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  • ISSN: 2373-9290
    Volume 2, Issue 4
    Research Article
    Marinko Erceg1*, Ivica Grkovic2, Mihajlo Lojpur3 and Stjepan Jagic4
    Aim: Most patients are pain-free and do not limp following the total hip replacement (THR) surgery. However, a percentage of patients still continue to limp despite not being in pain. Using a new approach to demonstrate biomechanical properties of the hip joint, we wish to offer an explanation for persistent limping following the surgery and how to prevent it or minimise it.
    Methods: Among numerous patients that had undergone a total hip replacement surgery, 12 patients were included into our study. All of them had developmental dysplasia and secondary arthritis in one hip joint, while the other joint was normal.
    All of them were limping and were in pain before the surgery. Following the THR surgery, all patients included in our study were pain-free but limping did not disappear. Limping was confirmed on examination at least 6 months after the surgery.
    Radiographs of the pelvis (with both hip joint visible) were taken before and after the surgery so that biomechanical properties could be calculated.
    Results: Developmental dysplasia led to significant lateral and cranial shifts of the hip joint centre. THR surgery annulled lateral shift but neither the centre of the hip nor the tip of greater trochanter could be 'lowered' to the level of the normal side. Centre of the hip and greater trochanter were on average still 10% and 9% higher than on the normal side, consecutively.
    Conclusion: Higher position of the hip joint centre and of the greater trochanter are reasons for shortening of vertical lever k2 and for relative insufficiency of the hip abductor muscles affecting hip biomechanics ultimately leading to limping. It appears that in some cases a complete 'lowering' of features on the femoral proximal ending cannot be achieved by THR surgery and this is the cause for persistent limping.
    Guillem Figueras Coll1*, Marta Bonjorn Marti2, Ramon Vives Planell3, Ernest Ros Montfort4, Ramon Serra Fernandez5 and Chairman Joan Cami Biayna6
    Abstract: The purpose of this paper is to assess clinically and radiologically our experience with constrained acetabular components for the unstable hip following total hip replacement.
    From July 2006 to August 2012 we retrospectively reviewed the clinical and radiographic outcome of 22 arthroplasties, in 20 patients. The mean age at surgery of constrained acetabular component was 73 years (range, 35 to 90 years) and the mean clinical and radiological follow-up period was 35 months (range, 3 to 73 months). Clinical assessment was performed by the Harris Hip Score and the SF-12.
    The constrained acetabular device eliminated or prevented hip instability in all patients except in 3 hips who had new dislocation. The mean Harris hip score in the last evaluation was 74 points, and SF-12 was 27 points.
    A constrained acetabular components are simple to use and provides satisfactory mid term results for the treatment of hip instability in primary and revision replacement in those at high risk of dislocation.
    The potential for aseptic loosening requires evaluation by long term studies and bigger series.
    Review Article
    MC Ford, AJ Woodowski, Narcisse, WM Mihalko*
    Abstract: In 2008, it was estimated that more than 1.46 billion adults were classified as overweight (BMI>25) and 500 million adults were considered obese. Many studies have proven that obesity can add to the risk of chronic medical conditions such as type 2 diabetes, hypertension, dyslipidemia, heart disease, and metabolic syndrome, all of which can affect outcomes of total joint replacement. An association of BMI with more rapid development of osteoarthritis also has been shown. Obese patients undergoing total joint replacement have an increased risk of both deep and superficial infection, wound complications and prolonged drainage, myocardial infarction and other cardiac events, pulmonary complications, and even death. Other problems that may be encountered with obese patients include problems with operative instrumentation and tables and the need for additional anesthetic and pain control agents. Overall, obesity in the United States is thought to be a contributing factor to functional outcomes, mobility, complications, and increased health care burden.Weight control and maintenance of a non-obese BMI may decrease certain risk factors and medical comorbidities. While demand for total joint replacement will likely increase over the next several decades, understanding the pathophysiology of obesity and its effects on the surgical patient will be vital for the delivery of safe, effective, and reliable total joint replacement surgery.
    Pastides PS1*, Dodd M2 and Gupte CM1
    Abstract: Patellofemoral instability and pain is a troublesome condition, affecting people in a significant manner. Its aetiology is multifactorial and can be related to either a soft tissue, bony or combination of soft tissue and bony pathology.
    Soft tissue pathology can be divided into static (medial patellofemoral ligament, capsular structures and laxity) and dynamic (muscular (especially the vastusmedialis muscle) and neuromuscular control of quadriceps and gluteus muscles). Bony pathology can be divided into proximal (patella and trochlea morphology and position) and distal (Q angle and tibial tubercle/trochlear groove distance).
    Treatment can include physiotherapy, bracing or surgery. Surgical options include proximal and distal soft tissue procedures (such as medial patellofemoral ligament reconstruction or patellar tendon transfer) or bony procedures (trochleoplasty, tibial tubercle transfer). The choice of treatment method depends on underlying pathology, patient preference and success of previous therapy. We propose an anatomically based method of assessment and review the literature to assess the outcomes of the various available treatment methods.
    William E. Lee III1, Sabrina A. Gonzalez-Blohm2*, James J. Doulgeris1,2, Jake Laun3, Andreas Filis2 and Frank D. Vrionis4
    Abstract: Rear-end collisions are the most frequently occurring type of collision in the United States, accounting for approximately 29% of all collisions. Of these collisions, many are so- called "low velocity" or "minimal impact" type collisions, characterized by low impact speeds (less than 9-10 mph) and limited observable damage to the rear-ended vehicle. Lumbar intervertebral disc injuries are sometimes claimed by injured parties as a result of such collisions. This paper addresses lumbar biomechanics and relevant topics, such as degeneration and potential injury mechanisms, with a focus of how such knowledge relates to the occurrence of lumbar intervertebral disc injuries as a result of low velocity rear-end impacts. We conclude that the evidence for the occurrence for lumbar disc injuries in such collisions is not compelling, reflecting limited impact forces, limited lumbar range of motion, and the general lack of injury mechanisms being present. However, it is acknowledged there are significant data gaps. Important questions needing further inquiry include the experimental validation of the concept that acute disc injuries can occur at all under such conditions and the role of degenerative processes.
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