Lateral sided hip pain frequently presents to the orthopaedic clinic. The most common cause of this pain is trochanteric bursitis. This usually improves with conservative treatment. In a few cases it doesn't settle and warrants further investigation and treatment. We present a series of 28 patients who underwent MRI scanning for such pain, 16 were found to have a tear of their abductors. All 16 underwent surgical repair using multiple soft tissue anchors inserted into the greater trochanter of the hip to reattach the abductors. There were 15 females and 1 male. All patients completed a self-administered questionnaire pre-operatively and 1 year post-operatively. Data collected included: A visual analogue score for hip pain, Charnley modification of the Merle D'Aubigne and Postel hip score, Oxford hip score, Kuhfuss score of Trendelenburg and SF36 scores.Of the 16 patients who underwent surgery 5 had a failure of surgical treatment. There were 4 re ruptures, 3 of which were revised and 1 deep infection which required debridement. In the remaining 11 patients there were statistically significant improvements in hip symptoms. The mean change in visual analogue score was 5 out of 10 (p=0.0024) The mean change of Oxford hip score was 20.5 (p=0.00085). The mean improvement in SF-36 PCS was 8.5 (P=0.0020) and MCS 13.7 (P=0.134). 6 patients who had a Trendelenburg gait pre-surgery had normal gait 1 year following surgery.We conclude that hip abductor mechanism tear is a frequent cause of recalcitrant trochanteric pain that should be further investigated with MRI scanning. Surgical repair is a successful operation for reduction of pain and improvement of function. However there is a relatively high failure rate.
Platelets have been implicated and abnormal platelet function proposed in the pathogenesis of coronary artery disease (CAD). This investigation examines platelet function in men with stable, arteriographically defined CAD and correlates results with lipid pattern, history of angina or myocardial infarction and smoking habits. Platelet survival (
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Chromium method), adhesiveness, and aggregation were measured in 21 men with CAD. Twelve patients had Type IV hyperlipoproteinemia and nine patients had normal lipoprotein level. Eighteen had angina and 13 had had infarction.
The average platelet survival for the total group was normal (6.8 ± 0.24 days, avg ±
sem
), but survival was shortened in 11 and normal in ten. There was no significant difference between: (1) patients with hyperlipoproteinemia (6.8 ± 0.30 days) and those with normal lipoproteins (6.9 ± 0.41 days); (2) patients with angina (6.8 ± 0.28 days) and without (6.6 ± 0.26 days); (3) patients with infarction (6.8 ± 0.26 days); and without (6.8 ± 0.50 days); (4) patients with varying patterns of arteriographic involvement; and (5) with varying smoking histories. Adhesiveness was normal in all. Aggregation was normal in 14. Neither adhesiveness nor aggregation correlated with platelet survival or defined the subgroups of CAD. Results suggest an abnormal short platelet survival frequently occurs in patients with CAD, but there is no discernible difference in platelet survival among the various clinical subgroups of CAD.
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