Postoperative complications after displaced intra-articular calcaneal fracture operations.

BACKGROUND: The objective was to compare postoperative complications in the management of displaced intra articular calcaneal fractures (DIACF) between two groups; the open reduction and internal fixation (ORIF) group versus the percutaneous fixation (PF) group. METHODS: A total of 243 DIACFs were diagnosed and 127 of them received operations either with ORIF 75 (59.1 %) or PF 52 (40.9 %) between 2004 and 2018. Postoperative complications, radiological Sanders's classification and improvement of Böhler's angle were analyzed. RESULTS: Early complication rate (<6 weeks), rate of deep wound infections and wound edge necrosis were significantly better in PF than in ORIF patient group. There were no significant differences in late complications (>6 weeks from operation) nor in improvement of Böhler's angle. CONCLUSION: Complication rate is lower when using PF technique while fracture reduction remains the same compared to the ORIF. LEVEL OF EVIDENCE: IV retrospective cohort study at a single institution.

Poor Acetabular Component Orientation Increases Revision Risk in Metal-on-Metal Hip Arthroplasty.

BACKGROUND: The rate of and the reasons for the failure of metal-on-metal (MoM) bearings have recently been discussed in literature. The aim of this study was to evaluate the influence of acetabular cup inclination and version angles on revision risk in patients with MoM hip arthroplasty. METHODS: We retrospectively reviewed 825 patients (976 hips) who underwent a MoM hip arthroplasty between 2000 and 2013. There were 474 men and 351 women, with a mean age of 58 (19-86) years. Acceptable cup orientation was considered to be inside the Lewinnek's safe zone. RESULTS: The mean acetabular inclination angle was 48.9° (standard deviation, 8.1°; range, 16°-76°) and version angle 20.6° (standard deviation, 9.9°; range, -25 to 46°). The cup was found to be outside the Lewinnek's safe zone in 571 hips (58.5%). Acetabular cup revision surgery was performed in 157 hips (16.1%). The cup angles were outside Lewinnek's safe zone in 69.2% of the revised hips. The mean interobserver reliability and intraobserver repeatability of the measurements of cup inclination and version angles were excellent (intraclass correlation coefficients >0.90). The odds ratio for revision in hips outside vs inside the Lewinnek's safe zone was 1.82 (95% confidence interval, 1.26-2.62; P = .0014). CONCLUSION: Our findings provide compelling evidence that a cup position outside the Lewinnek's safe zone is associated with increased revision risk in patients with MoM arthroplasty.

Two-stage revision for prosthetic joint infection: outcome and role of reimplantation microbiology in 107 cases.

Two-stage revision is widely used for the treatment of prosthetic joint infections. However, the duration of antibiotic treatment between stages and role of reimplantation microbiology are controversial. The purpose of this study was to evaluate the outcome and influence of the reimplantation microbiology of two-staged revisions with 6 weeks of antibiotic treatment. We retrospectively reviewed 107 patients treated with two-stage revision between 2001 and 2009. The overall treatment success rate was 94.4%. The reimplantation cultures were positive in 5/97 (5.2%) cases, and only one of them failed. Therefore, we achieved excellent results with a 6-week course of antibiotics between stages in two-stage revision. Positive reimplantation cultures do not seem to be associated with worse outcomes.

Syndesmotic fixation in supination-external rotation ankle fractures: a prospective randomized study.

BACKGROUND: This study was designed to assess whether transfixion of an unstable syndesmosis is necessary in supination-external rotation (Lauge-Hansen SE/Weber B)-type ankle fractures. METHODS: A prospective study of 140 patients with unilateral Lauge-Hansen supination-external rotation type 4 ankle fractures was done. After bony fixation, the 7.5-Nm standardized external rotation (ER) stress test for both ankles was performed under fluoroscopy. A positive stress examination was defined as a difference of more than 2 mm side-to-side in the tibiotalar or tibiofibular clear spaces on mortise radiographs. If the stress test was positive, the patient was randomized to either syndesmotic transfixion with 3.5-mm tricortical screws or no syndesmotic fixation. Clinical outcome was assessed using the Olerud-Molander scoring system, RAND 36-Item Health Survey, and Visual Analogue Scale (VAS) to measure pain and function after a minimum 1-year of followup. RESULTS: Twenty four (17%) of 140 patients had positive standardized 7.5-Nm ER stress tests after malleolar fixation. The stress view was positive three times on tibiotalar clear space, seven on tibiofibular clear space, and 14 times on both tibiotalar and tibiofibular clear spaces. There was no significant difference between the two randomization groups with regards to Olerud-Molander functional score, VAS scale measuring pain and function, or RAND 36-Item Health Survey pain or physical function at 1 year. CONCLUSION: Relevant syndesmotic injuries are rare in supination-external rotation ankle fractures, and syndesmotic transfixion with a screw did not influence the functional outcome or pain after the 1-year followup compared with no fixation.

Unicompartmental knee arthroplasties implanted for osteoarthritis with partial loss of joint space have high re-operation rates.

The indications and contraindications for unicompartmental knee arthroplasty (UKA) are controversial. The aim of the study was to determine the risk factors for re-operation in our practice. A series of 113 medial UKAs with mean follow-up of 63 months were reviewed retrospectively. Pre-operatively all knees had radiographic or arthroscopic evidence of severe cartilage damage. The re-operation rate was not related to age, gender, arthroscopic finding or body mass index. It was related to the joint space on pre-operative standing weight bearing radiographs taken in extension. The re-operation rate was 6 (95% CI 2.1-17, P<0.001) times higher when the thickness of the pre-operative medial joint space was >2 mm rather than ≤2 mm. It was 8 (95% CI 2.8-22.5, P<0.001) times higher when the thickness of the pre-operative medial space was >40% of the thickness of the lateral space. The ratio of pre-operative joint spaces has a greater influence on revision rate than the absolute measurement and is independent of radiographic magnification or the patient's normal cartilage thickness. We therefore recommend that, in medial knee osteoarthritis, UKA should only be used if the pre-operative medial joint space on standing radiographs is ≤40% of the lateral joint space, even if severe cartilage damage is seen arthroscopically.