An unusual case of persistent groin pain after total hip arthroplasty: a case report

ABSTRACT: INTRODUCTION: Arthroplasty is a well-established routine elective surgical procedure in orthopaedics. To a great extent, diagnosis, treatment and post-operative rehabilitation in these patients is standardised. In a busy clinic, surgeons from time to time tend to focus their attention on common causes of joint pain, but it may lead them to overlook sinister but less common pathologies. Here we report a case of a patient with groin pain due to pre-operatively undetected pelvic metastases from a pyeloureteral carcinoma who underwent total hip arthroplasty. There are several case reports which deal with primary or secondary tumours which were either discovered at the time of replacement surgery or developed at the site of prosthesis years after total hip or knee replacement. To the best of our knowledge, this is the first case report in which a metastatic cancer was missed pre-operatively and intra-operatively both by the radiologist and by the orthopaedic surgeon and should be reported so that surgeons are reminded to be careful when dealing with seemingly routine cases. CASE PRESENTATION: A 79-year-old Caucasian woman presented to the arthroplasty clinic with groin pain. Initial radiographs showed subtle bilateral abnormalities in the pelvis. Neither the radiologist nor the orthopaedic surgeon recognized it. A diagnosis of osteoarthritis of the hip was established, and she underwent total hip arthroplasty. Despite initial improvement, the patient came back with worsening hip pain three months later. Further radiological examination revealed multiple metastatic lesions throughout the pelvis due to a pyeloureteral carcinoma. CONCLUSIONS: This case report emphasizes the importance of meticulous, unbiased pre-operative assessment of patients and their radiographs, even in so-called routine clinical cases. Often subtle radiological changes are classed as normal, especially if they are bilateral. Further radiological imaging should be recommended in all cases where unexplained clinical features or radiological findings are present

High-intensity mechanical therapy for loss of knee extension for worker's compensation and non-compensation patients

<p>Abstract</p> <p>Background</p> <p>Knee flexion contractures have been associated with increased pain and a reduced ability to perform activities of daily living. Contractures can be treated either surgically or conservatively, but these treatment options may not be as successful with worker's compensation patients. The purposes of retrospective review were to 1) determine the efficacy of using adjunctive high-intensity stretch (HIS) mechanical therapy to treat flexion contractures, and 2) compare the results between groups of worker's compensation and non-compensation patients.</p> <p>Methods</p> <p>Fifty-six patients (19 women, 37 men, age = 51.5 ± 17.0 years) with flexion contractures were treated with HIS mechanical therapy as an adjunct to outpatient physical therapy. Mechanical therapy was only prescribed for those patients whose motion had reached a plateau when treated with physical therapy alone. Patients were asked to perform six, 10-minute bouts of end-range stretching per day with the ERMI Knee Extensionater^(r)(ERMI, Inc., Atlanta, GA). Passive knee extension was recorded during the postoperative visit that mechanical therapy was prescribed, 3 months after beginning mechanical therapy, and at the most recent follow-up. We used a mixed-model 2 × 3 ANOVA (group × time) to evaluate the change in passive knee extension between groups over time.</p> <p>Results</p> <p>Regardless of group, the use of adjunctive HIS mechanical therapy resulted in passive knee extension deficits that significantly improved from 10.5° ± 5.2° at the initial visit to 2.6° ± 3.5° at the 3 month visit (p < 0.001). The degree of extension was maintained at the most recent follow-up (2.0° ± 2.9°), which was significantly greater than the initial visit (p < 0.001), but did not differ from the 3 month visit (p = 0.23). The gains in knee extension did not differ between worker's compensation and non-compensation patients (p = 0.56).</p> <p>Conclusions</p> <p>We conclude that the adjunctive use of HIS mechanical therapy is an effective treatment option for patients with knee flexion contractures, regardless of whether the patient is being treated as part of a worker's compensation claim or not.</p

A systematic review of the evidence for single stage and two stage revision of infected knee replacement

BACKGROUND: Periprosthetic infection about the knee is a devastating complication that may affect between 1% and 5% of knee replacement. With over 79 000 knee replacements being implanted each year in the UK, periprosthetic infection (PJI) is set to become an important burden of disease and cost to the healthcare economy. One of the important controversies in treatment of PJI is whether a single stage revision operation is superior to a two-stage procedure. This study sought to systematically evaluate the published evidence to determine which technique had lowest reinfection rates. METHODS: A systematic review of the literature was undertaken using the MEDLINE and EMBASE databases with the aim to identify existing studies that present the outcomes of each surgical technique. Reinfection rate was the primary outcome measure. Studies of specific subsets of patients such as resistant organisms were excluded. RESULTS: 63 studies were identified that met the inclusion criteria. The majority of which (58) were reports of two-stage revision. Reinfection rated varied between 0% and 41% in two-stage studies, and 0% and 11% in single stage studies. No clinical trials were identified and the majority of studies were observational studies. CONCLUSIONS: Evidence for both one-stage and two-stage revision is largely of low quality. The evidence basis for two-stage revision is significantly larger, and further work into direct comparison between the two techniques should be undertaken as a priority

Učinkovitost u zadacima fine motorike i prostornih odnosa tijekom menstrualnog ciklusa

Various studies have shown fl uctuations in task performance during the menstrual cycle. The aim of this study was to see the effects of the menstrual cycle on performing fi ne motor and spatial tasks of different level of complexity in twenty students aged 18 to 21 years, with regular menstrual cycle (28 to 30 days). The students performed O’Connor Finger Dexterity Test and mental rotation test during the menstrual, late follicular, and midluteal phase. Before the tests were performed, we administered Spielberger’s State-Trait Anxiety Inventory for each phase. After the tasks were completed, the subjects ranked their diffi culty on Borg’s scale. The results showed the best performance in both tests in the midluteal phase (with sex hormones at their peak). The anxiety level and task diffi culty ranking were the highest in the menstrual phase, when the hormone levels were the lowest.Različita su istraživanja pokazala promjene učinkovitosti tijekom menstrualnog ciklusa. U zadacima u kojima su uspješnije žene, najveća učinkovitost događa se tijekom kasne folikularne ili srednje lutealne faze. U zadacima u kojima su pak uspješniji muškarci najveća je učinkovitost nađena u menstrualnoj fazi. Na osnovi uporabe zadataka fi ne motorike i prostornih zadataka različitih razina kompleksnosti, cilj ovog istraživanja bio je ispitati utjecaj menstrualnog ciklusa na kognitivne funkcije. U istraživanju je sudjelovalo dvadeset ispitanica, dobi od 18 do 21 godinu, s redovitim menstrualnim ciklusima (28 do 30 dana). Ispitanice su izvodile O’Connorov deksterimetar i zadatke mentalne rotacije tijekom menstrualne, kasne folikularne i srednje lutealne faze. Prije izvođenja zadataka, u svakoj fazi ciklusa primijenjen je Spielbergerov upitnik stanja anksioznosti. Nakon izvođenja zadataka, ispitanice su procjenjivale njihovu težinu na Borgovoj skali. Rezultati su pokazali najbolju učinkovitost u oba zadatka u fazi visokih razina spolnih hormona (srednja lutealna faza). Stanje anksioznosti i procijenjene težine zadataka bili su najviši u menstrualnoj fazi, kada su razine spolnih hormona najniže

The comorbidity and co-medication profile of patients with progressive supranuclear palsy

Background: Progressive supranuclear palsy (PSP) is usually diagnosed in elderly. Currently, little is known about comorbidities and the co-medication in these patients. Objectives: To explore the pattern of comorbidities and co-medication in PSP patients according to the known different phenotypes and in comparison with patients without neurodegenerative disease. Methods: Cross-sectional data of PSP and patients without neurodegenerative diseases (non-ND) were collected from three German multicenter observational studies (DescribePSP, ProPSP and DANCER). The prevalence of comorbidities according to WHO ICD-10 classification and the prevalence of drugs administered according to WHO ATC system were analyzed. Potential drug–drug interactions were evaluated using AiDKlinik®. Results: In total, 335 PSP and 275 non-ND patients were included in this analysis. The prevalence of diseases of the circulatory and the nervous system was higher in PSP at first level of ICD-10. Dorsopathies, diabetes mellitus, other nutritional deficiencies and polyneuropathies were more frequent in PSP at second level of ICD-10. In particular, the summed prevalence of cardiovascular and cerebrovascular diseases was higher in PSP patients. More drugs were administered in the PSP group leading to a greater percentage of patients with polypharmacy. Accordingly, the prevalence of potential drug–drug interactions was higher in PSP patients, especially severe and moderate interactions. Conclusions: PSP patients possess a characteristic profile of comorbidities, particularly diabetes and cardiovascular diseases. The eminent burden of comorbidities and resulting polypharmacy should be carefully considered when treating PSP patients

Subliminally Perceived Odours Modulate Female Intrasexual Competition: An Eye Movement Study

Background: Evidence suggests that subliminal odorants influence human perception and behavior. It has been hypothesized that the human sex-steroid derived compound 4,16-androstadien-3-one (androstadienone) functions as a human chemosignal. The most intensively studied steroid compound, androstadienone is known to be biologically relevant since it seems to convey information about male mate quality to women. It is unclear if the effects of androstadienone are menstrual cycle related. Methodology/Principal Findings: In the first experiment, heterosexual women were exposed to androstadienone or a control compound and asked to view stimuli such as female faces, male faces and familiar objects while their eye movements were recorded. In the second experiment the same women were asked to rate the level of stimuli attractiveness following exposure to the study or control compound. The results indicated that women at high conception risk spent more time viewing the female than the male faces regardless of the compound administered. Women at a low conception risk exhibited a preference for female faces only following exposure to androstadienone. Conclusions/Significance: We contend that a woman’s level of fertility influences her evaluation of potential competitors (e.g., faces of other women) during times critical for reproduction. Subliminally perceived odorants, such as androstadienone, might similarly enhance intrasexual competition strategies in women during fertility phases not critica