Biomedical subjects

J Verhaar

Publications and source records attributed to J Verhaar.

10 recordsLinked to original sources

PubMed2001

Influence of work on the development of osteoarthritis of the hip: a systematic review.

OBJECTIVE: To evaluate the evidence for the influence of physical workload on the occurrence of osteoarthritis (OA) of the hip. METHODS: We carried out a database search of Medline, Embase, and the Cochrane library to identify observational studies, and articles on the relationship between workload and hip OA were identified. Methodological quality of the selected studies was assessed using a standardized set of criteria. The outcome of each study was compared with its study characteristics and methodological quality score. Finally, a best-evidence synthesis was used to summarize the results from the individual studies. RESULTS: Two retrospective cohort studies and 14 case-control studies were included in this review. There was a slight negative, but not significant association between the study outcome and the methodological quality score. Overall, moderate evidence was found for a positive association, with an odds ratio of approximately 3, between previous heavy physical workload and the occurrence of hip OA. In addition, for the subcategories, i.e., > or = 10 years farming or lifting heavy weights (> or = 25 kg), moderate evidence was found for a positive relationship with hip OA. Possible selection of the populations studied may be partly responsible for the association we identified. CONCLUSION: The evidence for the influence of previous heavy physical workload on the occurrence of hip OA is moderate.

Case-Control Studies↗

PubMed2000

How do general practitioners manage hip problems in adults?

OBJECTIVE: To investigate the medical management, and its consistency and determinants, of hip problems in adult patients. SETTING: General practice, The Netherlands. DESIGN: Observational study based on four "paper patients" and on computerised patients records (CPRs) of 400 patients (20 per general practitioner), aged 50 years and over, with new hip problems. SUBJECTS: 20 general practitioners. MAIN OUTCOME MEASURES: Examination, diagnosis and treatment of hip patients. RESULTS: Medical history and physical examination consisted mainly of questions concerning pain localisation and onset, and examining passive hip motion. The paper patients, except for the one with alarming symptoms, and the CPRs showed high variation in management between general practitioners, particularly for medication prescription and X-ray requests. Main factors influencing medical management were patients' age, number of visits and attitude of the individual general practitioner. A specific diagnosis was registered for only 32% of the 400 patients. The diagnosis osteoarthritis varied greatly between general practitioners even after adjustment for patients' age, gender and number of visits. Patients with osteoarthritis were infrequently referred to physical therapy and received nonsteroidal anti-inflammatory drugs (NSAIDs) more often than paracetamol. CONCLUSION: Diagnosis and treatment of hip problems varies widely between general practitioners. Treatment of patients with osteoarthritis is inconsistent with published recommendations.

Aged↗

PubMed2000

Meralgia paresthetica is related to degenerative pubic symphysis.

OBJECTIVE: To investigate the relationship between meralgia paresthetica, a mononeuropathy of the lateral femoral cutaneous nerve that often starts in middle age, and radiological degeneration of the pubic symphysis. METHODS: A case-control study of patients aged 40 years and older with meralgia paresthetica who underwent surgical release of the lateral femoral cutaneous nerve; cases were included only when a pelvic radiograph was available. The control group was from a population study including persons aged 55 years and older and was matched to cases (4 controls per case) for sex and age as far as possible. We checked patient records from general practice to ensure control subjects had no symptoms of meralgia paresthetica during the previous 10 years. Radiological degeneration of the pubic symphysis was defined as present when 2 of 3 independent observers noted degeneration on the radiograph. RESULTS: Mantel-Haenszel procedure (stratified for age group and radiological osteoarthritis of the hip) showed a positive relationship (p = 0.004, OR = 4.38) between radiological degenerative pubic symphysis and meralgia paresthetica. In a separate analysis limited to men we also found this positive relationship. CONCLUSION: This study confirmed a positive relationship between radiological degeneration of the pubic symphysis and meralgia paresthetica.

Female↗

PubMed1999

Validity of American College of Rheumatology criteria for diagnosing hip osteoarthritis in primary care research.

OBJECTIVE: To study the validity of the American College of Rheumatology (ACR) criteria for hip osteoarthritis (OA) in patients receiving primary care. Three different sets of criteria are available, one with clinical symptoms only, and 2 with clinical symptoms and radiological signs combined. It is claimed that all 3 sets, separate from each other, can be used to diagnose hip OA for research purposes. METHODS: Consecutive patients (n = 227) aged 50 years or older, who had consulted a general practitioner for pain in the hip and had been referred for radiographic investigation of the hip, were recruited for a standardized history taking and physical investigation. The radiographs were evaluated according to a standardized protocol. The cross validity of the 3 different sets of ACR criteria was assessed by calculating the percentage agreement and the kappa between the separate sets. RESULTS: There was poor agreement between the set of clinical criteria and the 2 sets in which radiological signs were included (kappa 0.11 or lower). The 2 sets that included radiological signs showed high agreement (kappa 0.81-0.94, depending on cut off points for joint space narrowing). These sets also showed the highest agreement with the radiological OA defined as a Kellgren score 2 or more (kappa 0.13-0.48). CONCLUSION: The clinical ACR criteria showed no cross validity with the 2 other ACR criteria sets.

Female↗

PubMed1995

The results of operative treatment of medial epicondylitis.

The results of the operative treatment of medial epicondylitis in forty consecutive elbows (thirty-eight patients) were assessed retrospectively on the basis of the subjective outcome, pain noted during resisted palmar flexion of the hand and wrist, satisfaction of the patient, and grip strength. The mean age of the patients at the time of the operation was forty-two years (range, twenty-two to fifty-six years). Coexistent ulnar neuritis was identified preoperatively in twenty-four elbows. The operative procedure involved release of the attachment of the common flexor muscle of the forearm at the medial epicondyle in all of the elbows and release of the retinaculum over the cubital tunnel in seventeen of the twenty-four elbows that had coexistent ulnar neuritis. The patients were followed for a mean of forty-four months (range, twenty-four to sixty-seven months). Twenty-five elbows had a good over-all subjective outcome. The preoperative pain had resolved in twenty-eight elbows. The over-all subjective outcome was less favorable for the elbows that had had coexistent ulnar neuritis (p < 0.05). Eleven of the sixteen elbows that had had isolated medial epicondylitis and had been treated with a flexor release were free of symptoms at the time of follow-up, compared with only three of the twenty-four elbows that had had coexistent ulnar neuritis. This difference was significant (p < 0.01). Moreover, in fifteen elbows, the symptoms of ulnar neuritis persisted. There was no difference in grip strength between the treated and contralateral extremities.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1993

Lateral extensor release for tennis elbow. A prospective long-term follow-up study.

A prospective study was done of the results of lateral release of the common extensor origin in sixty-three patients who had a tennis elbow. Fifty-seven of these patients were followed for a mean of fifty-nine months (range, fifty to sixty-five months). At the time of the operation, the extensor origin was macroscopically normal in all but six patients. Forty-seven (76 per cent) of the sixty-two patients who were evaluated at one year had no pain or only slight pain, whereas before the operation three patients (5 per cent) had had slight pain and sixty (95 per cent), severe pain. Of the fifty-seven patients who were re-examined after five years, fifty-two (91 per cent) had no pain or only slight pain. At one year, twenty patients (32 per cent) had an excellent over-all result; twenty-three (37 per cent), a good result; twelve (19 per cent), a fair result; and seven (11 per cent), a poor result. At five years, there were thirty-two excellent results (56 per cent), nineteen good results (33 per cent), four fair results (7 per cent), and two poor results (4 per cent). No association between the preoperative findings and the results of the operation was found. It was concluded that lateral extensor release, a relatively simple operation that can be performed in an outpatient setting, may be regarded at this time as the operative procedure with which other operations for tennis elbow should be compared.

Adult↗

PubMed1991

Risks of neurovascular injury in elbow arthroscopy: starting anteromedially or anterolaterally?

A cadaver dissection study was performed to study the risks of neurovascular damage in elbow arthroscopy. The risk of injury to the radial nerve in the anterolateral approach was higher than the risk of damaging the median nerve in the anteromedial approach. In addition, starting medially may contribute to accurate placement of the anterolateral portal and may further help to decrease the risk of injuring the radial nerve. Therefore, starting with an anteromedial approach has several advantages above starting anterolaterally.

Arthroscopes↗

PubMed1991

Radial tunnel syndrome. An investigation of compression neuropathy as a possible cause.

Conventional electromyographic and nerve-conduction studies usually do not show abnormalities in patients who have a clinical diagnosis of radial tunnel syndrome. Therefore, posterior interosseous nerve-conduction measurements were performed during forced supination in patients who had this syndrome. Only one of sixteen patients had a major increase in latency. Our data do not support the hypothesis that the signs and symptoms in most patients who have a diagnosis of radial tunnel syndrome are caused by compression of the posterior interosseous nerve.

Adult↗

PubMed1989

Silicone arthroplasty for hallux rigidus. Implant wear and osteolysis.

Between 1980 and 1985, silicone hemiprostheses were implanted because of hallux rigidus in 58 feet of 43 patients who were followed up after an average of 5 years. The majority were satisfied and had good function without pain. However, the toes had shortened because of implant wear, and there was considerable associated osteolysis.

Adolescent↗

PubMed1989

Bone reaction to silicone metatarsophalangeal joint-1 hemiprosthesis.

The incidence of inflammatory response to silicone implants in the first metatarsophalangeal joint was investigated. In 34 of 59 silicone arthroplasties, cysts were noticed in the proximal phalanx after a mean follow-up period of 59 months. In the metatarsal head, cysts were seen in 40 cases. Histologic examination showed that the cysts were filled with an avascular cellular stroma containing histiocytes and multinucleated giant cells, opsonizing wear debris of the prosthesis. Because of this destructive process, caution is advised when using silicone prostheses in young, active people.

Adolescent↗