Search

Background: Mini-incision total hip replacement continues the current trend in orthopaedics and other specialties toward smaller-incision surgery. The purpose of this systematic review was to assess the effectiveness and safety of single mini-incision compared with standard-incision total hip replacement for treatment of arthritis of the hip.Methods: We conducted an electronic literature search for relevant studies published in any language up to March 2010. Key conference proceedings and national orthopaedic registries were searched, professional organizations and implant manufacturers were approached, and reference lists from included studies were screened. We included randomized and quasi-randomized controlled trials assessing single mini-incision surgery, defined as an incision of ≤ 10 cm, compared with standard primary total hip replacement. Two reviewers independently assessed studies for inclusion and extracted data.Results: Fifteen randomized and five quasi-randomized controlled trials, involving 1857 participants, were eligible. Included trials were of mixed methodological quality, with the sample size ranging from twenty to 219. Mean follow-up periods were short, ranging from six weeks to three years. Compared with standard total hip replacement, mini-incision procedures may have small perioperative advantages in terms of less blood loss, shorter operative time, and shorter inpatient stay, but the differences were not clinically important. Few complications were reported, and the complication rate did not differ significantly between groups. There was insufficient evidence to suggest any major difference in the short-term revision rate, and confidence intervals for surrogate measures for long-term outcome were broad enough to include clinically important differences in favor of either approach.Conclusions: Although there were marginal short-term advantages and disadvantages for each of the surgical techniques, there was no strong evidence either for or against mini-incision compared with standard-incision total hip replacement. Importantly, evidence on longer-term performance, especially the risk of revision arthroplasty, for mini-incision hip arthroplasty is very limited. [ABSTRACT FROM AUTHOR]

Pelvic organ prolapse is a common female complaint, with 50% of women experiencing some degree of pelvic relaxation, although not all have any symptoms. Prolapse is found most commonly in the anterior vaginal walls. Posterior vaginal wall and apical prolapse are the other, less common, categories. There are a large number of potential risk factors, but increased age, parity and body mass index are most consistently reported. A variety of symptoms may be experienced, including a feeling of something coming down, pelvic heaviness, urinary, bowel and sexual dysfunction. Two main treatment options exist, conservative management (pessary or pelvic floor rehabilitation) or surgical repair, however the evidence-base for treatment is weak. The specialist nurse is well-placed to contribute to the initial assessment, management and ongoing support of women with prolapse. [ABSTRACT FROM AUTHOR]

Controversy about the value of the post-coital test (PCT) has prompted us to re-analyse data from 207 couples, originally studied between 1982 and 1983, with at least 12 months' infertility at presentation, complete diagnostic information and exclusion of female factors, to clarify the effect of duration of infertility on the prediction of conception. In couples with less than 3 years infertility and a positive PCT, 68% conceived within 2 years compared with 17% of those with a negative result. After 3 years, corresponding rates were 14% and 11%. The relative risks of conception [95% confidence interval (CI)] calculated using the Cox's proportional hazards model were 0.23 (0.12-0.43) for a negative PCT (reference positive PCT) and 0.25 (0.13-0.51) for more than 36 months infertility (reference 12-23 months). Semen analysis had no extra predictive power given the duration of infertility and the PCT. The PCT is an effective predictor of conception where defined female causes of infertility are absent and duration of infertility is less than 3 years. Once infertility is prolonged (beyond 3 years) the conception rate is low even with a positive test because a large proportion of couples remaining childless so long have true unexplained infertility. Use of the PCT will enable clinicians to allocate scarce, expensive and invasive resources effectively. [ABSTRACT FROM AUTHOR]

Infertile women without any inherent female infertility factors and able to secrete normal cervical mucus were studied prospectively in relation to post-coital sperm-mucus penetration (PCT) and their partner's seminal analysis, excluding men with azoospermia. Time-specific cumulative conception rates calculated as for life-table analysis were related to each measured seminal variable on routine analysis of 2-3 samples (volume, density, proportion with progressive motility, and proportion with normal morphology); to various derivatives from combinations of these variables; to seminal findings after vital staining; and to the PCT results. The best seminal predictor of fertility was the motile normal sperm density (MNSD), the 18 month conception rates being 57.4% +/- 4.6 (SE) and 30.2% +/- 5.9 (ratio 1.9, P less than 0.001) above and below a derived threshold value of 4 x 10(6)/ml. The PCT led to rates of 55.6% +/- 4.3 and 14.9% +/- 5.1 (ratio 3.73, P less than 0.001) for positive and negative results, respectively. The PCT also gave rise to a significantly distinct intermediate poor-positive sub-group (conception rate 30.6% +/- 9.0). Seminal analysis (the MNSD) did not affect the conception rate associated with a positive PCT but helped to discriminate further with a negative PCT (conception rates 22.5% +/- 8.7 with an MNSD above 4 x 10(6)/ml versus 5.6% +/- 4.8 below, P less than 0.05). The PCT was the single best predictor of fertility but seminal analysis (the MNSD) was of additional value after a negative PCT. [ABSTRACT FROM AUTHOR]

In 94 infertile couples with negative postcoital tests (PCTs) the results of an in-vitro sperm-mucus invasion test (SMIT) were compared with seminal analysis (excluding sperm density less than 1 x 10(6)/ml) and agglutination assays for antisperm antibodies in semen (MAR, TAT) and in mucus (TAT). Abnormalities at the sperm-mucus interface were classed into three types. (i) Failure to form semen clefts and of spermatozoa to colonize the clefts was closely correlated with oligo-asthenoteratozoospermia, and vice versa, the two tests agreeing in 90% of cases (P less than 0.001). Most of the discrepancies, in which sperm-dense clefts developed despite low sperm counts, were due to antisperm antibodies in semen. (ii) Failure of spermatozoa to invade mucus, despite normal sperm colonization of clefts, was closely correlated with the presence of antisperm antibodies in semen (positive MAR or TAT), and vice versa, the tests agreeing in 81% of cases (P less than 0.001). (iii) Failure of sperm survival after normal invasion of mucus could not be correlated significantly with the TAT results on mucus, but more extensive study of this question is needed. Finally a normal SMIT result was associated with a significantly improved chance of conception (39 versus 10% at 12 months), particularly with artificial insemination, suggesting undisclosed coital failure as the cause of the negative PCT. In conclusion, the invasion test, when assessed in the foregoing detail, offers a reliable and simple substitute for laboratory assessment of both seminal quality and the presence of antisperm antibodies in semen, and would be applicable in general infertility practice everywhere. [ABSTRACT FROM AUTHOR]

One-hundred-and-seventy-four patients having hysterosalpingographs during the investigation of infertility have been reviewed to assess the incidence of tubo-cornual polyps and their relation to subsequent pregnancy. Definite polyps were present in 31 (18%) of the patients. There was no significant difference in age or parity in women with and without polyps, nor in associated infertility factors such as tubal occlusion or oligospermia. None of the patients with polyps had endometri-osis. Conception rates in the two groups were not significantly different. The cumulative rates at 18 months with and without polyps were 34.5 ± 13.7% (SE) and 43.6% ± 3.9% respectively in the overall groups, and 36.9% ±24.1% and 59.0% ± 9.1% in the couples with otherwise unexplained infertility. It is concluded that tubo-cornual polyps are not related to infertility and that they should not be treated. [ABSTRACT FROM PUBLISHER]