The Use of Standard Cemented Femoral Stems in Total Hip Replacement After Failed Internal Fixation of Intertrochanteric Femoral Fractures.

BACKGROUND: Total hip replacement (THR) after failed internal fixation of intertrochanteric femoral fractures is challenging. The aim of this study is to show the reliability of using standard cemented femoral stems in this operation. METHODS: This work included 107 THRs performed in 107 patients after failed treatment of intertrochanteric femoral fractures. The etiology of failure included 67 cases of failure of fixation, 16 cases of nonunion, 15 cases of avascular necrosis, and 9 cases of post-traumatic osteoarthritis. There were 48 males and 59 females. The mean age was 66 years (range 58-81). Failed dynamic hip screws were removed at the time of THR, and the screw holes were blocked with cement. All cases had cemented standard stem femoral prostheses. RESULTS: At an average 7.4 years with a minimum of 5 years of follow-up, 102 cases had good clinical and radiological outcomes and 5 cases had fair outcomes. One patient was infected and required 2 stages of revision arthroplasty. Two cases had intraoperative proximal femoral crack, and were treated by cerclage wires. Two patients had early postoperative dislocations. No patients had late periprosthetic femoral fractures or implant loosening. CONCLUSION: Standard cemented femoral stems are reliable and cost-effective prostheses in such cases. It is not necessary to bypass the distal screw hole by doubling the femoral canal diameter as long as the bone holes are covered by cement.

Comparison between results of high tibial osteotomy above and below tibial tubercle in relation to future total knee arthroplasty.

This prospective study included 50 patients with medial compartment osteoarthritis and varus knees. Twenty-five patients had high tibial closed wedge osteotomy above the tibial tubercle (TT) (group I), and the other 25 had the osteotomy just below it (group II). The two groups were matched. The osteotomies in both groups were fixed with plates and screws. All patients were followed up radiographically and clinically for more than 12 months. Clinical and radiographic results of both groups are comparable. Regarding factors that will affect future knee arthroplasty (TKA), osteotomies below TT are more advantageous. That is because soft tissues and bony changes of the knees in group II are minimal, and the issue of slower union rates can be diminished by using rigid plate fixation.

Revision of failed hip hemiarthroplasty. Classification, management, and follow-up.

BACKGROUND: Many types of failed hemiarthroplasties have been reported, but there is no classification of these failures. PATIENTS AND METHODS: Revisions of 217 cases of failed hemiarthroplasty were studied with an average follow-up of 6.2 years. Classification system based on site of problem, mode of failure, and type of revision, was introduced. RESULTS: In most cases, the intra-operative assessment of failure correlated with the preoperative classification (99%). At the last follow-up, there were 15/217 re-revisions; giving a success rate of 93%. CONCLUSION: This classification helps in choosing the appropriate revision method, leading to acceptable results.

Total hip arthroplasty for fused hips; planning and techniques.

Conversion of an arthrodesed or fused hip to total hip arthroplasty (THA) is a challenging orthopedic problem due to the effects of previous operations, the altered anatomy, atrophy of the muscles, arthritis of neighboring joints, and limb length discrepancy. This prospective work included conversion of 19 arthrodesed hips to THA. The failure rate was 5% after an average follow-up period of 7 years. Specific preoperative planning and refined techniques have been elucidated to achieve a success rate nearly similar to that of primary THA.

Continuous-flow cold therapy after total knee arthroplasty.

Cryotherapy is widely used as an emergency treatment of sports trauma and postoperatively especially after anterior cruciate ligament reconstruction. Studies in the literature on the effect of cryotherapy after total knee arthroplasty (TKA) have been limited and controversial. In this prospective study, 60 primary TKAs were done on 30 patients (all staged bilateral TKAs). For every patient, 1 TKA had a continuous-flow cooling device applied over the surgical dressing immediately postoperatively. The other TKA in the same patient (control TKA) was done 6 weeks later and had no cooling device. The study compared the range of motion, the volume of hemovac output and blood loss, visual analog pain score, analgesic consumption, and wound healing in the 2 limbs of the same patient. This study showed that continuous-flow cold therapy is advantageous after TKA because it provides better results in all the areas compared.

Tibial reconstruction using a non-vascularised fibular transfer.

A non-vascularised contralateral fibular transfer was performed on seven patients with non-union of the tibia and a sclerosed segmental bone defect following injury. The average follow-up was 2.7 years with a minimum of 2 years. The operation was successful in achieving fracture union in six patients, with an average time to union of 4.5 months (range: 3-6). Shortening of up to 2.4 cm was found in two patients and mild residual ankle stiffness in one. This procedure is successful and simple when compared to microvascular and Ilizarov techniques.