No difference in early functional outcome between the direct anterior approach and posterior approach in patients following total hip arthroplasty.

BACKGROUND: Objective and subjective outcomes in the direct anterior approach (DAA) and posterior approach (PA) in total hip arthroplasty (THA) were assessed in this study, using the Oxford Hip Score (OHS) as primary outcome. Pain, 3 objective performance-based tests, surgical time, blood loss and length of stay were assessed as secondary outcomes. METHODS: Patients with primary end-stage osteoarthritis were prospectively enrolled by shared decision making for the DAA (32 patients) or PA (26 patients). Baseline data were collected preoperatively and outcomes postoperatively at 2-, 6-, 9- and 12-month follow-up. RESULTS: There is no significant difference (p < 0.05) between the DAA and PA on primary outcome (OHS). There was a main effect of time which indicated an increase of OHS over time independent of group (p < 0.01). CONCLUSIONS: In the current study, no significant differences in postoperative functional outcome were found between DAA and PA in all follow-up moments.

Circulating Biomarkers Predictive of Postoperative Atrial Fibrillation.

Postoperative atrial fibrillation (PoAF), a common complication of cardiac surgery, contributes significantly to morbidity, mortality, and increasing healthcare costs. Despite advances in surgical and medical management, the overall incidence of PoAF has not changed significantly, partly because of the limited understanding of mechanisms underlying acute surgery-related factors, such as myocardial injury, inflammation, sympathetic activation, and oxidative stress, which play an important role in the initiation of PoAF, whereas a preexisting atrial substrate appears to be more important in the maintenance of this dysrhythmia. Thus, in a majority of patients, PoAF becomes a manifestation of an underlying arrhythmogenic substrate that is unmasked after acute surgical stress. As such, the ability to identify which patients have this proarrhythmic substrate and are, therefore, at high risk for developing AF postoperatively, is important for the improved selection for prophylactic interventions, closer monitoring for complications, and establishing the probability of AF in the long term. This review highlights the role of the underlying substrate in promoting PoAF, proposed mechanisms, and the potential role of serum biomarkers to identify patients at risk for PoAF.

Basic principles and uniform terminology for the head-neck junction in hip replacement.

Recent problems with large head metal on metal hip replacements have spiked renewed interest in the head-neck junction. A thorough knowledge of the principles of the locking mechanism, the assembly technique and affecting factors on the strength of this junction is needed. Currently a confusing variability in terms is used to describe this junction. This overcomplicates an already complex issue. The purpose of this literature review is to collect and list the different terms used and to propose a uniform terminology. Two authors independently searched the electronic databases of PubMed, CINAHL and MEDLINE with specific key words and combinations according to the PRISMA guidelines. The initial search yielded a total of 518 articles with ultimately 53 articles included in the present analysis. No consensus for a uniform term for the 2 sides of the head-stem junction was found. Since there is already pronounced variability in taper designs between different manufacturers (even so similarly named, e.g. "12/14"), a uniform terminology could be the first step to simplify the situation. "Male" and "female taper" is proposed as the appropriate terminology for the stem and head junction in hip replacement, respectively. The importance of the assembly technique understanding the principles of the locking mechanism is emphasised.

Primary uncemented hemiarthroplasty for severe fractures of the proximal humerus.

OBJECTIVES: The purpose of this study is to evaluate a consecutive series of proximally porous-coated hemiarthroplasty for the treatment of severe proximal humeral fractures with special emphasis on aseptic loosening and functional outcome. DESIGN: Observational cohort of a consecutive series of a single prosthetic design. SETTING: Orthopaedic clinic, nonacademic institutional hospital. PATIENTS/PARTICIPANTS: All patients (n = 30) treated with hemiarthroplasty for severe fractures of the proximal humerus with informed consent and at least 1 year follow-up were included. Follow-up averaged 37 months (range, 13-62 months). INTERVENTION: Uncemented proximally porous-coated hemiarthroplasty. MAIN OUTCOME MEASUREMENTS: We evaluated clinical and radiologic aseptic loosening, Constant score, patient satisfaction and visual analog scale score, range of motion, radiologic parameters such as head-to-tuberosity distance, lateral projection, and lateral offset. RESULTS: : The overall Constant score was 68 (standard deviation [SD] 18), the mean patient satisfaction 7.1 (SD 1.8), and the average visual analog scale score 3.7 (SD 2.5). We observed no cases of radiographic tilting or subsidence. In 17 cases (57%), radiolucent lines 1.0 mm or less were observed in less than three zones. None of the cases met the criteria for radiographic loosening. No revision was performed for aseptic loosening. The average head-to-tuberosity distance was 7.6 (SD 8.7 mm). We found that traumatic neurologic deficit and head-to-tuberosity distance significantly influenced Constant score. Lateral projection significantly correlated with Constant score, active forward flexion, and abduction. CONCLUSIONS: Proximally porous-coated hemiarthroplasty is a valuable alternative alongside cemented hemiarthroplasty for the treatment of severe fractures of the proximal humerus. The radiographic finding of increased lateral projection was associated with an improved range of motion.

Alternative humeral tubercle fixation in shoulder hemiarthroplasty for fractures of the proximal humerus.

HYPOTHESIS: We hypothesize that the sling technique provides better long term tuberosity fixation in hemiarthroplasty for severe fractures of the proximal humerus. BACKGROUND: After hemiarthroplasty for proximal humeral fractures, problems exist with deterioration of shoulder function by secondary displacement of the initially fixated humeral tuberosities. This study evaluated a new technique for fixation of the greater and lesser tuberosities in uncemented hemiarthroplasties in severely displaced 3- or 4-part proximal humeral fractures. MATERIALS AND METHODS: A consecutive series of 31 uncemented hemiarthroplasties using the new sling technique to repair the tuberosities was evaluated clinically and radiographically with special emphasis on the head-to-tuberosity distance (HTD). A historical cohort of 10 similar uncemented hemiarthroplasties was the control group in which the drill-hole technique was used for fixation of the humeral tuberosities. RESULTS: The sling technique had an overall better tuberosity positioning in terms of HTD compared with the drill-hole technique (8 vs 1 mm; P = .025, U test). There were significantly more normal HTD values in the sling-technique group (81% vs 44%; P = .032, chi(2) test). In the anatomic HTD group, the Constant score (70 vs 52; P = .009), patient satisfaction (7.1 vs 5.7; P = .038), and visual analog scale score (3.2 vs 5.2; P = .025) were statistically significantly superior compared with the nonanatomic HTD group. CONCLUSION AND DISCUSSION: The sling technique for tuberosity fixation seems to provide solid fixation. In this study, anatomic HTD fixation was associated with significantly better functional outcome, patient satisfaction, and pain scores.