What Is the Long-Term Survival of Impaction Allografting of the Femur?

What is the Long-term Survival of Impaction Allografting of the Femur?

Clin Orthop Relat Res. 2013 Mar 30;
Garvin KL, Konigsberg BS, Ommen ND, Lyden ER

BACKGROUND: Revision hip surgery of the femur for patients with substantial bone loss is challenging. We previously reported 41 patients (44 hips) treated with femoral impaction grafting followed for a minimum of 2 years. The survivorship, using femoral reoperation for symptomatic aseptic loosening as the end point, was 97% at 8 years. However, data on longer term survival are crucial to adequately compare this surgical technique with other types of revision hip arthroplasty procedures. QUESTIONS/PURPOSES: We therefore asked what the survivorship of impaction bone grafting was at longer followup, if the severity of bone loss was associated with failure, and finally, if longer length stems had improved survival compared with shorter stems. METHODS: Between 1993 and 2002, 78 femoral revisions were performed in 71 patients using impaction grafting. The average age of the patients was 67 years (range, 33-84 years). Sixty-nine of the 71 patients were available for followup evaluation. We obtained Harris hip scores preoperatively and postoperatively. Radiographs were measured for radiolucent lines. Patients were followed a minimum of 2 years (average, 10.6 years; range, 2-19 years). RESULTS: Survival of the femoral component without revision for any cause was 93% (confidence interval [CI], 83%-97%) and for aseptic loosening was 98% (CI, 87%-100%) at 19 years. Neither severity of bone loss nor the length of the stem predicted failure. CONCLUSIONS: Impaction bone grafting has a high survival of 93% at the 19-year followup for patients with severe bone loss of their femur. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. HubMed – rehab


Scheduled Analgesic Regimen Improves Rehabilitation After Hip Fracture Surgery.

Clin Orthop Relat Res. 2013 Mar 30;
Chin RP, Ho CH, Cheung LP

BACKGROUND: Postoperative pain often is the limiting factor in the rehabilitation of patients after hip fracture surgery. QUESTIONS/PURPOSES: We compared an approach using scheduled analgesic dosing with as-needed analgesic dosing in patients after hip fracture surgery, to compare these approaches in terms of (1) resting and dynamic pain intensity, (2) postoperative patient mobility, and (3) functional end points. METHODS: We conducted a prospective cohort study of 400 patients who underwent surgical treatment of hip fractures at our hospital. The groups were formed sequentially, such that the first 200 patients formed the intervention group (treated with scheduled analgesic intake for the first 3 weeks after surgery), and the next 200 patients were the control group (treated using a protocol of analgesic administration on request). Resting and dynamic pain intensity, mobility, and functional performance were compared between the two analgesic protocols. RESULTS: As expected, analgesic consumption was lower in the control group (tramadol doses, 27 versus 63; paracetamol doses, 29 versus 63). Despite the large difference in the amounts of analgesics consumed, resting and dynamic pain intensity showed improvement in each group and there was no difference between groups in terms of postoperative pain. However, there was a positive correlation between functional outcomes and analgesic consumption in the control group. The intervention group achieved higher functional performance on discharge (elderly mobility scale, 11 versus 8; functional independence measure, 88 versus 79). On discharge, fewer patients in the intervention group were wheelchair ambulators (3 versus 32), meaning more patients in the intervention group were able to walk. CONCLUSIONS: The study showed that a scheduled analgesic intake can improve the functional outcomes of patients with geriatric hip fractures after surgery. LEVEL OF EVIDENCE: Level II, therapeutic study. See the guidelines for authors for a complete description of levels of evidence. HubMed – rehab


An examination of the PROMIS(®) pediatric instruments to assess mobility in children with cerebral palsy.

Qual Life Res. 2013 Mar 31;
Kratz AL, Slavin MD, Mulcahey MJ, Jette AM, Tulsky DS, Haley SM

PURPOSE: The Patient-Reported Outcomes Measurement Information System (PROMIS(®)) provides adult and pediatric self-report measures of health-related quality of life designed for use across medical conditions and the general population. The purpose of this study was to examine the feasibility and validity of the PROMIS(®) Pediatric Short Form and computer-adaptive test (CAT) mobility measures in children with cerebral palsy (CP). METHODS: Eighty-two children with CP completed self-report (PROMIS(®) Mobility Short Form, PROMIS(®) Mobility CAT, Pediatric Quality of Life Inventory™) and performance-based assessments of mobility (Timed Up and Go, Gross Motor Function Measure). Parents provided three proxy reports of child mobility (Pediatric Outcomes Data Collection Instrument, Functional Assessment Questionnaire, Shriners Hospitals for Children CP-CAT). Validity of PROMIS(®) instruments was examined through correlations with other measures and “known groups” analyses determined by Gross Motor Function Classification System (GMFCS). RESULTS: On average, the PROMIS(®) CAT required less than seven items and 2 minutes to administer. Both PROMIS(®) measures showed moderate to high correlations with child- and parent-proxy report of child mobility; correlations with performance-based measure were small for the PROMIS(®) Short Form and non-significant for the PROMIS(®) CAT. All measures except for the PROMIS(®) CAT were able to distinguish between GMFCS categories. CONCLUSIONS: Results support the convergent and discriminant validity of the pediatric PROMIS(®) Mobility Short Form in children with CP. The PROMIS(®) Mobility CAT correlates well with child report and parent report of mobility but not with performance-based measures and does not differentiate between known mobility groups. HubMed – rehab


Does giving segmental muscle vibration alter the response to botulinum toxin injections in the treatment of spasticity in people with multiple sclerosis? A single-blind randomized controlled trial.

Clin Rehabil. 2013 Mar 29;
Paoloni M, Giovannelli M, Mangone M, Leonardi L, Tavernese E, Di Pangrazio E, Bernetti A, Santilli V, Pozzilli C

Objective:To determine if segmental muscle vibration and botulinum toxin-A injection, either alone or in combination, reduces spasticity in a sample of patients with multiple sclerosis.Design:Single-blind, randomized controlled trial.Setting:Physical medicine and rehabilitation outpatients service.Subjects:Forty-two patients affected by the secondary progressive form of multiple sclerosis randomized to group A (30 minutes of 120 Hz segmental muscle vibration over the rectus femoris and gastrocnemius medial and lateral, three per week, over a period of four weeks), group B (botulinum toxin in the rectus femoris, gastrocnemius medial and lateral and soleus, and segmental muscle vibration) and group C (botulinum toxin).Main measures:Modified Ashworth Scale at knee and ankle, and Fatigue Severity Scale. All the measurements were performed at baseline (T0), 10 weeks (T1) and 22 weeks (T2) postallocation.Results:Modified Ashworth Scale at knee and ankle significantly decreased over time (p < 0.001) in all groups. Patients in group C displayed a significant increase of knee and ankle spasticity at T2 when compared with T1 (p < 0.05). Fatigue Severity Scale values in groups A and C were significantly higher at T0 [A: 53.6 (2.31); C: 48.5 (2.77)] than at either T1 [A: 48.6 (2.21); p = 0.03; C: 43.5 (3.22); p = 0.03] or T2 [A: 46.7 (2.75); p = 0.02; 42.5 (2.17); p = 0.02], while no differences were detected in group B [T0: 43.4 (3.10); T1: 37.3 (3.15); T2: 39.7 (2.97)].Conclusion:Segmental muscle vibration and botulinum toxin-A reduces spasticity and improves fatigue in the medium-term follow-up in patients with multiple sclerosis. HubMed – rehab