The intraoperative use of a calliper predicts leg length and offset after total hip arthroplasty. Component subsidence influences the leg length.

BACKGROUND: The purpose of total hip arthroplasty (THA) post-surgery and proper physiotherapy is positive recovery for the patient. Consideration is given to hip replacement biomechanics by ensuring no discrepancies in limb length (LL) and a stable prosthesis. Therefore, the patient must have proper preoperative planning and communication and a clear understanding of what to expect. METHODS: A prospective series of 59 THA operated by a single surgeon via Hardinge approach was studied, using an intraoperative calliper (CAL) to predict the change of LL and offset. We compared the results of the intraoperative changes before and after THA implantation with the reference of these values on anteroposterior x-ray pelvis. The importance of leg length balance and a good offset restoration is questioned, and the effect of component subsidence on leg length is considered. RESULTS: The average preoperative leg length discrepancy was -6.0 mm, postoperatively +3.6 mm. There was a strong correlation between the CAL measurements and the values on the x-ray (LL, r=0.873, p<0.01; offset, r=0.542, p<0.01). Reliability is better for limb length than for offset. These results are comparable within the literature and the statistical results from other studies reviewed. In addition, we evaluate the importance of subsidence of the prosthesis components for long-term results. CONCLUSION: The intraoperative use of CAL gives excellent results in predicting the final LL and offset after THA. Considering subsidence of prosthesis components, a target zone around +5 mm might be more suitable for leg length directly postoperatively. Moreover, surgeons must discuss the topic of leg length discrepancy (LLD) intensively with the patient pre-operatively. LEVEL OF EVIDENCE: Level 4, prospective cohort study.

Swirl Sign - A C T Angiogram Alarm Sign or Congenital Trans-Mesenteric Hernias.

Congenital trans-mesenteric hernias (CTMHs) are caused by rent in the mesentry of bowel. The lesions commonly present in pediatric age group. Adult CTMHs usually present with complication of the problem. The diagnosis is often late and is associated with morbidity as well as mortality due to bowel ischemia. There is no specific sign associated with this condition. A case is reported of a patient diagnosed with CTMH on high suspicion by the radiologist based on her finding of abnormal swirling of superior mesenteric artery on CT angiogram. Swirl sign on CT angiogram warrants an early surgical consultation to prevent any morbidity.

Mesentro-axial gastric volvulus in a morgagni diaphragmatic hernia in an old female.

A Morgagni diaphragmatic hernia is a rare congenital anteromedial defect in adults (5%). Symptoms of visceral herniation are attributable to the organs involved. Imaging is the mainstay of diagnosis either in an asymptomatic person or in a person with respiratory and/or gastrointestinal symptoms, ultimately requiring surgical intervention because of the risk of incarceration. We present a rare case of 80 years old female with vague upper abdominal pain and recurrent vomiting. An anteromedial parasternal defect was established on conventional as well as on cross-sectional imaging in right hemidiaphragm through which the upper abdominal contents were protruding in the right hemithorax, all enclosed in a peritoneal sac. The herniation resulted in mesentro-axial gastric volvulus. Due to age and anaesthesia risk, patient was conservatively managed.