This study sought to investigate the relationship between multiple preoper- ative characteristics of pain (maximum pain severity location, the presence of pain in certain locations, the highest level of pain, and the number of pain locations) and psychological outcome measures as reported by patients. Fifty-four hips (50 patients) that underwent periacetabular osteotomy to treat acetabular dysplasia between February 2017 and July 2020 were re- viewed using the Depression, Anxiety, and Stress Scale-21 (DASS21), Hos- pital Anxiety and Depression Scale (HADS), and Pain Catastrophizing Scale (PCS), radiographic analysis, and questionnaires concerning pain severity/ location. Twenty-six hips had their worst pain in the groin, whereas 28 hips had greater or equal levels of pain at another location. There was no signifi- cant difference between these two locations on any of the postoperative psychological outcomes (HADS, P=.53; DASS21, P=.85; PCS, P=.97). Ad- ditionally, there was not a significant relationship between pain in any loca- tion other than the groin and any postoperative psychological outcomes (P >=.08). Finally, the highest level of preoperative pain and the number of locations of pain demonstrated no significant relationship with postopera- tive psychological outcomes (maximum severity: HADS, P=.28; DASS21, P=.49; PCS, P=.57; number of pain locations: HADS, P=.47; DASS21, P=.60; PCS, P=.35). Variance in preoperative pain location, severity, and number of pain locations seemingly does not result in any significant effect on postoperative psychological outcomes. Thus, a large range of patients with acetabular dysplasia may experience similar, favorable psychological outcomes from treatment with periacetabular osteotomy notwithstanding the characteristics of preoperative pain. [Orthopedics. 2024;47(1):28-33.]

Rationale: Septic arthritis (SA) is an uncommon condition in which a pathogen invades a joint. SA presents clinically with monoarticular joint pain, swelling, and fever. Computed tomography and magnetic resonance imaging are common diagnostic modalities for SA in conjunction with lab work such as white blood cell count. SA is typically treated by joint drainage and antibiotics and is associated with poor outcomes. Patient concerns: A 38-year-old woman with 3 prior arthroscopies over a seven-year period presented with an unresolved eight-year history of sharp intermittent pain in the groin and lateral hip. She was referred for nonsurgical treatment of her pain and received 2 corticosteroid hip injections. Subsequently following the injection, the patient developed fever, chills, and a mottled rash over her hip. Diagnoses: Magnetic resonance imaging and inflammatory markers were obtained. Osteomyelitis with septic arthritis of the right hip with extension into the retroperitoneum was confirmed. Interventions: The patient underwent resection arthroplasty with open retroperitoneal decompression of the iliopsoas abscess. Cultures isolated Staphylococcus aureus. Subsequent staged articulating hip spacer followed by reimplantation with total hip arthroplasty were performed. Outcomes: The patient had significant improvement as measured by patient reported outcomes scores. Lessons: This case report describes a unique case of hip septic arthritis, with retroperitoneal abscess post-intra articular injection, that resulted in subsequent open retroperitoneal incision and debridement followed by two-stage resection arthroplasty with articulating spacer and total hip arthroplasty.

AbstractThe changes in psychologic measures and symptoms of depression, anxiety, and pain catastrophizing following periacetabular osteotomy (PAO) are not well studied. This study aims to fill this knowledge gap by addressing the question: Do patients with acetabular dysplasia have significant improvement in psychological outcome scores after PAO? We reviewed 52 hips (48 patients) treated with PAO for acetabular dysplasia from February 2017 to July 2020 using Depression, Anxiety, and Stress Scale – 21 (DASS21), Hospital Anxiety and Depression Scale (HADS), Pain Catastrophizing Scale (PCS), radiographic analysis, and pain location/severity questionnaires. Descriptive statistics and a mixed effects model were used to test the difference in patient-reported outcome measures from before and after surgery with adjustment for age, body mass index, follow-up duration, previous hip surgery, and concurrent surgery while also accounting for clustered data. There was a statistically significant difference between preoperative and postoperative outcome scores for all three measures used in this study (DASS21 p = 3.22E-09; HADS p = 2.82E-10, PCS p = 2.12E-09). These results indicate that patients with acetabular dysplasia might expect significant improvement in symptoms of depression, anxiety, and pain catastrophizing following PAO.

The aims of this study were to determine if pre-operative pain characteristics (location of maximum severity of pain, presence of non-groin pain, maximum severity of pain and number of pain locations) affect patient-reported outcome measures in patients undergoing periacetabular osteotomy (PAO) for acetabular dysplasia. We reviewed 52 hips (48 patients) treated with PAO for acetabular dysplasia from February 2017 to July 2020 using modified Harris Hip Score (mHHS), Hip Outcome Score (HOS) and international Hip Outcome Tool (iHOT-12) score, radiographic analysis and pain location/severity questionnaires. Descriptive statistics, analysis of covariance and Spearman partial correlation coefficients were implemented. Twenty-six hips experienced the most severe pre-operative pain in the groin, and 26 hips experienced equal or greater pain in a non-groin location. Outcome scores between these groups were not significantly different (mHHS P = 0.59, HOS P = 0.48, iHOT-12 P = 0.99). Additionally, the presence of pre-operative pain in any non-groin location had no significant relationship with PROM (all P-values ≥0.14). Furthermore, the maximum severity of pre-operative pain and number of pain locations showed no significant relationship with PROM (maximum severity: mHHS P = 0.82, HOS P = 0.99, iHOT-12 P = 0.36; number of pain locations: mHHS P = 0.56, HOS P = 0.10, iHOT-12 P = 0.62). Varying pre-operative pain characteristics do not appear to have any significant impact on outcomes. Therefore, a wide array of patients with acetabular dysplasia might expect similar, favourable outcomes from PAO regardless of pre-operative pain characteristics.

Aims This study aims to answer the following questions in patients with hip osteoarthritis (OA) who underwent total hip arthroplasty (THA): are patient-reported outcome measures (PROMs) affected by the location of the maximum severity of pain?; are PROMs affected by the presence of non-groin pain?; are PROMs affected by the severity of pain?; and are PROMs affected by the number of pain locations? Methods We reviewed 336 hips (305 patients) treated with THA for hip OA from December 2016 to November 2019 using pain location/severity questionnaires, modified Harris Hip Score (mHHS), Hip Outcome Score (HOS), international Hip Outcome Tool (iHOT-12) score, and radiological analysis. Descriptive statistics, analysis of covariance (ANCOVA), and Spearman partial correlation coefficients were used. Results There was a significant difference in iHOT-12 scores between groups experiencing the most severe pain in the groin and the trochanter (p = 0.039). Additionally, more favourable mHHS scores were related to the presence of preoperative pain in trochanter (p = 0.049), lower back (p = 0.056), lateral thigh (p = 0.034), and posterior thigh (p = 0.005). Finally, the maximum severity of preoperative pain and number of pain locations had no significant relationship with PROMs (maximum severity: HHS: p = 0.928, HOS: p = 0.163, iHOT-12 p = 0.233; number of pain locations: HHS: p = 0.211; HOS: p = 0.801; iHOT-12: p = 0.112). Conclusion Although there was a significant difference in iHOT-12 scores between patients with the most severe pain in the groin or trochanter, and the presence of pain in the trochanter, lower back, lateral thigh, or posterior thigh was related to higher mHHS scores, the majority of preoperative pain characteristics did not have a significant impact on outcomes. Therefore, a broad array of patients with hip OA might expect similar, favourable outcomes from THA notwithstanding preoperative pain characteristics. Cite this article: Bone Jt Open 2022;3(4):332–339.

The left ventricular assist device (LVAD) has proven to be beneficial for patients with severe heart failure poorly responsive to anti heart failure medicine. To examine both grossly and histologically the portion of left ventricular (LV) free wall excised ("the left ventricular core") to insert a LVAD in 337 patients with severe heart failure from a variety of causes. We collected together all photographs of LV "cores" and the histologic sections prepared from them and reexamined both. Despite the fact that these LV cores usually weighed >100 times the quantity of myocardium available to examine compared with that available by biotome inserted via a transvenous catheter, the number in which histologic study allowed an unequivocal diagnosis was limited. Examination of the clinical records usually was required to establish the definitive diagnosis. Although the presence of a scarred myocardial wall usually suggested ischemic cardiomyopathy (IC), the scarring may not have involved the LV apex resulting in a nonscarred portion of myocardium simulating idiopathic dilated cardiomyopathy (IDC). Moreover, about 10% of the patients with IDC have myocardial scars thus simulating IC. Involvement of the LV core by amyloid, sarcoid, myocarditis, and acute infarction, of course, allowed a specific anatomic diagnosis. Despite the presence of ample tissue to secure a definitive diagnosis, the combination of clinical input and morphologic assessment was required to arrive at a definite diagnosis in most patients.