Early intraprosthetic dislocation in dual-mobility implants: a systematic review

Background: Dual mobility implants are subject to a specific implant-related complication, intraprosthetic dislocation (IPD), in which the polyethylene liner dissociates from the femoral head. For older generation designs, IPD was attributable to late polyethylene wear and subsequent failure of the head capture mechanism. However, early IPDs have been reportedly affecting contemporary designs. Methods: A systematic review of the literature according to the preferred reporting items for systematic reviews and meta-analyses guidelines was performed. A comprehensive search of PubMed, MEDLINE, Embase, and Google Scholar was conducted for English articles between January 1974 and August 2016 using various combinations of the keywords “intraprosthetic dislocation,” “dual mobility,” “dual-mobility,” “tripolar,” “double mobility,” “double-mobility,” “hip,” “cup,” “socket,” and “dislocation.” Results: In all, 16 articles met our inclusion criteria. Fourteen were case reports and 2 were retrospective case series. These included a total of 19 total hip arthroplasties, which were divided into 2 groups: studies dealing with early IPD after attempted closed reduction and those dealing with early IPD with no history of previous attempted closed reduction. Early IPD was reported in 15 patients after a mean follow-up of 3.2 months (2.9 SD) in the first group and in 4 patients after a mean follow-up of 15.1 months (9.9 SD) in the second group. Conclusions: Based on the current data, most cases have been preceded by an attempted closed reduction in the setting of outer, large articulation dislocation, perhaps indicating an iatrogenic etiology for early IPD. Recognition of this possible failure mode is essential to its prevention and treatment

Web-based patient portal access in an orthopedic adult reconstruction patient population

Background: We surveyed patients in an adult reconstruction practice as to their use of the Web-based portal provided by our electronic health record, seeking to reveal patterns of use and helpfulness. Methods: A total of 150 completed surveys were received. The survey queried demographics, the number of clinic visits, Internet access, portal activation, portal use frequency, and portal information questions and how patients answered them. Helpfulness was rated from 1 (not helpful) to 5 (very helpful). Statistical analysis included bivariate analysis and logistic regression, with odds ratio (OR) and 95% confidence interval (CI) reported. Results: The mean age was 67.6 years. Most were females (n = 97, 65.1%). Most (68.7%) patients used the portal. Younger age (OR, 0.94; CI, 0.90-0.99) and access to Internet (OR, 31.8; CI, 8.5-119.4) predicted portal use (P .373). Of all, 47.5% of patients were unclear about online chart information. Older age indicated being unclear of portal information (68.5 vs 66, P = .0002). Of those who clarified doubts regarding information (n = 67), 23 used the Internet (34.3%), 32 (47.7%) called the physician, and 12 (17.9%) asked a friend and/or family member. Most (90.3%) patients felt the portal was helpful in gathering health information. Conclusions: Age and Internet access affected portal usage; ability to understand chart information decreased with age. Most patients used the Internet or a family member to clarify doubts regarding portal information. The use of portal data resulted in 32 extra communications to the physician. Keywords: Electronic, Patient portal, Online, Access, Persona

Spinal Pathologies in Fossil Hominins

Back disorders are often conjectured to be a trade-off to the evolution of upright bipedalism. Yet, this association has not been substantiated so far. This chapter presents an overview of the known spinal pathologies in the hominin fossil record. Apart from a benign primary bone tumour in MH1 (Australopithecus sediba) and developmental defects in the Middle Pleistocene Pelvis 1 individual from Sima de los Huesos, the Kebara 2 Neanderthal and two individuals from El Sidrón, they include pathologies related to the biomechanical failure of the growing spine and degenerative osteoarthritis. While the latter is particularly common in Neanderthals, biomechanical failure of the growing spine seems to have affected all hominin species. This includes spondylolisthesis in the Pelvis 1 individual from Sima de los Huesos, traumatic juvenile disc herniation in KNM-WT 15000 (Homo erectus), anterior disc herniation (limbus vertebra) in StW 431 (A. africanus), and Scheuermann’s disease in A.L. 288-1 (A. afarensis) and three isolated thoracic vertebrae from Hadar, Sts 14 (A. africanus), SKX 3342 (Paranthropus robustus), the Pelvis 1 individual from Sima de los Huesos and perhaps Kebara 2 and Shanidar 3. Juvenile disc herniation, traumatic anterior disc herniation and Scheuermann’s disease all involve displacement of disc material and have a higher incidence following strains and trauma to the spine during the increased vulnerability phase of the pubertal growth spurt. The remarkably high prevalence of this kind of disorders in our ancestors might suggest that our spine has become less vulnerable during the course of human evolution