Hip reduction surgery versus scoliosis correction in non-ambulant neuromuscular patients: which surgery is the first step?

PURPOSE: Children and young adults with neuromuscular disorders have a high incidence of both spine and hip deformities. The aim of this study was to evaluate the outcome of either primary scoliosis or hip surgery in children and young adults with neuromuscular disorders. METHODS: A retrospective study was conducted on all children and young adults with neuromuscular-related synchronous hip subluxation/dislocation and scoliosis undergoing hip or scoliosis surgery in our institution between 2012 and 2021 with a minimum follow-up of 24 months. Demographic and operative data were collected; radiological parameters were measured preoperatively and postoperatively at final follow-up. RESULTS: Forty neuromuscular patients with synchronous hip displacement and scoliosis were included. Twenty patients with an average age of10.2 years had hip correction surgery performed primarily, with a mean follow-up of 54.9 (24-96) months. The other 20 patients with an average age of 12.4 years had scoliosis correction first, with a mean follow-up of 40 (24-60) months. In the "Hip first" group, pelvic obliquity, hip MP and Cobb angle were 16.8°, 71%, and 49°, respectively. At final follow-up, the mean pelvic obliquity and Cobb angles significantly progressed to 27.2° (p = 0.003) and 82.2° (p = 0.001), respectively. Eighteen patients (90%) required scoliosis correction after the hip surgery. In the "Scoliosis first" group, the mean pelvic obliquity, hip MP and Cobb angle were 21.2°, 49% and 65.5°, respectively. At final follow-up, both pelvic obliquity and Cobb angle significantly improved to 8.44° (p = 0.002) and 23.4° (p = 0.001), respectively. In 11/20 (55%) patients, the hip MP had significantly increased following the spinal surgery to 62% (p = 0.001), but only 5/20 (25%) patients underwent hip surgery after scoliosis correction. CONCLUSION: In neuromuscular patients presenting with synchronous hip displacement and scoliosis deformity, corrective scoliosis surgery is associated with a significant correction of pelvic obliquity and lower rates of secondary hip surgery. On the other hand, primary hip surgery does not reduce the risk of pelvic obliquity and scoliosis deformity progression.

Restoration of the sagittal profile according to the Roussouly classification reduces mechanical complications and revision surgery in older patients undergoing surgery for adult spinal deformity (ASD).

PURPOSE: The mechanical complications related to ASD remain a concern due to their morbidity and associated revision surgery. Restoration of each patient's Roussouly profile may reduce these. Our aim was to examine if the restoration of the Roussouly profile reduced these complications and revision rates in older patients operated for degenerative ASD. METHODS: Retrospective analysis of a single-centre, 2-year minimum follow-up patient database. All patients undergoing corrective surgery (≥ 4 levels) for ASD were included with analysis of demographic data, operative records, restoration of Roussouly sagittal profile, mechanical complications and revision rates. Univariate and multivariate analysis was conducted. RESULTS: Fifty-two patients were included (mean age was 72.3 years, average follow-up 56.3 months). Twenty-six patients had a "restored" profile (50%) and 26 an "unrestored" profile (50%). The incidence of mechanical complications was 7 (27%) and 23 (88%) for the restored and unrestored groups, respectively (p < 0.001). Revision rates were 4 (15.4%) and 18 (69.2%), respectively (p < 0.000), in the restored and unrestored profiles. Univariate analysis determined that profile restoration and BMI were associated with mechanical complications and revision surgery, whilst only the profile restoration status maintained its statistical power in multivariate analysis (p = 0.002 and p = 0.002, respectively). Age was not a significant factor in univariate analysis. The relative risk for mechanical failure and revision surgery was 5.6 times (CI 1.929-16.39) and 3.08 times (CI 1.642-5.734) greater if the profile was not restored. CONCLUSIONS: Achieving each patient's ideal Roussouly profile is associated with a reduced incidence of mechanical complications and revision rates in the older population after surgery for degenerative ASD.

Culture-negative Peri-prosthetic Joint Infection after Total Hip Arthroplasty Treatment Protocol and Outcomes in Acute and Chronic Cases.

The treatment of culture-negative periprosthetic joint infections (CN PJI) of the hip represents complex entities. We, as a result of this, report on 12 cases. Irrigation and debridement (I&D) with implant retention were performed in acute cases and two-stage revisions in chronic infections. Combined antibiotic therapy was administered in all cases for 12 weeks. Infection control was achieved in all patients with an infection-free rate of 100% at 7.5 years of average follow-up.

Cerclaje con alambre en fracturas subtrocantéricas de cadera. Análisis de beneficios y complicaciones / Cerclage wiring in subtrochanteric hip fractures. Analysis of benefits and complications

Introducción: El objetivo de este estudio retrospectivo fue evaluar si la reducción abierta con cerclaje de alambre afectó la consolidación, la tasa de complicaciones y de reoperaciones en pacientes con fracturas subtrocantéricas de cadera, tratadas con clavos cefalomedulares. materiales y métodos:Se evaluó a todos los pacientes operados consecutivamente entre enero de 2010 y diciembre de 2017. Se comparó a los tratados con cerclaje (Grupo A) o sin cerclaje (Grupo B) de alambre en términos de tipo de fractura, estancia hospitalaria, tiempo quirúrgico, necesidad de transfusiones, calidad de la reducción, consolidación y complicaciones (infección, seudoartrosis, reoperaciones). Resultados:Se incluyó a 58 pacientes. El grupo A estaba conformado por 20 pacientes y el grupo B, por 38. El tipo de fractura más frecuente fue 3A (p = 0,0004). La estancia hospitalaria fue similar (9.0 vs. 10.6 días; p = 0,81), el tiempo quirúrgico y la necesidad de transfusiones fue mayor en el grupo A (p<0,0001 y p = 0,58, respectivamente). La tasa de consolidación fue similar en ambos grupos (90 vs. 92,1%, respectivamente; p = 0,09). Los desejes se observaron solo en el grupo tratado sin lazadas (5-13,5%; p = 0,01). Las tasas de complicaciones (15 vs. 18,4%) y de reopera-ciones (15 vs. 15,8%) fueron similares (p = 0,99). Conclusiones: El uso de lazadas de alambre en fracturas subtrocantéricas de cadera tratadas con clavos cefalomedulares generó un aumento significativo del tiempo quirúrgico, y disminuyó significativamente la incidencia de desejes. La incidencia de reoperaciones fue menor, aunque no significativamente. Nivel de Evidencia: III

Background: The aim of this retrospective study was to assess whether open reduction with cerclage wire affected the union and/or complication rate in subtrochanteric hip fractures treated with cephalomedullary nails. materials and methods: We analyzed all patients who had undergone surgery in our center between January 2010 and December 2017. We comparatively analyzed those treated with (Group A) and without (Group B) cerclage wire in terms of fracture type, hospital stay, surgical time, blood transfusions, malalignment, union, and complications (infection rates, non-union, and reoperations). Results: Fifty-eight patients were included. Group A consisted of 20 patients and Group B of 38. The most frequent type of fracture was 3A (p 0.0004). The mean hospital stay was similar (9 vs 10.6 days p 0.81), the surgical time and transfusions were higher in group A (p<0.0001 and p 0.58 respectively). The union rate was similar (90 vs 92.1%; p 0.09, respectively). Malalignment was only observed in group B (5 - 13.5%; p 0.01). The complication (15 vs 18.4%) and reoperation (15 vs 15.8%) rates were similar (p 0.99). Conclusions: The use of cerclage wire in subtrochanteric hip fractures treated with cephalomedullary nails generated a significant increase in surgical time and a lower rate of malalignment. It allowed a lower rate of re-operation, although it was not significant. Level of Evidence: III

Congenital Fibular Deficiency: Total Knee Arthroplasty with Extraarticular Deformity: A Case Report.

CASE: A total knee arthroplasty (TKA) was performed on a 35-year-old man with congenital fibular deficiency and a 20° varus and 28° antecurvatum tibial deformity of the left lower limb. CONCLUSION: One-stage TKA and correction of the extraarticular deformity by means of intraarticular bone resections and a standard soft tissue release were performed to restore the limb's mechanical axis. Patients with congenital fibular deficiency present a wide range of limb deformities because of bone deficiencies or treatment sequels, which might require a specific surgical technique and small-sized implants to obtain good results during a TKA.

Extended trochanteric osteotomy (ETO) and fluted tapered modular stems in revision hip arthroplasty. Does ETO integrity or consolidation, really matter?

INTRODUCTION: The objective of this study was to assess if the fracture and/or non-union of extended trochanteric osteotomy (ETO) affected the behavior and survival of modular fluted and tapered distal fixation stems in revision total hip arthroplasties (rTHA). METHODS: We retrospectively analyzed 52 rTHA in 52 patients. Preoperative diagnoses were mechanical loosening (42 cases), septic loosening (8), periprosthetic fracture (1), and femoral stem fracture (1). According to the Paprosky classification, femoral bone stock deficiencies were 19 type-II, 26 type IIIA, and 7 type IIIB. We assessed the behavior of the osteotomy (union, fracture, migration) and the survival and behavior (integration and subsidence) of prosthetic femoral stems. RESULTS: ETO union and non-union rates were 84.61% (44 patients) and 15.38% (8 cases) respectively. There were twelve (23%) intra-operative fractures of the osteotomy fragment and 11 (21.15%) migrations (4.5 mm on average). We observed bone union in 39 (75%) stems and 13 (25%) stable fibrous unions. Nine (17.3%) stems subsided 7 mm (2-15 mm) on average before becoming stable. Stem subsidence and integration was not significantly affected by ETO fracture/no fracture or union/non-union. The postoperative Harris Hip Score (HHS) improved significantly as compared to the pre-operative HHS (38.41 ± 3.54 vs 85.29 ± 3.36; p < 0.01). Patients were followed up for 55 (24-100) months. The overall implant survival at the end of follow-up was 100%. CONCLUSIONS: In this series, neither the non-union nor the intra-operative fracture of the ETO segment affected the behavior or medium-term survival of femoral stems.

How do the new Olympic sports compare with the traditional Olympic sports? Injury and illness at the 2018 Youth Olympic Summer Games in Buenos Aires, Argentina.

OBJECTIVE: To describe injuries and illnesses across traditional and new sports among the participating athletes of the Buenos Aires 2018 Youth Olympic Summer Games (BA YOG) (6-18 October 2018). METHODS: We recorded the daily number of athlete injuries and illnesses (1) through the reporting of all National Olympic Committee (NOC) medical teams and (2) in the polyclinic and medical venues manned by the BA YOG 2018 medical staff. RESULTS: In total, 3.984 athletes from 206 NOCs were observed. NOCs and BA YOG 2018 medical staff reported 619 injuries and 334 illnesses, equalling 15.5 injuries and 8.4 illnesses per 100 athletes over the 13-day period. The eight new sports on the Youth Olympic programme (futsal, beach handball, karate, roller speed skating, kitesurfing, BMX freestyle, climbing and break dancing) fell in between the other sports with respect to injury and illness risk. Injury incidence was highest in rugby (43% of all rugby players), followed by boxing (33%) and badminton (24%), and lowest in swimming, archery, roller speed skating, equestrian, climbing and rowing (<5%). The highest incidences of illness were recorded in golf (20%), followed by triathlon (16%), beach volleyball and diving (both 14%). Of the illnesses, 50% affected the respiratory system and 15% the gastrointestinal system. Injury and illness incidences varied between continents with athletes representing Europe having significantly fewer injuries and illnesses compared with other continents, apart from a similar illness incidence to Asian athletes. CONCLUSION: The overall injury incidence of 15.5 injuries per 100 athletes was higher, while the overall illness incidence of 8.4 illnesses per 100 athletes was similar to previous youth and Olympic Games. The new sports did not differ significantly compared with the other sports with respect to injury and illness risk.