Objectives:
The purpose of this study is to report minimum 10-year survivorship and patient-reported outcomes (PROs) following primary hip arthroscopy with capsular repair for FAIS and to compare ...outcomes of patients undergoing capsular repair to capsular release.
Methods:
Data were prospectively collected and retrospectively reviewed on all patients undergoing primary hip arthroscopy with capsular repair between October 2008 and February 2011. Survivorship was defined as a non-conversion to total hip arthroplasty (THA). Patients with minimum 10-year follow-up for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), and Visual Analog Scale for pain (VAS). If available, preoperative and minimum 10-year follow-up for the Hip Outcome Score—Sports Specific Subscale (HOS-SSS) were reported. Patients with ipsilateral hip surgery, worker’s compensation, Tönnis osteoarthritis grade > 1, and hip dysplasia (lateral center-edge angle < 25°) were excluded. Survivorship defined by non-conversion to THA, PROS, and clinical benefit (minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS)) were reported. An additional propensity-matched sub-analysis comparing patients undergoing capsular repair with patients undergoing capsular release over the age of 40 with acetabular labrum articular disruption ≥ 2 was performed.
Results:
145 (130 patients) out of 180 eligible hips (165 patients) had minimum 10-year follow-up (80.6%). 126 hips (86.9%) were female, and 19 hips (13.1%) were male. The average patient age was 30.3 ± 12.9 years. The survivorship rate was 91.0% at minimum 10-year follow-up. The cohort experienced significant improvement (P < 0.001) in the mHHS, NAHS, HOS-SSS, and VAS for pain. Additionally, the cohort achieved high rates of PASS for the mHHS (89.8%), and high rates of the MCID for the mHHS (82.4%) and VAS for pain (80.6%). 29 capsular repair hips were matched to 81 capsular release hips. Both groups experienced significant improvement in all PROs, but there was a higher conversion to THA rate in the release group (P < 0.05).
Conclusions:
Patients undergoing primary hip arthroscopy with capsular repair experienced a high rate of survivorship of 91.0% at minimum 10-year follow-up. Patients that did not convert to THA saw favorable improvements in PROs and achieved high rates of clinical benefit. In the subanalysis, patients undergoing capsular repair demonstrated higher rates of survivorship.
To report the results of a series of patients with acquired distance esotropia (ET) who underwent lateral rectus resection. We retrospectively analysed data from 21 symptomatic patients with acquired ...esotropia who did not tolerate prisms. Twelve patients had myopic esotropia, 5 patients decompensated esophoria and 4 patients age-related distance esotropia. Patients were divided in two groups; myopic and non myopic. Two patients in each group had undergone surgery to medial recti muscles previously. Near and distance angles were measured over 2 visits. Data were analysed with t-test (paired and unpaired). Average age was 47 (myopes), 77 (distance ET) and 26 years (esophoria). Mean spherical equivalent was -4.00 DS (myopes) and + 1 SD (non myopes). Lateral rectus resection ranged between 6 and 8 mm with an average of 7 mm in the myopic group and between 4 and 8 mm with an average of 6 mm in the non-myopic group. The distance angle was reduced from 19 PD to 6 PD in myopes (mean difference 12 PD, p<0.0001) and from 19 PD to 8 PD in non myopes (mean difference 12 PD, p=0.0011). There was no difference in reduction of distance angle between myopes and non-myopes (p=0.771). All patients had complete resolution of diplopia after surgery without needing prisms. Near angle was also fully corrected in 19 patients. One patient with myopia and one patient with distance esotropia went on to have medial rectus recession. Unilateral lateral rectus resection is an effective procedure for acquired distance esotropia in myopic and non-myopic patients.
Purpose NHS Blood and Transplant Tissue and Eye Services provide a serum eye drop (SED) service to patients suffering from severe dry eye syndrome. Currently SED are dispensed using an automatic ...closed filling system (TF) manufactured by Meise Medizintechnik (Germany). An improved version (ATS) has recently been introduced by Meise, based on patient feedback on the TF system. ATS vials are easier to open, with a more secure, tamper evident closure and a better quality nozzle. To evaluate the suitability of ATS vials, a validation protocol, previously developed for TF vials, was repeated. It comprised assessment of their integrity following simulated storage and transport, and the stability and sterility of SED stored in them. Method Firstly, a process simulation assessment was performed using bovine serum. Vials were filled, and frozen to -80oC. They were then removed from frozen storage and checked for damage, before being put into transport containers and shipped on a round-trip journey to simulate delivery to patients. On return the vials were thawed and the integrity of each vial checked visually and by application of a standard force. Subsequently a shelf-life study was carried out using three batches of human SED. The vials were initially frozen to -80oC, then stored for set time points of 1, 3, 6 and 12 months in a standard domestic freezer set at 20oC (to mimic a home freezer). At each time point, 10 vials were thawed and examined for integrity, and the sterility and stability of the contents. Stability was assessed by measuring serum albumin concentrations and sterility by testing for presence of microbial contamination, under aerobic and anaerobic conditions. Results No vial damage or leakage was found at any time point in the ATS vials. No microbial contamination was detected, and no change in albumin levels was detected in SED throughout the storage period. Conclusion This study has demonstrated that the ATS vials are suitable for provision of SED for clinical use to patients. Feedback is now being gathered from a patient focus group relating to usability of the vials.
Abstract
INTRODUCTION
Circumferential lumbar arthrodesis leads to high fusion rates for degenerative lumbar spine. Interspinous posterior fixation pedicle screw fixation as an adjunct to interbody ...graft led to similar fusion rates and patient reported scores in prospective randomized multi-center study. Although commonly used as surrogates of each other it remains unclear whether the fusion scores correlate with patient reported outcomes.
METHODS
Data was collected as part of a prospective multi-center (11 investigators) study of 101 patients receiving single-level antero-lateral lumbar interbody fusion with supplemental interspinous process fixation (ISPF) or pedicle screw fixation (PSF) for the treatment of degenerative disc disease and/or spondylolisthesis. Subjects were randomized 2:1, ISPF to PSF, for posterior fixation. Patients were followed up to 24 months post-op. Patient reported outcome indices (ODI, SF-36) were collected at each follow-up time point. Lumbar x-ray radiographs were taken at 12 and 24 months. Interbody fusion was scored by an independent radiologist using the Brantigan-Stefee Fraser (BSF) criteria (BSF-1: pseudarthrosis; BSF-2: radiographic locked pseudarthrosis; BSF-3: radiographic fusion). A logistic regression model was used to determine whether a relationship existed between quality of fusion (BSF-3 vs. BSF-1&2) and clinical index improvement at 12 and 24 months.
RESULTS
>Change in ODI score at 12 and 24 months was not significantly associated with BSF score (P = 0.78 and P = 0.64, respectively). At 12 months,, BSF-3 patients had on average 1.4 greater reduction in ODI compared to BSF-1&2 (95% CI: -8.61, 11.41). Changes in SF-36 score were not significantly associated with BSF score (P = 0.63 and P = 0.18, respectively). For SF-36 Mental, BSF-3 patients had a 2.21 greater increase compared to BSF-1&2 (95% CI: -6.7, 11.13). Instead in SF-36 Physical, BSF-3 patients had a 4.14 lesser increase compared to BSF-1&2 (95% CI: -10.15, 1.88)
CONCLUSION
Radiological lumbar interbody fusion grading using BSF scale do not correlate with patient reported outcome.
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