Hip Joint Research Articles

Design and Development of Automated Lower Limb Continuous Passive Motion (CPM) Machine

Abstract: Post-operative rehabilitation is critical in orthopedic surgery, especially for hip joint surgeries. Traditional therapies like manual exercises and resource limits in rehabilitation centers might be tough, but early mobilization and rehabilitation are critical for regaining joint function and allowing patient return to normal activities. Continuously Passive Motion (CPM) devices, primarily developed for knee joint rehabilitation, offer a non-invasive method for passive joint mobility, restoring joint range of motion and lowering post-operative stiffness risk. Their application in hip joint healing is gaining pace, offering better results and increased patient satisfaction. The research also investigates abduction mobility in the hip joint, which is necessary for daily actions like stepping to the side, getting out of bed, or exiting a car. Understanding hip joint biomechanics and range of motion parameters is vital for establishing efficient rehabilitation approaches. By merging clinical insights with technology innovations, this research intends to optimize post-surgery rehabilitation regimens, enhancing patient outcomes and quality of life. The subject of orthopedic rehabilitation continues to expand through interdisciplinary collaboration and innovation, bringing new choices for enhancing patient care and recovery trajectories.

Impaired Perception of Body-Weight Distribution Marks Functional Mobility Problems in Patients Undergoing Total Hip Arthroplasty.

Hip osteoarthritis and total hip arthroplasty imply damaged articular and periarticular structures responsible for proprioception, and this damage may impair the accurate perception of body-weight distribution. In this study, we investigated proprioceptive abilities and accuracy perceiving body-weight distribution in patients undergoing total hip arthroplasty, and we assessed the associations between these abilities and body perception accuracy with functional mobility testing in 20 patients scheduled for total hip arthroplasty and 20 age-matched healthy participants. We assessed (a) absolute error in hip joint position sense (AE-JPS), (b) absolute error in body-weight distribution (AE-BWD) during standing and sit-to-stand tasks with open and closed eyes, and (c) functional mobility with the Timed Up and Go Test (TUG). We assessed patients undergoing hip arthroplasty before (T0) and five days after their surgery (T1), while control participants underwent a single evaluation. Relative to controls, participants undergoing surgery showed higher AE-JPS at 15° of hip flexion at T0 (p = .003) and at T1 (p = .007), greater AE-BWD during sit-to-stand with open eyes at T1 (p = .014) and with closed eyes at both T0 (p = .014) and at T1 (p < .001), and worse TUG at both T0 (p = .009) and T1 (p < .001). AE-BWD during sit-to-stand with closed eyes positively correlated with TUG at T0 (r = 0.55, p = .011) and at T1 (r = 0.51, p = .027). These findings suggested that impairments in body-weight distribution perception were evident both before and immediately after total hip arthroplasty, suggesting that these impairments may regularly mark these patients' functional mobility problems.

Epidemiological and clinical profiles of septic arthritis in children of 0-2 years of age in Eastern Uttar Pradesh, India

Background: Septic arthritis identified as infectious arthritis is a serious joint infection following the invasion of joint cavities by infectious agents usually bacteria. Due to speediness of joint destruction untreated septic arthritis may result in morbidity and mortality. Methods: Out of 71 sick children attending pediatric OPD/IPD of BRDMC Gorakhpur with musculoskeletal infection during November 2019 to October 2020, 52 patients of 0-2 years of age were enrolled for study. The computerized charts containing various parameters related to the epidemiological and clinical profiles of the patients were recorded and analyzed following statistical package for the social sciences (SPSS) version 23. Results: Out of 52 children 28.8% were neonates under the age of 28 days, 73.1% were full-term infants and 23.1% were premature. Likewise, 17.3% of the cases were with low birth weight whereas 7.7% had a history of septic infection. Hip joints in 65.4%, knee joints in 23.1% and elbow and shoulder joints in 5.8% of patients were infected. 44.2% of cases had right side involvement, 36.5% left side, 19.2% e bilateral joints, 80.8% Mono-articular and 19.2% showed poly-articular involvement. 84.6% of cases showed joint pain whereas 92.3% showed joint swelling. In 20% patients microbial culture of joint fluid revealed the growth of Staphylococcus aureus, Candida spp, E. coli and Pseudomonas spp. In 78.8% cases no growth of any pathogen was recorded in their blood culture. Ultrasonography (USG) diagnosis revealed fluid collection at joints in 94.2% cases while 5.8% exhibited pus collection. Conclusions: Septic arthritis was more common in males than females, monoarticular involvement was more common on the right side, hip joints were most affected joints and Staphylococcus aureus was the most common pathogen affecting the patients.

Impact of Specific Bioactive Collagen Peptides on Joint Discomforts in the Lower Extremity during Daily Activities: A Randomized Controlled Trial

Abstract: The intake of specific collagen peptides (SCPs) has been shown to decrease activity-related knee pain in young, physically active adults. This trial investigated the effect of a 12-week SCP supplementation in a wider age range of healthy men and women over 18 years with functional knee and hip pain during daily activities. A total of 182 participants were randomly assigned to receive either 5 g of specific collagen peptides (CP-G) or a placebo (P-G). Pain at rest and during various daily activities were assessed at baseline and after 12 weeks by a physician and participants using a 10-point numeric rating scale (NRS). The intake of 5 g SCP over 12 weeks significantly reduced pain at rest (p = 0.018) and during walking (p = 0.032) according to the physician’s evaluation. Participants in the CP-G also reported significantly less pain when climbing stairs (p = 0.040) and when kneeling down (p &lt; 0.001) compared to the P-G. Additionally, after 12 weeks, restrictions when squatting were significantly lower in the CP-G compared with the P-G (p = 0.014). The daily intake of 5 g of SCP seems to benefit healthy adults with hip and knee joint discomforts by reducing pain during daily activities.

Discordance between self-report and performance-based outcomes: Contribution of psychosocial factors.

The purpose of this study was to examine the role of psychosocial factors in the discordance between perceived and observed physical disability in patients with osteoarthritis of the hip or knee joint. This was a cross-sectional study of patients seen for consideration of joint arthroplasty surgery. Patients completed a psychosocial outcome measure, a patient self-reported functional scale, and two performance-based tests. Data of 121 patients, mean age, 67 (8), 81 (67%) females were used for analysis. The fear avoidance and positive affect domains had the strongest association with the discordance between the self-report and both performance outcome measures. Age, gender, and severity of osteoarthritis were associated with discordance in relation to walking. Fear avoidance beliefs and positive affect play important roles in perception of pain and function. Age, gender, and severity of arthritis should be taken into consideration for a more holistic approach to arthritis care.

The short external rotator muscles of the hip: a cadaveric study on 18 specimens with clinical implications.

The short external rotator muscles (SERMs) of the hip are composed of six postural muscles that constitute a single functional unit that is aligned to coapt the articular surfaces of the hip joint, providing dynamic stability. This study aims to provide a morphometric evaluation of this unit that could benefice clinical practice. In particular, the implication of the morphology and direction of the hip triceps tendon when performing a posterolateral approach for total hip arthroplasty. A total of 18 cadaveric hips were dissected rigorously. Variations of the origin, course and insertion of all SERMs were recorded and quantified. Measurements were conducted for the following parameters: total muscle lengths, intra-muscular and extra-muscular tendon lengths, muscle sagittal and frontal angles, and femoral neck length. Correlation was searched for between total muscle length and femoral neck length. Results were as follows: (a) the obturator internus and externus muscles insert quasi perpendicularly on the proximal femur, (b) both gemelli take distal insertion onto the tendon of the obturator internus to form the hip triceps tendon, (c) morphometric data of the studied parameters was reported, and (d) moderate to high correlation with femoral neck length was found for all muscles but the quadratus femoris. Our results showed that the direction of the hip triceps tendon is always orthogonal to the proximal femur in the frontal plane. Such anatomical reference could be used when performing total hip arthroplasty with the posterolateral approach. Future research is needed to assess whether the easy identification and re-insertion of the hip triceps could reduce leg length discrepancy and offset.

Application of metal cushion block combined with Jumbo cup in reconstruction of acetabular bone defect in revision of artificial hip joint

To investigate the application effect and imaging changes of metal cushion block combined with Jumbo cup in the reconstruction of acetabular bone defect after revision of artificial hip joint. Retrospective analysis was made on the clinical data of 83 patients who underwent revision acetabular bone defect reconstruction of the artificial hip joint in our hospital from September 2019 to October 2021. They were divided into group A and group B according to different surgical methods. There were 42 patients in group A, including 26 males and 16 females, aged from 44 to 72 years old with an average of (60.57±4.62) years, who underwent revision with metal cushion block and Jumbo cup. There were 41 patients in group B, including 22 males and 19 females, aged from 42 to 71 years old with an average of (58.74±4.25) years, who underwent revision with metal cushion block and bone cement mortar cup. The operation related indexes, Harris hip function score and visual analogue scale (VAS) of pain before operation, 1 month and 12 month after operation were compared between two groups. The results of X-ray imaging examination (hip rotation center height, acetabular abduction angle, femoral eccentricity and imaging standard qualification rate) before and 12 month after operation were evaluated, and the incidence of complications was compared between two groups. There was no significant difference in operation time, intraoperative bleeding volume and postoperative drainage volume between two groups (P>0.05). Both groups were followed up for 12 to 36 months with an average of (25.36±3.59) months. The scores of pain, function, deformity and Harris' total score in the two groups at 1 month after operation were higher than those before operation (P<0.05), and the scores of pain, function, deformity, joint activity and Harris' total score in two groups at 1 year after operation were higher than those before operation and 1 month after operation (P<0.05), and the above scores in group A were higher than those in group B at 1 year after operation (P<0.05). The VAS of two groups decreased successively at 1 month and 1 year after operation (P<0.05), but there was no significant difference in both groups at each time point (P>0.05). The femoral eccentricity increased in both groups at 1 year after operation (P<0.05), and group A was higher than group B (P<0.05). The height of rotation center and acetabular abduction angle decreased in both groups at 1 year after operation (P<0.05), and the height of rotation center in group A was lower than that in group B (P<0.05), but there was no significant difference in acetabular abduction angle between two groups (P>0.05). The imaging qualification rate of group A was higher than that of group B (P<0.05). There was no significant difference in the incidence of adverse reactions between two groups (P>0.05). Metal cushion block combined with Jumbo cup in the treatment of acetabular bone defects can provide the hip joint function, and restore the hip joint rotation center, femoral eccentricity and acetabular abduction angle, with obvious clinical effect.

Hip joint biomechanical analysis of the acetabular anatomical reconstruction and nonanatomical reconstruction in total hip arthroplasty for Crowe type Ⅲ developmental dysplasia of the hip by finite element method

To analyze the hip joint biomechanics of the acetabular anatomical reconstruction and nonanatomical reconstruction in total hip arthroplasty (THA) for Crowe type Ⅲ developmental dysplasia of the hip (DDH) by finite element method, which provided theoretical foundation and experimental basis for the anatomical acetabular reconstruction during THA in clinical practice. One patient with left end-stage hip arthritis secondary to Crowe type Ⅲ DDH was selected in this study, who underwent total hip arthroplasty in the orthopedic department of the First Affiliated Hospital of Bengbu Medical College in April 2020. This patient was female, 57 years old. The preoperative and postoperative three dimentional CT scan of the patient's pelvis were performed. Fourteen acetabular cup models with different anteversion, inclination and rotation center height were established in Mimics and 3-Matic software. The boundary and load conditions were set in Abaqus software. The Von Mises and stress distribution of the hip joint were calculated and observed. In the Crowe type Ⅲ DDH THA, if the hip rotation center was restored anatomically and the acetabular cup's inclination was set as 40°, the cup's anteversion varied from 5° to 25°, the lowest Von Mises value of acetabular cup and polyethylene liner occured in 20°anteversioin;if the hip rotation center was restored anatomically and the acetabular cup's anteversion was set as 15°, the cup's inclination varied from 35° to 55°, the lowest Von Mises value of acetabular cup and polyethylene liner occured in 35° inclination;if the acetabular cup's anteversion and inclination were set as 15°and 40°respectively, the up migration of hip rotaion center varied from 0 mm to 20 mm, the lowest Von Mises value of acetabular cup and polyethylene liner occured in 10 mm up migration. In all fourteen models, the Von Mises value of the acetabulum, acetabulum cup and polyethylene liner were lowest when the acetabular cup's anteversion and inlcination were 15°, 35° respectively, as well as the rotation center was restored anatomically. In total hip arthroplasty for Crowe type Ⅲ DDH, the anatomical restoration of hip rotation center with 15° anteversion and 35° inclination of the acetabular cup are suggested, bone graft above the acetabular cup and additional screws are recommended simultaneously to further reduce the Von Mises of hip joint.

Short term follow-up of femoral neck dynamic cross screw system and threaded cannulated screw in the treatment of vertically unstable femoral neck fractures

To analyze and compare the clinical effects of femoral neck dynamic cross screw system (FNS) and cannulated screws(CS) in the treatment of vertically unstable femoral neck fractures. The clinical data and short-term follow-up results of 40 patients with vertically unstable femoral neck fractures admitted from July 2020 to August 2021 were retrospectively analyzed. According to different internal fixation methods, 40 patients were divided into two groups, 20 cases in FNS group included 11 males and 9 females with a median of 58.5(50.3, 62.5) years old, and 20 in CS group included 9 males and 11 females with a median of 52.0(40.5, 58.0) years old. The operation time, knife edge length, blood loss and treatment cost of two gruops were observed and compared. The postoperative fracture healing and internal fixation were evaluated with X-ray imaging data, and the femoral neck shortening of the affected side was measured. The incidence of thigh irritation, the time of partial weight bearing and full weight bearing, early necrosis of femoral head, reoperation revision and Harris scores were compared between two groups. FNS group was followed up for 18.0(15.0, 19.0) months, CS group for 17.0(15.0, 18.8) months. There was no significant difference in operation time, incision length and blood loss between two groups(P>0.05). The cost of diagnosis and treatment in FNS group was higher than that in CS group(P<0.001). In FNS group, there was no irritation sign of the affected side thigh, while in CS group, there were 6 cases with discomfort or irritation sign of the lateral thigh(P<0.05). The average time of partial weight bearing activity in CS group was later than that in FNS group(P<0.05); However, there was no significant difference in the activity time of complete weight bearing between two groups(P=0.011>0.05). At the last follow-up, the shortened length of the affected femoral neck in CS group was greater than that in FNS group(P<0.05). There was no early necrosis of femoral head and reoperation in both groups. There was no significant difference in Harris score between two groups 12 months after operation(P>0.05). FNS treatment of vertically unstable femoral neck fractures can significantly reduce the incidence of lateral thigh irritation sign, and effectively reduce the postoperative shortening rate of vertically unstable femoral neck fractures, which can provide a relatively stable anti rotation force and anti cutting force, so that patients can go to the ground relatively early, which is conducive to the recovery of the affected hip joint function after surgery. It is a new option for the surgical treatment of vertically unstable femoral neck fractures. However, due to the high cost of treatment, In clinical practice, appropriate surgical treatment is selected according to the actual situation.

Value of serum levels in predicting lower extremity deep vein thrombosis after hip joint surgery in the elderly

To explore the value of serum D-dimer (D-D), fibrinogen (FIB), platelet (PLT), C-reactive protein (CRP) and tissue plasminogen activator inhibitor (PAI)-1 levels in predicting lower extremity deep vein thrombosis (DVT) after hip joint surgery in the elderly. A retrospective analysis was performed on 165 elderly patients with hip joint surgery admitted from February 2020 to May 2022, including 89 males and 76 females, aged from 60 to 75 years old with an average of (66.43±5.48) years, and there were 102 cases of femoral neck fracture and 63 cases of femoral head necrosis. Serum levels of D-D, FIB, PLT, CRP and PAI-1 tests were performed in all patients within 24 hours after admission, and the patients were divided into DVT group and non-DVT group according to whether they developed DVT. The levels of D-D, FIB, PLT, CRP, and PAI-1 in the DVT group were higher than those in the non-DVT group (P<0.001). Spearman analysis showed that DVT was positively correlated with PLT, CRP, D-D, FIB, and PAI-1 levels (r=0.382, 0.213, 0.410, 0.310, 0.353, all P<0.001). The results of binary Logistic regression analysis showed that D-D and PLT were independent factors affecting the occurrence of DVT (OR=0.038, 0.960, P=0.032, 0.011). The area under curve (AUC) of D-D, FIB, PLT, CRP, PAI-1, and the five combined predictions for DVT were 0.843, 0.692, 0.871, 0.780, 0.819, and 0.960, respectively. The AUC of the five combined predictions was higher than that of the single prediction (P<0.05). D-D, FIB, PLT, CRP and PAI-1 are effective in predicting DVT after hip surgery in the elderly, and the combined prediction of the five factors has higher efficacy.

The metabolic characteristics and changes of chondrocytes in vivo and in vitro in osteoarthritis

Osteoarthritis (OA) is an intricate pathological condition that primarily affects the entire synovial joint, especially the hip, hand, and knee joints. This results in inflammation in the synovium and osteochondral injuries, ultimately causing functional limitations and joint dysfunction. The key mechanism responsible for maintaining articular cartilage function is chondrocyte metabolism, which involves energy generation through glycolysis, oxidative phosphorylation, and other metabolic pathways. Some studies have shown that chondrocytes in OA exhibit increased glycolytic activity, leading to elevated lactate production and decreased cartilage matrix synthesis. In OA cartilage, chondrocytes display alterations in mitochondrial activity, such as decreased ATP generation and increased oxidative stress, which can contribute to cartilage deterioration. Chondrocyte metabolism also involves anabolic processes for extracellular matrix substrate production and energy generation. During OA, chondrocytes undergo considerable metabolic changes in different aspects, leading to articular cartilage homeostasis deterioration. Numerous studies have been carried out to provide tangible therapies for OA by using various models in vivo and in vitro targeting chondrocyte metabolism, although there are still certain limitations. With growing evidence indicating the essential role of chondrocyte metabolism in disease etiology, this literature review explores the metabolic characteristics and changes of chondrocytes in the presence of OA, both in vivo and in vitro. To provide insight into the complex metabolic reprogramming crucial in chondrocytes during OA progression, we investigate the dynamic interaction between metabolic pathways, such as glycolysis, lipid metabolism, and mitochondrial function. In addition, this review highlights prospective future research directions for novel approaches to diagnosis and treatment. Adopting a multifaceted strategy, our review aims to offer a comprehensive understanding of the metabolic intricacies within chondrocytes in OA, with the ultimate goal of identifying therapeutic targets capable of modulating chondrocyte metabolism for the treatment of OA.

Influence of aging on the relation between head control and hip joint kinematics during crossover stepping.

Falls in older individuals are a serious health issue in super-aged societies. The stepping reaction is an important postural strategy for preventing falls. This study aimed to reveal the characteristics of lateral stepping in response to mechanical disturbance by means of an analysis of the hip joint kinematics in the stepping leg and head stability during crossover steps. The participants included 11 healthy older and 13 younger individuals. An electromagnet-controlled disturbance-loading device induced crossover steps due to lateral disturbance. Responses were measured using a motion capture system and force plates. The righting reaction of the head was quantified by lateral displacement (sway), neck joint kinematics (angle displacement, angular velocity), and neck joint moment during crossover stepping. Moreover, the relationship between the neck lateral bending moment and angular velocity of hip flexion/adduction of the stepping leg was examined. The lateral head sway was significantly larger in the older participants (1.13±0.7 m/s2) than in the younger individuals (0.54±0.3 m/s2); whereas, the angle displacement (older -14.1±7.1 degree, young -8.3±4.5 degree) and angular velocity (older 9.9±6.6 degree/s, 41.2±27.7 degree/s) of the head were significantly lower in the older than in the younger participants. In both groups, the moment of neck lateral bending exhibited a significant negative correlation with the hip flexion angular velocity of the stepping leg. Correlation analysis also showed a significant negative correlation between the neck lateral bending moment and hip adduction angular velocity only in the older group (r = 0.71, p<0.01). In conclusion, older individuals increased instability in the lateral direction of the head and decreased righting angle displacement and angular velocity of the head during crossover steps. The correlation between neck moment and hip flexion/adduction angular velocity suggested a decrease in step speed due to increased neck muscle tone, which could be influenced by vestibulospinal reflexes.

Structural characteristics, biomechanics and clinical significance of calcar femorale: A review.

The calcar femorale, first identified by Merkel in 1874, plays a pivotal role in the weight-bearing capacity of the proximal femur, and its structural integrity is crucial for the efficient distribution of mechanical loads. Originating at the vertical ridge where the pubofemoral ligament anchors, this bony prominence extends laterally behind the neutral axis from the medial to lateral aspects. Its presence is not merely an anatomical curiosity but significantly influences the biomechanics of the hip joint by providing additional strength and support against compressive forces encountered during activities such as walking or jumping. Despite its clear description in orthopedic texts, misconceptions persist about its exact function and importance. This article delves into the nuanced anatomy and biomechanical properties of the calcar femorale, offering a detailed literature-based examination that demonstrates its relevance in clinical practice. The review highlights how the robustness of the calcar femorale contributes to the prevention of femoral neck fractures as well as the stabilization of hip prostheses. Furthermore, the indispensable role of the calcar femorale in surgical outcomes is discussed, especially in the context of fracture repair and joint replacement, thus illustrating its enduring significance in contemporary medical applications.

Cyclogram-based evaluation of inter-limb gait symmetry in Prader-Willi Syndrome

BackgroundPrader-Willi syndrome (PWS) is characterized by a complex clinical condition, whose typical features lead to impaired motor and functional skills. To date, limited data is available as regards symmetry of gait in PWS. Research questionThe aim of this study was to characterize lower-limb asymmetry during gait in a group of Prader-Willi Syndrome (PWS) individuals by using the synchronized cyclograms and to compare it with those of two different control groups, a normal-weight group and an obese group. MethodsA total of 18 PWS, 30 normal weight (NW) and 28 obese individuals (OG) matched for age, sex and height were assessed via 3D gait analysis. Gait spatio-temporal parameters were computed together with angle-angle diagrams, characterized in terms of their geometric features (i.e. area, orientation, and trend symmetry index). ResultsIndividuals with PWS exhibit reduced speed, stride length and cadence and increased duration of both stance and double support phase than the other groups. OG was characterized by the same pattern when compared to NW. With respect to inter-limb symmetry, individuals with PWS exhibited significantly larger cyclogram areas at hip joint with respect to the other two groups (203.32 degrees2 vs. 130.73 degrees2 vs. 111.59 degrees2) and significantly higher orientation angle (4.17° vs. 2.11° vs. 1.22°) and Trend Symmetry (3.72 vs. 2.02 vs. 1.21) with respect to the other two groups at knee joint; no differences were found at ankle joint. Both individuals with PWS and those of OG exhibited reduced ROM at knee and ankle joints with respect with normal weight, but no statistically significant differences were observed between PWS and OG. SignificanceThe obtained results may provide novel and useful insights to understand better the impairments in motor control associated with this pathological state, supporting clinics in the identification of the best rehabilitation program for this rare pathological state, aimed to improve stability and motor control.

#2460 Haemodialysis-related periarticular calcifications as cause of recurrent severe inflammatory state

Abstract Background and Aims End stage chronic kidney disease (CKD) and haemodialysis (HD) are associated with disturbances in mineral and bone turnover ultimately leading to chronic kidney disease–mineral and bone disorder (CKD-MBD), which affects more than 90 % of patients with stage 5D CKD. The primary changes observed in CKD–MBD involve elevated phosphorus levels, decreased calcium levels, insufficient serum vitamin D, and heightened release of parathyroid hormone from the parathyroid glands, leading to secondary hyperparathyroidism. CKD-MBD leads to vascular calcification, increasing cardiovascular risk. There is also a correlation between abnormal bone remodeling activity in CKD-MBD and the likelihood of calcification in soft tissues. In rare instances, profound calcification occurs in periarticular tissues, resulting in severe inflammation and manifesting as systemic disease with articular involvement clinically. The objective of this case report is to demonstrate a recurrent inflammatory condition caused by severe periarticular calcification in a patient on HD. Case report We present a case of a middle-aged white male diagnosed with hypertension, hypercholesterolemia, chronic obstructive pulmonary disease, hepatitis C, and end-stage renal disease caused by hydronephrosis. He was undergoing HD since July 2020. From summer 2021 the patient experienced recurrent fever and arthralgias in the hips, elbows, and shoulders. Frequent acute hospitalizations were needed due to recurring fevers and severe inflammatory response with markedly elevated acute phase reactants (CRP was repeatedly &amp;gt;200 mg/l), raising suspicion of infection. Laboratory and imaging tests however showed no clear signs of infection, and antibiotic therapy was ineffective. An x-ray of the right AC-joint showed multiple periarticular calcifications dorsally from the AC-joint. Later, due to severe pain and swelling an MRI-scan of right elbow joint was conducted, revealing an osteomyelitis-suspect finding of the olecranon, and olecranon bursitis. No bacteria were detected in the punctate of olecranon bursa. X-ray scans of the elbows revealed bilateral soft tissue calcification dorsally from the proximal ulna. The x-ray scan of the right shoulder revealed calcific expansion in the AC-joint area, leading to total destruction of the lateral part of the clavicle. MRI and CT scans showed severe periarticular calcification around AC- and glenohumeral joints without inflammatory involvement of the synovium. Bony erosions were observed due to the pressure of calcified tissue on the bone. Whole-body CT-scan showed no sites of infection but there was a periarticular calcification observed around the hip joints. A PET-CT scan of the whole body, neck, and upper extremities revealed no signs of malignancy or infections, but there was an increased uptake of 18F-fluorodeoxyglucose detected in several periarticular sites, indicating a multi-site inflammatory process resulting from severe periarticular calcifications. A dual-energy CT-scan of upper extremities was performed, excluding the accumulation of monosodium urate crystals. The cycle of multiple hospitalizations and antibacterial therapies was broken with the diagnosis of CKD and HD-related inflammatory periarticular calcification. Initially, the inflammation was addressed with high-dose glucocorticoids. However, the dose was successfully tapered during the first month of treatment, and the patient continued to do well on a maintenance dose of 5 mg/day of prednisolone. Subsequently, hospitalizations, antibiotics, or surgical procedures were no longer required. Conclusion Severe CKD and HD cause disturbances in mineral and bone metabolism, that can lead to periarticular calcification. Like in our presented case, multi-site calcifications may mimic infection or autoimmune rheumatoid conditions making the way to correct diagnosis cumbersome and costly. Imaging techniques help us distinguish periarticular deposits from inflammatory and infectious arthritis. In our case low-dose prednisolone effectively reduced inflammation, obviating hospitalizations and minimizing healthcare burden.

Single Versus 3-incision Triple Pelvic Osteotomy: Comparison of Clinical and Radiologic Results.

Triple pelvic osteotomy (TPO) is indicated when the anatomic and functional realignment of the hip joint is needed. Although the traditional approach for TPO involves a separate incision for ischial cut, there has been a trend for single-incision TPO in recent years. This study aims to compare the clinical and radiologic results of 2 different approaches. Forty-two hips of 39 patients treated using TPO with a minimum of 24 months of follow-up were included in our cohort. Demographics, perioperative, and radiologic parameters were evaluated. Harris Hip Score and International Hip Outcome Tool were used for clinical evaluation. A single anterolateral incision approach was used in 18 hips (17 patients), whereas a 3-incision approach was used in 24 hips (22 patients). The mean follow-up was 4.7 years in the 3-incision group and 3.8 years in the single-incision group (P=0.43), with mean surgery age at 8.7 years (range, 5.4 to 12) for single-incision and 9.7 years (range, 7.7 to 11.7) for 3e-incision (P=0.22). There were no significant differences observed between the 2 groups concerning radiographic measurements, complications, and functional scores. The mean surgical time was 118.6 minutes in the single-incision group and 97.9 minutes in 3-incision group (P=0.036). Mean intraoperative blood loss was 181.7ml in the single-incision group and 243.4ml in 3-incision group (P=0.028). Three-incision group demonstrated significantly higher intraoperative blood loss, leading to lower hemoglobin values (P=0.042). The single-incision TPO demonstrated similar outcomes compared with the traditional 3-incision approach in terms of radiologic correction and functional improvement. The single-incision technique exhibited advantages such as reduced intraoperative blood loss and potential benefit of decreased pain due to fewer scars. However, it required a longer surgical time compared with the 3-incision approach. Surgeons should consider patient-specific factors and their expertise when selecting the most appropriate approach for each case. Level III-retrospective comparative series.

Evaluation of the arterial kink point during flexion of the hip: A dynamic angiographic study in iliac endofibrosis patients.

The aim of the study was to determine the flexion point's location of the ilio-femoral arterial axis and its angulation. Thirty-seven dynamic digital subtraction angiographies were analyzed and were included in the current study. Different lengths were measured, based on specific anatomical landmarks: the origin of the external iliac artery, the inguinal ligament and the bifurcation of the femoral artery. These lengths were measured in extension and during flexion of the hip in order to determine the flexion point of the artery. In extension, some physiological angulations of the external iliac artery were measured. During flexion of the hip joint, the distance from the kink point to the bifurcation of the common iliac artery was respectively 82 ± 21mm (range 48-116) on the right side and 95 ± 20mm (range 59-132) on the left side. The distance from the kink point to the inguinal ligament was respectively 38 ± 40mm (range 12-138) on the right side and 26 ± 23mm (range 8-136) on the left side. The distance from the kink point to the bifurcation of the femoral artery was respectively 45 ± 29mm (range 15-107) on the right side and 27 ± 12mm (range 10-66) on the left side. During flexion, the angulation of the flexion point of the ilio-femoral axis was 114 ± 18° (range 81-136°). The flexion point was located cranially to the inguinal ligament and below the departure of the external iliac artery.

#495 Effect of Vit D supplementation on bone mineral density in haemodialysis patients. A comparative study

Abstract Background and Aims Low serum 25(OH) vit D levels are usually observed in haemodialysis patients. In this population, vit D deficiency is associated with secondary hyperparathyroidism (SHPT) and low bone mineral density (BMD). Although, vit D supplements are routinely prescribed in haemodialysis patients, their exact role in preventing bone loss hasn't been studied thoroughly. The primary aim of this study was to estimate the effect of cholecalciferol (vit D3) use on BMD changes of haemodialysis patients. Secondary aim was to evaluate how parathyroid hormone (PTH), phosphorus and calcium levels are affected by vit D3 supplementation. Method Twelve (12) haemodialysis patients with low levels of serum vit D were included. All of them had their bone density measured with Dual - Energy X-Ray Absorptionmetry (DXA). The study population was then divided in two groups. Half of them (6 patients) received oral cholecarciferol (study group) and the rest continued with their standard treatment (control group). Initial dose of cholecalciferol was 25000 iu weekly and titrated upwards until 25 (OH) vit D levels were reaching 20 ng/ml. Then, cholecarciferol was continued in maintenance dose to keep vit D levels between 20 and 40 ng/ml. Thirty (30) months later, DXA was repeated in all patients. BMD in total hip region was evaluated. During the study period, phosphorus, calcium and PTH levels were measured monthly while 25 (OH) vit D levels were measured every three months. Results Patients’ mean age was 61.9 (±8.8) years. There were no differences in age, initial BMD, PTH or vit D levels between the two groups. Overall, initial mean vit D value was 8.5 ng/ml. At the end of the study, vit D levels had increased to 23.6 ng/ml in the study group while remaining unchanged in the control group. At the beginning of the study, mean BMD in the whole population was 0.742 gr/cm3 and it decreased by 0.042 gr/cm3 after 30 months. No differences in BMD change were observed between the two groups (ΔBMD was −0.057 versus -0.029 gr/cm3 in the study and control group respectively, p = 0.12). PTH levels were reduced in the study group and increased in the control group but the observed difference was not significant (p = 0.11). Phosphorus and calcium levels were not affected by vit D supplementation. Of note, three fractures were observed in the study group and one in the control group during the study period. Conclusion Vit D3 supplementation didn't seem to affect the rate of bone loss in haemodialysis patients, at least in the doses received and levels of 25 (OH) achieved above. Its exact effect in PTH levels as well as in the rate of bone fractures needs to be verified by larger studies.

Efficacy and Safety of Catheter Interventions for Postoperative Urinary Retention After Primary Hip and Knee Total Joint Arthroplasty.

Postoperative urinary retention (POUR) is a common barrier to rapid-discharge hip and knee total joint arthroplasty (TJA). We evaluated the efficacy and safety of catheterization intervention methods for POUR before and after discharge. A total of 1,659 primary TJAs were retrospectively reviewed. POUR resolutions before and after discharge were evaluated relative to catheterization type and other covariates. Complications before and within 90 days of discharge were quantified. A total of 113 POUR cases comprised the analysis sample of 76 hips and 37 knees in 51 women and 62 men with an average age and body mass index of 68.6 (range 22 to 92) years and 31.7 (range 16 to 49) kg/m2. POUR resolved before discharge for 82.3% (93/113) of patients, with equivalent resolution rates for intermittent catheterization alone (84.2%, 32/38) compared with indwelling catheterization with or without intermittent catheterization (82.6%, 57/69, P < 0.999), equivalent time to resolution (P = 0.319), and no difference in complication rates (P = 0.999). Complication rates within 90 days of discharge were higher for patients treated with indwelling catheters before discharge (P = 0.049). Resolution before discharge was more likely with increasing body mass index (P = 0.026) and less likely for patients with a history of urinary retention (P = 0.033). 60 percent (12/20) of patients with unresolved POUR were discharged with self-intermittent catheterization and 40% (8/20) with indwelling catheters, with no differences in efficacy and safety based on the catheterization type (P = 0.109). Before discharge, we observed equivalent resolution rates and equivalent time to resolution for indwelling and intermittent catheterization alone without compromising patient safety. Intermittent catheterization is favored, however, because in situ catheter exposure is dramatically reduced and postdischarge complication rates are lower. Additional research is needed to develop evidence-based POUR guidelines for outpatient TJA.

Kinematics but not kinetics alterations to single-leg drop jump movements following a subject-tailored fatiguing protocol suggest an increased risk of ACL injury

IntroductionNeuromuscular fatigue causes a transient reduction of muscle force, and alters the mechanisms of motor control. Whether these alterations increase the risk of anterior cruciate ligament (ACL) injury is still debated. Here we compare the biomechanics of single-leg drop jumps before and after the execution of a fatiguing exercise, evaluating whether this exercise causes biomechanical alterations typically associated with an increased risk of ACL lesion. The intensity of the fatiguing protocol was tailored to the aerobic capacity of each participant, minimizing potential differential effects due to inter-individual variability in fitness.MethodsTwenty-four healthy male volunteers performed single leg drop jumps, before and after a single-set fatiguing session on a cycle ergometer until exhaustion (cadence: 65–70 revolutions per minute). For each participant, the intensity of the fatiguing exercise was set to 110% of the power achieved at their anaerobic threshold, previously identified by means of a cardiopulmonary exercise test. Joint angles and moments, as well as ground reaction forces (GRF) before and after the fatiguing exercise were compared for both the dominant and the non-dominant leg.ResultsFollowing the fatiguing exercise, the hip joint was more extended (landing: Δ=−2.17°, p = 0.005; propulsion: Δ=−1.83°, p = 0.032) and more abducted (landing: Δ=−0.72°, p = 0.01; propulsion: Δ=−1.12°, p = 0.009). Similarly, the knee joint was more extended at landing (non-dominant leg: Δ=−2.67°, p &amp;lt; 0.001; dominant: Δ=−1.4°, p = 0.023), and more abducted at propulsion (both legs: Δ=−0.99°, p &amp;lt; 0.001) and stabilization (both legs: Δ=−1.71°, p &amp;lt; 0.001) hence increasing knee valgus. Fatigue also caused a significant reduction of vertical GRF upon landing (Δ=−0.21 N/kg, p = 0.003), but not during propulsion. Fatigue did not affect joint moments significantly.ConclusionThe increased hip and knee extension, as well as the increased knee abduction we observed after the execution of the fatiguing exercise have been previously identified as risk factors for ACL injury. These results therefore suggest an increased risk of ACL injury after the execution of the participant-tailored fatiguing protocol proposed here. However, the reduced vertical GRF upon landing and the preservation of joint moments are intriguing, as they may suggest the adoption of protective strategies in the fatigued condition to be evaluated in future studied.