Osteoarthritis of the Hip Joint

The incidence of osteoarthritis of the hip is increasing internationally. With the population becoming older and the rates of obesity increasing on a global scale, we are seeing more traumatic and idiopathic degeneration of the native hip joint. The pathological processes occurring in the hip have been described at a macroscopic and microscopic level. The inability of surface hyaline cartilage to heal is one of the major contributors to the irreversible nature of degeneration once it begins. Many classification systems have been described to characterise the extent of disease. History and examination play a pivotal role in the management algorithm. The goals of treatment are to improve pain, function and quality of life. Numerous non-operative treatments exist as do many operative interventions. Total hip arthroplasty is arguably the most successful operation developed in orthopaedic surgery to date. We discuss the condition of osteoarthritis as it pertains to the hip and we consider the patients’ course from onset of symptoms through their investigation up to their definitive management

The effectiveness of sustainable serial casting for clubfoot deformity in a low resource setting

AimsOur aim was to assess the effectiveness of the Malawi Clubfoot Programme and comment on such health care strategies in developing countries.MethodsMedical records of 1069 children attending 29 clinics within Malawi were identified between 2007 and 2013. Due to incomplete recording, only 596 patients had adequate data which could be further analysed. ResultsThe mean age of presentation was 103 days (range 0-8 years) with a sex distribution of M1.76:F1. The mean Pirani score at presentation was 4.55 and on completion of casting was 1.39. A correlation was identified between the number of castings and the initial Pirani score (positive coefficient 0.2626 p<0.0001), the final casting score (negative coefficient -0.1441 p<0.0006) and the change in Pirani score (positive coefficient 0.3200 (p<0.0001)). The number of patients attending the clinics increased per year and the average number of castings was reduced from 6 to 5 between 2008 and 2012. There was also moderate correlation between the number of years the programme had been re-instated and the average change in Pirani score between in each casting (R score 0.36) ConclusionSerial casting performed by paramedical personnel within an established self- sustained national programme can effectively treat CTEV in low resource countries

Intramedullary versus extramedullary alignment of the tibial component in the Triathlon knee

<p>Abstract</p> <p>Background</p> <p>Long term survivorship in total knee arthroplasty is significantly dependant on prosthesis alignment. Our aim was determine which alignment guide was more accurate in positioning of the tibial component in total knee arthroplasty. We also aimed to assess whether there was any difference in short term patient outcome.</p> <p>Method</p> <p>A comparison of intramedullary versus extramedullary alignment jig was performed. Radiological alignment of tibial components and patient outcomes of 103 Triathlon total knee arthroplasties were analysed.</p> <p>Results</p> <p>Use of the intramedullary was found to be significantly more accurate in determining coronal alignment (p = 0.02) while use of the extramedullary jig was found to give more accurate results in sagittal alignment (p = 0.04). There was no significant difference in WOMAC or SF-36 at six months.</p> <p>Conclusion</p> <p>Use of an intramedullary jig is preferable for positioning of the tibial component using this knee system.</p

Establishing a national high fidelity cadaveric emergency urology simulation course to increase trainee preparedness for independent on-call practice: a prospective observational study

Background Whilst competence in the management of a wide range of urological emergencies is a requirement for certification in urology, many conditions are uncommon and exposure during training may be limited. This prospective observational study sought to evaluate the feasibility and effectiveness of a standardised cadaveric emergency urology simulation course aimed at improving operative confidence and competence prior to independent on-call practice in the United Kingdom. Methods A two-day cadaveric emergency urology simulation course supported by the British Association of Urological Surgeons (BAUS) was implemented at two pilot centres. All delegates that undertook one of the initial series of courses were invited to complete online pre- and post-course questionnaires relating to prior operative experience, documented competence and perceived confidence in being able to perform specific emergency procedures independently. Primary outcome was a self-reported ‘confidence score’ selected from a linear numeric scale ranging from 1 (not at all confident to perform a given procedure independently) to 10 (fully confident). Statistical analysis was undertaken using SPSS Statistics for Mac Version 25 and the paired student’s t-test used to compare mean pre- and post-course scores. Results One hundred and four delegates undertook the course during the study period. Of these, 85 (81.7%) completed the pre-course survey and 67 (64.4%) completed the post-course survey, with 61 (58.7%) completing both. The greatest proportion of respondents were Speciality Trainees in Urology of ST5 level or higher (equivalent of Resident/Fellows with 4 or more years of surgical training; n = 31, 36.5%). Delegates reported variable pre-course exposure, with most experience reported in loin approach to the kidney (median 10) and least in exploration and packing of a transurethral resection cavity and emergency nephrectomy (median 0). Following course completion, a statistically significant increase in confidence score was observed for each procedure, with the greatest increases seen for shunt for priapism (4.87 to 8.80, p < 0.001), ureteric reimplantation (3.52 to 7.33, p < 0.001) and primary ureteric anastomosis (3.90 to 7.49, p < 0.001). Conclusions A standardised high fidelity cadaveric simulation course is feasible and significantly improves the confidence of trainees in performing a wide range of emergency procedures to which exposure is currently limited

Eat Walk Sleep Discuss: Building a Multi-Dimensional Participatory Relationship

A multi-faceted relationship has developed between UMass Worcester and the Worcester Refugee Assistance Project (WRAP). The relationship has its roots in student engagement, and has grown to include faculty, students and community members in a range of community-based participatory activities, which can be shaped in response to needs as they are identified and defined. This poster describes the different ways student engagement and community partnerships worked together in a research project

Developmental dysplasia of the hip is common in patients undergoing total hip arthroplasty under 50 years of age

Introduction: Developmental dysplasia of the hip (DDH) refers to congenital and/or developmental hip instability that can result in hip joint subluxation or dislocation. When detected neonatally, conservative treatment with hip bracing can restore normal hip anatomy. Missed detection of DDH in the neonatal period or late development of DDH often requires surgical intervention to correct the abnormal anatomy. Furthermore, despite surgical intervention, residual sequelae may persist leading to early osteoarthritis of the hip joint requiring joint replacement surgery. Aim: This study investigates the prevalence of hip dysplasia in patients undergoing total hip arthroplasty (THA) under 50 years of age. Methods: The hip arthroplasty database at a national referral centre was investigated from January 2014 to December 2020. In patients under 50 years of age, those with an adequate pre-operative anteroposterior pelvic radiograph without previous hip arthroplasty were included, while those with inadequate radiographs were excluded. The following measurements were made on the contralateral non-operated hip: (1) lateral centre-edge angle (LCEA), (2) Tönnis angle, (3) acetabular version, (4) acetabular depth, (5) femoral head lateralisation, (6) femoral head extrusion index, and (7) acetabular depth-to-width ratio. Results: In total, 451 patients were included in this study. Twenty two percent of the patients had hip dysplasia, based on a LCEA of  10°. The mean LCEA and Tönnis angle were 31.47 ± 9.64 and 9.82 ± 6.79°, respectively. Conclusion: Hip dysplasia is common in patients undergoing THA under the age of 50 years with over 40% having dysplasia according to the Tönnis angle. Classification of primary and secondary osteoarthritis in the joint registries will benefit our knowledge on the prevalence of DDH in the adult population

Analogue experiments on the rise of large bubbles through a solids-rich suspension:A “weak plug” model for Strombolian eruptions

Physical interactions between bubbles and crystals affect gas migration and may play a major role in eruption dynamics of crystal-rich magmas. Strombolian eruptions represent an end member for bubble-crystal interactions, in which large bubbles (significantly larger than the crystal size) rise through a crystal-rich near-surface magma. Indeed, volcanoes that produce Strombolian eruptions often generate ejecta with > 30 vol% (often > 45 vol%) average crystallinity. At Stromboli Volcano, Italy, average crystallinity can reach 55 vol%, which is approaching the eruptibility limit for magmas. At such high crystallinities the solids interact mechanically with each other and with bubbles. This complex rheology complicates the two-phase (liquid-gas) slug flow model often applied to Strombolian eruptions. To examine the effect of crystals on bubble rise, we performed analogue experiments in which large bubbles rise in a vertical tube filled with silicone oil and polypropylene particles. The particles have a slightly lower density than the oil, and therefore form a layer of oil + particles at the upper surface. We varied surface pressure, particle volume fraction, length of the particle-bearing cap, and bubble size to examine the ways in which these parameters influence Strombolian-type eruptions. We show that in experiments, suspended solids begin to affect bubble rise dynamics at particle volume fractions as low as 30 vol% (or, when divided by the random close packing value, a normalized particle fraction φ=0.64). Bubbles in experiments with higher particle contents deform as they rise and burst through a small aperture, generating surface fountains that begin abruptly and decay slowly, and longer-lasting acoustic signals of lower amplitude than in particle-poor experiments. Particle fractions > 38 vol% (φ>0.80) generated strong deformations on fast-expanding bubbles that applied a high stress on the cap, but they trapped bubbles that were less overpressured. Qualitatively, the gas release behavior observed in particle-rich experiments is consistent with observations of Strombolian eruptions. Moreover, we estimate that the observed crystallinity of pyroclasts at Stromboli volcano represents φ>0.8. From this we suggest a “weak plug” model for Strombolian eruptions that evolves towards a low-viscosity equivalent of Vulcanian-style plug failure with a more crystalline, stronger, and less permeable plug. Importantly, this model allows the rise of several bubbles in the conduit at the same time and suggests that longer-lasting, more pulsatory and complex eruptions may reveal an increase in near-surface crystallinity, shedding some light on changing conduit conditions that could help determine the different gas rise regimes involved in passive degassing, puffing, and different expressions of Strombolian explosions

A little data goes a long way: automating seismic phase arrival picking at Nabro Volcano with transfer learning

Supervised deep learning models have become a popular choice for seismic phase arrival detection. However, they do not always perform well on out-of-distribution data and require large training sets to aid generalization and prevent overfitting. This can present issues when using these models in new monitoring settings. In this work, we develop a deep learning model for automating phase arrival detection at Nabro volcano using a limited amount of training data (2,498 event waveforms recorded over 35 days) through a process known as transfer learning. We use the feature extraction layers of an existing, extensively trained seismic phase picking model to form the base of a new all-convolutional model, which we call U-GPD. We demonstrate that transfer learning reduces overfitting and model error relative to training the same model from scratch, particularly for small training sets (e.g., 500 waveforms). The new U-GPD model achieves greater classification accuracy and smaller arrival time residuals than off-the-shelf applications of two existing, extensively-trained baseline models for a test set of 800 event and noise waveforms from Nabro volcano. When applied to 14 months of continuous Nabro data, the new U-GPD model detects 31,387 events with at least four P-wave arrivals and one S-wave arrival, which is more than the original base model (26,808 events) and our existing manual catalog (2,926 events), with smaller location errors. The new model is also more efficient when applied as a sliding window, processing 14 months of data from seven stations in less than 4 h on a single graphics processing unit