Allston J. Stubbs

Arthroscopic Management of Femoroacetabular Impingement Osteoplasty Technique and Literature Review

Morphological and spatial abnormalities of the proximal femur and acetabulum have been recently recognized as causes of femoroacetabular impingement. During joint motion in hips with femoroacetabular impingement, abnormal bony contact occurs, and soft tissue structures (chondral and labral) often fail. Femoroacetabular impingement has been reported to be a contributor to early-onset joint degeneration. Ganz et al have described good midterm success with an open surgical dislocation approach to reconstruct normal joint clearance. The purpose of this report is to discuss relevant literature and describe an arthroscopic approach to treat femoroacetabular impingement. This approach has particular relevance in high-demand patients, particularly in athletes seeking to return to high-level sport.

Revision Hip Arthroscopy

Background Hip arthroscopy has become increasingly popular; however, little is known about revision hip arthroscopy. Hypothesis Revision hip arthroscopy is associated with unaddressed femoroacetabular impingement. The purpose of this study was to describe reasons for revision hip arthroscopy. Study Design Case series; Level of evidence, 4. Methods Between March 2005 and March 2006, 37 revision hip arthroscopies were performed by the senior author. Data were collected through retrospective review of clinical and operative notes. Results All patients required revision surgery because of persistent hip pain. There were 25 women and 12 men with an average age of 33 years (range, 16-53 years). The average time from prior surgery to revision was 20.5 months (range, 2.9-84 months). Common findings among patients needing revision were hip pain, decreased range of motion, and functional disability. The average modified Harris Hip Score was 53 (range, 22-99). Thirty-six patients had radiographic evidence of femoroacetabular impingement at the time of revision. Revision procedures included 34 (95%) for femoroacetabular impingement, 32 (87%) for labral lesions, 26 (70%) for a chondral defect, 23 (62%) for lysis of adhesions, and 13 (35%) for previously unaddressed instability. Two patients had total hip arthroplasty after revision, and 3 patients required further revision. Of the remaining 32 patients, early follow-up was obtained on 27 (84%) at an average of 12.7 months postoperatively (range, 6-19 months). Outcomes showed patients regained some of their lost function within the first year. Conclusion Patients commonly required revision hip arthroscopy because of persistent impingement.

Anatrophic Nephrolithotomy in the Solitary Kidney

A retrospective analysis was conducted on 30 patients who had undergone anatrophic nephrolithotomy for staghorn calculus disease in a solitary kidney. No statistically significant difference (p greater than 0.1) was found between the average preoperative and postoperative renal function values. Of 27 patients who were infected preoperatively 19 were rendered free of further urinary tract infection and 24 of 30 patients (80 per cent) had no further recurrence of renal calculi. Because of the predictable morbidity and mortality associated with the non-operative management of staghorn calculus disease these patients are managed best by the complete surgical removal of all calculi and intensive antimicrobial therapy.

Classic measures of hip dysplasia do not correlate with three-dimensional computer tomographic measures and indices

Acetabular dysplasia is a precursor to osteoarthritis of the hip, and it causes acute and degenerative injuries of soft tissue stabilisers. Traditional radiographic assessments of dysplasia are useful in moderate and severe dysplasia, but they have questionable reliability in mild dysplasia. Computed tomography (CT) reconstruction provides a method for calculation of acetabular geometry and analysis of existing radiographic methods. We performed a retrospective radiographic review of anteroposterior pelvic films and their corresponding pelvic CT scans. Using 30 skeletally mature patients, we analyzed the following five measurements for 60 hips: lateral centre edge angle of Wiberg (LCE), Tönnis angle, Sharp angle, a modified Sharp angle, and the depth to width acetabular index. We also estimated hip surface areas, volumes, and ratios from 3-D reconstructions of a CT scan taken within 60 days of the plain radiograph. The Pearson Correlation Coefficient was used to evaluate the relationship between the plain film measurements and the computed hip indices. No moderate or strong correlation was found between the measured plain film indices and the calculated hip indices. Traditional 2-D measurements used to define acetabular dysplasia have little to no ability to quantify hip volumes and surface areas. CT reconstruction provides a better screening tool in the identification of subtle acetabular hip dysplasia in adults. Level of Evidence: Level III

Ischiofemoral space decompression through posterolateral approach: cutting block technique.

Ischiofemoral space impingement has become an increasingly recognized extracapsular cause of atypical hip, deep gluteal, and groin pain that can be treated endoscopically. We present a minimally invasive posterolateral technique that preserves the attachment of the iliopsoas tendon and quadratus femoris insertion while decompressing the ischiofemoral space by resecting the lesser trochanter. Furthermore, we present tips to perform this technique in a manner that minimizes the potential for damage to the sciatic nerve. This technique also allows the surgeon to treat concurrent hip pathology arthroscopically.

Basic Hip Arthroscopy: Supine Patient Positioning and Dynamic Fluoroscopic Evaluation.

Hip arthroscopy serves as both a diagnostic and therapeutic tool for the management of various conditions that afflict the hip. This article reviews the basics of hip arthroscopy by demonstrating supine patient positioning, fluoroscopic evaluation of the hip under anesthesia, and sterile preparation and draping. Careful attention to detail during the operating theater setup ensures adequate access to the various compartments of the hip to facilitate the diagnosis of disease and treatment with minimally invasive arthroscopy. Furthermore, having a routine method for patient positioning and operative setup improves patient safety, as well as operative efficiency, as the operative team becomes familiar with the surgeons standard approach to hip arthroscopy cases.

Central acetabular osteophyte (saber tooth sign), one of the earliest signs of osteoarthritis of the hip joint

Femoro-acetabular hip impingement is a recently recognized condition that leads to premature hip arthritis and possible need for joint replacement. Early treatment of this condition may delay the progression of the hip joint to osteoarthritis. Success of impingement surgery depends on the presence and severity of existing hip arthritis. Currently, Tönnis grade is used to assess the severity of early arthritis in the hip joint. We present a radiological sign, the “Saber tooth” sign, which may be visible on plain radiograph of the hip joint and in computer tomography of the hip joint even prior to the loss of joint space and the onset of hip arthritis.

Shigellosis associated with appendicitis

Abstract Shigellosis and acute appendicitis presented concomitantly in a 5-yr-old girl. The literature regarding the association of Shigella infections and acute appendicitis is reviewed briefly.

Non-operative management of femoroacetabular impingement: A prospective, randomized controlled clinical trial pilot study

OBJECTIVES To determine the efficacy of physical therapy on pain and physical function in patients with femoroacetabular impingement. DESIGN Randomized, participant- and assessor blinded controlled trial pilot study. METHODS This trial was registered at ClinicalTrials.gov (NCT01814124) and reported according to Consolidated Standards of Reporting Trials (CONSORT) requirements. Patients were randomly assigned to receive either a combination of manual therapy and supervised exercise (MTEX), plus advice and home exercise or advice and home exercise alone (Ad+HEP) over six weeks. Primary outcomes were average pain (Visual Analog Scale) and physical function (Hip Outcome Score) at week seven. RESULTS Fifteen patients, mean age 33.7 (SD 9.5, 73% female) satisfied the eligibility criteria and completed week seven measurements. The between group differences for changes in pain or physical function were not significant. Both groups showed statistically significant improvements in pain: the MTEX group improved a mean of 17.6mm and the Ad+HEP group, 18.0mm. CONCLUSIONS The results of this pilot study provide preliminary evidence that symptomatic femoroacetabular impingement may be amenable to conservative treatment strategies however further full-scale randomized controlled trials are required to demonstrate this. In this small pilot study, supervised manual therapy and exercise did not result in greater improvement in pain or function compared to advice and home exercise in patients with symptomatic femoroacetabular impingement.

Age specific electrophoretic patterns of prostatic fluid

Abstract Human prostatic fluid contains many distinct proteins that have only been partially characterized. Separations conducted with newer and more sensitive electrophoretic techniques afford an opportunity not only to identify the presence of previously unrecognized proteins but also a means to detect alterations that may occur secondary to aging and disease. Utilizing SDS polyacrylamide gel electrophoresis, the protein components of expressed prostatic fluid from 106 infection-free patients of varying ages were separated and specific protein bands quantitated by densitometry. Examination of the electrophoretic patterns obtained revealed the separation of only six protein components in sufficient quantity to allow further analysis. The variability of the individual components increased with advancing age. Patients less than 30 years of age had a more stable pattern when compared with those greater than 55 years of age. There did not appear to be any demonstrable difference between those patients with benign prostatic hyperplasia and prostatic carcinoma. Comparisons of one protein component to another demonstrated significant difference between young and old patients. Analysis of protein concentrations of prostatic fluid failed to reveal any significant differences related either to age or disease. Age specific changes in human prostatic secretions have not been previously described. Further studies are planned to isolate and identify the variable components of prostatic fluid in an effort to gain further understanding of the metabolic alterations associated with aging as well as with benign and malignant growth of the human prostate.