirmer's test, lysozyme activity, tears pH.

  20. Treatment of acetabular fractures in older patients-introduction of a new implant for primary total hip arthroplasty.

    PubMed

    Resch, H; Krappinger, D; Moroder, P; Auffarth, A; Blauth, M; Becker, J

    2017-04-01

    Fractures of the acetabulum in younger patients are commonly treated by open reduction and internal fixation. For elderly patients, stable primary total hip arthroplasty with the advantage of immediate postoperative mobilization might be the adequate treatment. For this purpose, a sufficiently stable fixation of the acetabular component is required. Between August 2009 and 2014, 30 cases were reported in which all patients underwent total hip arthroplasty additionally to a customized implant designed as an antiprotrusion cage. Inclusion criteria were an acetabular fracture with or without a previous hemiarthroplasty, age above 65 years, and pre-injury mobility dependent on a walking frame at the most. The median age was 79.9 years (65-92), and of 30 fractures, 25 were primary acetabular fractures (83%), four periprosthetic acetabular fractures (14%), and one non-union after a failed ORIF (3%). The average time from injury to surgery was 9.4 days (3-23) and 295 days for the non-union case. Mean time of surgery was 154.4 min (range 100 to 303). In 21 cases (70%), mobilization with full weight bearing was possible within the first 10 days. Six patients died before the follow-up examination 3 and 6 months after surgery, while 24 patients underwent radiologic examination showing consolidated fractures in bi-plane radiographs. In 9 patients, additional CT scan was performed which confirmed the radiographical results. 13 had regained their pre-injury level of mobility including the non-union case. Only one patient did not regain independent mobility. Four complications were recognized with necessary surgical revision (one prosthetic head dislocation, one pelvic cement leakage, one femoral shaft fracture, and one infected hematoma). The presented cage provides the possibility of early mobilization with full weight bearing which represents a valuable addition to the treatment spectrum in this challenging patient group.

  1. Variation in Treatment of Displaced Geriatric Acetabular Fractures Among 15 Level-I Trauma Centers.

    PubMed

    Manson, Theodore T; Reider, Lisa; OʼToole, Robert V; Scharfstein, Daniel O; Tornetta, Paul; Gary, Joshua L

    2016-09-01

    To document the initial treatment of displaced acetabular fractures among older adults across multiple trauma centers and to investigate the factors that influence the decision to operate and the choice of operative procedure [open reduction internal fixation (ORIF) vs. total hip arthroplasty (THA)]. Retrospective observational study. Fifteen US level-I trauma centers participating in the Major Extremity Trauma Research Consortium. Overall, 269 patients aged 60 years or older admitted for the treatment of a displaced acetabular fracture. None. Treatment. Sixty percent of fractures (n = 162) were treated operatively. Younger age (<80 years), injury from high-energy mechanism, fractures with femoral head impaction, and fractures without hip congruency were significantly associated with receiving operative treatment (P < 0.05). Significant site variation in operative versus nonoperative treatment occurred even after accounting for these factors (P = 0.0044). Among operatively treated patients, 88% (n = 142) received ORIF and 12% (n = 20) received THA as the initial treatment. Women were more likely to be treated with initial THA compared with men; of the known risk factors for poor outcomes with ORIF (ie, dome or roof impaction, femoral head impaction, or posterior wall involvement), only dome impaction was significantly associated with receiving initial THA (P < 0.05). Currently, no treatment guidelines exist for acetabular fractures in older adults, which likely explains the significant site variation in operative versus nonoperative treatment. This study identifies patient and injury factors that drive treatment decisions, which will be important in planning and designing future trials needed to determine the best treatment for these fractures.

  2. Computer-aided designed, three dimensional-printed hemipelvic prosthesis for peri-acetabular malignant bone tumour.

    PubMed

    Wang, Baichuan; Hao, Yongqiang; Pu, Feifei; Jiang, Wenbo; Shao, Zengwu

    2018-03-01

    Prosthetic reconstruction may be a promising treatment for peri-acetabular malignant bone tumour; however, it is associated with a high complication rate. Therefore, prosthetic design and approach of prosthetic reconstruction after tumour resection warrant study. We retrospectively analyzed 11 patients with peri-acetabular malignant bone tumours treated by personalized 3D-printed hemipelvic prostheses after en bloc resection between 2015 and 2016. Pre-operative and post-operative pain at rest was assessed according to a 10-cm VAS score. The results of functional improvement were evaluated using the MSTS-93 score at the final follow-up. We also analyzed tumour recurrence, metastases, and complications associated with the reconstruction procedure. All patients were observed for six to 24 months with an average follow-up of 15.5 months. One patient had occasional pain of the involved hip at the final follow-up (VAS, pre vs. post 8 months: 3 vs. 2). The mean MSTS-93 score was 19.2 (range, 13-25). Hip dislocation was detected in two patients, while delayed wound healing occurred in one patient. One patient with mesenchymal chondrosarcoma had a left iliac bone metastasis. Local tumour recurrence was not observed. Reconstruction of bony defect after tumour resection using personalized 3D-printed hemipelvic prostheses can obtain acceptable functional results without severe complications. Based on previous reports and our results, we believe that reconstruction arthroplasty using 3D-printed hemipelvic prostheses will provide a promising alternative for those patients with peri-acetabular malignant bone tumours. Level IV, therapeutic study.

  3. Influence of Ophthalmic Solutions on Tear Components.

    PubMed

    Shigeyasu, Chika; Yamada, Masakazu; Akune, Yoko

    2016-11-01

    Tear fluids are a mixture of secretions derived from lacrimal glands, accessory lacrimal glands, conjunctiva, and meibomian glands. Compositional changes to tears occur in the normal state and during ocular surface disease, such as dry eye conditions. We have investigated compositional changes to tears after topical application of ophthalmic solutions, with regard to tear-specific proteins (secretory immunoglobulin A, lactoferrin, lipocalin-1, and lysozyme) and ocular surface mucin in normal and dry eye conditions using high-performance liquid chromatography. After application of saline solution (0.9% sodium chloride) in normal subjects, transient but significant decreases in all tear components were observed. The recovery of protein concentrations took up to 30 minutes and lasted longer when the saline solution was applied more frequently. When applying ophthalmic solutions, a balance between washout and dilutional effects should be considered in addition to the therapeutic effect. Investigation of the effect of diquafosol solution (3%) in normal subjects revealed a significant increase in sialic acid concentration, a marker of ocular mucin, at 5 minutes after application, whereas a significant decrease was observed with saline. This result indicates the accelerated secretion of mucin from ocular tissues induced by diquafosol. A clinical study to determine the efficacy of diquafosol in patients with dry eye revealed improvements in tear breakup time, keratoconjunctival staining scores, and Schirmer test score, accompanied by an increase in sialic acid concentration in tears. Investigating normal and dry eye conditions through tear analysis may clarify the pathophysiology of dry eye conditions and support the efficacy of treatments.

  4. Formation of Hot Tear Under Controlled Solidification Conditions

    NASA Astrophysics Data System (ADS)

    Subroto, Tungky; Miroux, Alexis; Bouffier, Lionel; Josserond, Charles; Salvo, Luc; Suéry, Michel; Eskin, Dmitry G.; Katgerman, Laurens

    2014-06-01

    Aluminum alloy 7050 is known for its superior mechanical properties, and thus finds its application in aerospace industry. Vertical direct-chill (DC) casting process is typically employed for producing such an alloy. Despite its advantages, AA7050 is considered as a "hard-to-cast" alloy because of its propensity to cold cracking. This type of cracks occurs catastrophically and is difficult to predict. Previous research suggested that such a crack could be initiated by undeveloped hot tears (microscopic hot tear) formed during the DC casting process if they reach a certain critical size. However, validation of such a hypothesis has not been done yet. Therefore, a method to produce a hot tear with a controlled size is needed as part of the verification studies. In the current study, we demonstrate a method that has a potential to control the size of the created hot tear in a small-scale solidification process. We found that by changing two variables, cooling rate and displacement compensation rate, the size of the hot tear during solidification can be modified in a controlled way. An X-ray microtomography characterization technique is utilized to quantify the created hot tear. We suggest that feeding and strain rate during DC casting are more important compared with the exerted force on the sample for the formation of a hot tear. In addition, we show that there are four different domains of hot-tear development in the explored experimental window—compression, microscopic hot tear, macroscopic hot tear, and failure. The samples produced in the current study will be used for subsequent experiments that simulate cold-cracking conditions to confirm the earlier proposed model.

  5. Assessment, prevention and management of skin tears.

    PubMed

    Benbow, Maureen

    2017-04-28

    Skin tears are common in older people. They are acute wounds that are at high risk of becoming complex, chronic wounds due to the interplay between the physiological changes in the skin and trauma from the external environment. Skin tears have been reported to have prevalence rates equal to, or greater than, those for pressure ulcers. A comprehensive risk assessment should include assessment of the individual's general health (chronic/critical disease, polypharmacy and cognitive, sensory and nutritional status); mobility (history of falls, impaired mobility, dependent activities of daily living, and mechanical trauma); and skin (extremes of age, fragile skin and previous skin tears). A recognised classification system should be used to identify and document skin tears and guide treatment decisions in line with local wound management protocols. Nurses and carers are in a prime position to prevent, assess and manage skin tears.

  6. Phospholipid transfer protein is present in human tear fluid.

    PubMed

    Jauhiainen, Matti; Setälä, Niko L; Ehnholm, Christian; Metso, Jari; Tervo, Timo M T; Eriksson, Ove; Holopainen, Juha M

    2005-06-07

    The human tear fluid film consists of a superficial lipid layer, an aqueous middle layer, and a hydrated mucin layer located next to the corneal epithelium. The superficial lipid layer protects the eye from drying and is composed of polar and neutral lipids provided by the meibomian glands. Excess accumulation of lipids in the tear film may lead to drying of the corneal epithelium. In the circulation, phospholipid transfer protein (PLTP) and cholesteryl ester transfer protein (CETP) mediate lipid transfers. To gain insight into the formation of tear film, we investigated whether PLTP and CETP are present in human tear fluid. Tear fluid samples were collected with microcapillaries. The presence of PLTP and CETP was studied in tear fluid by Western blotting, and the PLTP concentration was determined by ELISA. The activities of the enzymes were determined by specific lipid transfer assays. Size-exclusion and heparin-affinity chromatography assessed the molecular form of PLTP. PLTP is present in tear fluid, whereas CETP is not. Quantitative assessment of PLTP by ELISA indicated that the PLTP concentration in tear fluid, 10.9 +/- 2.4 microg/mL, is about 2-fold higher than that in human plasma. PLTP-facilitated phospholipid transfer activity in tears, 15.1 +/- 1.8 micromol mL(-)(1) h(-)(1), was also significantly higher than that measured in plasma. Inactivation of PLTP by heat treatment (+58 degrees C, 60 min) or immunoinhibition abolished the phospholipid transfer activity in tear fluid. Size-exclusion chromatography of tear fluid indicated that PLTP eluted in a position corresponding to a size of 160-170 kDa. Tear fluid PLTP was quantitatively bound to Heparin-Sepharose and could be eluted as a single peak by 0.5 M NaCl. These data indicate that human tear fluid contains catalytically active PLTP protein, which resembles the active form of PLTP present in plasma. The results suggest that PLTP may play a role in the formation of the tear film by supporting phospholipid

  7. Antioxidant content and ultraviolet absorption characteristics of human tears.

    PubMed

    Choy, Camus Kar Man; Cho, Pauline; Benzie, Iris F F

    2011-04-01

    Dry eye syndrome is a common age-related disorder, and decreased antioxidant/ultraviolet (UV) radiation protection in tears may be part of the cause. This study aimed to compare the tear antioxidant content and flow rate in young and older adults. The total antioxidant content and UV absorbing properties of various commercially available ophthalmic solutions used to alleviate dry eye symptoms were also examined. Minimally stimulated tears were collected from 120 healthy Chinese adults with no ocular pathology. Two age groups were studied: 19 to 29 years (n = 58) and 50 to 75 years (n = 62). Tear samples from each subject and 13 ophthalmic solutions were analyzed for total antioxidant content (as the Ferric Reducing/Antioxidant Power value). Tear flow rates were estimated from time taken to collect a fixed volume of tear fluid. UV absorbance spectra of pooled fresh reflex tear fluid and the ophthalmic solutions were determined. Results showed that the antioxidant content of minimally stimulated tears from older subjects (398 ± 160 μmol/l) was not significantly lower than that of younger subjects (348 ± 159 μmol/l; p = 0.0915). However, there was a significant difference in the tear flow rates between the two groups (p < 0.0001), with the younger group having three to four fold higher flow rate. None of the commercial preparations tested had detectable antioxidant content, and none showed the UV absorption characteristics of natural reflex tears. The effect of low flow rate on the dynamic antioxidant supply to the corneal surface indicates that older subjects have poorer overall defense against photooxidative and other oxidative processes. This could predispose older persons to corneal stress and development of dry eye syndrome. The commercially available artificial tears tested lack both the antioxidant content and UV absorbing characteristics of natural tears. Artificial tears formulations that help restore natural antioxidant and UV absorbing properties to the

  8. Does the optimal position of the acetabular fragment should be within the radiological normal range for all developmental dysplasia of the hip? A patient-specific finite element analysis.

    PubMed

    Wang, Xuyi; Peng, Jianping; Li, De; Zhang, Linlin; Wang, Hui; Jiang, Leisheng; Chen, Xiaodong

    2016-10-04

    The success of Bernese periacetabular osteotomy depends significantly on how extent the acetabular fragment can be corrected to its optimal position. This study was undertaken to investigate whether correcting the acetabular fragment into the so-called radiological "normal" range is the best choice for all developmental dysplasia of the hip with different severities of dysplasia from the biomechanical view? If not, is there any correlation between the biomechanically optimal position of the acetabular fragment and the severity of dysplasia? Four finite element models with different severities of dysplasia were developed. The virtual periacetabular osteotomy was performed with the acetabular fragment rotated anterolaterally to incremental center-edge angles; then, the contact area and pressure and von Mises stress in the cartilage were calculated at different correction angles. The optimal position of the acetabular fragment for patients 1, 2, and 3 was when the acetabular fragment rotated 17° laterally (with the lateral center-edge angle of 36° and anterior center-edge angle of 58°; both were slightly larger than the "normal" range), 25° laterally following further 5° anterior rotation (with the lateral center-edge angle of 31° and anterior center-edge angle of 51°; both were within the "normal" range), and 30° laterally following further 10° anterior rotation (with the lateral center-edge angle of 25° and anterior center-edge angle of 40°; both were less than the "normal" range), respectively. The optimal corrective position of the acetabular fragment is severity dependent rather than within the radiological "normal" range for developmental dysplasia of the hip. We prudently proposed that the optimal correction center-edge angle of mild, moderate, and severe developmental dysplasia of the hip is slightly larger than the "normal" range, within the "normal" range, and less than the lower limit of the "normal" range, respectively.

  9. Mechanobiological simulations of peri-acetabular bone ingrowth: a comparative analysis of cell-phenotype specific and phenomenological algorithms.

    PubMed

    Mukherjee, Kaushik; Gupta, Sanjay

    2017-03-01

    Several mechanobiology algorithms have been employed to simulate bone ingrowth around porous coated implants. However, there is a scarcity of quantitative comparison between the efficacies of commonly used mechanoregulatory algorithms. The objectives of this study are: (1) to predict peri-acetabular bone ingrowth using cell-phenotype specific algorithm and to compare these predictions with those obtained using phenomenological algorithm and (2) to investigate the influences of cellular parameters on bone ingrowth. The variation in host bone material property and interfacial micromotion of the implanted pelvis were mapped onto the microscale model of implant-bone interface. An overall variation of 17-88 % in peri-acetabular bone ingrowth was observed. Despite differences in predicted tissue differentiation patterns during the initial period, both the algorithms predicted similar spatial distribution of neo-tissue layer, after attainment of equilibrium. Results indicated that phenomenological algorithm, being computationally faster than the cell-phenotype specific algorithm, might be used to predict peri-prosthetic bone ingrowth. The cell-phenotype specific algorithm, however, was found to be useful in numerically investigating the influence of alterations in cellular activities on bone ingrowth, owing to biologically related factors. Amongst the host of cellular activities, matrix production rate of bone tissue was found to have predominant influence on peri-acetabular bone ingrowth.

  10. Shoulder instability: impact of glenohumeral arthrotomography on treatment.

    PubMed

    el-Khoury, G Y; Kathol, M H; Chandler, J B; Albright, J P

    1986-09-01

    We used arthrotomography to study the glenoid labrum in 114 patients. Sixty-nine of the patients had anatomic instability of the shoulder (including recurrent dislocation and subluxation of the shoulder), and 45 patients had functional instability of the shoulder (denoted by chronic pain, clicking of the joint, and the sensation that an unstable condition exists without the objective signs of it). Labral tears were revealed arthrotomographically in 86% of the patients with anatomic instability, while only 40% of the patients with functional instability had labral abnormalities, and these were primarily of minor severity. Fifty-six patients (44 of whom had anatomic instability; 12, functional instability) required surgery. The surgical findings were correlated with the arthrotomographic findings, and no false-positive results were revealed. However, arthrotomography demonstrated only part of the pathologic condition of two patients. These results confirm that there is a strong correlation between labral pathologic conditions and anatomic instability of the shoulder. Arthrotomographic studies have a great impact on the selection of therapy in cases of both anatomic and functional instability of the shoulder.

  11. Reverse shoulder arthroplasty for massive irreparable rotator cuff tears and cuff tear arthropathy: a systematic review.

    PubMed

    Petrillo, S; Longo, U G; Papalia, R; Denaro, V

    2017-08-01

    To report the outcomes and complications of reverse shoulder arthroplasty (RSA) in massive irreparable rotator cuff tears (MIRCT) and cuff tear arthropathy (CTA). A systematic review of the literature contained in Medline, Cochrane, EMBASE, Google Scholar and Ovid databases was conducted on May 1, 2016, according to PRISMA guidelines. The key words "reverse total shoulder arthroplasty" or "reverse total shoulder prostheses" with "rotator cuff tears"; "failed rotator cuff surgery"; "massive rotator cuff tears"; "irreparable rotator cuff tears"; "cuff tear arthropathy"; "outcomes"; "complications" were matched. All articles reporting outcomes and complications of RSA for the management of MIRCT or CTA were included. The comparison between preoperative and postoperative clinical scores, as well as range of motion (ROM), was performed using the Wilcoxon-Mann-Whitney test. P values lower than 0.05 were considered statistically significant. Seven articles were included in our qualitative synthesis. A statistically significant improvement in all clinical scores and ROM was found comparing the preoperative value with the postoperative value. The degrees of retroversion of the humeral stem of the RSA do not influence the functional outcomes in a statistically significant fashion. There were 17.4% of complications. The most frequent was heterotopic ossification, occurring in 6.6% of patients. Revision surgery was necessary in 7.3% of patients. RSA restores pain-free ROM and improves function of the shoulder in patients with MIRCT or CTA. However, complications occur in a high percentage of patients. The lack of level I studies limits the real understanding of the potentials and limitations of RSA for the management of MIRCT and CTA.

  12. Human tears reveal insights into corneal neovascularization.

    PubMed

    Zakaria, Nadia; Van Grasdorff, Sigi; Wouters, Kristien; Rozema, Jos; Koppen, Carina; Lion, Eva; Cools, Nathalie; Berneman, Zwi; Tassignon, Marie-José

    2012-01-01

    Corneal neovascularization results from the encroachment of blood vessels from the surrounding conjunctiva onto the normally avascular cornea. The aim of this study is to identify factors in human tears that are involved in development and/or maintenance of corneal neovascularization in humans. This could allow development of diagnostic tools for monitoring corneal neovascularization and combination monoclonal antibody therapies for its treatment. In an observational case-control study we enrolled a total of 12 patients with corneal neovascularization and 10 healthy volunteers. Basal tears along with reflex tears from the inferior fornix, superior fornix and using a corneal bath were collected along with blood serum samples. From all patients, ocular surface photographs were taken. Concentrations of the pro-angiogenic cytokines interleukin (IL)-6, IL-8, Vascular Endothelial Growth Factor (VEGF), Monocyte Chemoattractant Protein 1 (MCP-1) and Fas Ligand (FasL) were determined in blood and tear samples using a flow cytometric multiplex assay. Our results show that the concentration of pro-angiogenic cytokines in human tears are significantly higher compared to their concentrations in serum, with highest levels found in basal tears. Interestingly, we could detect a significantly higher concentration of IL- 6, IL-8 and VEGF in localized corneal tears of patients with neovascularized corneas when compared to the control group. This is the first study of its kind demonstrating a significant difference of defined factors in tears from patients with neovascularized corneas as compared to healthy controls. These results provide the basis for future research using animal models to further substantiate the role of these cytokines in the establishment and maintenance of corneal neovascularization.

  13. Human Tears Reveal Insights into Corneal Neovascularization

    PubMed Central

    Wouters, Kristien; Rozema, Jos; Koppen, Carina; Lion, Eva; Cools, Nathalie; Berneman, Zwi; Tassignon, Marie-José

    2012-01-01

    Corneal neovascularization results from the encroachment of blood vessels from the surrounding conjunctiva onto the normally avascular cornea. The aim of this study is to identify factors in human tears that are involved in development and/or maintenance of corneal neovascularization in humans. This could allow development of diagnostic tools for monitoring corneal neovascularization and combination monoclonal antibody therapies for its treatment. In an observational case-control study we enrolled a total of 12 patients with corneal neovascularization and 10 healthy volunteers. Basal tears along with reflex tears from the inferior fornix, superior fornix and using a corneal bath were collected along with blood serum samples. From all patients, ocular surface photographs were taken. Concentrations of the pro-angiogenic cytokines interleukin (IL)-6, IL-8, Vascular Endothelial Growth Factor (VEGF), Monocyte Chemoattractant Protein 1 (MCP-1) and Fas Ligand (FasL) were determined in blood and tear samples using a flow cytometric multiplex assay. Our results show that the concentration of pro-angiogenic cytokines in human tears are significantly higher compared to their concentrations in serum, with highest levels found in basal tears. Interestingly, we could detect a significantly higher concentration of IL- 6, IL-8 and VEGF in localized corneal tears of patients with neovascularized corneas when compared to the control group. This is the first study of its kind demonstrating a significant difference of defined factors in tears from patients with neovascularized corneas as compared to healthy controls. These results provide the basis for future research using animal models to further substantiate the role of these cytokines in the establishment and maintenance of corneal neovascularization. PMID:22590547

  14. How Reliable is the Acetabular Cup Position Assessment from Routine Radiographs?

    PubMed Central

    Carvajal Alba, Jaime A.; Vincent, Heather K.; Sodhi, Jagdeep S.; Latta, Loren L.; Parvataneni, Hari K.

    2017-01-01

    Abstract Background: Cup position is crucial for optimal outcomes in total hip arthroplasty. Radiographic assessment of component position is routinely performed in the early postoperative period. Aims: The aims of this study were to determine in a controlled environment if routine radiographic methods accurately and reliably assess the acetabular cup position and to assess if there is a statistical difference related to the rater’s level of training. Methods: A pelvic model was mounted in a spatial frame. An acetabular cup was fixed in different degrees of version and inclination. Standardized radiographs were obtained. Ten observers including five fellowship-trained orthopaedic surgeons and five orthopaedic residents performed a blind assessment of cup position. Inclination was assessed from anteroposterior radiographs of the pelvis and version from cross-table lateral radiographs of the hip. Results: The radiographic methods used showed to be imprecise specially when the cup was positioned at the extremes of version and inclination. An excellent inter-observer reliability (Intra-class coefficient > 0,9) was evidenced. There were no differences related to the level of training of the raters. Conclusions: These widely used radiographic methods should be interpreted cautiously and computed tomography should be utilized in cases when further intervention is contemplated. PMID:28852355

  15. Rotator cuff tear and sarcopenia: are these related?

    PubMed

    Chung, Seok Won; Yoon, Jong Pil; Oh, Kyung-Soo; Kim, Hyung Sup; Kim, Young Gun; Lee, Hyun-Joo; Jeong, Won-Ju; Kim, Dong-Hyun; Lee, Jong Soo; Yoon, Jee Wook

    2016-09-01

    Sarcopenia is the loss of muscle mass and consequent loss of muscle function with aging. Its prevalence among the general population is 12% to 30% in those aged >60 years. We evaluated (1) the difference in the prevalence of sarcopenia between patients with rotator cuff tear and controls and (2) the sarcopenia severity according to the size of the rotator cuff tear. Group 1 included 48 consecutive patients with chronic symptomatic full-thickness rotator cuff tears (mean age, 60.1 ± 6.5 years; range, 46-76 years), and group 2 included 48 age- and sex-matched patients. The sarcopenic index was evaluated by using the grip strength of the asymptomatic contralateral side and the skeletal muscle mass. No significant differences were found in the baseline data and demographic factors between the groups. The sarcopenic index was significantly inferior in the rotator cuff tear group than in the age- and sex-matched control groups (P = .041, .007, and .05, respectively). Patients with large to massive tears had a significantly inferior sarcopenic index than those with small and medium tears. The results showed that sarcopenia was more severe in patients with a chronic symptomatic full-thickness rotator cuff tear than in the age- and sex-matched control population and was correlated with the size of the tear, with the numbers available. Despite the individual variance in the underlying medical condition and physical activities, this study suggests that clinicians should consider the sarcopenic condition of patients with a rotator cuff tear, especially in elderly patients with large to massive tears. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  16. The efficacy, sensitivity, and specificity of strip meniscometry in conjunction with tear function tests in the assessment of tear meniscus.

    PubMed

    Ibrahim, Osama M A; Dogru, Murat; Ward, Samantha K; Matsumoto, Yukihiro; Wakamatsu, Tais Hitomi; Ishida, Katsushi; Tsuyama, Atsushi; Kojima, Takashi; Shimazaki, Jun; Tsubota, Kazuo

    2011-04-06

    To evaluate the specificity and sensitivity of strip meniscometry (SM) testing in conjunction with tear function tests in the diagnosis of dry eye (DE) disease and to investigate the effect of SM on reflex tearing. One hundred seven left eyes of 107 patients with definite DE disease according to the Japanese DE diagnostic criteria and 68 left eyes of 68 age- and sex-matched control subjects were studied. Tear meniscus height (TMH) measurements, fluorescein tear film break-up time (FTBUT), fluorescein (F) and rose bengal (RB) staining, and Schirmer's test-1 (ST) were also performed. The assessment of reflex tearing before and after SM application was assessed with a graticule scale at the slit lamp and by optical coherence tomography. The sensitivity and specificity of SM alone and in combination with tear function tests were also sought. The SM scores, TMH measurements, FTBUTs, and STs were significantly lower in dry eye patients than in the controls (P < 0.001). The RB and F staining scores were significantly higher in the dry eye group than in the control group (P < 0.001). The meniscometry strips did not induce significant changes in relation to reflex tearing. SM had an acceptable sensitivity and specificity. SM is a swift, noninvasive, promising method of assessing tear meniscus volume. The combined SM and FTBUT examination appears to be a sensitive approach to the assessment of dry eye disease.

  17. [Charnley-type total hip prosthesis. Radiological technic of angular measurements of the acetabular piece (anteversion)].

    PubMed

    Chevrot, A; Najman, G

    1983-01-01

    A radiological technique is described based on the study of antero-posterior and lateral views of the hip. Mathematical calculations by trigonometry make it possible to deduce the degree of anteversion of the acetabular cup. The necessary tables are given.

  18. [Stress analysis on the acetabular side of bipolar hemiarthroplasty by the two-dimensional finite element method incorporating the boundary friction layer].

    PubMed

    Ichihashi, K; Imura, S; Oomori, H; Gesso, H

    1994-11-01

    We compared the biomechanical characteristics of bipolar and unipolar hemiarthroplasty on the proximal migration of the outer head by determining the von Mises stress distribution and acetabular (outer head) displacement with clinical assessment of hemiarthroplasty in 75 patients. This analysis used the two-dimensional finite element method, which incorporated boundary friction layers on both the inner and outer bearings of the prosthesis. Acetabular reaming increased stress within the pelvic bone and migration of the outer head. A combination of the acetabular reaming and bone transplantation increased the stress within the pelvic bone and grafted bone, and caused outer head migration. These findings were supported by clinical results. Although the bipolar endoprosthesis was biomechanically superior to the unipolar endoprosthesis, migration of the outer head still occurred. The bipolar endoprosthesis appeared to be indicated in cases of a femoral neck fracture or of avascular necrosis in the femoral head, but its use in cases of osteoarthritis in the hip required caution.

  19. Polyimide Film of Increased Tear Strength

    NASA Technical Reports Server (NTRS)

    St. Clair, A. K.; Hinkley, J. A.; Ezzell, S. A.

    1986-01-01

    High-temperature linear aromatic polyimide with improved resistance to tearing made by new process that incorporates elastomer into polyimide. Linear aromatic condensation polyimides are materials of prime choice for use as films and coatings on advanced spacecraft and aircraft where durability at temperatures in range of 200 to 300 degree C required. Elastomer-containing polyimide film with improved toughness proves useful for applications where resistance to tearing and long-term thermal stability necessary. Desired resistance to tearing achieved by careful control of amount and chemical composition of added elastomer.

  20. Age-related changes in the signal value of tears.

    PubMed

    Zeifman, Debra M; Brown, Sarah A

    2011-08-12

    Emotional tears may be uniquely human and are an effective signal of distress in adults. The present study explored whether tears signal distress in younger criers and whether the effect of tears on observers is similar in magnitude across the life span. Participants rated photographs of crying infants, young children, and adults, with tears digitally removed or added. The effectiveness of tears in conveying sadness and eliciting sympathy was greatest for images of adults, intermediate for images of children, and least potent for images of infants. These findings suggest that the signal value of tears varies with the age of the crier. The results may shed light on the functional significance of crying at different stages of human development.

  1. Neurostimulation of the Lacrimal Nerve for Enhanced Tear Production

    PubMed Central

    Kossler, Andrea L.; Wang, Jianhua; Feuer, William; Tse, David T.

    2014-01-01

    Purpose To design a proof-of-concept study to assess the effect of lacrimal nerve stimulation (LNS) with an implantable pulse generator (IPG) to increase aqueous tear production. Methods Experimental animal study design of six Dutch Belted rabbits. Ultra high-resolution optical coherence tomography (UHR-OCT) quantified tear production by measuring the baseline tear volume of each rabbit’s right and left eye. A neurostimulator was implanted adjacent to the right lacrimal nerve. After two minutes of LNS (100 μs, 1.6 mAmp, 20 Hz, 5–8 volts), the tear volumes were measured with UHR-OCT. The change in tear volume was quantified and compared to the non-stimulated left eye. Three rabbits underwent chronic LNS (100 μS, 1.6 mAmp, 10 Hz, 2 volts) and their lacrimal glands were harvested for histopathologic analysis. Results UHR-OCT imaging of the right eyes tear volume showed a 441% average increase in tear production after LNS as a percent of baseline. After stimulation, right eyes had statistically significant greater increase in tear volumes than left eyes (p=0.028, Wilcoxon test). Post-stimulation right eye tear volumes were significantly greater compared to baseline (p=0.028, Wilcoxon test). Histopathologic examination of the lacrimal glands showed no discernible tissue damage from chronic neurostimulation. Additionally, there were no gross adverse effects on the general well-beings of the animals due to chronic stimulation. Conclusions Lacrimal nerve stimulation with an implantable pulse generator appears to increase aqueous tear production. Chronic LNS showed no histopathologic lacrimal gland damage. This study suggests LNS is a promising new treatment strategy to increase aqueous tear production. PMID:25126767

  2. Duplex Tear Film Evaporation Analysis.

    PubMed

    Stapf, M R; Braun, R J; King-Smith, P E

    2017-12-01

    Tear film thinning, hyperosmolarity, and breakup can cause irritation and damage to the human eye, and these form an area of active investigation for dry eye syndrome research. Recent research demonstrates that deficiencies in the lipid layer may cause locally increased evaporation, inducing conditions for breakup. In this paper, we explore the conditions for tear film breakup by considering a model for tear film dynamics with two mobile fluid layers, the aqueous and lipid layers. In addition, we include the effects of osmosis, evaporation as modified by the lipid, and the polar portion of the lipid layer. We solve the system numerically for reasonable parameter values and initial conditions and analyze how shifts in these cause changes to the system's dynamics.

  3. 21 CFR 888.3330 - Hip joint metal/metal semi-constrained, with an uncemented acetabular component, prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... component is intended to be fixed with bone cement. The acetabular component is intended for use without bone cement (§ 888.3027). (b) Classification. Class III. (c) Date PMA or notice of completion of a PDP...

  4. 21 CFR 888.3330 - Hip joint metal/metal semi-constrained, with an uncemented acetabular component, prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... component is intended to be fixed with bone cement. The acetabular component is intended for use without bone cement (§ 888.3027). (b) Classification. Class III. (c) Date PMA or notice of completion of a PDP...

  5. 21 CFR 888.3330 - Hip joint metal/metal semi-constrained, with an uncemented acetabular component, prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... component is intended to be fixed with bone cement. The acetabular component is intended for use without bone cement (§ 888.3027). (b) Classification. Class III. (c) Date PMA or notice of completion of a PDP...

  6. 21 CFR 888.3330 - Hip joint metal/metal semi-constrained, with an uncemented acetabular component, prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... component is intended to be fixed with bone cement. The acetabular component is intended for use without bone cement (§ 888.3027). (b) Classification. Class III. (c) Date PMA or notice of completion of a PDP...

  7. 21 CFR 888.3330 - Hip joint metal/metal semi-constrained, with an uncemented acetabular component, prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... component is intended to be fixed with bone cement. The acetabular component is intended for use without bone cement (§ 888.3027). (b) Classification. Class III. (c) Date PMA or notice of completion of a PDP...

  8. Sphincter tears in primiparous women: Is age a factor?

    PubMed Central

    BOWLING, C. Bryce; WHEELER, Thomas L.; GERTEN, Kimberly A.; CHAPMAN, Victoria R.; BURGIO, Kathryn L.; RICHTER, Holly E.

    2011-01-01

    Introduction and Hypothesis Anal sphincter tears during vaginal delivery may result in serious sequelae. We examined whether younger primiparous patients were at increased risk for sphincter tears during vaginal delivery. Methods Data from an obstetric automated record were analyzed. Primiparous women delivering term infants (n = 5,937) were included to test for an association between age and sphincter tear rates. Three age groups were considered: young adolescents (≤16 years), older adolescents (17-20 years) and adults (≥21 years). Results No significant difference was found in tear rates among age cohorts (9.2%, 8.0%, and 9.6% respectively; p = 0.12). Logistic regression modeling revealed that young adolescents were not more likely to have sphincter tears compared to older cohorts. Conclusions Younger adolescents may not be at increased risk of anal sphincter tears. Decisions regarding interventions to decrease sphincter tears during vaginal delivery should not be made on the basis of maternal age alone. PMID:18985267

  9. Magnetic Resonance Imaging Currently Fails to Fully Evaluate the Biceps-Labrum Complex and Bicipital Tunnel.

    PubMed

    Taylor, Samuel A; Newman, Ashley M; Nguyen, Joseph; Fabricant, Peter D; Baret, Nikolas J; Shorey, Mary; Ramkumar, Prem; O'Brien, Stephen J

    2016-02-01

    To determine the diagnostic accuracy of magnetic resonance imaging (MRI) for biceps-labrum complex (BLC) lesions, including the extra-articular bicipital tunnel. A retrospective review of 277 shoulders with chronic refractory BLC symptoms that underwent arthroscopic subdeltoid transfer of the long head of the biceps tendon (LHBT) to the conjoint tendon was conducted. Intraoperative lesions were categorized as "inside" (labral tears and dynamic LHBT incarceration), "junctional" (LHBT partial tears, LHBT subluxation, and biceps chondromalacia), or "bicipital tunnel" (extra-articular bicipital tunnel scar/stenosis, loose bodies, LHBT instability, and LHBT partial tears) based on anatomic location. Attending radiologist-generated MRI reports were graded dichotomously as positive or negative for biceps and labral damage and then compared with intraoperative findings. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for MRI with respect to intraoperative findings. With regard to inside lesions, MRI had an overall sensitivity, specificity, PPV, and NPV for labrum lesions of 77.3%, 68.2%, 57.3%, and 84.5% respectively. The sensitivity, specificity, PPV, and NPV of MRI for junctional lesions were 43.3%, 55.6%, 73.1%, and 26.0%, respectively. For the bicipital tunnel, MRI had a sensitivity, specificity, PPV, and NPV of 50.4%, 61.4%, 48.7%, and 63.0%, respectively. MRI was unreliable for ruling out BLC lesions among chronically symptomatic patients, including when the bicipital tunnel was affected. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  10. Diet, nutraceuticals and the tear film.

    PubMed

    Jalbert, Isabelle

    2013-12-01

    Nutrition disorders and their correlates such as obesity are increasingly prevalent worldwide. A number of studies to date have suggested numerous potential associations between diet and tear film health; this paper will provide a summary of the available literature. The tear film is characterized through its protein and lipid content and through clinical measurements of characteristics such as osmolarity, volume and stability. Malnutrition, protein and vitamin-A deficiencies are extremely deleterious to tear film health and supplementation with oral vitamin A in this setting is of clear benefit. The relative impact of diet on tear film within what would be considered normal ranges of consumption is less clear. A number of population studies have suggested that hyperlipidemia and a diet low in omega-3 fatty acids are risks factor for dry eye disease. Numerous studies have investigated the effectiveness of oral supplementation with antioxidants, omega-3 (e.g. fish oil and linseed oil) and omega-6 (e.g. evening primrose oil) fatty acids in the last 10 years. Taken together, these suggest a small benefit of oral supplementation on tear film volume, stability and decreased ocular symptoms in patients previously diagnosed with diseases involving the ocular surface (e.g. Sjögren's syndrome, meibomian gland dysfunction, dry eye disease) and contact lens wearers suffering from dry eye. More research is required to determine the exact composition, dosage and indications for their use and to fully characterize how these nutraceuticals modulate the tear film. Copyright © 2013 Elsevier Ltd. All rights reserved.

  11. Effectiveness of Combined Tear Film Therapy in Patients with Evaporative Dry Eye with Short Tear Film Breakup Time.

    PubMed

    Kim, Yung Hui; Kang, Yeon Soo; Lee, Hyo Seok; Choi, Won; You, In Cheon; Yoon, Kyung Chul

    2017-10-01

    The aim of this study was to evaluate the effectiveness of combined tear film therapy targeted to aqueous, mucin, and lipid layers in patients with refractory evaporative dry eye (EDE) with short tear film breakup time (TBUT). The patients who had EDE with short TBUT and severe symptoms refractory to artificial tears were treated with hyaluronic acid (HA) 0.15% and diquafosol tetrasodium (DQS) 3% (Group 1), HA and carbomer-based lipid-containing eyedrops (Liposic EDO Gel, LPO) (Group 2), or HA, DQS, and LPO (Group 3). Ocular Surface Disease Index (OSDI) score, visual analog scale (VAS) symptom score, TBUT, Schirmer score, and corneal and conjunctival staining scores were evaluated, and noninvasive tear film breakup time (NIBUT) and tear meniscus height were measured using Keratograph ® 5 M before and 1 and 3 months after treatment. OSDI scores, VAS scores, TBUT, and NIBUT were improved at 1 and 3 months after treatment in all groups (all P < 0.05). At each follow-up visit, the total OSDI, OSDI symptom, and all VAS scores were significantly lower in group 3 compared with groups 1 and 2 (all P < 0.05). In addition, TBUT and NIBUT were significantly higher in group 3 compared with groups 1 and 2 (all P < 0.05). No significant adverse effects were noted in the groups during treatment. Mucin or lipid-targeting agents combined with aqueous supplements in patients with refractory EDE with short TBUT might improve subjective symptoms and TBUT. Of this, targeting whole tear film layers was most effective in improving ocular symptoms and tear film quality.

  12. The epidemiology and injury patterns of acetabular fractures: are the USA and China comparable?

    PubMed

    Mauffrey, Cyril; Hao, Jiandong; Cuellar, Derly O; Herbert, Benoit; Chen, Xiao; Liu, Bo; Zhang, Yingze; Smith, Wade

    2014-11-01

    Acetabular fractures are rare injuries in heterogeneous patient groups, making it difficult to develop adequately powered prospective single-center clinical trials in the USA or Europe. Chinese trauma centers treat a high volume of these injuries, and if the patient population and injury patterns are comparable to those in the USA, this might support development of multicenter studies in Level I trauma centers in the two countries. We determined whether the following parameters were similar between operative acetabular fractures treated at Chinese and US trauma centers: (1) epidemiology of injured patients, (2) mechanism of injuries and fracture types, and (3) hospital stay parameters, including symptomatic postoperative deep vein thrombosis (DVT) rate. We extracted data from trauma databases for patients admitted with acetabular fractures managed surgically from 2005 to 2012 for one Chinese center and from 2008 to 2012 for one US center. Sex, age, mechanism of injury, fracture classification, Injury Severity Score (ISS), time from injury to surgery, length of hospital stay, and symptomatic DVT rate were analyzed. We included 661 Chinese patients (539 men, 122 women) and 212 US patients (163 men, 49 women). Mean age at time of injury was different between China and the USA, at 40 years with a unimodal distribution and 44 years with a bimodal distribution (p<0.001), respectively. Incidence of surgically treated acetabular fractures has been increasing in China but decreasing in the USA. Mean ISSs were comparable. Although the distribution of mechanisms of injury was different (p=0.004), high-energy injuries (motor vehicle accidents, falls>10 feet) still accounted for most fractures in both centers. Fracture classifications (per Letournel) were comparable, with posterior wall fractures most common. Mean time from injury to surgery and mean hospital stay were longer in China than in the USA (9 versus 3 days [p<0.001] and 26 versus 11 days [p<0.001], respectively

  13. Comparison of Medial and Lateral Meniscus Root Tears.

    PubMed

    Koo, Ji Hyun; Choi, Sang-Hee; Lee, Seung Ah; Wang, Joon Ho

    2015-01-01

    The meniscus root plays an essential role in maintaining the circumferential hoop tension and preventing meniscal displacement. Studies on meniscus root tears have investigated the relationship of osteoarthritis and an anterior cruciate ligament tear. However, few studies have directly compared the medial and lateral root tears. To assess the prevalence of meniscal extrusion and its relationship with clinical features in medial and lateral meniscus root tears, we performed a retrospective review of the magnetic resonance imaging (MRI) results of 42 knee patients who had meniscus posterior horn root tears and who had undergone arthroscopic operations. The presence of meniscal extrusion was evaluated and the exact extent was measured from the tibial margin. The results were correlated with arthroscopic findings. Clinical features including patients' ages, joint abnormalities, and previous trauma histories were evaluated. Twenty-two patients had medial meniscus root tears (MMRTs) and twenty patients had lateral meniscus root tears (LMRTs). Meniscal extrusion was present in 18 MMRT patients and one LMRT patient. The mean extent of extrusion was 4.2mm (range, 0.6 to 7.8) in the MMRT group and 0.9mm (range, -1.9 to 3.4) in the LMRT group. Five patients with MMRT had a history of trauma, while 19 patients with LMRT had a history of trauma. Three patients with MMRT had anterior cruciate ligament (ACL) tears, while 19 patients with LMRT had ACL tears. The mean age of the patients was 52 years (range: 29-71 years) and 30 years (range: 14-62 years) in the MMRT and LMRT group, respectively. There was a significant correlation between a MMRT and meniscal extrusion (p<0.0001), and between an ACL tear and LMRT (p<0.0001). A history of trauma was significantly common in LMRT (p<0.0001). LMRT patients were significantly younger than MMRT patients (p<0.0001). Kellgren-Lawrence (K-L) grade differed significantly between MMRT and LMRT group (p<0.0001). Meniscal extrusion is common in

  14. Comparison of Medial and Lateral Meniscus Root Tears

    PubMed Central

    Koo, Ji Hyun; Choi, Sang-Hee; Lee, Seung Ah; Wang, Joon Ho

    2015-01-01

    The meniscus root plays an essential role in maintaining the circumferential hoop tension and preventing meniscal displacement. Studies on meniscus root tears have investigated the relationship of osteoarthritis and an anterior cruciate ligament tear. However, few studies have directly compared the medial and lateral root tears. To assess the prevalence of meniscal extrusion and its relationship with clinical features in medial and lateral meniscus root tears, we performed a retrospective review of the magnetic resonance imaging (MRI) results of 42 knee patients who had meniscus posterior horn root tears and who had undergone arthroscopic operations. The presence of meniscal extrusion was evaluated and the exact extent was measured from the tibial margin. The results were correlated with arthroscopic findings. Clinical features including patients’ ages, joint abnormalities, and previous trauma histories were evaluated. Twenty-two patients had medial meniscus root tears (MMRTs) and twenty patients had lateral meniscus root tears (LMRTs). Meniscal extrusion was present in 18 MMRT patients and one LMRT patient. The mean extent of extrusion was 4.2mm (range, 0.6 to 7.8) in the MMRT group and 0.9mm (range, -1.9 to 3.4) in the LMRT group. Five patients with MMRT had a history of trauma, while 19 patients with LMRT had a history of trauma. Three patients with MMRT had anterior cruciate ligament (ACL) tears, while 19 patients with LMRT had ACL tears. The mean age of the patients was 52 years (range: 29–71 years) and 30 years (range: 14–62 years) in the MMRT and LMRT group, respectively. There was a significant correlation between a MMRT and meniscal extrusion (p<0.0001), and between an ACL tear and LMRT (p<0.0001). A history of trauma was significantly common in LMRT (p<0.0001). LMRT patients were significantly younger than MMRT patients (p<0.0001). Kellgren-Lawrence (K-L) grade differed significantly between MMRT and LMRT group (p<0.0001). Meniscal extrusion is

  15. Effects of tear film dynamics on quality of vision.

    PubMed

    Koh, Shizuka; Tung, Cynthia I; Inoue, Yasushi; Jhanji, Vishal

    2018-06-15

    The precorneal tear film is maintained by blinking and exhibits different phases in the tear cycle. The tear film serves as the most anterior surface of the eye and plays an important role as a first refractive component of the eye. Alterations in tear film dynamics may cause both vision-related and ocular surface-related symptoms. Although the optical quality associated with the tear film dynamics previously received little attention, objective measurements of optical quality using wavefront sensors have enabled us to quantify optical aberrations induced by the tear film. This has provided an objective method for assessing reduced optical quality in dry eye; thus, visual disturbances were included in the definition of dry eye disease in the 2007 Dry Eye Workshop report. In addition, sequential measurements of wavefront aberrations have provided us with valuable insights into the dynamic optical changes associated with tear film dynamics. This review will focus on the current knowledge of the mechanisms of wavefront variations that are caused by different aspects of tear film dynamics: specifically, quality, quantity and properties of the tear film, demonstrating the respective effects of dry eye, epiphora and instillation of eye drops on the quality of vision. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  16. Lipid peroxidation is increased in tears from the elderly.

    PubMed

    Benlloch-Navarro, Soledad; Franco, Ilenia; Sánchez-Vallejo, Violeta; Silvestre, Dolores; Romero, Francisco Javier; Miranda, María

    2013-10-01

    We describe a procedure in which tears, obtained from Schirmer strips, are used to measure a marker of lipid peroxidation, malondialdehyde (MDA). We also compared the levels of proteins and MDA in tears from two groups of people: young adults (18-30 years old) and elderly adults (65-85 years old), because the data related to total protein concentration of human tears vary widely and because the majority of people over the age of 65 experience some symptoms of dry eyes and this condition has been recognized as an oxidative stress-induced disease. Our results show a significant difference in the protein concentration of the tears taken from the two age categories, younger adults (18-30 years old) and older adults (65-85 years old). Herein, we report for the first time an increase in MDA concentrations determined by HPLC in human tears based on age. It is possible that alterations in the tear lipid layer may lead to an increase in lipid peroxidation. Further studies are needed to understand the nature and function of tear film and stability in order to obtain new methods to analyze tears in patients with different diseases. In this sense, it would be interesting to compare MDA concentration in tears from control subjects and from people with meibomian gland dysfunction. Copyright © 2013 Elsevier Ltd. All rights reserved.

  17. Survivorship of the native hip joint after percutaneous repair of acetabular fractures in the elderly.

    PubMed

    Gary, Joshua L; Lefaivre, Kelly A; Gerold, Frank; Hay, Michael T; Reinert, Charles M; Starr, Adam J

    2011-10-01

    Our purpose was to examine survivorship of the native hip joint in patients ages 60 and over who underwent percutaneous reduction and fixation of acetabular fractures. A retrospective review at a University Level I Trauma Center was performed. Our institutional trauma database was reviewed. Patients aged 60 or older treated with percutaneous reduction and fixation of acetabular fractures between 1994 and 2007 were selected. 79 consecutive patients with 80 fractures were identified. Rate of conversion to total hip arthroplasty were used to construct a Kaplan-Meier curve showing survivorship of the native hip joint after treatment. 75 fractures had adequate clinical follow-up with a mean of 3.9 years (range 0.5-11.9 years). Average blood loss was 69 cc and there were no postoperative infections. 19/75 (25%) were converted to total hip arthroplasty at a mean time of 1.4 years after the index procedure. Survivorship analysis demonstrated a cumulative survival of 65% at 11.9 years of follow-up. There were no conversions to arthroplasty beyond 4.7 years postoperatively. There were no statistically significant associations between conversion to arthroplasty and age, sex, closed vs. limited open reduction, and simple vs. complex fracture pattern. Percutaneous fixation is a viable treatment option for patients age 60 or greater with acetabular fractures. Rates of conversion to total hip arthroplasty are comparable to open treatment methods and if conversion is required, soft tissues are preserved for future surgery. Copyright © 2010 Elsevier Ltd. All rights reserved.

  18. [Acetabular anteversion angle of the hip in the Mexican adult population measured with computed tomography].

    PubMed

    Rubalcava, J; Gómez-García, F; Ríos-Reina, J L

    2012-01-01

    Knowledge of the radiogrametric characteristics of a specific skeletal segment in a healthy population is of the utmost clinical importance. The main justification for this study is that there is no published description of the radiogrametric parameter of acetabular anteversion in a healthy Mexican adult population. A prospective, descriptive and cross-sectional study was conducted. Individuals of both genders older than 18 years and orthopedically healthy were included. They underwent a two-dimensional axial tomographic study of both hips to measure the acetabular anteversion angles. The statistical analysis consisted of obtaining central trend and scatter measurements. A multivariate analysis of variance (ANOVA) and statistical significance were performed. 118 individuals were studied, 60 males and 58 females, with a mean age of 47.7 +/- 16.7, and a range of 18-85 years. The anteversion of the entire group was 18.6 degrees + 4.1 degrees. Anteversion in males was 17.3 degrees +/- 3.5 degrees (10 degrees - 25 degrees) and in females 19.8 degrees +/- 4.7 degrees (10 degrees - 31 degrees). There were no statistically significant differences (p < or = 0.05) in right and left anteversion in the entire group. However, there were statistically significant differences (p > or = 0.005) both in the right and left sides when males and females were compared. Our study showed that there are great variations in the anteversion ranges of a healthy population. When our results are compared with those published by other authors the mean of most measurements exceeds 15 degrees. This should be useful to make therapeutic decisions that involve acetabular anteversion.

  19. Relationship of ABO Blood Type on Rotator Cuff Tears.

    PubMed

    Lee, Doo-Hyung; Lee, Han-Dong; Yoon, Seung-Hyun

    2015-11-01

    ABO blood groups are associated with various diseases. A relationship between Achilles tendon ruptures and blood type O has been reported, although its pathogenesis was not clear. To the best of our knowledge, there is no published study describing the relationship between blood type and rotator cuff tendon tears. To determine whether patients with rotator cuff tear had a greater prevalence of blood type O than those without rotator cuff tear. A cross-sectional study. Research hospital outpatient evaluation. A total of 316 subjects with shoulder pain were included and divided into "tear" and "no-tear" groups according to ultrasonographic examination. ABO blood group, gender, dominant arm, smoking history, trauma history, and age were compared between the 2 groups and the odds ratios of these factors were evaluated by logistic regression. The tear group (38.6%) had more instances of blood type O than the healthy population (27.2%; P = .002). The adjusted odds ratio for rotator cuff tear for blood type O to non-O was 2.38 (95% confidence interval 1.28-4.42). The odds ratios for rotator cuff tears for smoking, major trauma history, minor trauma history, and age were 2.08, 3.11, 2.29, and 1.06, respectively. Patients with rotator cuff tears were more likely to have blood type O. The odds ratios of factors for rotator cuff tears were high in the following order: major trauma history, blood type O, minor trauma history, and age. Copyright © 2015 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  20. Allergy and allergic mediators in tears.

    PubMed

    Leonardi, Andrea

    2013-12-01

    The identification of inflammatory mediators in the tear fluid have been extensively used in ocular allergy to find either a 'disease marker', to better understand the immune mechanisms involved in the ocular surface inflammation, or to identify potential targets for therapeutic interventions. While the clinical characteristics allow a relatively convincing diagnosis of ocular allergic diseases, in the initial, non active phases, or in the chronic stages, the diagnosis may not be clear. Although not highly specific, total tear IgE can be measured with local tests by inserting a paper strip in the lower meniscus. The measurement of tear specific inflammatory markers, such as histamine, tryptase, ECP, IL-4, IL-5 and eotaxin, may be useful for the diagnosis or monitoring ocular allergy. New technologies such as multiplex bead assays, membrane-bound antibody array and proteomic techniques can characterize the distribution of a wide range of bioactive trace proteins in tears. Dozens of mediators, cytokines, chemokines, growth factors, angiogenic modulators, enzymes and inhibitors were thus identified in small tear samples using these techniques, providing the possible identification of specific biomarker for either specific disease or disease activity. However, to date, there is no a single specific laboratory test suitable for the diagnosis and monitoring of allergic conjunctivitis. Copyright © 2013 Elsevier Ltd. All rights reserved.

  1. Effect of Ambient Temperature on the Human Tear Film.

    PubMed

    Abusharha, Ali A; Pearce, E Ian; Fagehi, Raied

    2016-09-01

    During everyday life, the tear film is exposed to a wide range of ambient temperatures. This study aims to investigate the effect of ambient temperature on tear film physiology. A controlled environment chamber was used to create different ambient temperatures (5, 10, 15, 20, and 25°C) at a constant relative humidity of 40%. Subjects attended for two separate visits and were exposed to 25, 20, and 15°C at one visit and to 10 and 5°C at the other visit. The subjects were exposed to each room temperature for 10 min before investigating tear film parameters. The order of the visits was random. Tear physiology parameters assessed were tear evaporation rate, noninvasive tear break-up time (NITBUT), lipid layer thickness (LLT), and ocular surface temperature (OST). Each parameter was assessed under each condition. A threefold increase in tear evaporation rate was observed as ambient temperature increased to 25°C (P=0.00). The mean evaporation rate increased from 0.056 μL/min at 5°C to 0.17 μL/min at 25°C. The mean NITBUT increased from 7.31 sec at 5°C to 12.35 sec at 25°C (P=0.01). A significant change in LLT was also observed (P=0.00), LLT median ranged between 20 and 40 nm at 5 and 10°C and increased to 40 and 90 nm at 15, 20, and 25°C. Mean reduction of 4°C OST was observed as ambient temperature decreased from 25 to 5°C. Ambient temperature has a considerable effect on human tear film characteristics. Tear evaporation rate, tear LLT, tear stability, and OST were considerably affected by ambient temperature. Chronic exposure to low ambient temperature would likely result in symptoms of dry eye and ultimately ocular surface disorders.

  2. Measuring acetabular component position on lateral radiographs - ischio-lateral method.

    PubMed

    Pulos, Nicholas; Tiberi Iii, John V; Schmalzried, Thomas P

    2011-01-01

    The standard method for the evaluation of arthritis and postoperative assessment of arthroplasty treatment is observation and measurement from plain films, using the flm edge for orientation. A more recent employment of an anatomical landmark, the ischial tuberosity, has come into use as orientation for evaluation and is called the ischio-lateral method. In this study, the use of this method was evaluated as a first report to the literature on acetabular component measurement using a skeletal reference with lateral radiographs. Postoperative radiographs of 52 hips, with at least three true lateral radiographs taken at different time periods, were analyzed. Component position was measured with the historical method (using the flm edge for orientation) and with the new method using the ischio-lateral method. The mean standard deviation (SD) for the historical approach was 3.7° and for the ischio-lateral method, 2.2° (p < 0.001). With the historical method, 19 (36.5%) hips had a SD greater than ± 4°, compared to six hips (11.5%) with the ischio-lateral method. By using a skeletal reference, the ischio-lateral method provides a more consistent measurement of acetabular component position. The high intra-class correlation coefficients for both intra- and inter-observer reliability indicate that the angle measured with this simple method, which employs no further technology, increased time, or cost, is consistent and reproducible for multiple observers.

  3. Tear dysfunction and the cornea: LXVIII Edward Jackson Memorial Lecture.

    PubMed

    Pflugfelder, Stephen C

    2011-12-01

    To describe the cause and consequence of tear dysfunction-related corneal disease. Perspective on effects of tear dysfunction on the cornea. Evidence is presented on the effects of tear dysfunction on corneal morphology, function, and health, as well as efficacy of therapies for tear dysfunction-related corneal disease. Tear dysfunction is a prevalent eye disease and the most frequent cause for superficial corneal epithelial disease that results in corneal barrier disruption, an irregular optical surface, light scattering, optical aberrations, and exposure and sensitization of pain-sensing nerve endings (nociceptors). Tear dysfunction-related corneal disease causes irritation and visual symptoms such as photophobia and blurred and fluctuating vision that may decrease quality of life. Dysfunction of 1 or more components of the lacrimal functional unit results in changes in tear composition, including elevated osmolarity and increased concentrations of matrix metalloproteinases, inflammatory cytokines, and chemokines. These tear compositional changes promote disruption of tight junctions, alter differentiation, and accelerate death of corneal epithelial cells. Corneal epithelial disease resulting from tear dysfunction causes eye irritation and decreases visual function. Clinical and basic research has improved understanding of the pathogenesis of tear dysfunction-related corneal epithelial disease, as well as treatment outcomes. Copyright © 2011 Elsevier Inc. All rights reserved.

  4. The effect of isolated labrum resection on shoulder stability.

    PubMed

    Pouliart, Nicole; Gagey, Olivier

    2006-03-01

    The present study was initiated to determine whether glenohumeral instability and dislocation can result from isolated lesions of the glenoid labrum in an arthroscopic cadaver model. Adjacent combinations of four zones of the labrum (superior, anterosuperior, anteroinferior and inferior) were sequentially removed with a motorised shaver, taking great care to leave the capsule intact in 24 cadaver shoulders. Stability was tested before and after inserting the scope and after each resection step. Inferior stability was examined by performing an inferior drawer test. Anterior stability was evaluated with an anteroposterior drawer test in 0 degrees of abduction and with a load-and-shift test in external rotation and 90 degrees abduction. Labral resection of all four zones maximally resulted in a grade 1 inferior instability (<10 mm inferior translation). When two adjacent labral zones were resected, a grade 2 anterior drawer (>10 mm anterior but no medial translation) was seen in 17% of the specimens. This was seen in one more specimen after the addition of a third zone. There were no differences in the stability of the load-and-shift test after any amount of labral resection. Total labral debridement increased inferior and anterior translation, but did not allow the humeral head to dislocate. The degree of stability in the cocked-arm position, which is the most prone to dislocation, is not altered. In patients, isolated labral tears, that is, without evidence of capsuloligamentous damage, can probably be safely debrided without risking glenohumeral instability to the point of dislocation. Nevertheless, anterior translation may significantly increase when two or more zones are resected.

  5. Immunoglobulin Concentration in Tears of Contact Lens Wearers

    PubMed Central

    Maurya, Rajendra P.; Bhushan, Prashant; Singh, Virendra P.; Singh, Mahendra K.; Kumar, Prakash; Bhatia, Ravindra P.S.; Singh, Usha

    2014-01-01

    Purpose: To evaluate changes in the concentration of tear immunoglobulins in contact lens wearers. Methods: A total of 45 cases including 23 contact lens wearers (43 eyes) and 22 age and sex matched healthy controls having no ocular pathology were studied for immunoglobulins (IgA, IgG, IgM) in their tears by single radial immunodiffusion method. Results: Most of the cases used soft (56.6%) and semi-soft gas permeable (30.4%) contact lenses. Tear IgM was detected in only 17.4% and tear IgG in 43.6% of contact lens wearers, while in controls IgG was detected in 9.1% but none of the controls had IgM. There was a significant rise in total tear IgA (13.17 ± 4.44 mg/dl) in contact lens wearer as compared to controls (8.93 ± 3.79 mg/dl). Rise of tear IgA was more in symptomatic patients (15.38 ± 5.28 mg/dl) and in those wearing hard (19.73 ± 5.43 mg/dl) and semi-soft contact lenses (13.31 ± 5.43 mg/dl). A significant increase in tear IgA was noticed in subjects wearing lenses for >3 years (15.69 ± 5.39 mg/dl). About 43.4% of lens wearers were symptomatic and 80% of their lenses showed deposits and/or haziness. All cases with IgM in tear were symptomatic. Conclusion: The relation of immunoglobulin concentration with increasing duration of wear and material of contact lens shows that tear immunoglobulin rise accrues due to mechanical stimulation, hence contact lenses should not be used for a long period and lenses of hard nature should be discouraged. The maintenance, cleaning and deproteinization of the lenses are of high importance to avoid immunostimulation. PMID:25667732

  6. [One-stage operation for pelvis and acetabular fractures combined with Morel-Lavallée injury by internal fixation associated with vacuum sealing drainage].

    PubMed

    Wei, Dan; Wang, Yue; Yuan, Jiabin; Tang, Xiaoming; Zhang, Bin; Lu, Bing; Tan, Bo

    2014-01-01

    To investigate the methods and effectiveness of one-stage operation for pelvis and acetabular fractures combined with Morel-Lavallée injury by internal fixation associated with vacuum sealing drainage (VSD). Between June 2008 and October 2012, 15 cases of pelvis and acetabular fractures combined with Morel-Lavallée injury were treated. There were 5 males and 10 females, aged from 18 to 67 years (mean, 36.8 years). Fractures were caused by traffic accident in 11 cases and crashing injury of heavy object in 4 cases. The time from injury to hospitalization was 3 hours to 9 days (mean, 5.4 days). Morel-Lavallée injury located in the above posterior superior iliac spine in 4 cases, greater trochanter in 7 cases, and anterior proximal thigh in 4 cases. In 10 cases complicated by pelvic fracture, there were 1 case of anteroposterior compression type, 3 cases of lateral compression type, 5 cases of vertical shear type, and 1 case of compound injury type; in 5 cases complicated by acetabular fracture, there were 1 case of transverse fracture, 1 case of posterior wall and posterior column fracture, 1 case of transverse acetabulum plus posterior wall fracture, and 2 cases of both columns fracture. Open reduction and internal fixation were used to treat pelvic and acetabular fractures, and VSD to treat Morel-Lavallée injury. When the drainage volume was less than 20 mL/d, interrupted wound suture or free skin grafting was performed. The hospitalization time was 16-31 days (mean, 20.8 days). Thirteen cases were followed up 4-16 months (mean, 7.8 months). The healing time of Morel-Lavallée injury was 16-36 days after operation (mean, 21.3 days). All the wounds had primary healing, and no infection occurred. The X-ray films showed that all fractures healed, with a mean healing time of 13.6 weeks (range, 11-18 weeks). At 6.5 months after operation, according to Majeed function scoring system in 8 cases of pelvic fracture, the results were excellent in 5 cases, good in 2 cases

  7. Tearfulness: a psychoanalytic interpretation.

    PubMed

    Wood, E C; Wood, C D

    1984-01-01

    In our view, the tearful feeling state is occasioned by the ego temporarily threatened with being inundated by complex memories and affects. For the moment, the ego cannot provide appropriate satisfying and integrated verbal expression. Words and verbal thinking are delayed. In this brief period, a controlled regression occurs during which the ego relates the current "precipitating experience" to temporally older conflictual experiences in the presence of the current object as a transference object and with a series of relationships so closely connected to that experience that they are interchanged in whole or part by the less selective, regressed, ego operations. The conscious experience may be sadness, gratitude, love, pride, or joy. But beneath these, there is the controlled regression, which interrupts verbal expression while the ego works through the earlier related conflicts,now remembered. The tearful feeling, a step in the direction of overt weeping, primitively expresses the frustration of an early wish for relief from pain, the pain of the imbalance of a complex conflict. The tearful feeling both expresses the wish for relief of pain and, at the same time, interrupts current verbal expression until the needed defense operations reduce the threat of ego disruption by working through old conflicts once again. Our thesis, then, is that within the analytic or psychotherapeutic hour the patient's feeling of tearfulness is a "too much" ego phenomenon that leads to a psychophysiological outlet.

  8. Towards Multiscale Interactions Between Tearing Modes and Microturbulence

    NASA Astrophysics Data System (ADS)

    Williams, Z. R.; Pueschel, M. J.; Terry, P. W.

    2017-10-01

    Work on the Madison Symmetric Torus Reversed-Field Pinch (RFP) has shown that large-scale tearing modes present in standard operation are highly detrimental to confinement. These tearing modes, even when reduced in improved confinement regimes of operation, significantly affect zonal flow activity and play a large role in setting microturbulent-induced transport levels. Previous gyrokinetic work has shown that a small but finite tearing fluctuation amplitude is necessary to produce transport values in agreement with experimental observation. This has previously been implemented via an ad-hoc, constant-in-time A∥ perturbation. This work details self-consistent modeling of tearing fluctuations in the RFP using the Gene code via the inclusion of a current gradient drive incorporated into the background distribution function. Tearing mode growth rates calculated from gyrokinetic simulations are benchmarked with results from fluid theory. Additionally, first results from multiscale Gene simulations describing tearing mode interactions with RFP microturbulence are presented. This work is supported by the U.S. Department of Energy, Grant No. DE-FG02-85ER-53121.

  9. Comparison of Medpor coated tear drainage tube versus silicon tear drainage tube in conjunctivodacryocystorhinostomy: problems and solutions.

    PubMed

    Sendul, Selam Yekta; Cagatay, Halil Huseyin; Dirim, Burcu; Demir, Mehmet; Yıldız, Ali Atakhan; Acar, Zeynep; Cinar, Sonmez; Guven, Dilek

    2014-01-01

    This study aims at comparing two different types of drainage tubes in conjunctivodacryocystorhinostomy, which are used for upper lacrimal system obstruction or damage, with respect to their respective postoperative problems and solutions. Nineteen eyes of 17 patients who underwent conjunctivodacryocystorhinostomy (CDCR) or conjunctivorhinostomy (CR) surgery with a Medpor coated tear drainage tube or silicon tube placement between October, 2010, and February, 2014, were included in this retrospective comparative study. In the initial surgery, Medpor coated tear drainage tubes were used in 11 eyes by CDCR, whereas silicon tear drainage tubes were implanted into 2 eyes by CR and 6 eyes by CDCR. In group 1, proximal and distal obstructions developed postoperatively in 4 eyes, while 1 eye showed tube malposition and 3 eyes developed luminal obstruction by debris 3 times. In group 2, tube extrusion developed in 4 eyes, whereas tube malposition developed in 6 eyes and luminal obstruction by debris developed in 6 eyes at different times, for a total of 20 times. In our study, the most significant complication we observed in the use of silicon tear drainage tubes was tube extrusion,whereas the leading complication related to the use of Medpor coated tear drainage tubes was tube obstruction.

  10. Comparison of Medpor Coated Tear Drainage Tube versus Silicon Tear Drainage Tube in Conjunctivodacryocystorhinostomy: Problems and Solutions

    PubMed Central

    Sendul, Selam Yekta; Cagatay, Halil Huseyin; Dirim, Burcu; Demir, Mehmet; Yıldız, Ali Atakhan; Acar, Zeynep; Cinar, Sonmez; Guven, Dilek

    2014-01-01

    Purpose. This study aims at comparing two different types of drainage tubes in conjunctivodacryocystorhinostomy, which are used for upper lacrimal system obstruction or damage, with respect to their respective postoperative problems and solutions. Methods. Nineteen eyes of 17 patients who underwent conjunctivodacryocystorhinostomy (CDCR) or conjunctivorhinostomy (CR) surgery with a Medpor coated tear drainage tube or silicon tube placement between October, 2010, and February, 2014, were included in this retrospective comparative study. Results. In the initial surgery, Medpor coated tear drainage tubes were used in 11 eyes by CDCR, whereas silicon tear drainage tubes were implanted into 2 eyes by CR and 6 eyes by CDCR. In group 1, proximal and distal obstructions developed postoperatively in 4 eyes, while 1 eye showed tube malposition and 3 eyes developed luminal obstruction by debris 3 times. In group 2, tube extrusion developed in 4 eyes, whereas tube malposition developed in 6 eyes and luminal obstruction by debris developed in 6 eyes at different times, for a total of 20 times. Conclusions. In our study, the most significant complication we observed in the use of silicon tear drainage tubes was tube extrusion,whereas the leading complication related to the use of Medpor coated tear drainage tubes was tube obstruction. PMID:25379518

  11. [Effects of acupuncture on lactoferrin content in tears and tear secretion in patients suffering from dry eyes: a randomized controlled trial].

    PubMed

    Shi, Jing-lin; Miao, Wan-hong

    2012-09-01

    With the understanding of the immune inflammatory response in the pathogenesis of dry eyes, and the limitations of widely used artificial tears and numerous pharmaceuticals and methods to promote tear secretion, clinicians pay more attention to the therapies that can promote tear secretion actively. Acupuncture treatment for dry eye may meet this requirement. To observe the clinical efficacy of acupuncture treatment on dry eye and the effects on duration, and to examine the mechanisms of acupuncture in treating patients with dye eyes. The study was performed at Department of Ophthalmology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine from August 2010 to May 2011. Patients with the primary diagnosis of dry eye were enrolled. Sixty-five patients were randomly divided into treatment group and control group, and were given 3 weeks of acupuncture treatment or artificial tear therapy respectively. The enzyme-linked immunosorbent assay was used to detect the lactoferrin content of the tears before and after treatment. In order to evaluate the efficacy of the treatment methods, the Schirmer I test and break-up time were also measured. Compared with before treatment, the lactoferrin content in the tears of patients in the treatment group increased, break-up time was prolonged and the result of the Schirmer I test showed improvement after 3 weeks of treatment. The indexes mentioned above did not change in the control group after treatment. There were no significant differences in tear lactoferrin and Schirmer I test between one week after treatment and after 3-week treatment in the treatment group, but break-up time was significantly shortened. The result of Schirmer I test in the treatment group was significantly higher than that in the control group one week after treatment. Acupuncture can increase tear lactoferrin level, extend tear film break-up time and promote tear secretion in patients with dry eye in a time-limited trial. With the end of

  12. Multicenter Analysis of Midterm Clinical Outcomes of Arthroscopic Labral Repair in the Hip: Minimum 5-Year Follow-up.

    PubMed

    Hevesi, Mario; Krych, Aaron J; Johnson, Nick R; Redmond, John M; Hartigan, David E; Levy, Bruce A; Domb, Benjamin G

    2018-02-01

    The technique of hip arthroscopic surgery is advancing and becoming more commonly performed. However, most current reported results are limited to short-term follow-up, and therefore, the durability of the procedure is largely unknown. To perform a multicenter analysis of mid-term clinical outcomes of arthroscopic hip labral repair and determine the risk factors for patient outcomes. Cohort study; Level of evidence, 3. Prospectively collected data of primary hip arthroscopic labral repair performed at 4 high-volume centers between 2008 and 2011 were reviewed retrospectively. Patients were assessed preoperatively and postoperatively with the visual analog scale (VAS), modified Harris Hip Score (mHHS), and Hip Outcome Score-Sports-Specific Subscale (HOS-SSS) at a minimum of 5 years' follow-up. Factors including age, body mass index (BMI), Tönnis grade, and cartilage grade were analyzed in relation to outcome scores, and revision rates were determined. Failure was defined as subsequent ipsilateral hip surgery, including revision arthroscopic surgery and open hip surgery. A total of 303 patients (101 male, 202 female) with a mean age of 32.0 years (range, 10.7-58.9 years) were followed for a mean of 5.7 years (range, 5.0-7.9 years). Patients achieved mean improvements in VAS of 3.5 points, mHHS of 20.1 points, and HOS-SSS of 29.3 points. Thirty-seven patients (12.2%) underwent revision arthroscopic surgery, and 12 (4.0%) underwent periacetabular osteotomy, resurfacing, or total hip arthroplasty during the study period. Patients with a BMI >30 kg/m 2 had a mean mHHS score 9.5 points lower and a mean HOS-SSS score 15.9 points lower than those with a BMI ≤30 kg/m 2 ( P < .01). Patients aged >35 years at surgery had a mean mHHS score 4.5 points lower and a HOS-SSS score 6.7 points lower than those aged ≤35 years ( P = .03). Patients with Tönnis grade 2 radiographs demonstrated a 12.5-point worse mHHS score ( P = .02) and a 23.0-point worse HOS-SSS score ( P < .01

  13. What is the impingement-free range of motion of the asymptomatic hip in young adult males?

    PubMed

    Larkin, Brian; van Holsbeeck, Marnix; Koueiter, Denise; Zaltz, Ira

    2015-04-01

    Femoroacetabular impingement is a recognized cause of chondrolabral injury. Although surgical treatment for impingement seeks to improve range of motion, there are very little normative data on dynamic impingement-free hip range of motion (ROM) in asymptomatic people. Hip ultrasound demonstrates labral anatomy and femoral morphology and, when used dynamically, can assist in measuring range of motion. The purposes of this study were (1) to measure impingement-free hip ROM until labral deflection is observed; and (2) to measure the maximum degree of sagittal plane hip flexion when further flexion is limited by structural femoroacetabular abutment. Forty asymptomatic adult male volunteers (80 hips) between the ages of 21 and 35 years underwent bilateral static and dynamic hip ultrasound examination. Femoral morphology was characterized and midsagittal flexion passive ROM was measured at two points: (1) at the initiation of labral deformation; and (2) at maximum flexion when the femur impinged on the acetabular rim. The mean age of the subjects was 28 ± 3 years and the mean body mass index was 25 ± 4 kg/m(2). Mean impingement-free hip passive flexion measured from full extension to initial labral deflection was 68° ± 17° (95% confidence interval [CI], 65-72). Mean maximum midsagittal passive flexion, measured at the time of bony impingement, was 96° ± 6° (95% CI, 95-98). Using dynamic ultrasound, we found that passive ROM in the asymptomatic hip was much less than the motion reported in previous studies. Measuring ROM using ultrasound is more accurate because it allows anatomic confirmation of terminal hip motion. Surgical procedures used to treat femoroacetabular impingement are designed to restore or increase hip ROM and their results should be evaluated in light of precise normative data. This study suggests that normal passive impingement-free femoroacetabular flexion in the young adult male is approximately 95°.

  14. Effect of acetabular cup abduction angle on wear of ultrahigh-molecular-weight polyethylene in hip simulator testing.

    PubMed

    Korduba, Laryssa A; Essner, Aaron; Pivec, Robert; Lancin, Perry; Mont, Michael A; Wang, Aiguo; Delanois, Ronald E

    2014-10-01

    The effect of acetabular component positioning on the wear rates of metal-on-polyethylene articulations has not been extensively studied. Placement of acetabular cups at abduction angles of more than 40° has been noted as a possible reason for early failure caused by increased wear. We conducted a study to evaluate the effects of different acetabular cup abduction angles on polyethylene wear rate, wear area, contact pressure, and contact area. Our in vitro study used a hip joint simulator and finite element analysis to assess the effects of cup orientation at 4 angles (0°, 40°, 50°, 70°) on wear and contact properties. Polyethylene bearings with 28-mm cobalt-chrome femoral heads were cycled in an environment mimicking in vivo joint fluid to determine the volumetric wear rate after 10 million cycles. Contact pressure and contact area for each cup abduction angle were assessed using finite element analysis. Results were correlated with cup abduction angles to determine if there were any differences among the 4 groups. The inverse relationship between volumetric wear rate and acetabular cup inclination angle demonstrated less wear with steeper cup angles. The largest abduction angle (70°) had the lowest contact area, largest contact pressure, and smallest head coverage. Conversely, the smallest abduction angle (0°) had the most wear and most head coverage. Polyethylene wear after total hip arthroplasty is a major cause of osteolysis and aseptic loosening, which may lead to premature implant failure. Several studies have found that high wear rates for cups oriented at steep angles contributed to their failure. Our data demonstrated that larger cup abduction angles were associated with lower, not higher, wear. However, this potentially "protective" effect is likely counteracted by other complications of steep cup angles, including impingement, instability, and edge loading. These factors may be more relevant in explaining why implants fail at a higher rate if

  15. Tear film measurement by optical reflectometry technique

    PubMed Central

    Lu, Hui; Wang, Michael R.; Wang, Jianhua; Shen, Meixiao

    2014-01-01

    Abstract. Evaluation of tear film is performed by an optical reflectometer system with alignment guided by a galvanometer scanner. The reflectometer system utilizes optical fibers to deliver illumination light to the tear film and collect the film reflectance as a function of wavelength. Film thickness is determined by best fitting the reflectance-wavelength curve. The spectral reflectance acquisition time is 15 ms, fast enough for detecting film thickness changes. Fast beam alignment of 1 s is achieved by the galvanometer scanner. The reflectometer was first used to evaluate artificial tear film on a model eye with and without a contact lens. The film thickness and thinning rate have been successfully quantified with the minimum measured thickness of about 0.3 μm. Tear films in human eyes, with and without a contact lens, have also been evaluated. A high-contrast spectral reflectance signal from the precontact lens tear film is clearly observed, and the thinning dynamics have been easily recorded from 3.69 to 1.31 μm with lipid layer thickness variation in the range of 41 to 67 nm. The accuracy of the measurement is better than ±0.58% of the film thickness at an estimated tear film refractive index error of ±0.001. The fiber-based reflectometer system is compact and easy to handle. PMID:24500519

  16. In vivo tear film thickness measurement and tear film dynamics visualization using spectral domain OCT and an efficient delay estimator

    NASA Astrophysics Data System (ADS)

    Aranha dos Santos, Valentin; Schmetterer, Leopold; Gröschl, Martin; Garhofer, Gerhard; Werkmeister, René M.

    2016-03-01

    Dry eye syndrome is a highly prevalent disease of the ocular surface characterized by an instability of the tear film. Traditional methods used for the evaluation of tear film stability are invasive or show limited repeatability. Here we propose a new noninvasive approach to measure tear film thickness using an efficient delay estimator and ultrahigh resolution spectral domain OCT. Silicon wafer phantoms with layers of known thickness and group index were used to validate the estimator-based thickness measurement. A theoretical analysis of the fundamental limit of the precision of the estimator is presented and the analytical expression of the Cramér-Rao lower bound (CRLB), which is the minimum variance that may be achieved by any unbiased estimator, is derived. The performance of the estimator against noise was investigated using simulations. We found that the proposed estimator reaches the CRLB associated with the OCT amplitude signal. The technique was applied in vivo in healthy subjects and dry eye patients. Series of tear film thickness maps were generated, allowing for the visualization of tear film dynamics. Our results show that the central tear film thickness precisely measured in vivo with a coefficient of variation of about 0.65% and that repeatable tear film dynamics can be observed. The presented method has the potential of being an alternative to breakup time measurements (BUT) and could be used in clinical setting to study patients with dry eye disease and monitor their treatments.

  17. Superior glenoid inclination and rotator cuff tears.

    PubMed

    Chalmers, Peter N; Beck, Lindsay; Granger, Erin; Henninger, Heath; Tashjian, Robert Z

    2018-03-23

    The objectives of this study were to determine whether glenoid inclination (1) could be measured accurately on magnetic resonance imaging (MRI) using computed tomography (CT) as a gold standard, (2) could be measured reliably on MRI, and (3) whether it differed between patients with rotator cuff tears and age-matched controls without evidence of rotator cuff tears or glenohumeral osteoarthritis. In this comparative retrospective radiographic study, we measured glenoid inclination on T1 coronal MRI corrected into the plane of the scapula. We determined accuracy by comparison with CT and inter-rater reliability. We compared glenoid inclination between patients with full-thickness rotator cuff tears and patients aged >50 years without evidence of a rotator cuff tear or glenohumeral arthritis. An a priori power analysis determined adequate power to detect a 2° difference in glenoid inclination. (1) In a validation cohort of 37 patients with MRI and CT, the intraclass correlation coefficient was 0.877, with a mean difference of 0° (95% confidence interval, -1° to 1°). (2) For MRI inclination, the inter-rater intraclass correlation coefficient was 0.911. (3) Superior glenoid inclination was 2° higher (range, 1°-4°, P < .001) in the rotator cuff tear group of 192 patients than in the control cohort of 107 patients. Glenoid inclination can be accurately and reliably measured on MRI. Although superior glenoid inclination is statistically greater in those with rotator cuff tears than in patients of similar age without rotator cuff tears or glenohumeral arthritis, the difference is likely below clinical significance. Copyright © 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  18. Early polyethylene wear and osteolysis with ABG acetabular cups (7- to 12-year follow-up).

    PubMed

    Badhe, Sachin; Livesley, Peter

    2006-02-01

    We reviewed 81 consecutive ABG I primary total hip replacements implanted in 72 patients between January 1993 and December 1998. The mean follow-up was 8.2 (range 7-12) years. There was significant polyethylene wear and osteolysis associated with the acetabular cup . The cumulative survival of the cup with revision being the end point at 8.2 years was 95.1% (95% CI: 92-97.6%). However, the cumulative survival of the cup with revision and aseptic loosening together was 72% (95% CI: 61-78%) and survival of the acetabular liner for wear was 62% (95% CI: 48-74%). Stem survival with revision being the end point was 100%. In spite of significant radiological failures of the cups, most patients remained asymptomatic. Though results of the ABG stems in this series were good, we advocate a regular follow-up of all these hips in view of the poor outcome of the cups.

  19. Early polyethylene wear and osteolysis with ABG acetabular cups (7- to 12-year follow-up)

    PubMed Central

    Livesley, Peter

    2005-01-01

    We reviewed 81 consecutive ABG I primary total hip replacements implanted in 72 patients between January 1993 and December 1998. The mean follow-up was 8.2 (range 7–12) years. There was significant polyethylene wear and osteolysis associated with the acetabular cup .The cumulative survival of the cup with revision being the end point at 8.2 years was 95.1% (95% CI: 92–97.6%). However, the cumulative survival of the cup with revision and aseptic loosening together was 72% (95% CI: 61–78%) and survival of the acetabular liner for wear was 62% (95% CI: 48–74%). Stem survival with revision being the end point was 100%. In spite of significant radiological failures of the cups, most patients remained asymptomatic. Though results of the ABG stems in this series were good, we advocate a regular follow-up of all these hips in view of the poor outcome of the cups. PMID:16283307

  20. Spectral-domain optical coherence tomography study on dynamic changes of human tears after instillation of artificial tears.

    PubMed

    Napoli, Pietro Emanuele; Satta, Giovanni Maria; Coronella, Franco; Fossarello, Maurizio

    2014-07-01

    To analyze in vivo the dynamic changes induced by different artificial tears (ATs) in the precorneal tear film (PCTF) and lower tear meniscus (LTM) by using spectral-domain (SD) anterior segment optical coherence tomography (OCT). We prospectively examined 42 normal human eyes by using SD-OCT imaging. On the day before OCT imaging, all enrolled subjects were evaluated for abnormalities of ocular surface. All tear film images were obtained before and after instillation of three different types of ATs (mucomimetic, lipid-based, and saline) in five serial scans: immediately (within 30 seconds), at the first, fifth, 10th, and 20th minute. Subjects received a drop of 35 μL in one randomly selected eye. All examinations were conducted in the same conditions of temperature, brightness, humidity, and time of day. Changes in the morphological pattern of both LTM and PCTF were associated with the type of artificial tear instilled on the ocular surface. Similarly, the radius of curvature (rc), the height (h), and the depth (d) showed dynamic variations depending on treatment. Although by the 20th minute, both h and d returned to baseline values in all groups, a significant difference in rc (compared with baseline) was detected for mucomimetic ATs (P = 0.04) and lipid ATs (P = 0.02). Spectral-domain OCT imaging has preliminarily proved to be a noninvasive tool to evaluate, in real time, the different changes induced by ATs instillation. An important stride in understanding the clinical response to various tear substitutes can be achieved by this objective and quantitative approach. Copyright 2014 The Association for Research in Vision and Ophthalmology, Inc.

  1. The effect of variable size posterior wall acetabular fractures on contact characteristics of the hip joint.

    PubMed

    Olson, S A; Bay, B K; Pollak, A N; Sharkey, N A; Lee, T

    1996-01-01

    The indications for open reduction and internal fixation of posterior wall acetabular fractures associated with a clinically stable hip joint are unclear. In previous work a large posterior wall defect (27% articular surface area) resulted in significant alteration of load transmission across the hip; specifically, there was a transition from evenly distributed loading along the acetabular articular surface to loading concentrated mainly in the superior portion of the articular surface during simulated single leg stance. However, the majority of posterior wall fractures involve a smaller amount of the articular surface. Posterior wall acetabular fractures not associated with instability of the hip are commonly treated nonoperatively. This practice does not account for the size of the posterior wall fracture. To study the biomechanical consequences of variably sized articular defects, a laboratory experiment was conducted evaluating three progressively larger posterior wall defects of the acetabulum during simulated single leg stance using superlow Fuji prescale film (Itochu International, New York): (a) 1/3 articular surface width through a 50 degrees arc along the posterior wall of the acetabulum, (b) 2/3, and (c) 3/3 articular width defects through the same 50 degrees arc along the posterior wall of the acetabulum. In the intact acetabulum, 48% of the total articular contact was located in the superior acetabulum. Twenty-eight percent of articular contact was in the anterior wall region of the acetabulum and 24% in the posterior wall region. After the 1/3 width posterior wall defect, 64% of the articular contact was located in the superior acetabulum (p = 0.0011). The 2/3 width posterior wall defect resulted in 71% of articular contact area being located in the superior acetabulum (p = 0.0006). After the 3/3 width posterior wall defect, 77% of articular contact was located in the superior acetabulum, significantly greater than the intact condition (p < 0

  2. Cup press fit in uncemented THA depends on sex, acetabular shape, and surgical technique.

    PubMed

    García-Rey, Eduardo; García-Cimbrelo, Eduardo; Cruz-Pardos, Ana

    2012-11-01

    Uncemented press-fit cups provide bone fixation in primary THA, but the use of screws is sometimes necessary to achieve primary stability of the socket. However, it is unclear whether and when screws should be used. We analyzed the factors related to screw use with a press-fit uncemented cup and assessed whether screw use is associated with the same rates of loosening and revision as a press-fit technique. We retrospectively reviewed 248 patients who underwent THA using the same prosthetic design. Eighty-eight hips had screws to achieve primary cup fixation (Group 1), and 189 did not (Group 2). Mean age was 50 years (range, 14-73 years). We analyzed factors related to the patient, acetabular type, and reconstruction of the rotation center of the hip. Minimum followup was 5 years (mean, 8.9 years; range, 5-12 years). We found higher screw use in women, patients with less physical activity, Acetabular Types A or C, and a distance from the center of the prosthetic femoral head to the normal center of rotation of more than 3 mm. There were four revisions in Group 1 and five in Group 2. Eight hips had radiographic loosening in Group 1 and nine in Group 2. Cups with a postoperative abduction angle of more than 50° had a higher risk for loosening. Press fit was achieved less frequently in women and patients with Acetabular Types A or C and less physical activity; a closer distance to the normal center of rotation decreased screw use. Screw use to augment fixation achieved survival similar to that of a press-fit cup. Level II, prognostic study. See Instructions for Authors for a complete description of levels of evidence.

  3. Post-deformation shape-recovery behavior of vitamin E-diffused, radiation crosslinked polyethylene acetabular components.

    PubMed

    Takahashi, Yasuhito; Tateiwa, Toshiyuki; Shishido, Takaaki; Masaoka, Toshinori; Kubo, Kosuke; Yamamoto, Kengo

    2016-10-01

    The in-vivo progression of creep and wear in ultra-high molecular weight polyethylene (UHMWPE) acetabular liners has been clinically evaluated by measuring radiographic penetration of femoral heads. In such clinical assessments, however, viscoelastic strain relaxation has been rarely considered after a removal of hip joint loading, potentially leading to an underestimation of the penetrated thickness. The objective of this study was to investigate shape-recovery behavior of pre-compressed, radiation crosslinked and antioxidant vitamin E-diffused UHMWPE acetabular liners, and also to characterize the effects of varying their internal diameter (ID) and wall thickness (WT). We applied uniaxial compression to the UHMWPE specimens of various ID (28, 32, 36mm) and WT (4.8, 6.8, 8.9mm) for 4320min under the constant load of 3000N, and subsequently monitored the strain-relaxation behavior as a function of time after unloading. It was observed that there was a considerable shape recovery of the components after removal of the external static load. Reducing ID and WT significantly accelerated the rate of creep strain recovery, and varying WT was more sensitive to the recovery behavior than ID. Creep deformation of the tested liners recovered mostly within the first 300min after unloading. Note that approximately half of the total recovery amount proceeded just within 5min after unloading. These results suggest a remarkably high capability of shape recovery of vitamin E-diffused highly crosslinked UHMWPE. In conclusion, the time-dependent shape recovering and the diameter-thickness effect on its behavior should be carefully considered when the postoperative penetration is quantified in highly crosslinked UHMWPE acetabular liners (especially on the non-weight bearing radiographs). Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. Posterior meniscus root tears: associated pathologies to assist as diagnostic tools.

    PubMed

    Matheny, Lauren M; Ockuly, Andrew C; Steadman, J Richard; LaPrade, Robert F

    2015-10-01

    The purpose of this study was to investigate associated pathologies identified at arthroscopy in patients with meniscus root tears. This study was Institutional Review Board approved. All patients who underwent arthroscopic knee surgery where a complete meniscus root tear was identified were included in this study. Concurrent ligament tears and articular cartilage changes ≥Outerbridge grade 2 were recorded and stored in a data registry. Fifty patients (28 males, 22 females) [mean age = 36.5 years (range 17.1-68.1 years)] who were diagnosed with a medial or lateral meniscus root tear at arthroscopy were included in this study out of 673 arthroscopic surgeries (prevalence 7.4 %). Twenty-three (46 %) patients had a medial meniscus root tear, 26 (52 %) patients had a lateral meniscus root tear and one (2 %) patient had both. Thirty-four per cent of patients (n = 17) underwent partial meniscectomy, while 60 % (n = 31) underwent suture repair. During arthroscopy, 60 % (n = 30) of patients were diagnosed with an anterior cruciate ligament (ACL) tear. Patients with lateral meniscus root tears were 10.3 times (95 % CI 2.6-42.5) more likely to have ACL tears than patients with medial meniscus root tears (p = 0.012). Patients who had medial meniscus root tears were 5.8 times (95 % CI 1.6-20.5) more likely to have chondral defects than patients who had lateral meniscus root tears (p = 0.044). In this study, patients' preoperative functional scores and activity levels were low. Patients with lateral meniscal root tears were more likely to have an ACL tear. Patients with medial meniscal root tears were more likely to have an knee articular cartilage defect with an Outerbridge grade 2 or higher chondral defect. This study confirms the importance of comprehensive assessment of concurrent injuries to properly diagnose meniscus root tears. IV.

  5. Patient acceptability of tear collection in the primary healthcare setting.

    PubMed

    Quah, Joanne Hui Min; Tong, Louis; Barbier, Sylvaine

    2014-04-01

    The primary healthcare setting is well placed for health screening. Tear fluid composition gives valuable information about the eye and systemic health, and there is now significant interest in the potential application of tears as a tool for health screening; however, the acceptability of tear collection in the primary healthcare setting as compared with other methods of human sample collection has not been previously addressed. The objective of this study was to evaluate the patient acceptability of tear collection in a primary healthcare setting. This was a cross-sectional study on 383 adult patients seeking primary healthcare, who were not diabetic and were not attending for an eye-related complaint. Tear collection was done using Schirmer strips, and an interviewer-administered questionnaire was conducted to collate information on the pain score (0-10) of the Schirmer tear collection, as well as to score the pain associated with their previous experience of antecubital venous puncture and finger prick test. The pain score for Schirmer tear collection was significantly lower (p < 0.001) than antecubital venous puncture but higher (p < 0.001) than finger prick. The pain scores for all three procedures were significantly higher in participants of younger age, female gender, and higher education level. Among the participants, 70% did not mind their tears being collected to screen for eye problems, whereas only 38% did not mind this procedure being performed for general health screening. Nevertheless, 69% of the participants preferred tear to urine collection, and 74% of participants preferred tear to blood collection. Tear collection using Schirmer strips is a highly acceptable form of investigation that has the potential for use in health screening in the primary healthcare setting. This study has implications on using tear collection as a method of ocular and systemic health screening in the primary healthcare setting.

  6. Alkaptonuria.

    PubMed

    Bassily, Emmanuel; O'Dell, M Cody; Homan, Brad; Wasyliw, Christopher

    2016-07-01

    A 50-year-old woman with a chronic polyarthropathy was seen by her orthopedist for long-standing back and shoulder and worsening hip pain. A lateral labral tear and chronic trochanteric bursitis were diagnosed on hip magnetic resonance imaging, which was otherwise unremarkable. Hip arthroscopy was performed revealing an unusual bluish-tinged femoral head articular surface. Computed tomography scans of the spine were also obtained. Copyright 2016, SLACK Incorporated.

  7. Readability of the Most Commonly Accessed Arthroscopy-Related Online Patient Education Materials.

    PubMed

    Akinleye, Sheriff D; Krochak, Ryan; Richardson, Nicholas; Garofolo, Garret; Culbertson, Maya Deza; Erez, Orry

    2018-04-01

    To assess the readability and comprehension of written text by the most commonly visited websites containing patient education materials on common conditions that can be treated arthroscopically. We examined 50 websites, assessed independently by 2 orthopaedic surgery residents (S.A. and G.G.), with educational materials on 5 common conditions treated by arthroscopic surgeons: anterior cruciate ligament (ACL) tear, meniscus tear, hip labral tear, shoulder labral tear, and rotator cuff tear. Following a Google search for each condition, we analyzed the 10 most visited websites for each disorder using a widely used and validated tool for assessing the reading levels of written materials (Flesch-Kincaid formula). The average grade reading level of the 50 websites studied was 9.90 with a reading ease of 52.14 ("fairly difficult, high school"). Only 26% of the websites were at or below the national average of an eighth-grade reading level. Of the 5 conditions treated by arthroscopic surgery, ACL tear had the highest average grade reading level at 10.73 ± 1.54, whereas meniscus tear had the lowest at 9.31 ± 1.81. Every condition in this study had an average readability at or above the ninth-grade reading level. The most frequently accessed materials for patients with injuries requiring arthroscopic surgery exceeds the readability recommendations of the American Medical Association and National Institutes of Health, as well as the average reading ability of US adults. Given the fact that these are the most commonly visited websites by the lay public, there needs to be a greater emphasis on tailoring written information to the literacy levels of the patient population. This study emphasizes the discrepancy between the recommended versus the measured reading levels of online patient education materials related to conditions treated by arthroscopic surgeons. The subject matter of these conditions is inherently complex; thus, relying solely on text to inform patients

  8. Biocompatibility of Bespoke 3D-Printed Titanium Alloy Plates for Treating Acetabular Fractures.

    PubMed

    Lin, Xuezhi; Xiao, Xingling; Wang, Yimeng; Gu, Cheng; Wang, Canbin; Chen, Jiahui; Liu, Han; Luo, Juan; Li, Tao; Wang, Di; Fan, Shicai

    2018-01-01

    Treatment of acetabular fractures is challenging, not only because of its complicated anatomy but also because of the lack of fitting plates. Personalized titanium alloy plates can be fabricated by selective laser melting (SLM) but the biocompatibility of these three-dimensional printing (3D-printed) plates remains unknown. Plates were manufactured by SLM and their cytocompatibility was assessed by observing the metabolism of L929 fibroblasts incubated with culture medium extracts using a CCK-8 assay and their morphology by light microscopy. Allergenicity was tested using a guinea pig maximization test. In addition, acute systemic toxicity of the 3D-printed plates was determined by injecting extracts from the implants into the tail veins of mice. Finally, the histocompatibility of the plates was investigated by implanting them into the dorsal muscles of rabbits. The in vitro results suggested that cytocompatibility of the 3D-printed plates was similar to that of conventional plates. The in vivo data also demonstrated histocompatibility that was comparable between the two manufacturing techniques. In conclusion, both in vivo and in vitro experiments suggested favorable biocompatibility of 3D-printed titanium alloy plates, indicating that it is a promising option for treatment of acetabular fractures.

  9. Retinal tear: an unusual complication of ocular toxoplasmosis.

    PubMed

    Celebi, Ali Riza Cenk; Kilavuzoglu, Ayse Ebru; Altiparmak, Ugur Emrah; Cosar, Cemile Banu; Ozkiris, Abdullah

    2015-01-01

    It is aimed to report on a 16-year-old patient with acquired ocular toxoplasmosis complicated by a retinal tear. Retrospective medical chart review. A 16-year-old Caucasian female presented with vision loss in her right eye. In addition to a white active lesion between the fovea and the optic nerve head, marked vitreous opacification was noted. She was diagnosed with ocular toxoplasmosis. The patient was treated with oral azithromycin, clindamycin, and trimethoprimsulfamethoxazole. One month later, retinochoroiditis resolved and vitreous cleared. Three months after onset, patient presented with floaters in the right eye and a retinal tear was located at the temporal region of the retina. Prophylactic argon laser treatment that encircled the retinal tear was performed. No other abnormalities were noted during 6 months of follow-up. Retinal tear associated with ocular toxoplasmosis is rare; however, a retinal tear can occur due to vitreoretinal traction following post-inflammatory structural alteration of the vitreous. Retinal tears may be seen during the healing phase, when the inflammation turns into tightening of vitreous substance. Careful retinal examination in cases of ocular toxoplasmosis is warranted, especially in patients with severe vitreous inflammation.

  10. Promising Mid-term Results With a Cup-cage Construct for Large Acetabular Defects and Pelvic Discontinuity.

    PubMed

    Amenabar, Tomas; Rahman, Wael A; Hetaimish, Bandar M; Kuzyk, Paul R; Safir, Oleg A; Gross, Allan E

    2016-02-01

    Restoring normal anatomy and achieving stable fixation of the acetabular component can be especially challenging when the surgeon must deal with severe acetabular defects and/or pelvic discontinuity. The cup-cage (CC) construct, where an ilioischial cage is cemented within a biologically fixed porous metal cup, has emerged as an excellent option to treat such challenges. We sought to determine (1) mid-term Kaplan-Meier survival; (2) clinical outcomes based on Merle d'Aubigné-Postel scores; (3) radiological outcomes based primarily on construct migration; and (4) the complication rate for a series of 67 CC procedures performed at our institution. All hip revision procedures between January 2003 and March 2012 where a CC was used (with the exception of tumor cases or acute fracture; four total cases) that had a minimum 2-year followup and that had been seen within the last 2 years were included in this retrospective review. Acetabular bone loss and presence of pelvic discontinuity were assessed according to the Gross classification. Sixty-seven CC procedures with an average followup of 74 months (range, 24-135 months; SD, 34.3) months were identified; 26 of 67 (39%) were Gross Type IV and 41 of 67 (61%) were Gross Type V (pelvic discontinuity). Postoperative clinical and radiological evaluation was done annually. Merle d'Aubigné-Postel scores were recorded and all radiographs were compared with the 6-week postoperative radiographs to evaluate for radiographic loosening or migration. Failure was defined as revision surgery for any cause, including infection. The 5-year Kaplan-Meier survival rate with revision for any cause representing failure was 93% (95% confidence interval [CI], 83.1-97.4), and the 10-year survival rate was 85% (95% CI, 67.2-93.8). The Merle d'Aubigné-Postel score improved significantly from a mean of 6 preoperatively to 13 postoperatively (p < 0.001). Four CC had nonprogressive radiological migration of the ischial flange and they remain stable

  11. Forced tearing of ductile and brittle thin sheets.

    PubMed

    Tallinen, T; Mahadevan, L

    2011-12-09

    Tearing a thin sheet by forcing a rigid object through it leads to complex crack morphologies; a single oscillatory crack arises when a tool is driven laterally through a brittle sheet, while two diverging cracks and a series of concertinalike folds forms when a tool is forced laterally through a ductile sheet. On the other hand, forcing an object perpendicularly through the sheet leads to radial petallike tears in both ductile and brittle materials. To understand these different regimes we use a combination of experiments, simulations, and simple theories. In particular, we describe the transition from brittle oscillatory tearing via a single crack to ductile concertina tearing with two tears by deriving laws that describe the crack paths and wavelength of the concertina folds and provide a simple phase diagram for the morphologies in terms of the material properties of the sheet and the relative size of the tool.

  12. Assessment and treatment strategies for rotator cuff tears

    PubMed Central

    Al-Hakim, Wisam; Noorani, Ali

    2014-01-01

    Tears of the rotator cuff are common and becoming an increasingly frequent problem. There is a vast amount of literature on the merits and limitations of the various methods of clinical and radiological assessment of rotator cuff tears. This is also the case with regard to treatment strategies. Certain popular beliefs and principles practiced widely and the basis upon which they are derived may be prone to inaccuracy. We provide an overview of the historical management of rotator cuff tears, as well as an explanation for how and why rotator cuff tears should be managed, and propose a structured methodology for their assessment and treatment. PMID:27582960

  13. Superior labrum anterior to posterior tears and glenohumeral instability.

    PubMed

    Virk, Mandeep S; Arciero, Robert A

    2013-01-01

    Cadaver experiments and clinical studies suggest that the superior labrum-biceps complex plays a role in glenohumeral stability. Superior labrum anterior to posterior (SLAP) tears can be present in acute and recurrent glenohumeral dislocations and contribute to glenohumeral instability. Isolated SLAP tears can cause instability, especially in throwing athletes. Diagnosing a SLAP tear on the basis of the clinical examination alone is difficult because of nonspecific history and physical examination findings and the presence of coexisting intra-articular lesions. Magnetic resonance arthrography is the imaging study of choice for diagnosing SLAP tears; however, arthroscopy remains the gold standard for diagnosis. Arthroscopy is the preferred technique for the repair of a type II SLAP tear and its variant types (V through X) in acute glenohumeral dislocations and instability in younger populations. Clinical outcome studies report a low recurrence of glenohumeral instability after the arthroscopic repair of a SLAP tear in addition to a Bankart repair. Long-term follow-up studies and further advances in arthroscopic fixation techniques will allow a better understanding and improvement in outcomes in patients with SLAP tears associated with glenohumeral instability.

  14. Use of a constrained tripolar acetabular liner to treat intraoperative instability and postoperative dislocation after total hip arthroplasty: a review of our experience.

    PubMed

    Callaghan, John J; O'Rourke, Michael R; Goetz, Devon D; Lewallen, David G; Johnston, Richard C; Capello, William N

    2004-12-01

    Constrained acetabular components have been used to treat certain cases of intraoperative instability and postoperative dislocation after total hip arthroplasty. We report our experience with a tripolar constrained component used in these situations since 1988. The outcomes of the cases where this component was used were analyzed for component failure, component loosening, and osteolysis. At average 10-year followup, for cases treated for intraoperative instability (2 cases) or postoperative dislocation (4 cases), the component failure rate was 6% (6 of 101 hips in 5 patients). For cases where the constrained liner was cemented into a fixed cementless acetabular shell, the failure rate was 7% (2 of 31 hips in 2 patients) at 3.9-year average followup. Use of a constrained liner was not associated with an increased osteolysis or aseptic loosening rate. This tripolar constrained acetabular liner provided total hip arthroplasty construct stability in most cases in which it was used for intraoperative instability or postoperative dislocation.

  15. Rotator cuff tear measurement by arthropneumotomography

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Kilcoyne, R.F.; Matsen, F.A. III

    1983-02-01

    Five years of experience with a method of shoulder arthrography using upright tomography in cases of suspected or known rotator cuff tears has demonstrated its effectiveness. The value of the procedure lies in its ability to demonstrate the size of the cuff tear and the thickness of the remaining cuff tissue. This information provides the surgeon with a preoperative estimate of the difficulty of the repair and the prognosis for a good functional recovery. In 33 cases, there was good correlation between the upright thin-section tomogram findings and the surgical results. The tomograms provided better information about the size ofmore » the tear and the quality of the remaining cuff than did plain arthrograms.« less

  16. The prevalence of rotator cuff tears: is the contralateral shoulder at risk?

    PubMed

    Liem, Dennis; Buschmann, Vera Elisa; Schmidt, Carolin; Gosheger, Georg; Vogler, Tim; Schulte, Tobias L; Balke, Maurice

    2014-04-01

    Rotator cuff tears are a common cause of pain and disability of the shoulder. Information on the prevalence and identification of potential risk factors could help in early detection of rotator cuff tears and improve treatment outcome. Patients treated for a symptomatic rotator cuff tear on one side have a higher prevalence of rotator cuff tears and decreased shoulder function on the contralateral side compared with an age- and sex-matched group of healthy individuals. Case control study; Level of evidence, 3. One group consisted of 55 patients who had been arthroscopically treated on one shoulder for rotator cuff tear (tear group). In this group, the nonoperated contralateral shoulder was examined. For comparison, the matching shoulder in a control group consisting of 55 subjectively healthy individuals matched by age (±1 year) and sex to the tear group was included. Diagnosis of a rotator cuff tear was made by ultrasound. Outcomes were measured using the Constant score. The prevalence of supraspinatus tears was significantly higher (P < .0001) in the tear group (67.3%) compared with the control group (11.0%). The Constant score for the activities of daily living subscale, however, was significantly lower (18.4) in the tear group compared with the control group (19.9; P = .012). No other subcategory score nor the overall score showed a significant difference. There was a significantly higher tear prevalence in the tear group of patients aged between 50 and 59 years (P < .001) and 60 and 69 years (P = .004). No tear was diagnosed in the control group in individuals younger than 60 years. Patients treated for partial and full-thickness rotator cuff tears have a significantly higher risk of having a tear on the contralateral side and have noticeable deficits in their shoulder function regarding activities of daily living even if the tear is otherwise asymptomatic.

  17. Partial Thickness Rotator Cuff Tears: Current Concepts

    PubMed Central

    Matthewson, Graeme; Beach, Cara J.; Nelson, Atiba A.; Woodmass, Jarret M.; Ono, Yohei; Boorman, Richard S.; Lo, Ian K. Y.; Thornton, Gail M.

    2015-01-01

    Partial thickness rotator cuff tears are a common cause of pain in the adult shoulder. Despite their high prevalence, the diagnosis and treatment of partial thickness rotator cuff tears remains controversial. While recent studies have helped to elucidate the anatomy and natural history of disease progression, the optimal treatment, both nonoperative and operative, is unclear. Although the advent of arthroscopy has improved the accuracy of the diagnosis of partial thickness rotator cuff tears, the number of surgical techniques used to repair these tears has also increased. While multiple repair techniques have been described, there is currently no significant clinical evidence supporting more complex surgical techniques over standard rotator cuff repair. Further research is required to determine the clinical indications for surgical and nonsurgical management, when formal rotator cuff repair is specifically indicated and when biologic adjunctive therapy may be utilized. PMID:26171251

  18. Usefulness of Arthroscopic Treatment of Painful Hip after Acetabular Fracture or Hip Dislocation.

    PubMed

    Hwang, Jung-Taek; Lee, Woo-Yong; Kang, Chan; Hwang, Deuk-Soo; Kim, Dong-Yeol; Zheng, Long

    2015-12-01

    Painful hip following hip dislocation or acetabular fracture can be an important signal for early degeneration and progression to osteoarthritis due to intraarticular pathology. However, there is limited literature discussing the use of arthroscopy for the treatment of painful hip. The purpose of this retrospective study was to analyze the effectiveness and benefit of arthroscopic treatment for patients with a painful hip after major trauma. From July 2003 to February 2013, we reviewed 13 patients who underwent arthroscopic treatment after acetabular fracture or hip dislocation and were followed up for a minimum of 2 postoperative years. The degree of osteoarthritis based on the Tonnis classification pre- and postoperatively at final follow-up was determined. Clinical outcomes were evaluated using visual analogue scale for pain (VAS) and modified Harris hip score (MHHS), and range of motion (ROM) of the hip pre- and postoperatively at final follow-up. There were nine male and four female patients with a mean age at surgery of 28 years (range, 20 to 50 years). The mean follow-up period of the patients was 59.8 months (range, 24 to 115 months), and the mean interval between initial trauma and arthroscopic treatment was 40.8 months (range, 1 to 144 months). At the final follow-up, VAS and MHHS improved significantly from 6.3 and 53.4 to 3.0 and 88.3, respectively (p = 0.002 and p < 0.001, respectively). However, there were no significant differences in hip flexion, abduction, adduction, external rotation, and internal rotation as minor improvements from 113.1°, 38.5°, 28.5°, 36.5°, and 22.7° to 118.5°, 39.0°, 29.2°, 38.9°, and 26.5° were observed, respectively (p = 0.070, p = 0.414, p = 0.317, p = 0.084, and p = 0.136, respectively). None of the patients exhibited progression of osteoarthritis of the hip at the final follow-up. Arthroscopic treatment after acetabular fracture or hip dislocation is effective and delays the progression of traumatic

  19. [Correlation analysis between residual displacement and hip function after reconstruction of acetabular fractures].

    PubMed

    Ma, Kunlong; Fang, Yue; Luan, Fujun; Tu, Chongqi; Yang, Tianfu

    2012-03-01

    To investigate the relationships between residual displacement of weight-bearing and non weight-bearing zones (gap displacement and step displacement) and hip function by analyzing the CT images after reconstruction of acetabular fractures. The CT measures and clinical outcome were retrospectively analyzed from 48 patients with displaced acetabular fracture between June 2004 and June 2009. All patients were treated by open reduction and internal fixation, and were followed up 24 to 72 months (mean, 36 months); all fractures healed after operation. The residual displacement involved the weight-bearing zone in 30 cases (weight-bearing group), and involved the non weight-bearing zone in 18 cases (non weight-bearing group). The clinical outcomes were evaluated by Merle d'Aubigné-Postel criteria, and the reduction of articular surface by CT images, including the maximums of two indexes (gap displacement and step displacement). All the data were analyzed in accordance with the Spearman rank correlation coefficient analysis. There was strong negative correlation between the hip function and the residual displacement values in weight-bearing group (r(s) = -0.722, P = 0.001). But there was no correlation between the hip function and the residual displacement values in non weight-bearing group (r(s) = 0.481, P = 0.059). The results of clinical follow-up were similar to the correlation analysis results. In weight-bearing group, the hip function had strong negative correlation with step displacement (r(s) = 0.825, P = 0.002), but it had no correlation with gap displacement (r(s) = 0.577, P = 0.134). In patients with acetabular fracture, the hip function has correlation not only with the extent of the residual displacement but also with the location of the residual displacement, so the residual displacement of weight-bearing zone is a key factor to affect the hip function. In patients with residual displacement in weight-bearing zone, the bigger the step displacement is, the

  20. Should money follow the patient: Financial implication for being the National Centre for the Treatment and Management of Pelvic and Acetabular Fractures in Ireland.

    PubMed

    Kelly, M E; Leonard, M; Green, C; Beggs, R; Cheung, C; McElwain, J; Morris, S

    2013-12-01

    Pelvic and acetabular fractures are complex injuries requiring specialist treatment. Our institution is the National Centre for Treatment and Management of these injuries. To audit all referrals to our institution over a 6-month period and calculate the cost incurred by being the national referral centre. Retrospective review of database, and subsequent allocation of Casemix points to assess total cost of treatment for each patient referred to our institution. 103 patients referred with pelvic or acetabular fracture for operative management. The furthest referral distance was 181miles. Over-all, the length of stay was 15.4 days. The average inclusive cost for a referral to our unit for operative management was €16,302. Pelvic and acetabular fractures are complex injuries that require specialist referral unit management. However for these units to remain sustainable money needs to "follow the patient". Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

  1. Effects of Titanium Mesh Surfaces-Coated with Hydroxyapatite/β-Tricalcium Phosphate Nanotubes on Acetabular Bone Defects in Rabbits

    PubMed Central

    Nguyen, Thuy-Duong Thi; Bae, Tae-Sung; Yang, Dae-hyeok; Park, Myung-sik; Yoon, Sun-jung

    2017-01-01

    The management of severe acetabular bone defects in revision reconstructive orthopedic surgery is challenging. In this study, cyclic precalcification (CP) treatment was used on both nanotube-surface Ti-mesh and a bone graft substitute for the acetabular defect model, and its effects were assessed in vitro and in vivo. Nanotube-Ti mesh coated with hydroxyapatite/β-tricalcium phosphate (HA/β-TCP) was manufactured by an anodizing and a sintering method, respectively. An 8 mm diameter defect was created on each acetabulum of eight rabbits, then treated by grafting materials and covered by Ti meshes. At four and eight weeks, postoperatively, biopsies were performed for histomorphometric analyses. The newly-formed bone layers under cyclic precalcified anodized Ti (CP-AT) meshes were superior with regard to the mineralized area at both four and eight weeks, as compared with that under untreated Ti meshes. Active bone regeneration at 2–4 weeks was stronger than at 6–8 weeks, particularly with treated biphasic ceramic (p < 0.05). CP improved the bioactivity of Ti meshes and biphasic grafting materials. Moreover, the precalcified nanotubular Ti meshes could enhance early contact bone formation on the mesh and, therefore, may reduce the collapse of Ti meshes into the defect, increasing the sufficiency of acetabular reconstruction. Finally, cyclic precalcification did not affect bone regeneration by biphasic grafting materials in vivo. PMID:28686210

  2. MR imaging of the traumatic triangular fibrocartilaginous complex tear

    PubMed Central

    Griffith, James F.; Fung, Cindy S. Y.; Lee, Ryan K. L.; Tong, Cina S. L.; Wong, Clara W. Y.; Tse, Wing Lim; Ho, Pak Cheong

    2017-01-01

    Triangular fibrocartilage complex is a major stabilizer of the distal radioulnar joint (DRUJ). However, triangular fibrocartilage complex (TFCC) tear is difficult to be diagnosed on MRI for its intrinsic small and thin structure with complex anatomy. The purpose of this article is to review the anatomy of TFCC, state of art MRI imaging technique, normal appearance and features of tear on MRI according to the Palmar’s classification. Atypical tear and limitations of MRI in diagnosis of TFCC tear are also discussed. PMID:28932701

  3. What Safe Zone? The Vast Majority of Dislocated THAs Are Within the Lewinnek Safe Zone for Acetabular Component Position.

    PubMed

    Abdel, Matthew P; von Roth, Philipp; Jennings, Matthew T; Hanssen, Arlen D; Pagnano, Mark W

    2016-02-01

    Numerous factors influence total hip arthroplasty (THA) stability including surgical approach and soft tissue tension, patient compliance, and component position. One long-held tenet regarding component position is that cup inclination and anteversion of 40° ± 10° and 15° ± 10°, respectively, represent a "safe zone" as defined by Lewinnek that minimizes dislocation after primary THA; however, it is clear that components positioned in this zone can and do dislocate. We sought to determine if these classic radiographic targets for cup inclination and anteversion accurately predicted a safe zone limiting dislocation in a contemporary THA practice. From a cohort of 9784 primary THAs performed between 2003 and 2012 at one institution, we retrospectively identified 206 THAs (2%) that subsequently dislocated. Radiographic parameters including inclination, anteversion, center of rotation, and limb length discrepancy were analyzed. Mean followup was 27 months (range, 0-133 months). The majority (58% [120 of 206]) of dislocated THAs had a socket within the Lewinnek safe zone. Mean cup inclination was 44° ± 8° with 84% within the safe zone for inclination. Mean anteversion was 15° ± 9° with 69% within the safe zone for anteversion. Sixty-five percent of dislocated THAs that were performed through a posterior approach had an acetabular component within the combined acetabular safe zones, whereas this was true for only 33% performed through an anterolateral approach. An acetabular component performed through a posterior approach was three times as likely to be within the combined acetabular safe zones (odds ratio [OR], 1.3; 95% confidence interval [CI], 1.1-1.6) than after an anterolateral approach (OR, 0.4; 95% CI, 0.2-0.7; p < 0.0001). In contrast, acetabular components performed through a posterior approach (OR, 1.6; 95% CI, 1.2-1.9) had an increased risk of dislocation compared with those performed through an anterolateral approach (OR, 0.8; 95% CI, 0.7-0.9; p

  4. Ocular Pharmacology of Tear Film, Dry Eye, and Allergic Conjunctivitis.

    PubMed

    Gulati, Shilpa; Jain, Sandeep

    2017-01-01

    Dry Eye Disease (DED) is "a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear-film instability with potential damage to the ocular surface." DED comprises two etiologic categories: aqueous-deficient dry eye (ADDE) and evaporative dry eye (EDE). Diagnostic workup of DED should include clinical history, symptom questionnaire, fluorescein TBUT, ocular surface staining grading, Schirmer I/II, lid and meibomian pathology, meibomian expression, followed by other available tests. New diagnostic tests employ the Oculus Keratograph, which performs non-invasive tear-film analysis and a bulbar redness (BR). The TearLab Osmolarity Test enables rapid clinical evaluation of tear osmolarity. Lipiview is a recently developed diagnostic tool that uses interferometry to quantitatively evaluate tear-film thickness. In DED, epithelial and inflammatory cells produce a variety of inflammatory mediators. A stagnant tear film and decreased concentration of mucin result in the accumulation of inflammatory factors that can penetrate tight junctions and cause epithelial cell death. DED treatment algorithms are based on severity of clinical signs and symptoms, and disease etiology. Therapeutic approaches include lubricating artificial tears and immunomodulatory agents.

  5. [The peroxidase content of human tears].

    PubMed

    Buchberger, W; Rieger, G

    1989-01-01

    The peroxidase-(POD)-thiocyanate-hydrogenperoxide-system is a well-known antibacterial system, which has been demonstrated to exist, for example, in milk and saliva. Earlier investigations by van Haeringen et al. established a POD level in human tears of 10(3) units/l, yet the thiocyanate concentration was only about 0.2 mmol/l. Therefore van Haeringen et al. excluded the existence of a POD-thiocyanate-hydrogenperoxide antibacterial system in human tears because of the insufficient amount of thiocyanate in the tears examined. Instead of thiocyanate halides such as J- can also complete the POD hydrogen peroxide system as electron donors. Sufficient amounts of iodide can be expected after the application of iodine-containing eye drops or after local treatment with iodine-containing brine, as done in Bad Hall in Austria. Therefore, the above mentioned antibacterial system may be of importance if the POD-level is high enough (greater than 250 units/l). We investigated 22 tear samples from healthy persons: the POD levels were below 20 units/l in 19 cases; in 3 cases the POD concentration was found to be between 20 and 50 units/l. Therefore, in normal human tear fluid, not only the amount of thiocyanate but also the concentration of POD is too low for effective antimicrobial activity of the peroxidase-thiocyanate-hydrogenperoxide system. It is so far not known whether this system is effective under pathological conditions.

  6. Asymptomatic rotator cuff tears: Patient demographics and baseline shoulder function

    PubMed Central

    Keener, Jay D.; Steger-May, Karen; Stobbs, Georgia; Yamaguchi, Ken

    2010-01-01

    Background The purpose of this study is to characterize the demographic features and physical function of subjects with asymptomatic rotator cuff tears and to compare their shoulder function to controls with an intact rotator cuff. Materials and Methods 196 subjects with an asymptomatic rotator cuff tear and 54 subjects with an intact rotator cuff presenting with a painful rotator cuff tear in the contralateral shoulder were enrolled. Various demographic features, shoulder function (ASES score and SST score), range of motion and strength were compared. Results The demographic features of the study and control groups were similar. Hand dominance was associated with the presence of shoulder pain (p < .05). Subjects with an intact rotator cuff had greater but clinically insignificant ASES (p < .05) and SST scores (p < .05) than those with an asymptomatic tear. No differences in functional scores, range of motion or strength were seen between partial (n=61) and full-thickness tears (n=135). Of the full-thickness tears, 36 (27%) were classified as small, 85 (63%) as medium and 14 (10%) as large tears. No differences were seen in functional scores between full-thickness tears of various sizes. Conclusions When asymptomatic, a rotator cuff tear is associated with a clinically insignificant loss of shoulder function compared to those with an intact rotator cuff. Therefore, a clinically detectable decline in shoulder function may indicate an “at-risk” asymptomatic tear. The presence of pain is important in cuff deficient shoulders for creating a measurable loss of shoulder function. Hand dominance appears to be an important risk factor for pain. PMID:21030274

  7. Cemental tear: To know what we have neglected in dental practice.

    PubMed

    Jeng, Po-Yuan; Luzi, Arlinda Luzi; Pitarch, Rocio Marco; Chang, Mei-Chi; Wu, Yu-Hsueh; Jeng, Jiiang-Huei

    2018-04-01

    Cemental tear is a special kind of root surface fracture, contributing to periodontal and periapical breakdown. However, it is a challenge for doctors to diagnose, resulting in delayed or improper treatment. We reviewed the predisposing factors, location, radiographic/clinical characteristics, diagnosis and treatments of cemental tears. From the literature, patients with cemental tear were mainly males, over 60 year-old. Possible predisposing factors include gender, age, tooth type, traumatic occlusal force and vital teeth. Cemental tears were common in upper and lower anterior teeth, single or multiple, and can be present in cervical, middle and apical third of roots. Morphology of cemental tears can be either piece-shaped or U-shaped. Clinically, cemental tear shows a unitary periodontal pocket and signs/symptoms mimicking localized periodontitis, apical periodontitis and vertical root fractures. Treatment of cemental tears include scaling, root planning, root canal treatment, periodontal/periapical surgery, guided tissue regeneration, bone grafting, and intentional replantation. Recurrence of cemental tear is possible especially when the fracture involves root apex. Extraction is recommended for teeth with poor prognosis. In conclusion, cemental tears can involve both periodontal and periapical area. Dentists should understand the predisposing factors and clinical features of cemental tears for early diagnosis/treatment to prevent bone loss/tooth extraction. Copyright © 2017. Published by Elsevier B.V.

  8. Isotretinoin in lacrimal gland fluid and tears.

    PubMed

    Rismondo, V; Ubels, J L

    1987-03-01

    Isotretinoin (13-cis-retinoic acid) is used in the treatment of severe cystic acne. Adverse ocular reactions, including blepharoconjunctivitis and dry eye symptoms, are frequent side effects of this drug. Our previous observation that retinol is present in tears and lacrimal gland fluid suggests that isotretinoin may also be secreted by the lacrimal gland. Rabbits were treated with isotretinoin, and lacrimal gland fluid was collected from the cannulated lacrimal gland duct. Tears were collected from patients who were being treated with isotretinoin. Lacrimal gland fluid and tears were analyzed by reverse-phase high-pressure liquid chromatography and a peak eluted from each sample, which was identified as isotretinoin. We conclude that the lacrimal gland is able to secrete isotretinoin in addition to retinol and that, in animals and patients treated systemically with isotretinoin, the ocular surface is exposed to the drug via the tear film.

  9. Comparison of camel tear proteins between summer and winter

    PubMed Central

    Chen, Ziyan; Shamsi, Farrukh A.; Li, Kaijun; Huang, Qiang; Al-Rajhi, Ali A.; Chaudhry, Imtiaz A.

    2011-01-01

    Purpose Proteins in the tear fluid have positive effects on maintaining the integrity and stabilization of the tear film, which is affected by several environmental factors. The aim of this study is to investigate seasonal variation of protein patterns in camel tears collected during the summer and winter season. Methods Tears from both eyes of 50 clinically normal camels (Camelus dromedarius) were collected in the summer (June – July) and in the winter (December – January) respectively. Pooled tear protein samples from two seasons were separated by SDS–PAGE and two-dimensional electrophoresis (2-DE). Protein spots of differential expression in two season gels were excised and subjected to in-gel digestion and identification by matrix assisted laser desorption/ionization-time of flight/time of flight-mass spectrum (MALDI-TOF/TOF-MS) analysis. Two differentially expressed proteins, lactoferrin (LF) and vitelline membrane outer layer protein 1 homolog (VMO1 homolog), were validated by western blotting. Results Thirteen well resolved bands were detected in SDS–PAGE gels of both summer and winter camel tears. By band densitometry, significantly higher intensities of band 6, 7, 11, and lower intensity of band 13 were observed in the summer group compared to the winter group. In 2-DE profiles of camel tears, four protein spots were found expressed differentially in two seasons. Further protein identification by MALDI-TOF/TOF-MS and confirmation by western blotting indicated that there was a significant decrease in LF (p=0.002) and an increase in VMO1 homolog (p=0.042) in tears in the summer compared to the winter. Conclusions The seasonal variation of camel tear fluids has been found in the composition of proteins, including LF and VMO1 homolog. This result will expand our knowledge of physiologic characteristics of tear fluids and establish a foundation for the mechanistic studies and clinical practices on ocular surface disorders. PMID:21293736

  10. Does a critical rotator cuff tear stage exist?: a biomechanical study of rotator cuff tear progression in human cadaver shoulders.

    PubMed

    Oh, Joo Han; Jun, Bong Jae; McGarry, Michelle H; Lee, Thay Q

    2011-11-16

    It is unknown at which stage of rotator cuff tear the biomechanical environment is altered. The purpose of this study was to determine if a critical rotator cuff tear stage exists that alters glenohumeral joint biomechanics throughout the rotational range of shoulder motion, and to evaluate the biomechanical effect of parascapular muscle-loading. Eight cadaver shoulders were used with a custom testing system. Four progressive rotator cuff tear stages were investigated on the basis of footprint anatomy. Three muscle-loading conditions were examined: rotator cuff only; rotator cuff with deltoid muscle; and rotator cuff, deltoid, pectoralis major, and latissimus dorsi muscles. Testing was performed in the scapular plane with 0°, 30°, and 60° of shoulder abduction. The maximum internal and external rotations were measured with 3.4 Nm of torque. The position of the humeral head apex with respect to the glenoid was calculated with use of a MicroScribe 3DLX digitizing system throughout the rotational range of motion. The abduction capability was determined as the abduction angle achieved with increasing deltoid load. Tear of the entire supraspinatus tendon significantly increased maximum external rotation and significantly decreased abduction capability with higher deltoid loads (p < 0.05). Tear of the entire supraspinatus tendon and half of the infraspinatus tendon significantly shifted the humeral head apex posteriorly at the midrange of rotation and superiorly at maximum internal rotation (p < 0.05). Loading the pectoralis major and latissimus dorsi muscles decreased the amount of humeral head elevation due to deltoid loading. Tear of the entire supraspinatus tendon was the critical stage for increasing rotational range of shoulder motion and for decreased abduction capability. Further tear progression to the infraspinatus muscle was the critical stage for significant changes in humeral head kinematics. The pectoralis major and latissimus dorsi muscles played an

  11. Posterior root tear of the medial and lateral meniscus.

    PubMed

    Petersen, Wolf; Forkel, Philipp; Feucht, Matthias J; Zantop, Thore; Imhoff, Andreas B; Brucker, Peter U

    2014-02-01

    An avulsion of the tibial insertion of the meniscus or a radial tear close to the meniscal insertion is defined as a root tear. In clinical practice, the incidence of these lesions is often underestimated. However, several biomechanical studies have shown that the effect of a root tear is comparable to a total meniscectomy. Clinical studies documented progredient arthritic changes following root tears, thereby supporting basic science studies. The clinical diagnosis is limited by unspecific symptoms. In addition to the diagnostic arthroscopy, MRI is considered to be the gold standard of diagnosis of a meniscal root tear. Three different direct MRI signs for the diagnosis of a meniscus root tear have been described: Radial linear defect in the axial plane, vertical linear defect (truncation sign) in the coronal plane, and the so-called ghost meniscus sign in the sagittal plane. Meniscal extrusion is also considered to be an indirect sign of a root tear, but is less common in lateral root tears. During arthroscopy, the function of the meniscus root must be assessed by probing. However, visualization of the meniscal insertions is challenging. Refixation of the meniscal root can be performed using a transtibial pull-out suture, suture anchors, or side-to-side repair. Several short-term studies reported good clinical results after medial or lateral root repair. Nevertheless, MRI and second-look arthroscopy revealed high rates of incomplete or absent healing, especially for medial root tears. To date, most studies are case series with short-term follow-up and level IV evidence. Outerbridge grade 3 or 4 chondral lesions and varus malalignment of >5° were found to predict an inferior clinical outcome after medial meniscus root repair. Further research is needed to evaluate long-term results and to define evident criteria for meniscal root repair.

  12. Rotator cuff tears: An evidence based approach

    PubMed Central

    Sambandam, Senthil Nathan; Khanna, Vishesh; Gul, Arif; Mounasamy, Varatharaj

    2015-01-01

    Lesions of the rotator cuff (RC) are a common occurrence affecting millions of people across all parts of the globe. RC tears are also rampantly prevalent with an age-dependent increase in numbers. Other associated factors include a history of trauma, limb dominance, contralateral shoulder, smoking-status, hypercholesterolemia, posture and occupational dispositions. The challenge lies in early diagnosis since a high proportion of patients are asymptomatic. Pain and decreasing shoulder power and function should alert the heedful practitioner in recognizing promptly the onset or aggravation of existing RC tears. Partial-thickness tears (PTT) can be bursal-sided or articular-sided tears. Over the course of time, PTT enlarge and propagate into full-thickness tears (FTT) and develop distinct chronic pathological changes due to muscle retraction, fatty infiltration and muscle atrophy. These lead to a reduction in tendon elasticity and viability. Eventually, the glenohumeral joint experiences a series of degenerative alterations - cuff tear arthropathy. To avert this, a vigilant clinician must utilize and corroborate clinical skill and radiological findings to identify tear progression. Modern radio-diagnostic means of ultrasonography and magnetic resonance imaging provide excellent visualization of structural details and are crucial in determining further course of action for these patients. Physical therapy along with activity modifications, anti-inflammatory and analgesic medications form the pillars of nonoperative treatment. Elderly patients with minimal functional demands can be managed conservatively and reassessed at frequent intervals. Regular monitoring helps in isolating patients who require surgical interventions. Early surgery should be considered in younger, active and symptomatic, healthy patients. In addition to being cost-effective, this helps in providing a functional shoulder with a stable cuff. An easily reproducible technique of maximal strength and

  13. Measurement of Tear Production in English Angora and Dutch Rabbits

    PubMed Central

    Rajaei, Seyed Mehdi; Rafiee, Siamak Mashhady; Ghaffari, Masoud Selk; Masouleh, Mohammad N; Jamshidian, Mahmoud

    2016-01-01

    The purpose of this study was to establish normal values for tear production tests in different breeds of domestic rabbits. Healthy adult rabbits (n = 60; 120 eyes) of 2 different breeds (English angora and Dutch; n = 15 of each sex and breed) were used in this study. Tear production was measured by using the 1-min Schirmer tear test (STT), phenol red thread test (PRTT), and endodontic absorbent paper point tear test (EAPTT). In addition, horizontal palpebral fissure length was evaluated as a measure of ocular adnexal dimensions. Tear production (mean ± 1 SD) in English angora rabbits was 5.4 ± 1.6 mm/min according to the STT, 25.0 ± 2.7 mm in 15 s for the PRTT, and 18.8 ± 2.1 mm/min by the EAPTT; in Dutch rabbits, these values were 4.6 ± 1.2 mm/min, 23.6 ± 2.3 mm in 15 s, and 16.9 ± 1.7 mm/min, respectively. Only the EAPTT revealed a significant difference in tear production between English Angora and Dutch rabbits. These results provide reference values for tear production in English Angora and Dutch rabbits according to 3 different quantitative tear film assessment methods. PMID:27025815

  14. Tear Film Dynamics: the roles of complex structure and rheology

    NASA Astrophysics Data System (ADS)

    Dey, Mohar; Feng, James; Vivek, Atul S.; Dixit, Harish N.; Richhariya, Ashutosh

    2016-11-01

    Ocular surface infections such as microbial and fungal keratitis are among leading causes of blindness in the world. A thorough understanding of the pre-corneal tear film dynamics is essential to comprehend the role of various tear layer components in the escalation of such ocular infections. The pre-corneal tear film comprises of three layers of complex fluids, viz. the innermost mucin layer, a hydrophilic protective cover over the sensitive corneal epithelium, the intermediate aqueous layer that forms the bulk of the tear film and is often embedded with large number of bio-polymers either in the form of soluble mucins or pathogens, and finally the outermost lipid layer that stabilizes the film by decreasing the air/tear film interfacial tension. We have developed a comprehensive mathematical model to describe such a film by incorporating the effects of the non-uniform mucin distribution along with the complex rheology of the aqueous layer with/without pathogens, Marangoni effects from the lipid layer and the slip effects at the base of the tear film. A detailed linear stability analysis and a fully non-linear solution determine the break up time (BUT) of such a tear film. We also probe the role of the various components of the pre-corneal tear film in the dynamics of rupture.

  15. Advanced Rotator Cuff Tear Score (ARoCuS): a multi-scaled tool for the classification and description of rotator cuff tears.

    PubMed

    Walter, S G; Stadler, T; Thomas, T S; Thomas, W

    2018-03-02

    To introduce a (semi-)quantitative surgical score for the classification of rotator cuff tears. A total of 146 consecutive patients underwent rotator cuff repair and were assessed using the previously defined Advanced Rotator Cuff Tear Score (ARoCuS) criteria: muscle tendon, size, tissue quality, pattern as well as mobilization of the tear. The data set was split into a training (125 patients) and a testing set (21 patients). The training data set fitted a nonlinear predictive model of the tear score based on the ARoCuS criteria, while the testing data served as control. Based on the scoring results, rotator cuff tears were assigned to one of four categories (ΔV I-IV) and received a stage-adapted treatment. For statistical analysis, mean values ± standard deviation, interclass correlation coefficients (ICC) and kappa values were calculated. Overall, 32 patients were classified as ΔV I, 68 as ΔV II and 37 as ΔV III. Nine patients showed ΔV IV tears. Patients of all ΔV groups improved significantly their Constant scores (p < 0.001) and profited from significant pain reduction after surgery (p < 0.001). To date, ten patients have undergone revision surgery with five of them primarily classified as ΔV IV. Kappa values for the interobserver reliability ranged between 0.69 and 0.95. ICC scores for the ΔV category were 0.95 for interobserver reliability. The ARoCuS facilitates intra-operative decision-making and enables surgeons and researches to document rotator cuff tears in a standardized and reproducible manner.

  16. Basic considerations for determining the amount of press fit in acetabular cup endoprostheses as a function of the elastic bone behavior.

    PubMed

    Winter, Werner; Karl, Matthias

    2014-10-01

    Acetabular cup endoprostheses are frequently placed in pelvic bone, employing the mechanical principle of press fit. While a sufficiently stable bone-implant connection is desirable, deformation of the cup and fracture of the pelvis should be avoided. The goal of this work is to demonstrate the importance of the elastic properties of bone on the amount of press fit achievable in a specific situation. On the basis of previous work describing the relation between relative bone mineral density and relative elastic modulus for cortical and trabecular bone, mechanical equations were used for analyzing the press-fit loading situation of an acetabular cup. Additionally, a two-dimensional finite element model was used for visualizing the stress and strain situation in the host bone occurring as a consequence of implant insertion, as well as the effect of moment loads acting on the acetabular cup. Given the fact that oversizing the implant for a specific recipient site is the only clinical means of optimizing press fit, knowledge of the elastic properties of the host bone before implant selection would be beneficial. Such information could, for instance, be derived from intraoperative compressive testing of the host bone.

  17. Interferometric measurements of the tear film irregularities on the human cornea

    NASA Astrophysics Data System (ADS)

    Szczesna, Dorota H.; Jaronski, Jaroslaw; Kasprzak, Henryk T.; Stenevi, Ulf

    2005-09-01

    The pre-ocular tear film is the most anterior refractive surface of the eye. Its stability plays an important role in the condition of vision from the optical and physiological point of view. If the eye is opened for a significantly long time or suffers from an anormalities in tear production, there appear isolated dry islands - break-ups - with a random distribution in the continuous lacrimal film. We applied an interferometric method - Lateral Shearing Technique for investigating the tear film stability and the smoothness of the tear film surface. This method is non-invasive and it is characterised by the high accuracy and sensitivity. Interferometry allows dynamic measurements of the tear film stability in real time by observation of interference fringes. The evaporation of tears and appearance of the breakups causes changes in the fringe geometry. Fast Fourier Transform has been used for quantitative assessment of the fringe smoothness and as a consequence of the tear film surface geometry. This paper presents the method used for quantitative evaluation of the tear film distribution on the cornea. Examples of interferograms recorded on eyes of patients with healthy eyes, suffering from dry eye syndrome and wearing contact lenses are also given. With our technique we were able to observe distinct differences in stability of the tear film between healthy and dry eyes, and the tear film on contact lenses.

  18. Diagnostic accuracy of 3T conventional shoulder MRI in the detection of the long head of the biceps tendon tears associated with rotator cuff tendon tears.

    PubMed

    Lee, Ro Woon; Choi, Soo-Jung; Lee, Man Ho; Ahn, Jae Hong; Shin, Dong Rock; Kang, Chae Hoon; Lee, Ki Won

    2016-12-01

    To evaluate the diagnostic performance (DP) of 3T (3 Tesla field strength) conventional shoulder magnetic resonance imaging (MRI) in detecting the long head of the biceps tendon (LHBT) tears in association with rotator cuff tendon tears. This study included 80 consecutive patients who underwent arthroscopic surgery for rotator cuff tendon tears. Two radiologists independently evaluated the preoperative 3T shoulder MRI for the presence of LHBT tears. The DP of MRI was evaluated using the results of arthroscopy as the reference standard. We also evaluated the DP of several MR signs of LHBT in detection of partial LHBT tears. Arthroscopic examination revealed 35 partial and 5 complete tears. According to the results of evaluation by reviewers 1 and 2, shoulder MRI exhibited sensitivities of 77.14 and 80 % and specificities of 71.11 and 73.33 % in detection of partial LHBT tears and sensitivities of 80 and 100 % and a specificity of 100% (both) in detection of complete LHBT tears. In detecting partial LHBT tears, increased T2 signal intensity of the LHBT exhibited high sensitivities (reviewers 1 and 2; 82.85 and 80 %, respectively) and the presence of intratendinous defects or C-signs exhibited the highest specificities (reviewers 1 and 2; 95.55 and 93.33 %, respectively), followed by abnormalities in shape and outer margins of the LHBT (reviewers 1 and 2; 91.11 and 82 %; 91.11 and 86.66 %, respectively). Non-contrast-enhanced 3T shoulder MRI is potentially highly accurate in detection of complete LHBT tears, but moderately accurate in detection of partial LHBT tears.

  19. Influence of toroidal rotation on tearing modes

    NASA Astrophysics Data System (ADS)

    Cai, Huishan; Cao, Jintao; Li, Ding

    2017-10-01

    Tearing modes stability analysis including toroidal rotation is studied. It is found that rotation affects the stability of tearing modes mainly through the interaction with resistive inner region of tearing mode. The coupling of magnetic curvature with centrifugal force and Coriolis force provides a perturbed perpendicular current, and a return parallel current is induced to affect the stability of tearing modes. Toroidal rotation plays a stable role, which depends on the magnitude of Mach number and adiabatic index Γ, and is independent on the direction of toroidal rotation. For Γ >1, the scaling of growth rate is changed for typical Mach number in present tokamaks. For Γ = 1 , the scaling keeps unchanged, and the effect of toroidal rotation is much less significant, compared with that for Γ >1. National Magnetic Confinement Fusion Science Program and National Science Foundation of China under Grants No. 2014GB106004, No. 2013GB111000, No. 11375189, No. 11075161 and No. 11275260, and Youth Innovation Promotion Association CAS.

  20. Tearing relaxation and the globalization of transport in field-reversed configurations

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Steinhauer, Loren; Barnes, D. C.

    2009-09-15

    Tearing instability of field-reversed configurations (FRC) is investigated using the method of neighboring equilibria. It is shown that the conducting wall position in experiment lies very close to the location needed for tearing stability. This strongly suggests that vigorous but benign tearing modes, acting globally, are the engine of continual self-organization in FRCs, i.e., tearing relaxation. It also explains the ''profile consistency'' and anomalous loss rate of magnetic flux. In effect, tearing globalizes the effect of edge-driven transport.

  1. On tear film breakup (TBU): dynamics and imaging.

    PubMed

    Braun, Richard J; Driscoll, Tobin A; Begley, Carolyn G; King-Smith, P Ewen; Siddique, Javed I

    2018-06-13

    We report the results of some recent experiments to visualize tear film dynamics. We then study a mathematical model for tear film thinning and tear film breakup (TBU), a term from the ocular surface literature. The thinning is driven by an imposed tear film thinning rate which is input from in vivo measurements. Solutes representing osmolarity and fluorescein are included in the model. Osmolarity causes osmosis from the model ocular surface, and the fluorescein is used to compute the intensity corresponding closely to in vivo observations. The imposed thinning can be either one-dimensional or axisymmetric, leading to streaks or spots of TBU, respectively. For a spatially-uniform (flat) film, osmosis would cease thinning and balance mass lost due to evaporation; for these space-dependent evaporation profiles TBU does occur because osmolarity diffuses out of the TBU into the surrounding tear film, in agreement with previous results. The intensity pattern predicted based on the fluorescein concentration is compared with the computed thickness profiles; this comparison is important for interpreting in vivo observations. The non-dimensionalization introduced leads to insight about the relative importance of the competing processes; it leads to a classification of large vs small TBU regions in which different physical effects are dominant. Many regions of TBU may be considered small, revealing that the flow inside the film has an appreciable influence on fluorescence imaging of the tear film.

  2. 21 CFR 888.3320 - Hip joint metal/metal semi-constrained, with a cemented acetabular component, prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Hip joint metal/metal semi-constrained, with a cemented acetabular component, prosthesis. 888.3320 Section 888.3320 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic...

  3. 21 CFR 888.3320 - Hip joint metal/metal semi-constrained, with a cemented acetabular component, prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Hip joint metal/metal semi-constrained, with a cemented acetabular component, prosthesis. 888.3320 Section 888.3320 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic...

  4. 21 CFR 888.3320 - Hip joint metal/metal semi-constrained, with a cemented acetabular component, prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Hip joint metal/metal semi-constrained, with a cemented acetabular component, prosthesis. 888.3320 Section 888.3320 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic...

  5. Predicting Rotator Cuff Tears Using Data Mining and Bayesian Likelihood Ratios

    PubMed Central

    Lu, Hsueh-Yi; Huang, Chen-Yuan; Su, Chwen-Tzeng; Lin, Chen-Chiang

    2014-01-01

    Objectives Rotator cuff tear is a common cause of shoulder diseases. Correct diagnosis of rotator cuff tears can save patients from further invasive, costly and painful tests. This study used predictive data mining and Bayesian theory to improve the accuracy of diagnosing rotator cuff tears by clinical examination alone. Methods In this retrospective study, 169 patients who had a preliminary diagnosis of rotator cuff tear on the basis of clinical evaluation followed by confirmatory MRI between 2007 and 2011 were identified. MRI was used as a reference standard to classify rotator cuff tears. The predictor variable was the clinical assessment results, which consisted of 16 attributes. This study employed 2 data mining methods (ANN and the decision tree) and a statistical method (logistic regression) to classify the rotator cuff diagnosis into “tear” and “no tear” groups. Likelihood ratio and Bayesian theory were applied to estimate the probability of rotator cuff tears based on the results of the prediction models. Results Our proposed data mining procedures outperformed the classic statistical method. The correction rate, sensitivity, specificity and area under the ROC curve of predicting a rotator cuff tear were statistical better in the ANN and decision tree models compared to logistic regression. Based on likelihood ratios derived from our prediction models, Fagan's nomogram could be constructed to assess the probability of a patient who has a rotator cuff tear using a pretest probability and a prediction result (tear or no tear). Conclusions Our predictive data mining models, combined with likelihood ratios and Bayesian theory, appear to be good tools to classify rotator cuff tears as well as determine the probability of the presence of the disease to enhance diagnostic decision making for rotator cuff tears. PMID:24733553

  6. Biocompatibility of Bespoke 3D-Printed Titanium Alloy Plates for Treating Acetabular Fractures

    PubMed Central

    Xiao, Xingling; Wang, Yimeng; Gu, Cheng; Wang, Canbin; Chen, Jiahui; Liu, Han; Luo, Juan; Li, Tao

    2018-01-01

    Treatment of acetabular fractures is challenging, not only because of its complicated anatomy but also because of the lack of fitting plates. Personalized titanium alloy plates can be fabricated by selective laser melting (SLM) but the biocompatibility of these three-dimensional printing (3D-printed) plates remains unknown. Plates were manufactured by SLM and their cytocompatibility was assessed by observing the metabolism of L929 fibroblasts incubated with culture medium extracts using a CCK-8 assay and their morphology by light microscopy. Allergenicity was tested using a guinea pig maximization test. In addition, acute systemic toxicity of the 3D-printed plates was determined by injecting extracts from the implants into the tail veins of mice. Finally, the histocompatibility of the plates was investigated by implanting them into the dorsal muscles of rabbits. The in vitro results suggested that cytocompatibility of the 3D-printed plates was similar to that of conventional plates. The in vivo data also demonstrated histocompatibility that was comparable between the two manufacturing techniques. In conclusion, both in vivo and in vitro experiments suggested favorable biocompatibility of 3D-printed titanium alloy plates, indicating that it is a promising option for treatment of acetabular fractures. PMID:29682523

  7. Investigation of Tear Biomarkers as an Indicator of Human Health

    NASA Technical Reports Server (NTRS)

    Morton, Stephen; Tucker, Bethany; Crucian, Brian; Steinberg, Susan; Hagan, Suzanne

    2017-01-01

    Scientific literature suggests that tear biomarkers can be used as a guide towards clinical diagnosis of human health (Hagan et al., 2016). This study will investigate whether tear biomarkers represents a research and clinical opportunity to assess human health prior to, during, and after exposure to the spaceflight environment. The focus of this study is to compare biomarkers previously identified as potentially relevant to both ocular and brain health against unique physiological outcomes of exposure to the space flight environment. Study subjects suffering from terrestrial conditions thought to be similar to Spaceflight Associated Neuro-ocular Syndrome (SANS: formerly VIIP), e.g. patients with idiopathic intracranial hypertension (IIH) and optic neuritis may be relevant to conditions associated with spaceflight. This study will review methodologies, tear biomarkers related to state of ocular and brain health, the strengths and weakness of using tear fluid biomarkers versus other body fluid samples, and will survey current tear fluid biomarker knowledge in research and clinical practice. A strength of using tear biomarkers is that sampling is non-invasive and used as a guide in understanding pathologies, including ocular and systemic inflammatory conditions (Cocho et al., 2016)., Salvisberg et al., 2014). Moreover, tear biomarkers may reflect diseases affecting the central nervous system (CNS) (Salvisberg et al., 2014). For example, in multiple sclerosis (MS), the concordance rate between tear biomarkers versus cerebrospinal fluid (CSF) is approximately 83%, indicating that, in the majority of cases, tears are at least as effective as CSF in potentially identifying novel MS biomarkers (Devos et al., 2001).

  8. The Coracohumeral Distance in Shoulders With Traumatic and Degenerative Subscapularis Tendon Tears.

    PubMed

    Balke, Maurice; Banerjee, Marc; Greshake, Oliver; Hoeher, Juergen; Bouillon, Bertil; Liem, Dennis

    2016-01-01

    A reduced coracohumeral distance (CHD) is thought to be responsible for subcoracoid impingement. This only accounts for degenerative tendon tears. In traumatic tears, the subcoracoid space should be normal. The CHD in patients with traumatic subscapularis tendon tears is larger than that in patients with degenerative tears and does not differ from patients with an intact subscapularis tendon. Cohort study; Level of evidence, 3. A total of 83 patients with arthroscopically certified subscapularis tendon tears were included in the study. Forty-four patients had degenerative causes (group 1), and 39 had traumatic causes (group 2). The control group consisted of 20 patients with traumatic supraspinatus tendon tears and arthroscopically proven, intact subscapularis tendons (group 3). On preoperative axial magnetic resonance imaging, the distance between the CHD was measured, and the values of the 3 groups were compared using the t test. The mean (±SD) CHD in patients with degenerative subscapularis tendon tears was 8.6 ± 2.0 mm (range, 4.0-13.2 mm) and was significantly (P = .0003) smaller than that in patients with traumatic tears (10.2 ± 2.0 mm; range, 6.6-16.2 mm) or controls (10.4 ± 1.8 mm; range, 6.8-14.0 mm). The CHD of controls and patients with traumatic tears did not differ significantly (P = .7875). A CHD of less than 6 mm only occurred in patients with degenerative subscapularis tendon tears. The hypothesis that the CHD in patients with degenerative subscapularis tendon tears is significantly smaller than that in patients with traumatic tears or intact subscapularis tendons was confirmed. The CHD in patients with traumatic tears does not differ from that in controls. A CHD of less than 6 mm only occurs in patients with degenerative subscapularis tendon tears. © 2015 The Author(s).

  9. Interactions of toroidally coupled tearing modes in the KSTAR tokamak

    NASA Astrophysics Data System (ADS)

    Kim, Gnan; Yun, Gunsu S.; Woo, Minho; Park, Hyeon K.; KSTAR Team2, the

    2018-03-01

    The evolutions of toroidally coupled radially-distant and radially-adjacent tearing modes are visualized in 2D in detail on the Korea superconducting tokamak for advanced research. The coupled tearing modes are in-phase on the out-board mid-plane and become destabilized or compete with each other depending on their spatial separation. When two coupled tearing modes are far apart, both are increasingly destabilized. On the other hand, when they become close to each other, one becomes stabilized while the other becomes destabilized. In such cases, an additional tearing mode is often formed on outer rational flux surface and the three tearing modes compete. The competitions suggest that spatial overlap (merging) of coupled magnetic islands is difficult.

  10. Is transverse acetabular ligament an anatomical landmark to reliably orient the cup in primary total hip arthroplasty?

    PubMed

    Viste, A; Chouteau, J; Testa, R; Chèze, L; Fessy, M-H; Moyen, B

    2011-05-01

    Accurate positioning of the acetabular cup in primary total hip arthroplasty is critical to decrease the rate of dislocation. Inaccurate orientation of the cup is the most common error during this procedure. Target acetabular orientation is still controversial. An original study found a dislocation rate of 0.6% when the cup was aligned with the transverse acetabular ligament (TAL). TAL is a patient-specific anatomical landmark and a tool for cup orientation. Eight cadaveric pelves (14 hips included for study) were harvested in toto at our research laboratory. Anatomical versions of the TAL, labrum and horns were measured in relation to the anterior pelvic plane. A navigator sensor and an optoelectronic device (Motion Analysis™) were used. Anatomical versions of the TAL, horns and labrum averaged 1.9° (range, -8° to +13.3°), 3° (range, -12.2° to 14°), and 26.3° (range, 17.4° to 41.8°), respectively. To our knowledge, this is the first study to report the orientation of the periacetabular soft-tissues. TAL anteversion was outside the safe zone described by Lewinnek, while labrum anteversion was within this safe-zone. We discuss the reference used, Lewinnek's safe zone, and functional orientation of the implants. Lewinnek's safe-zone does not seem to be valid. The TAL seems to be a specific reference for each patient but its reliability must still be confirmed as an adequate reference for positioning the cup in total hip arthroplasty. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  11. A review of patient and skin characteristics associated with skin tears.

    PubMed

    Rayner, R; Carville, K; Leslie, G; Roberts, P

    2015-09-01

    Skin tears are the most common wound among the elderly and have the potential to cause infection, form chronic wounds, reduce quality of life and increase health-care costs. Our aim was to identify studies that reviewed patient and skin characteristics associated with skin tears. A review of skin tear studies reported in the English literature between 1980 and 2013 was undertaken using the following electronic databases: PubMed, Medline, CINAHL, Embase, Scopus, Evidence Based and Medicine Reviews (EBM). Search terms included aged, skin, tears or lacerations, skin tearing, geri tear, epidermal tear and prevalence. There were 343 articles found with using the search terms. After abstract review nine were found to be relevant to the search. The principle findings from these eight published articles and one unpublished study revealed that the most common patient characteristics were a history of skin tears, impaired mobility and impaired cognition. Skin characteristics associated with skin tears included senile purpura, ecchymosis and oedema. This review provides an overview of identified patient and skin characteristics that predispose the elderly to skin tears and exposes the lack of research within this domain. R. Rayner is a recipient of a 2013 Australian Postgraduate Award, Curtin University Postgraduate Scholarship and a Wound Management Cooperative Research Centre (CRC) PhD stipend. The School of Nursing, Midwifery and Paramedicine, Curtin University and the Silver Chain Group, Western Australia are participants in the Wound Management Innovation CRC. No conflict of interest exists among the authors.

  12. Does using a polyethylene RM press-fit cup modify the preparation of the acetabulum and acetabular offset in primary hip arthroplasty?

    PubMed

    Erivan, R; Aubret, S; Villatte, G; Mulliez, A; Descamps, S; Boisgard, S

    2017-09-01

    When performing total hip arthroplasty (THA), it is important to maintain the femoral and acetabular offsets to ensure good joint stability and to restore the function of the hip abductor muscles. In our practice, we mainly use a lateralized stem and hollow out the acetabulum to the quadrilateral plate to accommodate a press-fit polyethylene cup. However, the repercussions of this preparation method, which is driven by the cup's design, are not known. We carried out a retrospective study to assess: (1) the changes in the femoral and acetabular offset; (2) the height of the center of rotation; and (3) the repercussions on wear. We hypothesized there would be no significant differences between the preoperative and postoperative femoral and acetabular offsets. We reviewed 88 primary THA cases performed with the RM Pressfit™ cup that had a minimum of 5 years' follow-up. A lateralized self-locking Muller-type cemented femoral stem was used in 92.0% of cases and a standard stem in 8.0%. Measurements were done on plain radiographs with MHP™ and Mesurim Pro™ software. The average follow-up was 6.5 years (5-8). On average, the acetabular offset was reduced by 2.75mm±5.9 mm (range: -17.5 to +10.6 mm) (P<0.001) and the femoral offset was increased by 0.01mm±5.5 mm (range: -17.8 to +11.0 mm) (P=0.99). In terms of total offset, medialization of 2.74mm±7 mm (range: -17.7 to +18.2mm) was found (P=0.001). The acetabular center of rotation was on average 4.77mm±5.1 mm higher (P<0.001). The mean annual wear at the more recent follow-up (min.: 5 years) was 0.068mm (range: 0.01 to 0.25mm) per year. The wear was not impacted by having more than 5mm change in offset. Measurements of acetabular offset revealed statistically significant medialization due to the type of implant used and the surgical technique. The anatomical technique consists of positioning the cup in subchondral bone without contacting the quadrilateral plate. This preserves bone stock, which may be

  13. Hip arthroscopy for Legg-Calvè-Perthes disease: minimum 2-year follow-up.

    PubMed

    Freeman, Carl R; Jones, Kay; Byrd, J W Thomas

    2013-04-01

    The purpose of this study is to report the results of arthroscopy for the treatment of adolescents and adults with hip pain cause by sequelae of Legg-Calvè-Perthes disease. All patients undergoing hip arthroscopy were prospectively assessed with the modified Harris Hip Score at 3, 6, 12, 24, 60, 120, and 180 months. We identified a cohort of 22 consecutive patients (23 hips) with Legg-Calvè-Perthes disease who had undergone arthroscopy with at least 2-year follow-up; this cohort represents the substance of this report. There was 100% follow-up at 24 months (range, 24 to 180 months). The median age was 27 years (range, 7 to 58 years) with 14 male and 8 female patients. Findings during arthroscopy included 18 labral tears, 17 hypertrophic or torn ligamentum teres, 9 femoral and 8 acetabular chondral lesions, 5 loose bodies, 3 osteochondral defects, and 2 cam lesions. The mean improvement at 24 months was 28 points (56.7 preoperatively and 82 postoperatively). All patients were improved, although this improvement was negligible in 2 patients who underwent repeat arthroscopy. There were no complications. This series reports the results of arthroscopy for Legg-Calvè-Perthes disease and reflects that it does have a role in the management of painful sequelae. Successful outcomes can often be expected with minimal morbidity. Reduced symptoms and improved quality of life are reasonable expectations, although these data do not suggest that hip arthroscopy alters the natural history of the disease process. Level IV, therapeutic case series. Published by Elsevier Inc.

  14. Acute Medial Plantar Fascia Tear.

    PubMed

    Pascoe, Stephanie C; Mazzola, Timothy J

    2016-06-01

    A 32-year-old man who participated in competitive soccer came to physical therapy via direct access for a chief complaint of plantar foot pain. The clinical examination findings and mechanism of injury raised a concern for a plantar fascia tear, so the patient was referred to the physician and magnetic resonance imaging was obtained. The magnetic resonance image confirmed a high-grade, partial-thickness, proximal plantar fascia tear with localized edema at the location of the medial band. J Orthop Sports Phys Ther 2016;46(6):495. doi:10.2519/jospt.2016.0409.

  15. A hierarchy of computationally derived surgical and patient influences on metal on metal press-fit acetabular cup failure.

    PubMed

    Clarke, S G; Phillips, A T M; Bull, A M J; Cobb, J P

    2012-06-01

    The impact of anatomical variation and surgical error on excessive wear and loosening of the acetabular component of large diameter metal-on-metal hip arthroplasties was measured using a multi-factorial analysis through 112 different simulations. Each surgical scenario was subject to eight different daily loading activities using finite element analysis. Excessive wear appears to be predominantly dependent on cup orientation, with inclination error having a higher influence than version error, according to the study findings. Acetabular cup loosening, as inferred from initial implant stability, appears to depend predominantly on factors concerning the area of cup-bone contact, specifically the level of cup seating achieved and the individual patient's anatomy. The extent of press fit obtained at time of surgery did not appear to influence either mechanism of failure in this study. Copyright © 2012 Elsevier Ltd. All rights reserved.

  16. Goldmann tonometry tear film error and partial correction with a shaped applanation surface.

    PubMed

    McCafferty, Sean J; Enikov, Eniko T; Schwiegerling, Jim; Ashley, Sean M

    2018-01-01

    The aim of the study was to quantify the isolated tear film adhesion error in a Goldmann applanation tonometer (GAT) prism and in a correcting applanation tonometry surface (CATS) prism. The separation force of a tonometer prism adhered by a tear film to a simulated cornea was measured to quantify an isolated tear film adhesion force. Acrylic hemispheres (7.8 mm radius) used as corneas were lathed over the apical 3.06 mm diameter to simulate full applanation contact with the prism surface for both GAT and CATS prisms. Tear film separation measurements were completed with both an artificial tear and fluorescein solutions as a fluid bridge. The applanation mire thicknesses were measured and correlated with the tear film separation measurements. Human cadaver eyes were used to validate simulated cornea tear film separation measurement differences between the GAT and CATS prisms. The CATS prism tear film adhesion error (2.74±0.21 mmHg) was significantly less than the GAT prism (4.57±0.18 mmHg, p <0.001). Tear film adhesion error was independent of applanation mire thickness ( R 2 =0.09, p =0.04). Fluorescein produces more tear film error than artificial tears (+0.51±0.04 mmHg; p <0.001). Cadaver eye validation indicated the CATS prism's tear film adhesion error (1.40±0.51 mmHg) was significantly less than that of the GAT prism (3.30±0.38 mmHg; p =0.002). Measured GAT tear film adhesion error is more than previously predicted. A CATS prism significantly reduced tear film adhesion error bŷ41%. Fluorescein solution increases the tear film adhesion compared to artificial tears, while mire thickness has a negligible effect.

  17. A new, specular reflection-based, precorneal tear film stability measurement technique in a rabbit model: viscoelastic increases tear film stability.

    PubMed

    Nankivil, Derek; Gonzalez, Alex; Arrieta, Esdras; Rowaan, Cornelis; Aguilar, Mariela C; Sotolongo, Krystal; Cabot, Florence A; Yoo, Sonia H; Parel, Jean-Marie A

    2014-06-19

    To develop a safe, noninvasive, noncontact, continuous in vivo method to measure the dehydration rate of the precorneal tear film and to compare the effectiveness of a viscoelastic agent in maintaining the precorneal tear film to that of a balanced salt solution. Software was designed to analyze the corneal reflection produced by the operating microscope's coaxial illumination. The software characterized the shape of the reflection, which became distorted as the precorneal tear film evaporated; characterization was accomplished by fitting an ellipse to the reflection and measuring its projected surface area. Balanced salt solution Plus (BSS+) and a 2% hydroxypropylmethylcellulose viscoelastic were used as the test agents. The tear film evaporation rate was characterized and compared over a period of 20 minutes in 20 eyes from 10 New Zealand white rabbits. The ellipse axes ratio and surface area were found to decrease initially after each application of either viscoelastic or BSS+ and then to increase linearly as the tear film began to evaporate (P < 0.001) for eyes treated with BSS+ only. Eyes treated with BSS+ required 7.5 ± 2.7 applications to maintain sufficient corneal hydration during the 20-minute test period, whereas eyes treated with viscoelastic required 1.4 ± 0.5 applications. The rates of evaporation differed significantly (P < 0.043) between viscoelastic and BSS+. The shape and surface area of the corneal reflection are strongly correlated with the state of the tear film. Rabbits' corneas treated with viscoelastic remained hydrated significantly longer than corneas treated with BSS+. Copyright 2014 The Association for Research in Vision and Ophthalmology, Inc.

  18. [Functional tear production indices in thyroid eye disease].

    PubMed

    Safonova, T N; Likhvantseva, V G; Gontiurova, O A; Rudenko, E I; Vygodin, V A

    2013-01-01

    Analysis of functional tear production indices in patients with Grave's disease and thyroid eye disease confirmed lacrimal gland involvement in inflammatory autoimmune process. Close direct correlation was found between tear production and main disease characteristics - severity and activity.

  19. The potential of optical coherence tomography in meniscal tear characterization

    NASA Astrophysics Data System (ADS)

    Ling, Hang-yin; Guo, Shuguang; Thieman, Kelley M.; Wise, Brent T.; Pozzi, Antonio; Xie, Huikai; Horodyski, MaryBeth

    2009-02-01

    Meniscal tear is one of the most common knee injuries leading to pain and discomfort. Partial and total meniscectomies have been widely used to treat the avascular meniscal injuries in which tears do not heal spontaneously. However, the meniscectomies would cause an alteration of the tibiofemoral contact mechanics resulting in progressive osteoarthritis (OA). To mitigate the progression of OA, maximal preservation of meniscal tissue is recommended. The clinical challenge is deciding which meniscal tears are amenable to repair and which part of damaged tissues should be removed. Current diagnosis techniques such as arthroscopy and magnetic resonance imaging can provide macrostructural information of menisci, but the microstructural changes that occur prior to the observable meniscal tears cannot be identified by these techniques. Serving as a nondestructive optical biopsy, optical coherence tomography (OCT), a newly developed imaging modality, can provide high resolution, cross-sectional images of tissues and has been shown its capabilty in arthroscopic evaulation of articular cartilage. Our research was to demonstrate the potential of using OCT for nondestructive characterization of the histopathology of different types of meniscal tears from clinical cases in dogs, providing a fundamental understanding of the failure mechanism of meniscal tears. First, cross-sectional images of torn canine menisci obtained from the OCT and scanning electronic microscopy (SEM) were be compared. By studying the organization of collegan fibrils in torn menisci from the SEM images, the feasibility of using OCT to characterize the organization of collegan fibrils was elucidated. Moreover, the crack size of meniscal tears was quantatitively measured from the OCT images. Changes in the crack size of the tear may be useful for understanding the failure mechanism of meniscal tears.

  20. Oxidative Stress Measures of Lipid and DNA Damage in Human Tears.

    PubMed

    Haworth, Kristina M; Chandler, Heather L

    2017-05-01

    We evaluate feasibility and repeatability of measures for lipid peroxidation and DNA oxidation in human tears, as well as relationships between outcome variables, and compared our findings to previously reported methods of evaluation for ocular sun exposure. A total of 50 volunteers were seen for 2 visits 14 ± 2 days apart. Tear samples were collected from the inferior tear meniscus using a glass microcapillary tube. Oxidative stress biomarkers were quantified using enzyme-linked immunosorbent assay (ELISA): lipid peroxidation by measurement of hexanoyl-lysine (HEL) expression; DNA oxidation by measurement of 8-oxo-2'-deoxyguinosone (8OHdG) expression. Descriptive statistics were generated. Repeatability estimates were made using Bland-Altman plots with mean differences and 95% limits of agreement were calculated. Linear regression was conducted to evaluate relationships between measures. Mean (±SD) values for tear HEL and 8OHdG expression were 17368.02 (±9878.42) nmol/L and 66.13 (±19.99) ng/mL, respectively. Repeatability was found to be acceptable for both HEL and 8OHdG expression. Univariate linear regression supported tear 8OHdG expression and spring season of collection to be predictors of higher tear HEL expression; tear HEL expression was confirmed as a predictor of higher tear 8OHdG expression. We demonstrate feasibility and repeatability of estimating previously unreported tear 8OHdG expression. Seasonal temperature variation and other factors may influence tear lipid peroxidation. Support is demonstrated to suggest lipid damage and DNA damage occur concurrently on the human ocular surface.

  1. A comparison of MRI findings in patients with acute and chronic ACL tears.

    PubMed

    Dimond, P M; Fadale, P D; Hulstyn, M J; Tung, G A; Greisberg, J

    1998-01-01

    This retrospective study compared the magnetic resonance imaging (MRI) findings in 87 patients with acute and chronic anterior cruciate ligament (ACL) tears. Sixty patients had acute tears and 27 had chronic tears. The appearance of the torn ligament was examined on MRI, and associated meniscal and osteochondral injuries were described. All findings were verified at arthroscopy. Acute ACL tears (MRI examination was performed within 6 weeks of injury) were typified by the presence of diffuse (58%) or focal (42%) increased signal within the ligament, whereas chronic ACL tears (MRI examination was performed more than 6 months after injury) usually appeared as either a fragmented ligament (44%) or an intact band of low signal with abnormal orientation (30%). Patients with chronic ACL tears had a higher prevalence of medial meniscal tears (78% versus 40%), articular chondromalacia, and an increased posterior cruciate bow ratio (0.47 versus 0.37) in association with chronic ACL tears. A bone bruise was seen in 68% of acute ACL tears but in no case of chronic ACL tear. On MRI, there are salient differences between acute and chronic ACL tears. Chronic ACL tears are associated with a greater prevalence of meniscal and osteochondral injuries. These findings may have implications for future treatment recommendations.

  2. Learning curve of office-based ultrasonography for rotator cuff tendons tears.

    PubMed

    Ok, Ji-Hoon; Kim, Yang-Soo; Kim, Jung-Man; Yoo, Tae-Wook

    2013-07-01

    To compare the accuracy of ultrasonography and MR arthrography (MRA) imaging in detecting of rotator cuff tears with arthroscopic finding used as the reference standard. The ultrasonography and MRA findings of 51 shoulders that underwent the arthroscopic surgery were prospectively analysed. Two orthopaedic doctors independently performed ultrasonography and interpreted the findings at the office. The tear size measured at ultrasonography and MRA was compared with the size measured at surgery using Pearson correlation coefficients (r). The sensitivity, specificity, accuracy, positive predictive value, negative predictive value and false-positive rate were calculated for a diagnosis of partial-and full-thickness rotator cuff tears. The kappa coefficient was calculated to verify the inter-observer agreement. The sensitivity of ultrasonography and MRA for detecting partial-thickness tears was 45.5 and 72.7 %, and that for full-thickness tears was 80.0 and 100 %, respectively. The accuracy of ultrasonograpy and MRA for detecting partial-thickness tears was 45.1 and 88.2 %, and that for full-thickness tears was 82.4 and 98 %, respectively. Tear size measured based on ultrasonography examination showed a poor correlation with the size measured at arthroscopic surgery (r = 0.21; p < 0.05). However, tear size estimated by MRA showed a strong correlation (r = 0.75; p < 0.05). The kappa coefficient was 0.47 between the two independent examiners. The accuracy of office-based ultrasonography for beginner orthopaedic surgeons to detect full-thickness rotator cuff tears was comparable to that of MRA but was less accurate for detecting partial-thickness tears and torn size measurement. Inter-observer agreement on the interpretation was fair. These results highlight the importance of the correct technique and experience in operation of ultrasonography in shoulder joint. Diagnostic study, Level II.

  3. Fluorophotometric measurement of the buffering action of human tears in vivo.

    PubMed

    Yamada, M; Kawai, M; Mochizuki, H; Hata, Y; Mashima, Y

    1998-10-01

    The buffering action of human tears is thought to be important to keep its pH constant. We measured the change in pH in the precorneal tear film in vivo when the acidic solution is challenged, using a fluorophotometric technique. Twelve eyes from 6 healthy subjects were entered in this study. Each subject was pretreated with either one drop of 0.4% oxybuprocaine for once (light anesthesia), three times (deep anesthesia), or none (controls). The measurement was initiated by instilling 20 microl of 0.067 M phosphate buffer at pH 5.5 containing 2 mM bis-carboxyethyl-carboxyfluorescein free acid, a pH sensitive dye, into the subject's eye. The pH was determined by the ratio of fluorescent intensities at two excitation wavelengths (490 and 430 nm). pH recovery time (PHRT) as defined by the time required for pH to reach 95% of pH at equilibrium was used for the marker of tear buffering action. Tear turnover rate was also determined using the fluorescent decay curve at 430 nm, which was independent of pH, but dependent on dye concentration. Immediately after the instillation, the pH value in the tear film was around 6.0-6.5 in all cases. The tear film rapidly became more alkaline, reaching its normal value in 2.3 +/- 0.5 min in untreated eyes. The pretreatment with 0.4% oxybuprocaine retarded the neutralization process. A single regression analysis revealed that the PHRT had a significant negative correlation with the tear turnover rate (r = -0.78). Our results suggest that the neutralization process of tears largely depends on the tear turnover rate. The buffering action of tears in vivo consists of the tear turnover as well as its chemical buffering capacity.

  4. Simultaneous measurement of tear film dynamics using wavefront sensor and optical coherence tomography.

    PubMed

    Koh, Shizuka; Tung, Cynthia; Aquavella, James; Yadav, Rahul; Zavislan, James; Yoon, Geunyoung

    2010-07-01

    PURPOSE. To investigate tear film dynamics using simultaneous measurements of ocular aberrations and lower tear meniscus. METHODS. Simultaneous measurements of wavefront aberration and lower tear meniscus were performed for 11 normal eyes and 7 eyes with short tear film break-up time (SBUT) dry eye, with a tear film break-up time shorter than 5 seconds, using a wavefront sensor and an anterior segment optical coherence tomography (OCT). During the measurement, the subjects were instructed to blink every 6 seconds for a total of 30 seconds. From the measured aberration, root mean square (RMS) wavefront error and volume modulation transfer function (vMTF) induced by changes in tear film dynamics were calculated for a 5-mm pupil. Lower tear meniscus height (TMH) and area (TMA) were estimated from the cross-sectional OCT images of lower tear meniscus. RESULTS. There was a positive correlation between RMS and tear meniscus dimensions and a negative correlation between vMTF and tear meniscus in both groups. There were moderate negative correlations between the postblink initial RMS change and baseline TMH (R = -0.61) and TMA (R = -0.54) in SBUT dry eyes that were stronger than in normal eyes (R = -0.37, R = -0.38). CONCLUSIONS. Tear meniscus dimensions increase with RMS over time, and tear quantity before blink has a significant role in maintaining initial optical integrity, especially in SBUT dry eye. Simultaneous measurement of optical quality and tear meniscus has the potential to improve understanding of tear stability in normal eyes and dry eyes.

  5. Press-fit versus threaded acetabular cups in total hip arthroplasty: Functional and radiological results after five years.

    PubMed

    Ellenrieder, Martin; Bader, Rainer; Bergschmidt, Philipp; Mittelmeier, Wolfram

    2016-03-01

    Prospectively the outcome after total hip replacement with a new threaded acetabular cup design was compared to an established press-fit cup. After 1, 2 and 5 years, the 36-item Short Form Health Survey, Western Ontario and McMaster University Osteoarthritis Index and Harris Hip Score revealed no significant differences between the two groups (each group: n=42 patients), except for a higher Harris Hip Score in the threaded cup group after five years (p=0.02). After five years, one threaded cup had a mild radiolucent line without further signs of loosening. All other cups of both groups (98.6%) showed a full osseous integration. The cup inclination angle ranged from 41-58° (threaded cups) to 39-77° (press-fit cups). The new threaded cup provides equivalent clinical outcomes and osseous integration but more precise implant positioning compared to the press-fit design. No complications typically ascribed to threaded cups (acetabular fractures, bone resorption, nerve impairment) occurred.

  6. Analysis of Arthroscopic Therapy for hip Pathologies.

    PubMed

    Przybył, Michał; Walenczak, Krzysztof; Lebiedziński, Radosław; Domżalski, Marcin

    2017-05-10

    [b]Background. [/b]This paper analyses the outcomes of treatment of avascular necrosis (AVN), femoroacetabular impingement (FAI), hip labral tear (HLT) and snapping hip syndrome (SHS). Moreover, the results of individual groups are also compared. The study group consisted of 70 persons (surgeries of 72 hips). AVN - 14 patients, FAI - 38 patients (39 hips), HLT - 12 patients (13 hips), SHS - 6 patients. Two questionnaires, namely the MHHS (Modified Harris Hip Score) and NAHS (Non Arthritic Hip Score), were used to evaluate the patients before the surgery and at 6- and 12-month follow-up.[b]Results. [/b]AVN : local improvement was recorded at both 6 and 12 months, FAI: local improvement was recorded at both 6 and 12 months, HLT: local improvement was recorded at both 6 and 12 months, SHS: local improvement was recorded at both 6 and 12 months. Comparison of the results between the groups showed that: At baseline, local status in AVN was poorer than in FAI. At 6- and 12-month follow-up, local status in AVN was poorer than in FAI, HLT and SHS.[b]Conclusions.[/b] AVN Group 1. The study demonstrates that arthroscopic treatment of avascular necrosis produced fairly good outcomes at 6 and 12 months after the surgery. 2. Treatment of avascular necrosis showed significantly poorer results than therapy of femoroacetabular impingement, hip labral tear and snapping hip syndrome at 6 and 12 months. FAI Group 1. Arthroscopic treatment of femoroacetabular impingement produced good outcomes at 6 and 12 months after the surgery. HLT Group 1. Arthroscopic treatment of hip labral tear produced excellent outcomes at 6 and 12 months after the surgery. SHS Group 1. Arthroscopic treat ment of snapping hip syndrome produced excellent outcomes at 6 and 12 months after the surgery.Additional conclusions. 1. Studies showing long-term effect of arthroscopic treatment of selected conditions are necessary to further assess the effectiveness of this treatment. 2. It is necessary to evaluate the

  7. Ply-tear webbing energy absorber

    NASA Technical Reports Server (NTRS)

    Stevens, G. W. H.

    1972-01-01

    Ply-tear webbing is essentially two plain webbings that are bound together by a portion of the warps and that can be torn apart and do work by breaking the binders. Nylon webbing were woven to range in tear force from 1 to 10 kilonewtons. This force is substantially independent of speed, which was as high as 100 m/sec in some cases. A specific energy absorption of 90 J/g was achieved in the dry state. However, lower rated webbings that absorb approximately 40 J/g are recommended for use in practice where it is acceptable.

  8. Non-invasive pre-lens tear film assessment with high-speed videokeratoscopy.

    PubMed

    Llorens-Quintana, Clara; Mousavi, Maryam; Szczesna-Iskander, Dorota; Iskander, D Robert

    2018-02-01

    To evaluate the effect of two types of daily contact lenses (delefilcon A and omafilcon A) on the tear film and establish whether it is dependent on pre-corneal tear film characteristics using a new method to analyse high-speed videokeratoscopy recordings, as well as to determine the sensitivity of the method in differentiating between contact lens materials on eye. High-speed videokeratoscopy recordings were analysed using a custom made automated algorithm based on a fractal dimension approach that provides a set of parameters directly related to tear film stability. Fifty-four subjects participated in the study. Baseline measurements, in suppressed and natural blinking conditions, were taken before subjects were fitted with two different daily contact lenses and after four hours of contact lens wear. The method for analysing the stability of the tear film provides alternative parameters to the non-invasive break up time to assess the quality of the pre-corneal and pre-lens tear film. Both contact lenses significantly decreased the quality of the tear film in suppressed and natural blinking conditions (p<0.001). The utilised method was able to distinguish between contact lens materials on eye in suppressed blinking conditions. The pre-corneal tear film characteristics were not correlated with the decrease in pre-lens tear film quality. High-speed videokeratoscopy equipped with an automated method to analyse the dynamics of the tear film is able to distinguish between contact lens materials in vivo. Incorporating the assessment of pre-lens tear film to the clinical practice could aid improving contact lens fitting and understand contact lens comfort. Copyright © 2017 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

  9. Relationship Between the Lateral Center-Edge Angle and 3-Dimensional Acetabular Coverage.

    PubMed

    Wylie, James D; Kapron, Ashley L; Peters, Christopher L; Aoki, Stephen K; Maak, Travis G

    2017-04-01

    The lateral center-edge angle (LCEA) is an important measurement in understanding acetabular morphology and has had multiple interpretations. Misunderstanding of the LCEA and its relationship with acetabular 3-dimensional (3D) morphology may result in misdiagnosis and poor outcomes. To determine the discrepancy between bone-edge and sourcil-edge LCEA measurements on anteroposterior (AP) radiographs and to determine the 3D anatomic location of the sourcil-edge and bone-edge LCEA measurements. Cohort study (diagnosis); Level of evidence, 2. The LCEA was measured on radiographs to both the sourcil-edge and bone-edge on AP images of 60 symptomatic hips. On computed tomography (CT), coronal slices producing an LCEA matching the magnitude of each AP LCEA were identified. These coronal slices were mapped to a sagittal image of the acetabulum, which was divided into a standard clockface (3 = anterior, 12 = superior). We identified clockface locations corresponding to the AP sourcil-edge and bone-edge LCEA measurements. Paired t tests identified differences in magnitude and location of the bone and sourcil LCEAs. Limits of agreement were calculated for the differences between measures. Intraclass correlation coefficients (ICCs) assessed inter- and intraobserver repeatability. On the AP radiographs, the bone-edge LCEA was a mean 4.7° (95% CI, -4.0° to 13.3°) greater than the sourcil-edge LCEA ( P < .001). On CT, the sagittal clockface location of the sourcil-edge LCEA was more anterior compared with the sagittal clockface location of the maximum bone-edge LCEA (1:03 ± 0:42 vs 12:06 ± 0:30, respectively; P < .001). In hips with a difference >5° between sourcil-edge and bone-edge measurements, the coronal CT slice corresponding to the sourcil-edge LCEA was significantly more anterior (1:26 ± 0:35) than the CT slice corresponding to the bone-edge LCEA (11:46 ± 0:29; P < .001). This significant difference was similar in location but less pronounced in hips with a

  10. Increasing age and tear size reduce rotator cuff repair healing rate at 1 year.

    PubMed

    Rashid, Mustafa S; Cooper, Cushla; Cook, Jonathan; Cooper, David; Dakin, Stephanie G; Snelling, Sarah; Carr, Andrew J

    2017-12-01

    Background and purpose - There is a need to understand the reasons why a high proportion of rotator cuff repairs fail to heal. Using data from a large randomized clinical trial, we evaluated age and tear size as risk factors for failure of rotator cuff repair. Patients and methods - Between 2007 and 2014, 65 surgeons from 47 hospitals in the National Health Service (NHS) recruited 447 patients with atraumatic rotator cuff tendon tears to the United Kingdom Rotator Cuff Trial (UKUFF) and 256 underwent rotator cuff repair. Cuff integrity was assessed by imaging in 217 patients, at 12 months post-operation. Logistic regression analysis was used to determine the influence of age and intra-operative tear size on healing. Hand dominance, sex, and previous steroid injections were controlled for. Results - The overall healing rate was 122/217 (56%) at 12 months. Healing rate decreased with increasing tear size (small tears 66%, medium tears 68%, large tears 47%, and massive tears 27% healed). The mean age of patients with a healed repair was 61 years compared with 64 years for those with a non-healed repair. Mean age increased with larger tear sizes (small tears 59 years, medium tears 62 years, large tears 64 years, and massive tears 66 years). Increasing age was an independent factor that negatively influenced healing, even after controlling for tear size. Only massive tears were an independent predictor of non-healing, after controlling for age. Interpretation - Although increasing age and larger tear size are both risks for failure of rotator cuff repair healing, age is the dominant risk factor.

  11. Tribological assessment of a flexible carbon-fibre-reinforced poly(ether-ether-ketone) acetabular cup articulating against an alumina femoral head.

    PubMed

    Scholes, S C; Inman, I A; Unsworth, A; Jones, E

    2008-04-01

    New material combinations have been introduced as the bearing surfaces of hip prostheses in an attempt to prolong their life by overcoming the problems of failure due to wear-particle-induced osteolysis. This will hopefully reduce the need for revision surgery. The study detailed here used a hip simulator to assess the volumetric wear rates of large-diameter carbon-fibre-reinforced pitch-based poly(ether-ether-ketone) (CFR-PEEK) acetabular cups articulating against alumina femoral heads. The joints were tested for 25 x 10(6) cycles. Friction tests were also performed on these joints to determine the lubrication regime under which they operate. The average volumetric wear rate of the CFR-PEEK acetabular component of 54 mm diameter was 1.16 mm(3)/10(6) cycles, compared with 38.6 mm(3)/10(6) cycles for an ultra-high-molecular-weight polyethylene acetabular component of 28 mm diameter worn against a ceramic head. This extremely low wear rate was sustained over 25 x 10(6) cycles (the equivalent of up to approximately 25 years in vivo). The frictional studies showed that the joints worked under the mixed-boundary lubrication regime. The low wear produced by these joints showed that this novel joint couple offers low wear rates and therefore may be an alternative material choice for the reduction of osteolysis.

  12. Atypical anterior wall fracture of the acetabulum: case series of anterior acetabular rim fracture without involvement of the pelvic brim.

    PubMed

    Lenarz, Christopher J; Moed, Berton R

    2007-09-01

    The purpose of this study was to describe a form of anterior wall acetabular fracture, which has been inadequately defined in the literature. Retrospective analysis of consecutive patients. Level 1 trauma center. A retrospective analysis of consecutive acetabulum patients treated by a single surgeon between 1999 and 2005 identified 6 patients with a form of anterior wall fracture without involvement of the pelvic brim. All fractures were treated operatively. Open reduction and internal fixation through an anterior surgical approach. Final radiographic appearance and modified Merle d'Aubigne score. All 6 cases demonstrated characteristics of an atypical fracture of the anterior wall, involving the anterior rim of the acetabulum similar in nature to those described for the posterior wall, rather than the standard anterior wall fracture type described by Letournel. Of the 6 cases that were identified, 5 had follow-up 1 year or greater with a mean modified Merle d'Aubigne Score of 17 (range: 17-18). A form of anterior wall acetabular fracture exists, which involves the anterior acetabular rim without involvement of the pelvic brim. It can occur in young patients with high-energy mechanisms of injury, as well as in the elderly with low-energy trauma. With appropriate surgical management, using a modified Smith-Peterson approach, good to excellent clinical outcomes should be expected.

  13. Inter- and intra-observer variability of radiography and computed tomography for evaluation of Zurich cementless acetabular cup placement ex vivo.

    PubMed

    Leasure, Jessica O; Peck, Jeffrey N; Villamil, Armando; Fiore, Kara L; Tano, Cheryl A

    2016-11-23

    To evaluate the inter- and intra-observer variability in measurement of the angle of lateral opening (ALO) and version angle measurement using digital radiography and computed tomography (CT). Each hemipelvis was implanted with a cementless acetabular cup. Ventrodorsal and mediolateral radiographs were made of each pelvis, followed by CT imaging. After removal of the first cup, the pelves were implanted with an acetabular cup in the contralateral acetabulum and imaging was repeated. Three surgeons measured the ALO and version angles three times for each cup from the mediolateral radiographic projection. The same measurements were made using three-dimensional multiplanar reconstructions from CT images. Two anatomical axes were used to measure pelvic inclination in the sagittal plane, resulting in six measurements per cup. Two-way repeated measures analysis of variance evaluated inter- and intra-observer repeatability for radiographic and CT-based measurements. Version angle based on radiographic measurement did not differ within surgeons (p = 0.433), but differed between surgeons (p <0.001). Radiographic measurement of ALO differed within surgeons (p = 0.006) but not between surgeons (p = 0.989). The ALO and version angle measured on CT images did not differ with or between surgeons. Assessment of inter- and intra-observer measurement of ALO and version angle was more reproducible using CT images than conventional mediolateral radiography for a Zurich cementless acetabular cup.

  14. The Changes of Tear Status after Conventional and Wavefront-Guided IntraLASIK

    PubMed Central

    Foo, Say Kiang; Kaur, Sharanjeet; Abd Manan, Faudziah; Low, Aloysius Joseph

    2011-01-01

    Background: IntraLASIK is a LASIK surgery that involved IntraLase femtosecond laser for the corneal flap creating. The objective of this research was to investigate and compare the changes in tear status at 1 and 3 months after undergoing conventional IntraLASIK with Bausch & Lomb PlanoScan (PS) algorithm, Bausch & Lomb Zyoptix Tissue Saving (ZTS) algorithm, and wavefront-guided (WG) IntraLASIK with VISX CustomVue. Methods: Tear status of 36 patients who were divided into 3 groups depending on the type of IntraLASIK they underwent (PS, n = 13; ZTS, n = 9; WG, n = 14) was evaluated. Tear status was determined by classifying the category of the thickness of pre-corneal tear lipid layer, non-invasive tear break-up time, and tear meniscus height. Repeated measures analysis of variance (ANOVA) and one way ANOVA were used for the statistical analyses. Results: The category of the thickness of tear lipid layer, non-invasive tear break up time and tear meniscus height were neither significantly changed after IntraLASIK for all groups nor showed significant difference among groups at 1 and 3 months post-IntraLASIK (P > 0.05). Blinking rate and palpebral aperture also had no significant changed after IntraLASIK. Conclusion: Both conventional (PS and ZTS) and WG IntraLASIK did not affect tear status up to 3 months post-IntraLASIK. WG IntraLASIK did not show superiority in preserving tear status 1 and 3 months post-surgery compared with conventional IntraLASIK. PMID:22135584

  15. Complete vs partial-thickness tears of the posterior cruciate ligament: MR findings.

    PubMed

    Patten, R M; Richardson, M L; Zink-Brody, G; Rolfe, B A

    1994-01-01

    We sought to define the MRI appearance of both complete and partial-thickness tears of the posterior cruciate ligament (PCL) and to describe patterns of injury and associated MRI findings. Three radiologists retrospectively reviewed MR images and medical records on 32 patients with PCL tears (15 complete, 17 partial) and correlated MRI findings to results of clinical testing and surgery. The PCL had indistinct margins in 27 (84%) of 32 patients and was abnormally thick in 25 (78%) patients. In 31 (97%) patients, the torn PCL showed increased signal intensity on both T1- and T2-weighted pulse sequences. Although there was no statistically significant difference between patients with complete tears and those with partial tears with regard to thickness, margination, and signal intensity of the PCL, MR images in patients with complete tears were more likely to show focal areas of ligamentous discontinuity (10 of 15 cases) (p = 0.01). Associated knee injuries were seen in 21 (66%) patients and were seen more frequently in patients with complete PCL tears (p = 0.015). Bony injury (n = 11, 34%) and tears of the medial collateral ligament (n = 13, 41%) and menisci (n = 10, 31%) were common. No specific pattern of bony injury was found. Posterior cruciate ligament tears can be diagnosed readily by multiplanar MRI using both morphological and signal intensity characteristics. Although differentiation between complete and partial-thickness PCL tears by MRI criteria alone is more problematic, complete tears are more likely to show focal areas of discontinuity and partial tears are more likely to show at least some intact fibers.

  16. Initial stability of cementless acetabular cups: press-fit and screw fixation interaction--an in vitro biomechanical study.

    PubMed

    Tabata, Tomonori; Kaku, Nobuhiro; Hara, Katsutoshi; Tsumura, Hiroshi

    2015-04-01

    Press-fit and screw fixation are important technical factors to achieve initial stability of a cementless acetabular cup for good clinical results of total hip arthroplasty. However, how these factors affect one another in initial cup fixation remains unclear. Therefore, this study aimed to evaluate the mutual influence between press-fit and screw fixation on initial cup stability. Foam bone was subjected to exact hemispherical-shape machining to diameters of 48, 48.5 and 49 mm. A compressive force was applied to ensure seating of a 48-mm-diameter acetabular cup in the foam bone prior to testing. Screws were inserted in six different conditions and tightened in a radial direction at the same torque strength. Then, the socket was rotated with a twist-testing machine, and the torque value at the start of axial rotation between the socket and the foam bone was measured under each screw condition. The torque values for the 48-mm-diameter reaming were >20 N m higher than those for the 48.5- and 49-mm-diameter reaming in each screw condition, indicating that press-fit fixation is stronger than screw fixation. Meanwhile, torque values for the 48.5- and 49-mm-diameter reaming tended to increase with increasing the number of screws. According to our experiment, press-fit fixation of a cementless acetabular cup achieved rigid stability. Although the supplemental screws increased stability of the implant under good press-fit conditions, they showed little impact on whole-cup stability. In the case of insufficient press-fit fixation, cup stability depends on screw stability and increasing the number of additional screws increases cup stability.

  17. From current-driven to neoclassically driven tearing modes.

    PubMed

    Reimerdes, H; Sauter, O; Goodman, T; Pochelon, A

    2002-03-11

    In the TCV tokamak, the m/n = 2/1 island is observed in low-density discharges with central electron-cyclotron current drive. The evolution of its width has two distinct growth phases, one of which can be linked to a "conventional" tearing mode driven unstable by the current profile and the other to a neoclassical tearing mode driven by a perturbation of the bootstrap current. The TCV results provide the first clear observation of such a destabilization mechanism and reconcile the theory of conventional and neoclassical tearing modes, which differ only in the dominant driving term.

  18. Patterns of meniscal tears associated with anterior cruciate ligament lesions in athletes.

    PubMed

    Binfield, P M; Maffulli, N; King, J B

    1993-09-01

    In this study, 400 clinically anterior cruciate ligament (ACL) deficient knees were arthroscoped and studied prospectively in the period January 1986 to April 1992. An ACL tear was always confirmed, and 41 per cent of these patients did not have an associated meniscal tear. In 30.25 per cent the lateral meniscus was torn; in 21.25 per cent the ACL tear was associated with a medial meniscus tear, and in the remaining 7 per cent both menisci were torn. The most frequently associated meniscal injury was the bucket handle tear of the medial meniscus (9 per cent), followed by the posterior horn tear of the lateral meniscus, which showed the same frequency as the ragged (or degenerated) tear of the lateral meniscus (6 per cent). The horizontal tear of the posterior part of the lateral meniscus showed a prevalence of 4.3 per cent. This picture is probably dependent on a secondary referral nature of the centre surveyed, in which the average time between injury and arthroscopy was 23.3 months.

  19. The effect of bearing friction torques on the primary stability of press-fit acetabular cups: A novel in vitro method.

    PubMed

    Alexander, Jahnke; Stefan, Schroeder; Alfonso, Fonseca Ulloa Carlos; Adam, Ahmed Gafar; Alexander, Ishaque Bernd; Markus, Rickert

    2018-05-10

    Aseptic loosening is the main reason for revision of total hip arthroplasty, and relative micromotions between cementless acetabular cups and bone play an important role regarding their comparatively high loosening rate. Therefore, the aim of the present study was to analyze the influence of resulting frictional torques on the primary stability of press-fit acetabular cups subjected to two different bearing partners. A cementless press-fit cup was implanted in bone-like foam. Primary stability of the cup was analyzed by determining spatial total, translational and rotational interface micromotions by means of an eddy current sensor measuring system. Torque transmission into the cup was realized by three synchronous servomotors considering resultant friction torques based on constant friction for ceramic-on-ceramic (CoC: µ = 0.044; max. resultant torque: 1.5 Nm) and for ceramic-on-polyethylene (CoP: µ = 0.063; max. resultant torque: 1.9 Nm) bearing partners. Rotational micromotion of CoC was 8.99 ± 0.85µm and of CoP 13.39 ± 1.43µm. Translational micromotion of CoC was 29.93 ± 1.44µm and of CoP 39.91 ± 2.25µm. Maximum total relative micromotions were 37.10 ± 1.07µm for CoC and 51.64 ± 2.18µm for CoP. Micromotions resulting from CoC were statistically lower than those resulting from CoP (p < 0.05). The described 3D-measuring set-up offers a novel in vitro method of measuring primary stability of acetabular cups. We can therefore conclude, that primary stability of acetabular cup systems can be observed using either the lower friction curve (CoC) or the higher friction curve (CoP). In future studies different cup designs or cup fixation mechanisms may be tested and compared in vitro and assessed prior to implantation. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  20. Increasing age and tear size reduce rotator cuff repair healing rate at 1 year

    PubMed Central

    Rashid, Mustafa S; Cooper, Cushla; Cook, Jonathan; Cooper, David; Dakin, Stephanie G; Snelling, Sarah; Carr, Andrew J

    2017-01-01

    Background and purpose — There is a need to understand the reasons why a high proportion of rotator cuff repairs fail to heal. Using data from a large randomized clinical trial, we evaluated age and tear size as risk factors for failure of rotator cuff repair. Patients and methods — Between 2007 and 2014, 65 surgeons from 47 hospitals in the National Health Service (NHS) recruited 447 patients with atraumatic rotator cuff tendon tears to the United Kingdom Rotator Cuff Trial (UKUFF) and 256 underwent rotator cuff repair. Cuff integrity was assessed by imaging in 217 patients, at 12 months post-operation. Logistic regression analysis was used to determine the influence of age and intra-operative tear size on healing. Hand dominance, sex, and previous steroid injections were controlled for. Results — The overall healing rate was 122/217 (56%) at 12 months. Healing rate decreased with increasing tear size (small tears 66%, medium tears 68%, large tears 47%, and massive tears 27% healed). The mean age of patients with a healed repair was 61 years compared with 64 years for those with a non-healed repair. Mean age increased with larger tear sizes (small tears 59 years, medium tears 62 years, large tears 64 years, and massive tears 66 years). Increasing age was an independent factor that negatively influenced healing, even after controlling for tear size. Only massive tears were an independent predictor of non-healing, after controlling for age. Interpretation — Although increasing age and larger tear size are both risks for failure of rotator cuff repair healing, age is the dominant risk factor. PMID:28880113

  1. Interferometer for measuring the dynamic surface topography of a human tear film

    NASA Astrophysics Data System (ADS)

    Primeau, Brian C.; Greivenkamp, John E.

    2012-03-01

    The anterior refracting surface of the eye is the thin tear film that forms on the surface of the cornea. Following a blink, the tear film quickly smoothes and starts to become irregular after 10 seconds. This irregularity can affect comfort and vision quality. An in vivo method of characterizing dynamic tear films has been designed based upon a near-infrared phase-shifting interferometer. This interferometer continuously measures light reflected from the tear film, allowing sub-micron analysis of the dynamic surface topography. Movies showing the tear film behavior can be generated along with quantitative metrics describing changes in the tear film surface. This tear film measurement allows analysis beyond capabilities of typical fluorescein visual inspection or corneal topography and provides better sensitivity and resolution than shearing interferometry methods. The interferometer design is capable of identifying features in the tear film much less than a micron in height with a spatial resolution of about ten microns over a 6 mm diameter. This paper presents the design of the tear film interferometer along with the considerations that must be taken when designing an interferometer for on-eye diagnostics. Discussions include eye movement, design of null optics for a range of ocular geometries, and laser emission limits for on-eye interferometry.

  2. Association Between Contact Lens Discomfort and Pre-lens Tear Film Kinetics.

    PubMed

    Guillon, Michel; Dumbleton, Kathryn A; Theodoratos, Panagiotis; Wong, Stephanie; Patel, Kishan; Banks, Gaidig; Patel, Trisha

    2016-08-01

    The relationship between contact lens wettability and comfort has been extensively evaluated; however, a direct correlation between the characteristics of the pre-lens tear film and the symptoms associated with contact lens discomfort has yet to be established. In addition, there is relatively limited knowledge relating to the entire tear film kinetics during the inter-blink period in contact lens wearers. The purpose of this analysis was to identify the characteristics of the pre-lens tear film kinetics that may be associated with the symptoms of contact lens discomfort. The study population comprised 202 soft (hydrogel and silicone hydrogel) contact lens wearers attending pre-screening visits at the OTG-i research clinic. All participants completed the Ocular Surface Disease Index (OSDI) questionnaire and the tear film was quantified via post hoc, masked analysis of high definition digital Tearscope videos recorded at the visit. The tear film kinetics of the least symptomatic wearers (OSDI lowest quintile scores, n = 45) were compared to the tear film kinetics of the most symptomatic wearers (OSDI highest quintile scores, n = 43). The hypothesis tested was that the tear film kinetics of asymptomatic wearers were better than tear film kinetics of symptomatic wearers. The distribution of lens types worn was as follows: Daily Disposable 46.5%, 1-Month Replacement 39.6%, and 2-Week Replacement 13.6%. 48.2% of lenses were silicone hydrogel and 51.8% hydrogel. Symptomatic wearers had a shorter break-up time (4.7 s vs. 6.0 s; p = 0.003), lesser surface coverage by the tear film during the interblink period (95.1% vs. 98.5%; p < 0.001) and greater surface exposure at the time of the blink (9.4% vs. 3.9%; p = 0.001). The current study demonstrated that the tear film kinetics of asymptomatic and symptomatic contact lens wearers were different, the findings supporting the hypothesis of poorer tear film kinetics for symptomatic than asymptomatic wearers in a general contact

  3. Magnetic Resonance Imaging Findings in the Symptomatic Hips of Younger Retired National Football League Players.

    PubMed

    Domb, Benjamin G; Jackson, Timothy J; Carter, Christopher C; Jester, Jon R; Finch, Nathan A; Stake, Christine E

    2014-07-01

    American football players have an increased level of risk for hip injuries because of the high level of contact, biomechanical load, and anatomic strain placed on the hip joint. Many injuries are attributed to soft tissue injury rather than intra-articular lesions. However, because of improved imaging and increased knowledge, physicians are attributing unexplained hip pain to intra-articular lesions with increasing frequency. To assess the prevalence of pathologic intra-articular hip lesions in a younger, retired National Football League (NFL) player cohort evaluated for persistent hip pain. Case series; Level of evidence, 4. A retrospective chart review was performed of magnetic resonance imaging (MRI) on retired NFL players evaluated at an orthopaedic clinic for persistent hip pain. All MRIs were performed at the same location and reviewed by the same independent radiologist. The study included 62 hips; MRI was used to evaluate 27 hips, and MRI arthrogram was used to evaluate 35 hips. Images were assessed for labral tears, chondral lesions, ligamentum teres (LT) tears, bone cysts, osteophytes, loose bodies, trochanteric bursitis, and alpha angle. Player demographics, including position and seasons played, were recorded. From February 2011 to December 2012, a total of 50 retired players from the NFL (average age, 33 years; range, 27-39 years) received impairment evaluations assessing all symptomatic joints. Thirty-eight (76%) players had hip complaints and underwent a dedicated hip MRI. Twenty-four players (63%) had bilateral hip pain, for a total of 62 hips evaluated. There were 55 (89%) labral tears, 61 (98%) chondral lesions, and 50 (81%) partial or complete LT tears identified on MRI. Additional findings included 3 (5%) hips with osteophytes, 9 (14.5%) with subchondral bone cysts, and 3 (5%) with paralabral cysts. None of the players were found to have trochanteric bursitis or loose bodies. Fifty-eight of 62 alpha angles could be measured, for a mean of 59

  4. Secure Screw Placement in Management of Acetabular Fractures Using the Suprapectineal Quadrilateral Buttress Plate.

    PubMed

    Egli, R J; Keel, M J B; Cullmann, J L; Bastian, J D

    2017-01-01

    Acetabular fractures involving predominantly the anterior column associated with a disruption of the quadrilateral surface can be treated with instrumentation implementing the stabilization of the quadrilateral surface. The recently introduced suprapectineal quadrilateral buttress plate is specifically designed to prevent secondary medial subluxation of the femoral head, especially in elderly patients with reduced ability for partial weight bearing. Whereas there are guidelines available for safe screw fixation for the anterior and posterior columns, there might be a concern for intra-articular placement of screws placed through the infrapectineal part of the quadrilateral buttress plate. Within this report we analyzed retrospectively screw placement in 30 plates in postoperative CT scans using algorithms for metal artifact reduction. None of the screws of the buttress plate penetrated the hip joint. We describe the placement, length, and spatial orientation of the screws used for fracture fixation and suggest that the use of intraoperative image intensifiers with a combined inlet-obturator view of 30-45° best projects the screws and the hip joint. Preoperative knowledge of approximate screw placement and information for accurate intraoperative imaging may contribute to safe acetabular fracture fixation and may reduce operating time and limit radiation exposure to the patient and the personnel. This trial is registered with KEK-BE: 266/2014.

  5. Initial stability of a highly porous titanium cup in an acetabular bone defect model.

    PubMed

    Yoshimoto, Kensei; Nakashima, Yasuharu; Wakiyama, Miyo; Hara, Daisuke; Nakamura, Akihiro; Iwamoto, Mikio

    2018-04-12

    The purpose of this study was to quantify the initial stability of a highly porous titanium cup using an acetabular bone defect model. The maximum torque of a highly porous titanium cup, with a pore size of 640 μm and porosity of 60%, was measured using rotational and lever-out torque testing and compared to that of a titanium-sprayed cup. The bone models were prepared using a polyurethane foam block and had three levels of bone coverage: 100, 70, and 50%. The highly porous titanium cup demonstrated significantly higher maximum torque than the titanium-sprayed cups in the three levels of bone defects. On rotational torque testing, it was found to be 1.5, 1.3, and 1.3 times stronger than the titanium-sprayed cups with 100, 70 and 50% bone coverage, respectively. Furthermore, it was found to be 2.2, 2.3, and 1.5 times stronger on lever-out testing than the titanium-sprayed cup. No breakage in the porous layers was noted during the testing. This study provides additional evidence of the initial stability of highly porous titanium cup, even in the presence of acetabular bone defects. Copyright © 2018. Published by Elsevier B.V.

  6. Comparison of non-invasive tear film stability measurement techniques.

    PubMed

    Wang, Michael Tm; Murphy, Paul J; Blades, Kenneth J; Craig, Jennifer P

    2018-01-01

    Measurement of tear film stability is commonly used to give an indication of tear film quality but a number of non-invasive techniques exists within the clinical setting. This study sought to compare three non-invasive tear film stability measurement techniques: instrument-mounted wide-field white light clinical interferometry, instrument-mounted keratoscopy and hand-held keratoscopy. Twenty-two subjects were recruited in a prospective, randomised, masked, cross-over study. Tear film break-up or thinning time was measured non-invasively by independent experienced examiners, with each of the three devices, in a randomised order, within an hour. Significant correlation was observed between instrument-mounted interferometric and keratoscopic measurements (p < 0.001) but not between the hand-held device and the instrument-mounted techniques (all p > 0.05). Tear film stability values obtained from the hand-held device were significantly shorter and demonstrated narrower spread than the other two instruments (all p < 0.05), while no significant differences were observed between the two instrument-mounted devices (all p > 0.05). Good clinical agreement exists between the instrument-mounted interferometric and keratoscopic measurements but not between the hand-held device and either of the instrument-mounted techniques. The results highlight the importance of specifying the instrument employed to record non-invasive tear film stability. © 2017 Optometry Australia.

  7. Artificially modified collagen fibril orientation affects leather tear strength.

    PubMed

    Kelly, Susyn J; Wells, Hannah C; Sizeland, Katie H; Kirby, Nigel; Edmonds, Richard L; Ryan, Tim; Hawley, Adrian; Mudie, Stephen; Haverkamp, Richard G

    2018-07-01

    Ovine leather has around half the tear strength of bovine leather and is therefore not suitable for high-value applications such as shoes. Tear strength has been correlated with the natural collagen fibril alignment (orientation index, OI). It is hypothesized that it could be possible to artificially increase the OI of the collagen fibrils and that an artificial increase in OI could increase tear strength. Ovine skins, after pickling and bating, were strained biaxially during chrome tanning. The strain ranged from 2 to 15% of the initial sample length, either uniformly in both directions by 10% or with 3% in one direction and 15% in the other. Once tanned, the leather tear strengths were measured and the collagen fibril orientation was measured using synchrotron-based small-angle X-ray scattering. The OI increased as a result of strain during tanning from 0.48 to 0.79 (P = 0.001) measured edge-on and the thickness-normalized tear strength increased from 27 to 43 N mm -1 (P < 0.001) after leather was strained 10% in two orthogonal directions. This is evidence to support a causal relationship between high OI (measured edge-on), highly influenced by thickness, and tear strength. It also provides a method to produce stronger leather. © 2017 Society of Chemical Industry. © 2017 Society of Chemical Industry.

  8. Concentrations of MUC16 and MUC5AC using three tear collection methods

    PubMed Central

    Nichols, Jason J.

    2017-01-01

    Purpose To determine the optimal tear collection method for analysis of ocular surface mucins MUC5AC and MUC16. Methods Fifteen subjects without ocular surface disease were recruited. Subjects presented for tear collection on three separate days for three different tear collection methods with the order of method randomized. Methods used to collect tears from right and left eyes included Schirmer’s strip, basal tear collection, and flush tear collection. All samples from the right eyes were individually analyzed for MUC5AC whereas the left eye samples were individually analyzed for MUC16. For each individual sample, 10 μg of protein were loaded per lane into a 1% (w/v) agarose gel and run in electrophoresis buffer for 2 h. After overnight capillary transfer, membranes were incubated with either MUC5AC antibody CLH2 or MUC16 antibody OC125 for western blot analysis. Blots were developed with enhanced chemiluminescence (ECL) and signals captured with the Odyssey Fc (LI-COR). The relative amounts of MUC5AC and MUC16 were quantified with densitometry using software and compared for statistically significant differences between tear collection methods using the Kruskal–Wallis test in SPSS 22 and GraphPad Prism 7.02. Dunn’s multiple comparisons test was used for pairwise post-hoc comparisons. Results Samples containing less than 10 μg of total protein were not used for analysis which left eight samples (out of 45) unusable. The calculated MUC5AC median signal intensities from Schirmer’s strip, basal tears, and flush tears were 2.86 (n = 15, the interquartile range [IQR] = 2.54–3.21), 1.65 (n = 14, IQR = 1.34–3.1), and 1.67 (n = 9, IQR = 1.42–1.72), respectively (H = 9.5, p = 0.009). Post-hoc pairwise comparisons showed a statistically significant difference between Schirmer’s strip and flush tears (p = 0.01). The calculated MUC16 median signal intensities from Schirmer’s strip, basal tears, and flush tears were 1.88 (n = 14, IQR = 1.43–2.61), 5

  9. Slab tears and intermediate-depth seismicity

    USGS Publications Warehouse

    Meighan, Hallie E.; ten Brink, Uri S.; Pulliam, Jay

    2013-01-01

    Active tectonic regions where plate boundaries transition from subduction to strike slip can take several forms, such as triple junctions, acute, and obtuse corners. Well-documented slab tears that are associated with high rates of intermediate-depth seismicity are considered here: Gibraltar arc, the southern and northern ends of the Lesser Antilles arc, and the northern end of Tonga trench. Seismicity at each of these locations occurs, at times, in the form of swarms or clusters, and various authors have proposed that each marks an active locus of tear propagation. The swarms and clusters start at the top of the slab below the asthenospheric wedge and extend 30–60 km vertically downward within the slab. We propose that these swarms and clusters are generated by fluid-related embrittlement of mantle rocks. Focal mechanisms of these swarms generally fit the shear motion that is thought to be associated with the tearing process.

  10. [Biomechanical significance of the acetabular roof and its reaction to mechanical injury].

    PubMed

    Domazet, N; Starović, D; Nedeljković, R

    1999-01-01

    The introduction of morphometry into the quantitative analysis of the bone system and functional adaptation of acetabulum to mechanical damages and injuries enabled a relatively simple and acceptable examination of morphological acetabular changes in patients with damaged hip joints. Measurements of the depth and form of acetabulum can be done by radiological methods, computerized tomography and ultrasound (1-9). The aim of the study was to obtain data on the behaviour of acetabular roof, the so-called "eyebrow", by morphometric analyses during different mechanical injuries. Clinical studies of the effect of different loads on acetabular roof were carried out in 741 patients. Radiographic findings of 400 men and 341 women were analysed. The control group was composed of 148 patients with normal hip joints. Average age of the patients was 54.7 years and that of control subjects 52.0 years. Data processing was done for all examined patients. On the basis of our measurements the average size of female "eyebrow" ranged from 24.8 mm to 31.5 mm with standard deviation of 0.93 and in men from 29.4 mm to 40.3 mm with standard deviation of 1.54. The average size in the whole population was 32.1 mm with standard deviation of 15.61. Statistical analyses revealed high correlation coefficients between the age and "eyebrow" size in men (r = 0.124; p < 0.05); it was statically in inverse proportion (Graph 1). However, in female patients the correlation coefficient was statistically significant (r = 0.060; p > 0.05). The examination of the size of collodiaphysial angle and length of "eyebrow" revealed that "eyebrow" length was in inverse proportion to the size of collodiaphysial angle (r = 0.113; p < 0.05). The average "eyebrow" length in relation to the size of collodiaphysial angle ranged from 21.3 mm to 35.2 mm with standard deviation of 1.60. There was no statistically significant correlation between the "eyebrow" size and Wiberg's angle in male (r = 0.049; p > 0.05) and

  11. The association between body fat and rotator cuff tear: the influence on rotator cuff tear sizes.

    PubMed

    Gumina, Stefano; Candela, Vittorio; Passaretti, Daniele; Latino, Gianluca; Venditto, Teresa; Mariani, Laura; Santilli, Valter

    2014-11-01

    Rotator cuff tear (RCT) has a multifactorial etiology. We hypothesized that obesity may increase the risk of RCT and influence tear size. A case-control design study was used. We studied 381 consecutive patients (180 men, 201 women; mean age ± standard deviation, 65.5 ± 8.52 years; range, 43-78 years) who underwent arthroscopic rotator cuff repair. Tear size was determined intraoperatively. The control group included 220 subjects (103 men, 117 women; mean age ± standard deviation, 65.16 ± 7.24 years; range, 42-77 years) with no RCT. Body weight, height, and bicipital, tricipital, subscapularis, and suprailiac skinfolds of all participants were measured to obtain body mass index (BMI) and the percentage of body fat (%BF). For the purposes of the study, the 601 participants were divided into 2 groups by BMI (group A, BMI ≥ 25; group B, BMI < 25). The odds ratios (ORs) were calculated to investigate whether adiposity affects the risk of RCT. Data were stratified according to gender and age. Multiple linear regression analyses were applied to explore the association between obesity and tear size. The highest ORs for both men (OR, 2.49; 95% confidence interval, 1.41-3.90; P = .0037) and women (OR, 2.31; 95% confidence interval, 1.38-3.62; P = .0071) were for individuals with a BMI ≥ 30; 69% (N = 303) of group A and 48% (N = 78) of group B had RCTs. Patients with RCT had a BMI higher than that of subjects with no RCT in both groups (P = .031, group A; P = .02, group B). BMI and %BF significantly increased from patients with a small tear (BMI, 27.85; %BF, 37.63) to those with a massive RCT (BMI, 29.93; %BF, 39.43). Significant differences were found (P = .004; P = .031). Our results provide evidence that obesity, measured through BMI and %BF, is a significant risk factor for the occurrence and severity of RCT. Copyright © 2014. Published by Elsevier Inc.

  12. Antibody Protein Array Analysis of the Tear Film Cytokines

    PubMed Central

    Li, Shimin; Sack, Robert; Vijmasi, Trinka; Sathe, Sonal; Beaton, Ann; Quigley, David; Gallup, Marianne; McNamara, Nancy A.

    2013-01-01

    Purpose Many bioactive proteins including cytokines are reported to increase in dry eye disease although the specific profile and concentration of inflammatory mediators varies considerably from study to study. In part this variability results from inherent difficulties in quantifying low abundance proteins in a limited sample volume using relatively low sensitivity dot ELISA methods. Additional complexity comes with the use of pooled samples collected using a variety of techniques and intrinsic variation in the diurnal pattern of individual tear proteins. The current study describes a recent advance in the area of proteomics that has allowed the identification of dozens of low abundance proteins in human tear samples. Methods Commercially available stationary phase antibody protein arrays were adapted to improve suitability for use in small volume biological fluid analysis with particular emphasis on tear film proteomics. Arrays were adapted to allow simultaneous screening for a panel of inflammatory cytokines in low volume tear samples collected from individual eyes. Results A preliminary study comparing tear array results in a small population of Sjögren’s syndrome patients was conducted. The multiplex microplate array assays of cytokines in tear fluid present an unanticipated challenge due to the unique nature of tear fluid. The presence of factors that exhibit an affinity for plastic, capture antibodies and IgG and create a complex series of matrix effects profoundly impacting the reliability of dot ELISA, including with elevated levels of background reactivity and reduction in capacity to bind targeted protein. Conclusions Preliminary results using tears collected from patients with Sjögren’s syndrome reveal methodological advantages of protein array technology and support the concept that autoimmune-mediated dry eye disease has an inflammatory component. They also emphasize the inherent difficulties one can face when interpreting the results of micro

  13. Glycan involvement in the adhesion of Pseudomonas aeruginosa to tears.

    PubMed

    Kautto, Liisa; Nguyen-Khuong, Terry; Everest-Dass, Arun; Leong, Andrea; Zhao, Zhenjun; Willcox, Mark D P; Packer, Nicolle H; Peterson, Robyn

    2016-04-01

    The human eye is constantly bathed by tears, which protect the ocular surface via a variety of mechanisms. The O-linked glycans of tear mucins have long been considered to play a role in binding to pathogens and facilitating their removal in the tear flow. Other conjugated glycans in tears could similarly contribute to pathogen binding and removal but have received less attention. In the work presented here we assessed the contribution of glycan moieties, in particular the protein attached N-glycans, presented by the broad complement of tear proteins to the adhesion of the opportunistic pathogen Pseudomonas aeruginosa, a leading cause of microbial keratitis and ulceration of the cornea. Our adhesion assay involved immobilising the macromolecular components of tears into the wells of a polyvinyl difluoride (PVDF) microtitre filter plate and probing the binding of fluorescently labelled bacteria. Three P. aeruginosa strains were studied: a cytotoxic strain (6206) and an invasive strain (6294) from eye infections, and an invasive strain (320) from a urinary tract infection (UTI). The ocular isolates adhered two to three times more to human tears than to human saliva or porcine gastric mucin, suggesting ocular niche-specific adaptation. Support for the role of the N-glycans carried by human tear proteins in the binding and removal of P. aeruginosa from the eye was shown by: 1) pre-incubation of the bacteria with free component sugars, galactose, mannose, fucose and sialyl lactose (or combination thereof) inhibiting adhesion of all the P. aeruginosa strains to the immobilised tear proteins, with the greatest inhibition of binding of the ocular cytotoxic 6206 and least for the invasive 6294 strain; 2) pre-incubation of the bacteria with N-glycans released from the commercially available human milk lactoferrin, an abundant protein that carries N-linked glycans in tears, inhibiting the adhesion to tears of the ocular bacteria by up to 70%, which was significantly more

  14. Predictive MRI correlates of lesser metatarsophalangeal joint plantar plate tear.

    PubMed

    Umans, Rachel L; Umans, Benjamin D; Umans, Hilary; Elsinger, Elisabeth

    2016-07-01

    To identify correlated signs on non-enhanced MRI that might improve diagnostic detection of plantar plate (PP) tear. We performed an IRB-approved, HIPAA-compliant retrospective analysis of 100 non-contrast MRI (50 PP tear, 50 controls). All were anonymized, randomized, and reviewed; 20 were duplicated to assess consistency. One musculoskeletal radiologist evaluated qualitative variables. A trained non-physician performed measurements. Consistency and concordance were assessed. Pearson's Chi-square test was used to test the correlation between qualitative findings and PP tear status. Correlation between measurements and PP status was assessed using t tests and Wilcoxon's rank-sum test (p values < 0.05 considered significant). Classification and regression trees were utilized to identify attributes that, taken together, would consistently distinguish PP tear from controls. Quantitative measurements were highly reproducible (concordance 0.88-0.99). Elevated 2nd MT protrusion, lesser MT supination and rotational divergence of >45° between the 1st-2nd MT axis correlated with PP tear. Pericapsular soft tissue thickening correlated most strongly with PP tear, correctly classifying 95 % of cases and controls. Excluding pericapsular soft tissue thickening, sequential assessment of 2nd toe enthesitis, 2nd flexor tendon subluxation, and splaying of the second and third toes accurately classified PP status in 92 %. Pericapsular soft tissue thickening most strongly correlated with PP tear. For cases in which it might be difficult to distinguish pericapsular fibrosis from neuroma, sequential assessment of 2nd toe enthesitis, flexor tendon subluxation and splaying of the 2nd and 3rd toe is most helpful for optimizing accurate diagnosis of PP tear.

  15. Does midwife experience affect the rate of severe perineal tears?

    PubMed

    Mizrachi, Yossi; Leytes, Sophia; Levy, Michal; Hiaev, Zvia; Ginath, Shimon; Bar, Jacob; Kovo, Michal

    2017-06-01

    Our aim was to study whether midwife experience affects the rate of severe perineal tears (3rd and 4th degree). A retrospective cohort study of all women with term vertex singleton pregnancies, who underwent normal vaginal deliveries, in a single tertiary hospital, between 2011 and 2015, was performed. Exclusion criteria were instrumental deliveries and stillbirth. All midwives used a "hands on" technique for protecting the perineum. The midwife experience at each delivery was calculated as the time interval between her first delivery and current delivery. A comparison was performed between deliveries in which midwife experience was less than 2 years (inexperienced), between 2 and 10 years (moderately experienced), and more than 10 years (highly experienced). A multivariate regression analysis was performed to assess the association between midwife experience and the incidence of severe perineal tears, after controlling for confounders. Overall, 15 146 deliveries were included. Severe perineal tears were diagnosed in 51 (0.33%) deliveries. Women delivered by inexperienced midwives had a higher rate of severe perineal tears compared with women delivered by highly experienced midwives (0.5% vs 0.2%, respectively, P=.024). On multivariate regression analysis, midwife experience was independently associated with a lower rate of severe perineal tears, after controlling for confounding factors. Each additional year of experience was associated with a 4.7% decrease in the risk of severe perineal tears (adjusted OR 0.95 [95% CI 0.91-0.99, P=.03). More experienced midwives had a lower rate of severe perineal tears, and may be preferred for managing deliveries of women at high risk for such tears. © 2017 Wiley Periodicals, Inc.

  16. The knee meniscus: management of traumatic tears and degenerative lesions

    PubMed Central

    Beaufils, Philippe; Becker, Roland; Kopf, Sebastian; Matthieu, Ollivier; Pujol, Nicolas

    2017-01-01

    Meniscectomy is one of the most popular orthopaedic procedures, but long-term results are not entirely satisfactory and the concept of meniscal preservation has therefore progressed over the years. However, the meniscectomy rate remains too high even though robust scientific publications indicate the value of meniscal repair or non-removal in traumatic tears and non-operative treatment rather than meniscectomy in degenerative meniscal lesions In traumatic tears, the first-line choice is repair or non-removal. Longitudinal vertical tears are a proper indication for repair, especially in the red-white or red-red zones. Success rate is high and cartilage preservation has been proven. Non-removal can be discussed for stable asymptomatic lateral meniscal tears in conjunction with anterior cruciate ligament (ACL) reconstruction. Extended indications are now recommended for some specific conditions: horizontal cleavage tears in young athletes, hidden posterior capsulo-meniscal tears in ACL injuries, radial tears and root tears. Degenerative meniscal lesions are very common findings which can be considered as an early stage of osteoarthritis in middle-aged patients. Recent randomised studies found that arthroscopic partial meniscectomy (APM) has no superiority over non-operative treatment. Thus, non-operative treatment should be the first-line choice and APM should be considered in case of failure: three months has been accepted as a threshold in the ESSKA Meniscus Consensus Project presented in 2016. Earlier indications may be proposed in cases with considerable mechanical symptoms. The main message remains: save the meniscus! Cite this article: EFORT Open Rev 2017;2. DOI: 10.1302/2058-5241.2.160056. Originally published online at www.efortopenreviews.org PMID:28698804

  17. The brilliant beauty of the eye: light reflex from the cornea and tear film.

    PubMed

    Goto, Eiki

    2006-12-01

    Light reflex from the cornea and tear film as contributors to beautiful eyes ("eye sparkling") are reviewed. A systematic literature review was conducted using "Purkinje-Sanson image," "corneal light reflex," "corneal topography," "corneal wavefront aberration," and "tear interference image" as search terms. Articles on corneal surface regularity and stability and tear interferometry of the precorneal tear lipid layer were reviewed. PS-1 image, that is light reflex from the cornea and tear film, is widely used in practical ophthalmic examination. To achieve a brilliant beauty of the eye ("eye sparkling"), it is important that the tear film (aqueous layer) surface is smooth and stable with adequate tear volume and that the tear lipid layer is present in adequate thickness.

  18. Tear film proteome in age-related macular degeneration.

    PubMed

    Winiarczyk, Mateusz; Kaarniranta, Kai; Winiarczyk, Stanisław; Adaszek, Łukasz; Winiarczyk, Dagmara; Mackiewicz, Jerzy

    2018-06-01

    Age-related macular degeneration (AMD) is the main reason for blindness in elderly people in the developed countries. Current screening protocols have limitations in detecting the early signs of retinal degeneration. Therefore, it would be desirable to find novel biomarkers for early detection of AMD. Development of novel biomarkers would help in the prevention, diagnostics, and treatment of AMD. Proteomic analysis of tear film has shown promise in this research area. If an optimal set of biomarkers could be obtained from accessible body fluids, it would represent a reliable way to monitor disease progression and response to novel therapies. Tear films were collected on Schirmer strips from a total of 22 patients (8 with wet AMD, 6 with dry AMD, and 8 control individuals). 2D electrophoresis was used to separate tear film proteins prior to their identification with matrix-assisted laser desorption/ionization time of flight spectrometer (MALDI-TOF/TOF) and matching with functional databases. A total of 342 proteins were identified. Most of them were previously described in various proteomic studies concerning AMD. Shootin-1, histatin-3, fidgetin-like protein 1, SRC kinase signaling inhibitor, Graves disease carrier protein, actin cytoplasmic 1, prolactin-inducible protein 1, and protein S100-A7A were upregulated in the tear film samples isolated from AMD patients and were not previously linked with this disease in any proteomic analysis. The upregulated proteins supplement our current knowledge of AMD pathogenesis, providing evidence that certain specific proteins are expressed into the tear film in AMD. As far we are aware, this is the first study to have undertaken a comprehensive in-depth analysis of the human tear film proteome in AMD patients.

  19. Freezing Range, Melt Quality, and Hot Tearing in Al-Si Alloys

    NASA Astrophysics Data System (ADS)

    Uludağ, Muhammet; Çetin, Remzi; Dispinar, Derya

    2018-02-01

    In this study, three different aluminum-silicon alloys (A356, A413, and A380) that have different solidification morphology and solidification ranges were examined with an aim to evaluate the hot tearing susceptibility. T-shape mold and Constrained Rod Casting (CRC) mold were used for the characterization. Reduced Pressure Test (RPT) was used to quantify the casting quality by measuring bifilm index. It was found that bifilm index and solidification range have an important role on the hot tearing formation. As it is known, bifilms can cause porosity and in this case, it was shown that porosity formed by bifilms decreased hot tearing tendency. As the freezing range of alloy increases, bifilms find the time to unravel that reduces hot tearing. However, for eutectic alloy (A413), due to zero freezing range, regardless of bifilm content, hot tearing was never observed. A380.1 alloy had the highest tendency for hot tearing due to having the highest freezing range among the alloys investigated in this work.

  20. Mental Health Has a Stronger Association with Patient-Reported Shoulder Pain and Function Than Tear Size in Patients with Full-Thickness Rotator Cuff Tears.

    PubMed

    Wylie, James D; Suter, Thomas; Potter, Michael Q; Granger, Erin K; Tashjian, Robert Z

    2016-02-17

    Patient-reported outcome measures have increasingly accompanied objective examination findings in the evaluation of orthopaedic interventions. Our objective was to determine whether a validated measure of mental health (Short Form-36 Mental Component Summary [SF-36 MCS]) or measures of tear severity on magnetic resonance imaging were more strongly associated with self-assessed shoulder pain and function in patients with symptomatic full-thickness rotator cuff tears. One hundred and sixty-nine patients with full-thickness rotator cuff tears were prospectively enrolled. Patients completed the Short Form-36, visual analog scales for shoulder pain and function, the Simple Shoulder Test (SST), and the American Shoulder and Elbow Surgeons (ASES) instrument at the time of diagnosis. Shoulder magnetic resonance imaging examinations were reviewed to document the number of tendons involved, tear size, tendon retraction, and tear surface area. Age, sex, body mass index, number of medical comorbidities, smoking status, and Workers' Compensation status were recorded. Bivariate correlations and multivariate regression models were calculated to identify associations with baseline shoulder scores. The SF-36 MCS had the strongest correlation with the visual analog scale for shoulder pain (Pearson correlation coefficient, -0.48; p < 0.001), the visual analog scale for shoulder function (Pearson correlation coefficient, -0.33; p < 0.001), the SST (Pearson correlation coefficient, 0.37; p < 0.001), and the ASES score (Pearson correlation coefficient, 0.51; p < 0.001). Tear severity only correlated with the visual analog scale for shoulder function; the Pearson correlation coefficient was 0.19 for tear size (p = 0.018), 0.18 for tendon retraction (p = 0.025), 0.18 for tear area (p = 0.022), and 0.20 for the number of tendons involved (p = 0.011). Tear severity did not correlate with other scores in bivariate correlations (all p > 0.05). In all multivariate models, the SF-36 MCS had the

  1. Is metal-on-metal squeaking related to acetabular angle of inclination?

    PubMed

    Bernasek, Thomas; Fisher, David; Dalury, David; Levering, Melissa; Dimitris, Kirk

    2011-09-01

    Postoperative audible squeaking has been well documented in ceramic-on-ceramic hip prostheses, and several metal-on-metal (MOM) THA designs, specifically those used for large-head resurfacing and MOM polyethylene sandwich designs, and are attributed to different implant- and patient-specific factors. Current literature does not identify the incidence of squeaking in modular MOM THA or possible etiologic factors. Our purposes were to (1) identify the incidence of squeaking in modular MOM prostheses in THA; (2) determine whether males or females were more likely to have squeaking; and (3) determine whether the incidence of squeaking relates to acetabular inclination angle. We retrospectively reviewed the patient records and radiographs of 539 patients (542 hips) from three independent centers who underwent a MOM THA between February 2001 and December 2005. Demographic and implant factors were evaluated, including measurement of cup inclination angles. The minimum followup was 36 months (mean, 76 months; range, 36-119 months). We identified squeaking in eight of the 542 hips (1.5%); five were in women and two were in men (one patient had bilateral squeaking). The time to onset of patient-reported audible squeaking averaged 23 months (range, 6-84 months). Squeaking was more likely to occur in women (six of eight hips). No hips with 45º or less acetabular inclination squeaked (291 hips); eight of 251 hips (3.2%) with inclination angles greater than 45º squeaked. Patients who reported squeaking had higher inclination angles than those who did not report squeaking. Our observations suggest an increased frequency of squeaking in female patients and in patients with greater inclination angles with this MOM implant design.

  2. Radiographic progression of arthritic changes in shoulders with degenerative rotator cuff tears.

    PubMed

    Chalmers, Peter N; Salazar, Dane H; Steger-May, Karen; Chamberlain, Aaron M; Stobbs-Cucchi, Georgia; Yamaguchi, Ken; Keener, Jay D

    2016-11-01

    Very little longitudinal information has been available regarding the relationship of cuff tears and arthritis. The purpose of this study was to determine the midterm risk of and risk factors for rotator cuff tear arthropathy progression in a cohort of subjects with an asymptomatic rotator cuff tear. Baseline (visit 1), 5-year (visit 2), and most recent follow-up (visit 3) radiographs were reviewed in a cohort of 105 subjects enrolled for longitudinal surveillance of asymptomatic degenerative rotator cuff tears and 33 controls. The radiographs were assessed in a blinded, randomized fashion by 3 observers who graded glenohumeral arthritic changes using the Hamada scores, Samilson-Prieto (SPO) scores, and acromiohumeral interval (AHI). Osteoarthritis (SPO classification), cuff tear arthropathy (Hamada classification), and AHI progressed between visits 1 and 3 (median, 8 years; P < .001 in all cases). SPO progression was not significantly different for partial- vs. full-thickness vs. control baseline tear types (P = .19). Both full-thickness and partial-thickness tears had greater progression in Hamada scores than controls did in the first 5 years of follow-up (P = .02 and P = .03, respectively), but scores did not differ between partial- and full-thickness tears. Tears with and without enlargement did not differ in progression in SPO grade, Hamada grade, or AHI. Glenohumeral arthritic changes progress significantly but remain minimal within an 8-year period in early to moderate degenerative cuff disease. Whereas the presence of a rotator cuff tear influences progression in Hamada grade, the magnitude of radiographic progression is not influenced by tear severity or enlargement at midterm time points. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  3. Prevalence of triceps tendon tears on MRI of the elbow and clinical correlation.

    PubMed

    Koplas, Monica C; Schneider, Erika; Sundaram, Murali

    2011-05-01

    Triceps tendon injuries are reported to be very rare. To our knowledge, there have been no studies describing its prevalence or injury patterns on MR imaging. The purpose of this retrospective study was to determine the prevalence and patterns of triceps injuries based on a large series of consecutive MR examinations. Clinical correlation was obtained. From 801 consecutive elbow MR examinations over a 15-year period, 28 patients with 30 triceps tendon injuries were identified and graded as partial tendon tear and complete tendon tear. The patients' medical records were reviewed to determine age, gender, cause of tears, and management. The prevalence of triceps tendon injuries was 3.8%. There were 5 women and 23 men with partial or complete tears (mean age: 46.6 years; range: 2.7 to 75.1 years). The most common injury was partial tear, found in 18 patients. There were 10 patients with 12 complete tears (2 had re-torn following surgical repair). A tear was suspected in 12 out 28 (43%) patients prior to the MRI. The most common presenting symptom was pain. The most common cause was athletic injury (8 patients [29%], including weightlifting [2 patients]). Tendon tear was found to be a complication of infection in 6 patients, and in 3 patients the tears were a complication of steroid use. Thirteen tendon tears were surgically repaired (8 of these were complete tears). Triceps tendon injury is not as rare as commonly reported and may often be clinically underdiagnosed.

  4. Proteases, proteolysis and inflammatory molecules in the tears of people with keratoconus.

    PubMed

    Balasubramanian, Sivaraman Arumugam; Mohan, Sujatha; Pye, David Cecil; Willcox, Mark Duncan Perry

    2012-06-01

    To investigate the expression of proteases, proteolytic activity and cytokines in the tear film of people with keratoconus. Basal tears from people with keratoconus, from individuals who had undergone corneal collagen cross-linking for the treatment of keratoconus, and from normal controls were collected using a capillary tube. Corneal curvature of each subject was mapped. The total protein in tears was estimated. Levels and activity of proteases in the tears were analysed using specific antibody arrays and activity assays. The total tear protein level was significantly reduced in keratoconus (4.1 ± 0.9 mg/ml) compared with normals (6.7 ± 1.4 mg/ml) (p < 0.0001) or subjects who had undergone corneal collagen cross-linking (5.7 ± 2.3 mg/ml) (p < 0.005). Significantly (p < 0.05) increased tear expression of matrix metalloproteinases (MMP) -1, -3, -7, -13, interleukins (IL) -4, -5, -6, -8 and tumour necrosis factor (TNF) -α, -β were evident in keratoconus. Tear IL-6 was the only cytokine significantly (p < 0.05) increased in tears of keratoconus subjects compared with the collagen cross-linked group. No significant difference in tear proteases were observed between the normal and the cross-linked groups, although the expression of TNF-α was significantly (p < 0.05) increased in the cross-linked group compared with the controls. Elevated gelatinolytic (87.5 ± 33.6 versus 45.8 ± 24.6 FIU, p < 0.0001) and collagenolytic (6.1 ± 3.2 versus 3.6 ± 2.0 FIU, p < 0.05) activities were observed in tears from keratoconus compared with normal subjects. The activity of tear gelatinases (69.6 ± 22.2 FIU) and collagenases (5.7 ± 3.3 FIU) in the collagen cross-linked group was not significantly different compared with either keratoconus or normals. Tears of people with keratoconus had 1.9 times higher levels of proteolytic activity and over expression of several MMPs and cytokines compared with tears from controls. Further investigations are required to study the possible

  5. [Diagnostic value of MRI for posterior root tear of medial and lateral meniscus].

    PubMed

    Qian, Yue-Nan; Liu, Fang; Dong, Yi-Long; Cai, Chun-Yuan

    2018-03-25

    To explore diagnostic value of MRI on posterior root tear of medial and lateral meniscus. From January 2012 to January 2016, clinical data of 43 patients with meniscal posterior root tear confirmed by arthroscopy were retrospective analyzed, including 25 males and 18 females, aged from 27 to 69 years old with an average age of(42.5±8.3)years old;27 cases on the right side and 16 cases on the left side. MRI examinations of 43 patients with tear of posterior meniscus root confirmed by knee arthroscopies were retrospectively reviewed. MRI images were double-blinded, independently, retrospectively scored by two imaging physicians. Sensitivity, specificity and accuracy of MRI diagnosis of lateral and medial meniscus posterior root tear were calculated, and knee ligament injury and meniscal dislocation were calculated. Forty-three of 143 patients were diagnosed with meniscus posterior root tears by arthroscopy, including 19 patients with lateral tears and 24 patients with medial tears. The sensitivity, specificity and accuracy in diagnosis of posterior medial meniscus root tears for doctor A were 91.67%, 86.6% and 83.9% respectively, and for doctor B were 87.5%, 87.4% and 87.4%, 19 patients with medial meniscal protrusion and 2 patients with anterior cruciate ligament tear. The sensitivity, specificity and accuracy in diagnosis of posterior lateral meniscus root tears for doctor A were 73.7%, 79.9% and 79% respectively, and for doctor B were 78.9%, 82.3% and 82.5%, 4 patients with lateral meniscus herniation and 16 patients with cruciate ligament tear. Kappa statistics for posterior medial meniscus root tears and posterior lateral meniscus root tears were 0.84 and 0.72. MRI could effectively demonstrate imaging features of medial and lateral meniscal root tear and its accompanying signs. It could provide the basis for preoperative diagnosis of clinicians, and be worthy to be popularized. Copyright© 2018 by the China Journal of Orthopaedics and Traumatology Press.

  6. Relationship of Tear Size and Location to Fatty Degeneration of the Rotator Cuff

    PubMed Central

    Kim, H. Mike; Dahiya, Nirvikar; Teefey, Sharlene A.; Keener, Jay D.; Galatz, Leesa M.; Yamaguchi, Ken

    2010-01-01

    Background: Fatty degeneration of the rotator cuff muscles may have detrimental effects on both anatomical and functional outcomes following shoulder surgery. The purpose of this study was to investigate the relationship between tear geometry and muscle fatty degeneration in shoulders with a deficient rotator cuff. Methods: Ultrasonograms of both shoulders of 262 patients were reviewed to assess the type of rotator cuff tear and fatty degeneration in the supraspinatus and infraspinatus muscles. The 251 shoulders with a full-thickness tear underwent further evaluation for tear size and location. The relationship of tear size and location to fatty degeneration of the supraspinatus and infraspinatus muscles was investigated with use of statistical comparisons and regression models. Results: Fatty degeneration was found almost exclusively in shoulders with a full-thickness rotator cuff tear. Of the 251 shoulders with a full-thickness tear, eighty-seven (34.7%) had fatty degeneration in either the supraspinatus or infraspinatus, or both. Eighty-two (32.7%) of the 251 full-thickness tears had a distance of 0 mm between the biceps tendon and anterior margin of the tear. Ninety percent of the full-thickness tears with fatty degeneration in both muscles had a distance of 0 mm posterior from the biceps, whereas only 9% of those without fatty degeneration had a distance of 0 mm. Tears with fatty degeneration had significantly greater width and length than those without fatty degeneration (p < 0.0001). Tears with fatty degeneration had a significantly shorter distance posterior from the biceps than those without fatty degeneration (p < 0.0001). The distance posterior from the biceps was found to be the most important predictor for supraspinatus fatty degeneration, whereas tear width and length were found to be the most important predictors for infraspinatus fatty degeneration. Conclusions: Fatty degeneration of the rotator cuff muscles is closely associated with tear size and

  7. Full-thickness tears of the supraspinatus tendon: A three-dimensional finite element analysis.

    PubMed

    Quental, C; Folgado, J; Monteiro, J; Sarmento, M

    2016-12-08

    Knowledge regarding the likelihood of propagation of supraspinatus tears is important to allow an early identification of patients for whom a conservative treatment is more likely to fail, and consequently, to improve their clinical outcome. The aim of this study was to investigate the potential for propagation of posterior, central, and anterior full-thickness tears of different sizes using the finite element method. A three-dimensional finite element model of the supraspinatus tendon was generated from the Visible Human Project data. The mechanical behaviour of the tendon was fitted from experimental data using a transversely isotropic hyperelastic constitutive model. The full-thickness tears were simulated at the supraspinatus tendon insertion by decreasing the interface area. Tear sizes from 10% to 90%, in 10% increments, of the anteroposterior length of the supraspinatus footprint were considered in the posterior, central, and anterior regions of the tendon. For each tear, three finite element analyses were performed for a supraspinatus force of 100N, 200N, and 400N. Considering a correlation between tendon strain and the risk of tear propagation, the simulated tears were compared qualitatively and quantitatively by evaluating the volume of tendon for which a maximum strain criterion was not satisfied. The finite element analyses showed a significant impact of tear size and location not only on the magnitude, but also on the patterns of the maximum principal strains. The mechanical outcome of the anterior full-thickness tears was consistently, and significantly, more severe than that of the central or posterior full-thickness tears, which suggests that the anterior tears are at greater risk of propagating than the central or posterior tears. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. Stabilizing effect of helical current drive on tearing modes

    NASA Astrophysics Data System (ADS)

    Yuan, Y.; Lu, X. Q.; Dong, J. Q.; Gong, X. Y.; Zhang, R. B.

    2018-01-01

    The effect of helical driven current on the m = 2/n = 1 tearing mode is studied numerically in a cylindrical geometry using the method of reduced magneto-hydro-dynamic simulation. The results show that the local persistent helical current drive from the beginning time can be applied to control the tearing modes, and will cause a rebound effect called flip instability when the driven current reaches a certain value. The current intensity threshold value for the occurrence of flip instability is about 0.00087I0. The method of controlling the development of tearing mode with comparative economy is given. If the local helical driven current is discontinuous, the magnetic island can be controlled within a certain range, and then, the tearing modes stop growing; thus, the flip instability can be avoided. We also find that the flip instability will become impatient with delay injection of the driven current because the high order harmonics have been developed in the original O-point. The tearing mode instability can be controlled by using the electron cyclotron current drive to reduce the gradient of the current intensity on the rational surfaces.

  9. Superior Labrum Anterior-Posterior Tears in the National Football League.

    PubMed

    Chambers, Caitlin C; Lynch, T Sean; Gibbs, Daniel B; Ghodasra, Jason H; Sahota, Shawn; Franke, Kristina; Mack, Christina D; Nuber, Gordon W

    2017-01-01

    Shoulder disorders are common in football players, with up to 50% of National Football League (NFL) recruits reporting a history of shoulder injuries. Superior labrum anterior-posterior (SLAP) tears are an entity with well-described detrimental effects on return to play in overhead-throwing athletes but with minimal data in contact athletes. To identify the incidence, predisposing factors, and effect of SLAP tears in NFL athletes and prospects as well as the treatment patterns of NFL team physicians. Descriptive epidemiology study. This study was a comprehensive analysis of SLAP tears in elite football players using a dual approach: (1) SLAP injuries recorded in the NFL Injury Surveillance System from 2000 to 2014 were evaluated by player position, type of play, days/games lost, and surgical intervention; (2) NFL Scouting Combine athletes from 2003 to 2011 with prior SLAP repair were evaluated for draft success, and drafted athletes were compared with matched controls for career length and performance scores. SLAP tears represented a small portion (3.1%) of shoulder injuries in NFL athletes from 2000 to 2014, occurring most commonly in offensive linemen (28%). Surgically treated SLAP tears (42%) resulted in more days missed than did nonoperatively managed tears (140.2 vs 21.5 days; P < .001) and more games missed (8.4 vs 2.6 games; P = .003). SLAP repairs were also rare in NFL Combine athletes (n = 25 of 2965 athletes), with most having been performed in offensive linemen (32%). As compared with control NFL Combine athletes without SLAP tears, those drafted into the NFL with prior SLAP repair played significantly fewer games (33.7 vs 48.3; P = .049) and had fewer game starts (19.6 vs 35.4; P = .036). In this comprehensive analysis of SLAP tears in elite football players, it is clear that these injuries have the potential to cause significant detriment to an athlete's career.

  10. Cytokine changes in tears and relationship to contact lens discomfort.

    PubMed

    Willcox, Mark D P; Zhao, Zhenjun; Naduvilath, Thomas; Lazon de la Jara, Percy

    2015-01-01

    To determine the reproducibility of a multiplex bead assay for measuring cytokines in tears and correlations between ocular discomfort with or without contact lens wear and the concentration of cytokines in tears. Ninety participants (divided into two groups) were enrolled in this prospective study. They were asked to rate their ocular comfort and collect their tears in the morning and just before sleep for 10 days with or without contact lenses. The participants collected their tears using a glass microcapillary tube for both stages. Galyfilcon A lenses were worn on a daily disposable basis during the contact lens stage, and comfort scores and tears were collected before lens insertion and prior to lens removal at the end of the day. Tears were analyzed for cytokine concentrations using a 27-plex multibead assay. Correlations were sought between cytokine concentrations and comfort. There was a significant (p<0.022) decrease in ocular comfort over the day with or without lens wear. The magnitude of ocular discomfort was significantly greater (p<0.009) with lens wear. The concentrations of 12 cytokines differed significantly between the groups; thus, these cytokines were not analyzed further. For the remaining 15 cytokines, interleukin-8 (IL-8) was the only cytokine that changed in both groups during the day without (reduced by >-0.5 Log pg/ml, p<0.001) or with lens wear (reduced by >-0.2 Log pg/ml, p<0.001). The change in the vascular endothelial growth factor (VEGF) concentration only in tears was correlated to ocular comfort, but this was not changed by contact lens wear. Ocular comfort during the day is magnified by contact lens wear. However, the increase in the change in comfort during lens wear was not associated with changes in 15 cytokines in the tear film.

  11. Cytokine changes in tears and relationship to contact lens discomfort

    PubMed Central

    Zhao, Zhenjun; Naduvilath, Thomas; Lazon de la Jara, Percy

    2015-01-01

    Purpose To determine the reproducibility of a multiplex bead assay for measuring cytokines in tears and correlations between ocular discomfort with or without contact lens wear and the concentration of cytokines in tears. Methods Ninety participants (divided into two groups) were enrolled in this prospective study. They were asked to rate their ocular comfort and collect their tears in the morning and just before sleep for 10 days with or without contact lenses. The participants collected their tears using a glass microcapillary tube for both stages. Galyfilcon A lenses were worn on a daily disposable basis during the contact lens stage, and comfort scores and tears were collected before lens insertion and prior to lens removal at the end of the day. Tears were analyzed for cytokine concentrations using a 27-plex multibead assay. Correlations were sought between cytokine concentrations and comfort. Results There was a significant (p<0.022) decrease in ocular comfort over the day with or without lens wear. The magnitude of ocular discomfort was significantly greater (p<0.009) with lens wear. The concentrations of 12 cytokines differed significantly between the groups; thus, these cytokines were not analyzed further. For the remaining 15 cytokines, interleukin-8 (IL-8) was the only cytokine that changed in both groups during the day without (reduced by >-0.5 Log pg/ml, p<0.001) or with lens wear (reduced by >-0.2 Log pg/ml, p<0.001). The change in the vascular endothelial growth factor (VEGF) concentration only in tears was correlated to ocular comfort, but this was not changed by contact lens wear. Conclusions Ocular comfort during the day is magnified by contact lens wear. However, the increase in the change in comfort during lens wear was not associated with changes in 15 cytokines in the tear film. PMID:25814827

  12. Tearing Instability of a Current Sheet Forming by Sheared Incompressible Flow

    NASA Astrophysics Data System (ADS)

    Tolman, Elizabeth; Loureiro, Nuno; Uzdensky, Dmitri

    2017-10-01

    Sweet-Parker current sheets are unstable to the tearing mode, suggesting they will not form in physical systems. Understanding magnetic reconnection thus requires study of the stability of a current sheet as it forms. Such formation can occur as a result of sheared, sub-Alfvénic incompressible flows into and along the sheet. This work presents an analysis of how tearing perturbations behave in a current sheet forming under the influence of such flows, beginning with a phase when the growth rate of the tearing mode is small and the behavior of perturbations is primarily governed by ideal MHD. Later, after the tearing growth rate becomes significant relative to the time scale of the driving flows, the flows cause a slight reduction in the tearing growth rate and wave vector of the dominant mode. Once the tearing mode enters the nonlinear regime, the flows accelerate the tearing growth slightly; during X-point collapse, the flows have negligible effect on the system behavior. This analysis allows greater understanding of reconnection in evolving systems and increases confidence in the application of tools developed in time-independent current sheets to changing current sheets. This material is based upon work supported by the National Science Foundation Graduate Research Fellowship.

  13. Potential of FTIR spectroscopy for analysis of tears for diagnosis purposes.

    PubMed

    Travo, Adrian; Paya, Clément; Déléris, Gérard; Colin, Joseph; Mortemousque, Bruno; Forfar, Isabelle

    2014-04-01

    It has been widely reported that the tear film, which is crucially important as a protective barrier of the eye, undergoes biochemical changes as a result of a wide range of ocular pathology. This tends to suggest the possibility of early detection of ocular diseases on the basis of biochemical analysis of tears. However, studies of tears by conventional methods of biomolecular and biochemical analysis are often limited by methodological difficulties. Moreover, such analysis could not be applied in the clinic, where structural and morphological analyses by, mainly, slit-lamp biomicroscopy remains the recommended method. In this study, we assessed, for the first time, the potential of FTIR spectroscopy combined with advanced chemometric processing of spectral data for analysis of raw tears for diagnosis purposes. We first optimized sampling and spectral acquisition (tears collection method, tear sample volume, and preservation of the samples) for accurate spectral measurement. On the basis of the results, we focused our study on the possibility of discriminating tears from normal individuals from those of patients with different ocular pathologies, and showed that the most discriminating spectral range is that corresponding to variations of CH2 and CH3 of lipid aliphatic chains. We also report more subtle discrimination of tears from patients with keratoconus and those from patients with non-specific inflammatory ocular diseases, on the basis of variations in spectral ranges attributed notably to lipid and carbohydrate vibrations. Finally, we also succeeded in distinguishing tears from patients with early-stage and late-stage keratoconus on the basis of spectral features attributed to protein structure. Therefore, this study strongly suggests that FTIR spectral analysis of tears could be developed as a valuable and cost-saving tool for biochemical-based detection of ocular diseases, potentially before the appearance of the first morphological signs of diseases

  14. Bone mineralization changes of the glenoid in shoulders with symptomatic rotator cuff tear.

    PubMed

    Harada, Yohei; Yokoya, Shin; Akiyama, Yuji; Mochizuki, Yu; Ochi, Mitsuo; Adachi, Nobuo

    2018-06-06

    Computed tomography osteoabsorptiometry (CTO) is a method to analyze the stress distribution in joints by measuring the subchondral bone density. The purpose of this study was to evaluate the bone mineralization changes of the glenoid in shoulders with rotator cuff tears by CTO and to evaluate whether rotator cuff tears are associated with stress changes in the glenoid. In total, 32 patients, who were diagnosed with unilateral rotator cuff tears and underwent arthroscopic rotator cuff repair, were enrolled in this study. They underwent CT scanning of both shoulders pre-operatively and the glenoid was evaluated using CTO. Hounsfield units (HU) in seven areas of the glenoid were compared between the affected and unaffected sides. The central area of the glenoid on the affected side had significantly lower HU than on the unaffected side among all patients. Focusing on the rotator cuff tear size and the subscapularis tendon, only patients with larger cuff tears or with subscapularis tendon tears showed significantly lower HU in the central area of the affected side. This study showed a decrease in bone mineralization density in the central glenoid in shoulders with rotator cuff tear. This change was observed in the case of larger cuff tears and subscapularis tendon tears. Our results help clarify the changes in stress distribution in the shoulder joint caused by symptomatic rotator cuff tears.

  15. Partial supraspinatus tears are associated with tendon lengthening.

    PubMed

    Farshad-Amacker, Nadja A; Buck, Florian M; Farshad, Mazda; Pfirrmann, Christian W A; Gerber, Christian

    2015-02-01

    Tendon tear may result in muscular retraction with the loss of contractile amplitude and strength of the rotator cuff muscles. Currently, neither a validated method of measuring supraspinatus tendon length nor normal values are known. It was therefore the purpose of this study to measure the normal length of the supraspinatus tendon and to determine whether partial tears are associated with changes in tendon length. MR examinations of 49 asymptomatic volunteers and 37 patients with arthroscopically proven, isolated partial tears of the supraspinatus tendon were compared. The ratio of the extramuscular tendon length to the distance between the footprint and the glenoid surface was calculated (TL/FG ratio). Tendon length measurements were taken by two independent readers at the bursal and articular surfaces at the anterior, the central and the posterior parts of the tendon. TL/FG ratios at the bursal surface of tendons with partial tears were significantly higher than those in the control group [anterior: 0.78 ± 0.20 vs. 0.66 ± 0.15 (p < 0.05); central: 0.61 ± 0.13 vs. 0.52 ± 0.10 (p < 0.05); posterior: 0.57 ± 0.15 vs. 0.52 ± 0.10 (p < 0.05)]. At the articular surface, differences were significant only anteriorly [0.60 ± 0.13, vs. 0.54 ± 0.10 (p < 0.05)]. A cut-off TL/FG ratio of 0.63 for measurements at the bursal surface in the center of the tendon achieved a sensitivity of 46 % and a specificity of 92 % for the identification of partial cuff tearing. A reproducible method for measurement of extramuscular supraspinatus tendon length is described. Partial tearing of the supraspinatus tendon is associated with significant tendon lengthening, suggesting failure in continuity, and this is most reliably measured on the bursal surface. III.

  16. Symptoms, visual function, and mucin expression of eyes with tear film instability.

    PubMed

    Shimazaki-Den, Seika; Dogru, Murat; Higa, Kazunari; Shimazaki, Jun

    2013-09-01

    We examined symptoms, tear stability, visual function, and conjunctival cytology in eyes with an unstable tear film (UTF), expressed as a short tear film breakup time without epithelial damage or low tear secretion, and compared the results with those from eyes with aqueous deficiency (AD) associated with epithelial damage, and healthy eyes. We divided the patients with ocular discomfort into 2 groups according to the breakup time, Schirmer value, and epithelial staining score: UTF group (≤5 seconds, >5 mm, and <3 points; 21 eyes of 21 patients) and AD group (≤5 seconds, ≤5 mm, and ≥3 points; 21 eyes of 21 patients). We examined all patients and 17 healthy subjects for symptoms, tear functions, tear film stability by tear film lipid layer interferometry and tear film analysis system, and functional visual acuity. Conjunctival impression cytology was performed to investigate changes in goblet cell density, squamous metaplasia, and messenger RNA expression of MUC5AC and MUC16. The symptom scores, tear film analysis system index, and functional visual acuity testing were significantly worse in the UTF and AD groups compared with those in the control group (P < 0.05). The messenger RNA expression levels of MUC5AC and MUC16 were significantly lower in UTF and AD eyes compared with those in the control eyes (P < 0.0001). An UTF itself can cause dry eye symptoms and visual disturbance comparable with those of AD dry eyes.

  17. Effect of topical ophthalmic epinastine and olopatadine on tear volume in mice.

    PubMed

    Villareal, Arturo L; Farley, William; Pflugfelder, Stephen C

    2006-12-01

    To investigate the effects of topical epinastine and olopatadine on tear volume by using a mouse model. Eighty-five C57BL6 mice (170 eyes) were treated twice daily with topical ophthalmic epinastine 0.05%, olopatadine 0.1%, or atropine 1% or served as untreated controls. A thread-wetting assay was used to measure tear volume at baseline and 15, 45, 90, 120, and 240 minutes after the last instillation of the drug on days 2 and 4 of treatment. After 2 days of treatment, epinastine-treated mice showed greater mean tear volumes than olopatadine-treated mice did at 15, 45, 90, and 240 minutes, with statistical significance at 15 and 45 minutes (P<0.001). Olopatadine significantly reduced tear volume versus untreated controls at 15 and 45 minutes (P<0.001). After 4 days, tear volumes with epinastine treatment exceeded those with olopatadine treatment at all time points, with statistical significance at 45 minutes (P<0.05). Atropine rendered tears undetectable at 15, 45, and 90 minutes; tear volume returned to baseline levels at 240 minutes. Topical epinastine did not inhibit tear secretion, whereas olopatadine caused a significant decrease in tear volume. Because of its neutral impact on the lacrimal functional unit, epinastine may be an especially good choice for the treatment of allergic conjunctivitis in patients with dry eye disease or in those who are at risk for developing dry eye.

  18. A Comparison of Open and Endoscopic Repair of Full-Thickness Tears of the Gluteus Medius Tendon at a Minimum of 2 Years Follow-up

    PubMed Central

    Nawabi, Danyal H.; Wentzel, Catherine; Ranawat, Anil S.; Bedi, Asheesh; Kelly, Bryan T.

    2015-01-01

    %) in the endoscopic group (p=0.09). Seven hips (78%) in the open group had varus necks (FNSA30°) compared to 15 hips (54%) in the endoscopic group (p=0.93). At a mean follow-up of 38.1 months (range, 24-87 months), there were large (> 35 points) and significant improvements (p0.8). One patient (11.1%) in the open group had a poor clinical outcome compared to 2 patients (11.1%) in the endoscopic group that required revision abductor repairs at 5 and 24 months respectively. The mean surgical time was 98.7 ± 21.3 minutes in the open and 122.0 ± 26.8 minutes in the endoscopic group (p=0.003). Conclusion: This study demonstrates that an open gluteus medius tendon repair results in a significant improvement in clinical outcome, that is similar to the scores seen after endoscopic repair. Varus femoral necks and acetabular overcoverage are common features of hips with abductor tears and may be useful diagnostic aids. The surgical time for an open technique is significantly shorter than the endoscopic technique. We recommend an open technique where an intra-articular hip arthroscopy is not required, or in those patients with large and retracted tears.

  19. Acetabular cup position and risk of dislocation in primary total hip arthroplasty.

    PubMed

    Seagrave, Kurt G; Troelsen, Anders; Malchau, Henrik; Husted, Henrik; Gromov, Kirill

    2017-02-01

    Background and purpose - Hip dislocation is one of the most common complications following total hip arthroplasty (THA). Several factors that affect dislocation have been identified, including acetabular cup positioning. Optimal values for cup inclination and anteversion are debatable. We performed a systematic review to describe the different methods for measuring cup placement, target zones for cup positioning, and the association between cup positioning and dislocation following primary THA. Methods - A systematic search of literature in the PubMed database was performed (January and February 2016) to identify articles that compared acetabular cup positioning and the risk of dislocation. Surgical approach and methods for measurement of cup angles were also considered. Results - 28 articles were determined to be relevant to our research question. Some articles demonstrated that cup positioning influenced postoperative dislocation whereas others did not. The majority of articles could not identify a statistically significant difference between dislocating and non-dislocating THA with regard to mean angles of cup anteversion and inclination. Most of the articles that assessed cup placement within the Lewinnek safe zone did not show a statistically significant reduction in dislocation rate. Alternative target ranges have been proposed by several authors. Interpretation - The Lewinnek safe zone could not be justified. It is difficult to draw broad conclusions regarding a definitive target zone for cup positioning in THA, due to variability between studies and the likely multifactorial nature of THA dislocation. Future studies comparing cup positioning and dislocation rate should investigate surgical approach separately. Standardized tools for measurement of cup positioning should be implemented to allow comparison between studies.

  20. Computed tomography arthrography with traction in the human hip for three-dimensional reconstruction of cartilage and the acetabular labrum

    PubMed Central

    Henak, C.R.; Abraham, C.L.; Peters, C.L.; Sanders, R.K.; Weiss, J.A.; Anderson, A.E.

    2014-01-01

    AIM To develop and demonstrate the efficacy of a computed tomography arthrography (CTA) protocol for the hip that enables accurate three-dimensional reconstructions of cartilage and excellent visualization of the acetabular labrum. MATERIALS AND METHODS Ninety-three subjects were imaged (104 scans); 68 subjects with abnormal anatomy, 11 patients after periacetabular osteotomy surgery, and 25 subjects with normal anatomy. Fifteen to 25 ml of contrast agent diluted with lidocaine was injected using a lateral oblique approach. A Hare traction splint applied traction during CT. The association between traction force and intra-articular joint space was assessed qualitatively under fluoroscopy. Cartilage geometry was reconstructed from the CTA images for 30 subjects; the maximum joint space under traction was measured. RESULTS Using the Hare traction splint, the intra-articular space and boundaries of cartilage could be clearly delineated throughout the joint; the acetabular labrum was also visible. Dysplastic hips required less traction (~5 kg) than normal and retroverted hips required (>10 kg) to separate the cartilage. An increase in traction force produced a corresponding widening of the intra-articular joint space. Under traction, the maximum width of the intra-articular joint space during CT ranged from 0.98–6.7 mm (2.46 ± 1.16 mm). CONCLUSIONS When applied to subjects with normal and abnormal hip anatomy, the CTA protocol presented yields clear delineation of the cartilage and the acetabular labrum. Use of a Hare traction splint provides a simple, cost-effective method to widen the intra-articular joint space during CT, and provides flexibility to vary the traction as required. PMID:25070373