Ten-year follow-up and clinical outcome of a metaphyseal anchoring short hip stem prosthesis: a retrospective single-centre analysis.

PURPOSE: Short stems for total hip arthroplasty are an alternative to traditional conventional long stems. Short stems are designed to facilitate minimal-invasive surgery, improve bone-stock preservation, and mimic a physiological load distribution. However, there is little evidence of the long-term outcome of short stems. This study aims to analyze the ten year survival rates and clinical outcome of one specific metaphyseal short hip stem implant. METHODS: We retrospectively analyzed the patient records of the patients who underwent a total hip arthroplasty with a monoblock partial collum sparing metaphyseal short hip stem prosthesis in 2008 and 2009 in our clinic. Patients were contacted, and clinical follow-up was recorded using the German version of the modified Harris Hip Score. Furthermore, complications, revision surgery, and post-operative radiographs were analyzed. RESULTS: Data from 339 primary implantations in 322 patients were retrieved. The mean follow-up was 10.6 years. Seven patients underwent a revision. The ten year survival rate with any revision surgery as the endpoint was 97.5%. The mean modified Harris Hip Score was 86 points (range 30 to 91 points). Five patients had an intraoperative fracture of the femur (1.6%). Two patients (0.6%) had a dislocation of the hip. The stem tip-to-cortex distance, measured in the anterior posterior view, was 2.6 mm (range 0 to 8.3 mm). CONCLUSION: The ten year survival rate of our used monoblock partial collum sparing metaphyseal short hip stem implant is comparable to traditional stems for total hip arthroplasty.

Debridement, antibiotics and implant retention in early periprosthetic joint infection after primary total hip arthroplasty : 88 percent survival after two years follow-up.

Treatment protocols and results of debridement, antibiotics, irrigation and retention of the prosthesis (DAIR) for early prosthetic joint infection (PJI) vary in literature. The purpose of this study was to analyze the results of DAIR with a multidisciplinary designed customized antibiotic protocol for early PJI after primary total hip replacement (THR). We retrospectively analyzed all patients with an early PJI between 2008 and 2012. When an infection was suspected, debridement of the prosthesis, and -collection of intraoperative cultures, was performed. -Patients were multidisciplinary discussed and treated with an appropriate antibiotic scheme for 12 weeks. Primary outcome was retention of the prosthesis after at least two years follow-up and without any signs of infection. We indentified 25 patients with early PJI. At a median follow-up time of 3.1 years (range 2.1-5.5 years), 88% had retention of the prosthesis and no signs of infection. This study suggests that DAIR with a multidisciplinary approach and an aimed antibiotic treatment for early PJI after THR is a reasonable treatment -option with 88% implant retention after two years follow-up.

Subperiosteal abscess in a child. Trueta's osteomyelitis hypothesis undermined?

Subperiosteal abscess formation is almost exclusively seen secondary to underlying hematogenous infected osteomyelitis or secondary as a result of a contagious focus. We present an unusual case of a 9-year-old girl with progressive ankle pain due to an isolated subperiosteal abscess of the distal fibula without concomitant osteomyelitis. The subperiosteal abscess was most likely caused by hematogenous spread to the periosteal region of the distal fibula located above the highly vascularized metaphysis. Remarkably, there were no signs of osteomyelitis on either MRI or during surgical inspection. She was successfully treated with debridement and antibiotic therapy. We hypothesize that subperiosteal abscess formation near the metaphysis originates in the periosteal region and not from outward extension from the sinusoidal veins in the intrametaphyseal area to the cortex and subperiosteal region.