Is acetabular osteoplasty always required in mixed impingement?

Background Mixed femoroacetabular impingement (FAI) is typically managed with both femoral and acetabular rim osteoplasties, but it has not been reported if the rim osteoplasty is always required. Hypothesis/purpose We hypothesized that mixed FAI managed by femoral or combined femoral and acetabular osteoplasties will both attain satisfactory clinical results, provided intraoperative impingement-free functional motion is attained. Methods We retrospectively reviewed 30 hips (23 patients, mean age at surgery 24.3 years, mean follow-up time 1.6 years) with mixed FAI who underwent surgical dislocation of the hip and had femoral osteochondroplasty with rim trim (RT, n = 21) or no rim trim (NRT, n = 9). Physical examination results and Western Ontario and McMaster Universities Osteoarthritis (WOMAC) scores were evaluated. Results Mean (±SD) WOMAC pain scores improved from 6.56 (±2.96) to 2.33 (±3.64) in the NRT group (p = .002) and from 6.86 (±4.15) to 3.86 (±3.95) in the RT group (p = .014). Function improved in both groups, but the difference was significant only for the NRT group (p < .001). Over 50 % of patients in both groups had resolution of impingement sign. Internal rotation increased from 8.6° (±11.8) to 20.0° (±10.4) in the NRT group (p = .043) and from 4.0° (±12.1) to 18.6° (±14.0) in the RT group (p < .001). Both groups had increased flexion post-operatively to normal range, but the change was only significant for the RT group (p = .02). Both groups had insignificant decreases in external rotation. Conclusion Satisfactory clinical outcomes were seen in hips with mixed impingement, regardless of whether RT was performed, provided impingement-free functional motion was attained and no severe cartilage damage was seen

Disassociation of an anteriorly implanted dual-mobility component with migration to the distal posterior thigh: a case report

CASE: Intraprosthetic dislocation, a rare complication of modular dual-mobility hip replacements, occurs when the polyethylene component becomes dislodged. Our patient sustained an intraprosthetic dislocation with subsequent implant migration to the posterior thigh. In an anterior approach revision surgery at an outside institution, the component was unable to be located. Subsequent imaging revealed marked implant migration. Computed tomography (CT)-guided needle localization was used to facilitate component removal. CONCLUSION: In the presence of different surgical approaches, dissociated polyethylene components may migrate to anatomic compartments distinct from the approach of implantation. CT and needle localization may be used to facilitate component removal

Is acetabular osteoplasty always required in mixed impingement?

Background: Mixed femoroacetabular impingement (FAI) is typically managed with both femoral and acetabular rim osteoplasties, but it has not been reported if the rim osteoplasty is always required. Hypothesis/purpose: We hypothesized that mixed FAI managed by femoral or combined femoral and acetabular osteoplasties will both attain satisfactory clinical results, provided intraoperative impingement-free functional motion is attained. Methods: We retrospectively reviewed 30 hips (23 patients, mean age at surgery 24.3years, mean follow-up time 1.6years) with mixed FAI who underwent surgical dislocation of the hip and had femoral osteochondroplasty with rim trim (RT, n=21) or no rim trim (NRT, n=9). Physical examination results and Western Ontario and McMaster Universities Osteoarthritis (WOMAC) scores were evaluated. Results: Mean (±SD) WOMAC pain scores improved from 6.56 (±2.96) to 2.33 (±3.64) in the NRT group (p=.002) and from 6.86 (±4.15) to 3.86 (±3.95) in the RT group (p=.014). Function improved in both groups, but the difference was significant only for the NRT group (p<.001). Over 50% of patients in both groups had resolution of impingement sign. Internal rotation increased from 8.6° (±11.8) to 20.0° (±10.4) in the NRT group (p=.043) and from 4.0° (±12.1) to 18.6° (±14.0) in the RT group (p<.001). Both groups had increased flexion post-operatively to normal range, but the change was only significant for the RT group (p=.02). Both groups had insignificant decreases in external rotation. Conclusion: Satisfactory clinical outcomes were seen in hips with mixed impingement, regardless of whether RT was performed, provided impingement-free functional motion was attained and no severe cartilage damage was seen

Concomitant Arthroscopy With Labral Reconstruction and Periacetabular Osteotomy for Hip Dysplasia

In the setting of true hip dysplasia, the high prevalence of intra-articular pathology may lead to recurrent symptoms and failure after periacetabular osteotomy (PAO). Femoral neck osteochondroplasty, microfracture, removal of loose bodies, and labral repair are examples of procedures that are performed with concomitant arthroscopy. When damage to the labrum is too severe to repair, reconstruction instead of extensive debridement before PAO can be more effective in restoring the labral seal to maintain joint lubrication and chondral protection. This Technical Note describes a method for concomitant hip arthroscopy with circumferential labral reconstruction with allograft and PAO

Assessment of an atmospheric transport model for annual inverse estimates of California greenhouse gas emissions

Atmospheric inverse estimates of gas emissions depend on transport model predictions, hence driving a need to assess uncertainties in the transport model. In this study we assess the uncertainty in WRF-STILT (Weather Research and Forecasting and Stochastic Time-Inverted Lagrangian Transport) model predictions using a combination of meteorological and carbon monoxide (CO) measurements. WRF configurations were selected to minimize meteorological biases using meteorological measurements of winds and boundary layer depths from surface stations and radar wind profiler sites across California. We compare model predictions with CO measurements from four tower sites in California from June 2013 through May 2014 to assess the seasonal biases and random errors in predicted CO mixing ratios. In general, the seasonal mean biases in boundary layer wind speed (\u3c ~ 0.5 m/s), direction (\u3c ~ 15°), and boundary layer height (\u3c ~ 200 m) were small. However, random errors were large (~1.5–3.0 m/s for wind speed, ~ 40–60° for wind direction, and ~ 300–500 m for boundary layer height). Regression analysis of predicted and measured CO yielded near-unity slopes (i.e., within 1.0 ± 0.20) for the majority of sites and seasons, though a subset of sites and seasons exhibit larger (~30%) uncertainty, particularly when weak winds combined with complex terrain in the South Central Valley of California. Looking across sites and seasons, these results suggest that WRF-STILT simulations are sufficient to estimate emissions of CO to up to 15% on annual time scales across California

Gut CD4+ T cell phenotypes are a continuum molded by microbes, not by TH archetypes

CD4 effector lymphocytes (T ) are traditionally classified by the cytokines they produce. To determine the states that T cells actually adopt in frontline tissues in vivo, we applied single-cell transcriptome and chromatin analyses to colonic T cells in germ-free or conventional mice or in mice after challenge with a range of phenotypically biasing microbes. Unexpected subsets were marked by the expression of the interferon (IFN) signature or myeloid-specific transcripts, but transcriptome or chromatin structure could not resolve discrete clusters fitting classic helper T cell (T ) subsets. At baseline or at different times of infection, transcripts encoding cytokines or proteins commonly used as T markers were distributed in a polarized continuum, which was functionally validated. Clones derived from single progenitors gave rise to both IFN-γ- and interleukin (IL)-17-producing cells. Most of the transcriptional variance was tied to the infecting agent, independent of the cytokines produced, and chromatin variance primarily reflected activities of activator protein (AP)-1 and IFN-regulatory factor (IRF) transcription factor (TF) families, not the canonical subset master regulators T-bet, GATA3 or RORγ. + eff eff eff H

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