Recovery of Function Following Hip Resurfacing Arthroplasty: A Randomized Controlled Trial Comparing an Accelerated Versus Standard Physiotherapy Rehabilitation Programme.

Recovery of function following hip resurfacing arthroplasty: a randomized controlled trial comparing an accelerated versus standard physiotherapy rehabilitation programme.

Clin Rehabil. 2013 Apr 10;
Barker KL, Newman MA, Hughes T, Sackley C, Pandit H, Kiran A, Murray DW

Objective:To identify if a tailored rehabilitation programme is more effective than standard practice at improving function in patients undergoing metal-on-metal hip resurfacing arthroplasty.Design:Randomized controlled trial.Setting:Specialist orthopaedic hospital.Subjects:80 men with a median age of 56 years.Interventions:Tailored post-operative physiotherapy programme compared with standard physiotherapy.Main Outcomes:Primary outcome – Oxford Hip Score (OHS), Secondary outcomes: Hip disability and Osteoarthritis Outcome Score (HOOS), EuroQol (EQ-5D-3L) and UCLA activity score. Hip range of motion, hip muscle strength and patient selected goals were also assessed.Results:At one year the mean (SD) Oxford Hip Score of the intervention group was higher, 45.1 (5.3), than the control group, 39.6 (8.8). This was supported by a linear regression model, which detected a 5.8 unit change in Oxford Hip Score (p < 0.001), effect size 0.76. There was a statistically significant increase in Hip disability and Osteoarthritis Outcome Score of 12.4% (p < 0.0005), effect size 0.76; UCLA activity score differed by 0.66 points (p < 0.019), effect size 0.43; EQ 5D showed an improvement of 0.85 (p < 0.0005), effect size 0.76. A total of 80% (32 of 40) of the intervention group fully met their self-selected goal compared with 55% (22 of 40) of the control group. Hip range of motion increased significantly; hip flexion by a mean difference 17.9 degrees (p < 0.0005), hip extension by 5.7 degrees (p < 0.004) and abduction by 4 degrees (p < 0.05). Muscle strength improved more in the intervention group but was not statistically significant.Conclusions:A tailored physiotherapy programme improved self-reported functional outcomes and hip range of motion in patients undergoing hip resurfacing. HubMed – rehab


Surgical management of delayed retrograde type A aortic dissection following complete supra-aortic de-branching and stent-grafting of the transverse arch.

Eur J Cardiothorac Surg. 2013 Apr 10;
Luehr M, Etz CD, Lehmkuhl L, Schmidt A, Misfeld M, Borger MA, Mohr FW

OBJECTIVES: Hybrid endovascular procedures are rapidly evolving and have recently been adopted for high-risk patients deemed unsuitable for conventional aortic arch surgery. We describe here our initial experience with this technique, including the management of 2 patients who developed a retrograde type A aortic dissection post-de-branching. METHODS: Between May 2010 and October 2012, 109 patients underwent conventional aortic arch repair at our institution. A further 9 high-risk patients with complex aortic arch pathology (median logistic EuroSCORE: 26, range: 11-41) were deemed unsuitable for conventional total aortic arch replacement and therefore underwent hybrid aortic arch repair. Complete supra-aortic de-branching, followed by endovascular stent-grafting (TEVAR) of the transverse arch and descending aorta, was performed in these high-risk patients. RESULTS: In-hospital mortality was zero and no patient developed paraplegia/paraparesis due to spinal cord ischaemia. However, 2 patients (22%) developed retrograde type A aortic dissection on Days 10 and 12 post-TEVAR. Both patients had a dilated ascending aorta and received a stent graft containing bare metal springs at the proximal end. Emergency ascending aortic replacement was performed during moderate-to-mild hypothermia (28-34°C) and bilateral antegrade cerebral perfusion via cannulation of the de-branching prosthesis. A Hemashield prosthetic graft was anastomosed to the proximal stent graft in an elephant trunk technique. Both patients suffered from minor non-debilitating stroke, with 1 being discharged home and 1 transferred to a neurological rehabilitation centre 2 and 3 weeks after reoperation, respectively. CONCLUSIONS: Retrograde type A aortic dissection after hybrid endovascular treatment of the aortic arch represents a new-most likely under-reported-pathology that may be successfully treated with open surgical repair. The use of stent grafts with protruding proximal bare stents and the implementation of oversizing and post-deployment ballooning should be avoided in patients undergoing hybrid arch procedures, particularly if the ascending aorta is dilated. HubMed – rehab


Prediction of headache severity (density and functional impact) after traumatic brain injury: A longitudinal multicenter study.

Cephalalgia. 2013 Apr 10;
Walker WC, Marwitz JH, Wilk AR, Ketchum JM, Hoffman JM, Brown AW, Lucas S

BACKGROUND: Headache (HA) following traumatic brain injury (TBI) is common, but predictors and time course are not well established, particularly after moderate to severe TBI. METHODS: A prospective, longitudinal cohort study of HA severity post-TBI was conducted on 450 participants at seven participating rehabilitation centers. Generalized linear mixed-effects models (GLMMs) were used to model repeated measures (months 3, 6, and 12 post-TBI) of two outcomes: HA density (a composite of frequency, duration, and intensity) and HA disruptions to activities of daily living (ADL). RESULTS: Although HA density and ADL disruptions were nominally highest during the first three months post-TBI, neither showed significant changes over time. At all time points, history of pre-injury migraine was by far the strongest predictor of both HA density and ADL disruptions (odds ratio (OR)?=?8.0 and OR?=?7.2, averaged across time points, respectively). Furthermore, pre-injury non-migraine HA (at three and six months post-TBI), penetrating-type TBI (at six months post-TBI), and female sex (at six and 12 months post-TBI) were each associated with an increase in the odds of a more severe HA density. Severity of TBI (post-traumatic amnesia (PTA) duration) was not associated with either outcome. CONCLUSION: Individuals with HA at three months after moderate-severe TBI do not improve over the ensuing nine months with respect to HA density or ADL disruptions. Those with pre-injury HA, particularly of migraine type, are at greatest risk for HA post-TBI. Other independent risk factors are penetrating-type TBI and, to a lesser degree and post-acutely only, female sex. Individuals with these risk factors should be monitored and considered for aggressive early intervention. HubMed – rehab