Clinical and radiographic outcomes after total hip arthroplasty with the NANOS neck preserving hip stem: a 10 to 16-year follow-up study.

BACKGROUND: Short-stem Hip Arthroplasty (SHA) are increasingly implanted in recent years thanks to their potential advantage in preserving metaphyseal bone-stock. Among them, the NANOS® short-stem implant demonstrated satisfactory results to short and mid-term. The purpose of this retrospective study was to evaluate the clinical and radiographic outcome of the Nanos® short stem at a minimum follow-up of 10 years. METHODS: Sixty-seven patients aged 53 ± 20 years were enlisted in the study, for a total of 72 hips. Primary outcomes were survivorship of the implant and clinical outcome measured using the Hip disability and Osteoarthritis Outcome scores (HOOS) and the Short Form Survey (SF12) questionnaire. The secondary outcome was a radiological evaluation calculating the inclination and the anteversion angle of the acetabular cup for each implant and investigating osteolysis, heterotopic ossifications and stem position. RESULTS: We observed a 95.5% stem survivorship. The complication rate was 7.6% and three implants underwent revision because of an aseptic loosening, an infection and a periprosthetic fracture due to trauma. Among 58 patients (63 hips) evaluated in an outpatient visit 10-16 years after surgery, improvement in clinically relevant scores comparing with baseline was observed: HOOS score increased after surgery in all its subcategories (from 32.25 ± 14.07% up to 91.91 ± 9.13%) as well as SF12 which increased by more than 18 percentage points. On clinical assessment, the range of motion (ROM) was restored at follow-up, 1 patient (1.7%) showed a squeaking hip and 2 (3.4%) reported leg-length discrepancy. Neutral stem positioning was achieved in 58 hips and heterotopic ossifications occurred in 10 hips (16%). CONCLUSIONS: The current study reports good clinical and radiological outcomes following NANOS® short-stem hip implant at minimum 10 years-follow-up. Since the high rate of stem survivorship, the low complication rate demonstrated and the overall patient satisfaction, our results suggest NANOS® neck-preserving prostheses should be considered as a valid alternative to standard implants.

Survivorship and clinical outcomes of proximal femoral replacement in non-neoplastic primary and revision total hip arthroplasty: a systematic review.

BACKGROUND: Several studies have evaluated the survivorship and clinical outcomes of proximal femoral replacement (PFR) in complex primary and revision total hip arthroplasty with severe proximal femoral bone loss; however, there remains no consensus on the overall performance of this implant. We therefore performed a systematic review of the literature in order to examine survivorship and complication rates of PFR usage. METHODS: A systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed. A comprehensive search of PubMed, MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews was conducted for English articles using various combinations of keywords. RESULTS: In all, 18 articles met the inclusion criteria. A total of 578 PFR were implanted. The all-cause reoperation-free survivorship was 76.6%. The overall complication rate was 27.2%. Dislocation was the most common complication observed and the most frequent reason for reoperation with an incidence of 12.8 and 7.6%, respectively. Infection after PFR had an incidence of 7.6% and a reoperation rate of 6.4%. The reoperation rate for aseptic loosening of the implant was 5.9%. Overall, patients had improved outcomes as documented by postoperative hip scores. CONCLUSION: PFR usage have a relatively high complication rate, however, it remains an efficacious treatment option in elderly patients with osteoporotic bone affected by severe proximal femoral bone loss. Modular designs have shown reduced dislocations rate and higher survivorship free from dislocation. However, PFR should only be used as salvage procedure when no other reconstruction options are available.

The stiff elbow: Current concepts.

Elbow stiffness is defined as any loss of movement that is greater than 30° in extension and less than 120° in flexion. Causes of elbow stiffness can be classified as traumatic or atraumatic and as congenital or acquired. Any alteration affecting the stability elements of the elbow can lead to a reduction in the arc of movement. The classification is based on the specific structures involved (Kay's classification), anatomical location (Morrey's classification), or on the degree of severity of rigidity (Vidal's classification). Diagnosis is the result of a combination of medical history, physical examination (evaluating both active and passive movements), and imaging. The loss of soft tissue elasticity could be the result of bleeding, edema, granulation tissue formation, and fibrosis. Preventive measures include immobilization in extension, use of post-surgical drain, elastic compression bandage and continuous passive motion. Conservative treatment is used when elbow stiffness has been present for less than six months and consists of the use of serial casts, static or dynamic splints, CPM, physical therapy, manipulations and functional re-education. If conservative treatment fails or is not indicated, surgery is performed. Extrinsic rigidity cases are usually managed with an open or arthroscopic release, while those that are due to intrinsic causes can be managed with arthroplasties. The elbow is a joint that is particularly prone to developing stiffness due to its anatomical and biomechanical complexity, therefore the treatment of this pathology represents a challenge for the physiotherapist and the surgeon alike.

Efficacy of postoperative drainage in total knee arthroplasty: Review of the literature.

Postoperative drainage after total knee arthroplasty (TKA) is an established routine procedure for orthopedic surgeries, and is considered a useful practice in postoperative, but the use of drainage is controversial. Our study aims to clarify this aspect of knee prosthetic surgery. A systematic review of the literature was performed in the electronic databases to investigate the risks and the benefits of wound drainage in total knee arthroplasty: 30 articles were included in our review for eligibility. After the analysis of the literature performed, we found no significant advantages related with the use of wound drain following total knee replacement (TKR) in terms of pain, transfusion rate, blood loss, swelling, postoperative range of motion, wound complications, deep infection and hospital stay, while no drainage means a significant cost saving compared to drainage use. Thus, the use of drainage after TKA cannot be justified on the basis of the results of this study.