NEW DELHI: A study found that for young individuals with borderline hip dysplasia BHD , primary arthroscopy improves symptoms and function while eliminating the need for hip replacement surgery in the majority of instances. The findings of the study were published in the Journal of Bone and Joint Surgery. The journal is part of the Lippincott portfolio and is published in collaboration with Wolters Kluwer. According to a case study by Benjamin G. Domb, MD of the American Hip Institute in Chicago, ten year follow up data gives additional evidence on the benefits of arthroscopy for the treatment of BHD. BHD is a congenital condition in which the hip socket does not fully cover the ball like femoral head. Symptoms such as pain, limping, and hip instability often do not develop until young adulthood. Over time, patients with BHD are at risk of developing osteoarthritis, in many cases leading to total hip arthroplasty THA . There is ongoing controversy regarding the best treatment for BHD. The standard treatment is surgery periacetabular osteotomy to reconstruct and reposition the hip joint. Arthroscopy has emerged as a less invasive alternative procedure, with studies showing improvement in symptoms and hip function at short to medium term follow up.
However, because of a lack of long term follow up data, it has been unclear whether arthroscopy is a temporary or definitive solution, according to the authors. To address this question, Dr. Domb and colleagues report their experience with primary arthroscopic surgery for BHD. Typical of patients requiring BHD treatment, the patients were young mean age, 31 years and predominantly female 38 of 45 patients . All patients met standard radiographic criteria for BHD diagnosis i.e., a lateral center edge angle between 18 and 25 . Arthroscopic surgery included tightening plication of the joint capsule and preservation of the cartilage lining the labrum. All patients had 10 year follow up data to assess the need for conversion to THA as well as patient reported ratings of symptoms and hip function. Eight of the 35 patients underwent THA during follow up, performed at an average of about five and a half years after arthroscopy. On Kaplan Meier analysis, estimated survivorship was 82.8 per cent about four out of five patients with BHD could expect to remain free of THA for at least 10 years after primary arthroscopy.
This rate was compared favourably to a matched control group of patients without BHD. Patients who required THA were older and heavier than those who did not. After adjustment for other factors, the likelihood of THA was 4.4 times higher for patients with a body mass index of 23 kg m2 or greater, and 7.1 times higher for those 42 years or older. Primary arthroplasty for BHD was also associated with significant improvement on standard patient reported outcome measurements, including pain and hip function. For example, three fourths of patients met the minimum clinically important difference for improvement in pain score. Building on previous short to medium term studies, the study adds new evidence showing good long term outcomes following primary arthroplasty for BHD. In addition to a low rate of conversion to THA over 10 year follow up, less invasive treatment with arthroscopy also avoids the longer recovery time required by standard surgery for BHD. The study was published in Medicine Science in Sports Exercise. According to a 2021 2022 national pet ownership survey, nearly 53 of U.S. households own at least one dog, says Ridge Maxson, the study s first author and a third year medical student at The Johns Hopkins University.
Dog ownership also increased significantly in recent years during the COVID 19 pandemic. Although dog walking is a common daily activity for many adults, few studies have characterized its injury burden. We saw a need for more comprehensive information about these kinds of incidents. The researchers were from the Johns Hopkins University School of Medicine and the Johns Hopkins Bloomberg School of Public Health. Using the National Electronic Injury Surveillance System database, which is operated by the U.S. Consumer Product Safety Commission, the researchers found that an estimated 422,659 adults sought treatment in U.S. emergency rooms for injuries resulting from leash dependent dog walking from 2001 to 2020. Nearly half of all patients were adults age 40 to 64, and 75 of patients were women. Most injuries occurred due to falling after being pulled by, tangled in or tripped by the leash connected to a dog they were walking. The three most common injuries among all adults were, in order, finger fracture, TBI, and shoulder sprain or strain. TBI and hip fracture were the two most common injuries among adults age 65 and older. TBIs identified in this study consisted of both concussions and nonconcussive internal head injuries, which can include brain contusion a bruise of the brain tissue , epidural hematoma bleeding in above the brain s outer membrane or subdural hematoma bleeding beneath the brain s outer membrane .
