The clicky hip that may deserve an ultrasound, and the choice of operation for renal cell metastases

The edition in brief

A single-institution series of 105 patients with renal cell carcinoma long-bone metastases found that intralesional procedures and resection with reconstruction had similar reoperation rates, while intralesional surgery was associated with higher mortality overall but not in patients with a solitary metastasis. A small randomised trial of a modified enhanced recovery protocol for total knee arthroplasty found stronger quadriceps and better flexion at five days, with no difference from three months onwards. The practice-changer comes from a UK selective screening programme of 42,338 infants: a clicky hip recorded at the newborn or six-to-eight-week check was independently associated with developmental dysplasia needing treatment (adjusted OR 4.68), and one case was found for every 26 clicky hips scanned. That supports considering ultrasound referral for an isolated clicky hip, pending prospective evaluation.