Minimum 2-Year Outcomes of All-Polyethylene Tibial Components in Patients Who Have Body Mass Index of 35 or Greater.

BACKGROUND: Several studies have reported negative results after total knee arthroplasty (TKA) in obese patients. This study aims to analyze the minimum 2-year outcomes in patients who have a body mass index (BMI) > 35 undergoing cemented TKA using an all-polyethylene tibial component (APTC) at a minimum of 2 years of follow-up. METHODS: We retrospectively studied 163 obese patients (192 TKAs) who underwent a primary cemented TKA using an APTC comparing the outcomes of 96 TKA patients who had a BMI > 35 to 39.9 (group A) with 96 patients who a TKA and a BMI ≥40 (group B). Median follow-up of groups A and B were 3.8 years and 3.5 years respectively (P = .02). Multiple regression analyses were performed to evaluate independent risk factors associated with complications. Kaplan-Meier survival curves were estimated, defining failure as the need for any further femoral or tibial revision surgery with implant removal, irrespective of the reason. RESULTS: There was no significant difference at the latest follow-up patient-reported outcomes between both groups. Survivorship, as defined by revision for any reason, was 99% for group A and 99% for group B (P = 1.00). There was 1 aseptic tibial failure in group A, and 1 septic failure in group B. Multiple regression analyses showed no significant associations between age (odds ratio [OR] = 1.00; P = .98; 95% confidence interval (CI) = 0.93 to 1.08), sex (OR = 1.38; P = .70; 95% CI = 0.26 to 7.25), BMI (OR = 1.00; P = .95; 95% CI = 0.87 to 1.16), and complication rate. CONCLUSION: At a median 3.7-year follow-up, the use of an APTC provided excellent outcomes and survivorship in patients who had Class 2 and Class 3 obesity. LEVEL OF EVIDENCE: Level III, therapeutic study.

Preliminary outcomes of the cementless UNITED hip system for primary total hip arthroplasty at a minimum 2-year follow-up.

INTRODUCTION: This study aimed to report the initial results of the cementless UNITED hip system in primary total hip arthroplasty (THA) with a minimum follow-up of 2 years. METHODS: We retrospectively studied a consecutive series of 203 cementless THAs in 180 patients operated between 2015-2017. We included 89 female and 91 male patients with a mean age of 67 (28 to 89) years. The mean follow-up was 40 (29 to 62) months. Clinical outcome scores and radiographs were measured. Survival was calculated defining failure as the need for any further femoral or acetabular revision, irrespective of the reason. RESULTS: No femoral component loosening was detected. One patient had a Vancouver-B1 intraoperative periprosthetic femoral fracture treated with implant retention and cerclage wires. Two acetabular components were revised for aseptic loosening. Three patients suffered an acute infection treated with debridement, antibiotics, and implant retention. The mean Merle d'Aubigné et Postel scores improved from 13 (4 to 16) points preoperatively to 17 (12 to 18) points at the latest follow-up (p < 0.001). At a mean time of 40 months of follow-up, the survival was 99% and 100% for the acetabular and the femoral components, respectively. CONCLUSION: This cementless design showed excellent preliminary outcomes in terms of fixation and patient satisfaction, comparable to that of other well-known similar systems.

Unaddressed arterial injuries in revision total hip arthroplasty: mortality outcomes of a low-prevalence complication.

PURPOSE: Peri-operative major arterial haemorrhage after revision total hip arthroplasty (RTHA) is an odd but limb- and life-threatening complication. In this retrospective analysis, we sought to determine the prevalence of such injuries requiring selective catheter embolization or bypass after RTHA and to evaluate the associated mortality rate. METHODS: Between 1995 and 2016, 2524 RTHAs were performed at a high-volume centre (1031 one-stage revisions, 1370 two-stage revisions and 123 resection arthroplasties). Throughout this period, nine patients presented with signs of persistent bleeding unaddressed during index surgery (9/2524; 0.35%), causing haemodynamic instability. All patients underwent angiographic exploration within the first 24 post-operative hours. Angiography evidenced four cases of bleeding pseudoaneurysms (three of them related to the common femoral artery and one to the medial circumflex femoral artery) and five cases of direct lacerations (one case in the inferior epigastric artery, one in the hypogastric artery, one in the external iliac artery, one in the popliteal artery and another in the superior gluteal artery). RESULTS: Six cases underwent selective percutaneous angiographic embolization with gelatin microspheres, obtaining immediate haemodynamic stabilization; whereas three cases required a further bypass surgery with synthetic graft. Of the former group, four patients had an uneventful evolution, while two died at a mean of 49 days after surgery due to multi-organ failure (MOF). Two cases of the bypass group died because of MOF at a mean of 22 days. Overall mortality rate was 44%. CONCLUSIONS: The overall risk of arterial injury associated with RTHA was low. However, recognition of such a complication is imperative since it was associated with a high mortality rate.

Impaction Bone Grafting or Uncemented Modular Stems for the Treatment of Type B3 Periprosthetic Femoral Fractures? A Complication Rate Analysis.

BACKGROUND: Because the gold standard for the treatment of Vancouver type-B3 periprosthetic femoral fractures (PFFs) is yet to be defined, we sought to analyze the complication rate between the impaction bone grafting (IBG) technique with a cemented stem and reconstruction with an uncemented distally-fixed modular stem (DFMS). METHODS: We retrospectively studied 54 B3 PFFs operated between 2000 and 2016, comparing the complication rate of 33 patients treated with the IBG technique (group A) with 21 patients treated with a DFMS (group B). Median follow-up of groups A and B were 75 months (interquartile range [IQR], 36-111 months) and 55 months (IQR, 32-73 months), respectively (P = .008). Median age of groups A and B were 78 years (IQR, 74-83 years) and 81 years (IQR, 74-86 years), respectively (P = .30). Median grade of Endo-Klink femoral bone defect was 3 (IQR, 3-3) for both groups (P = .11). We performed a multiple regression analysis to determine risk factors for complications including the following variables: age, initial diagnosis, and surgical technique. RESULTS: As for infection outcomes, 2-stage revision surgery was more frequent in group A than in group B (4 vs 0, P = .003). Group A presented more implant failures than group B (5 vs 1, P = .195). We found 4 dislocations in group B and 2 in group A (P = .192). Multiple regression analysis showed a significant association between surgical technique and complication rate (P = .01). The IBG technique presented an odds risk for complications of 4.77 (P = .016; IQR, 1.33-17.21). CONCLUSION: Femoral reconstruction with the IBG technique evidenced an ostensibly higher complication rate than that of DFMS for the treatment of B3 PFF.

Medium-term outcomes of conventional versus short uncemented femoral stems for primary total hip arthroplasty in patients younger than 55 years.

BACKGROUND: Short stems are designed with a bone preservation philosophy in mind. This study aims to compare the outcomes/complications and survival of a collarless fully hydroxyapatite (HA)-coated conventional tapered stem and a HA-coated partial neck-retaining uncemented short stem in patients ⩽55 years old at medium-term follow-up. METHODS: We retrospectively studied 247 uncemented THAs operated between 2010 and 2014, comparing 146 patients treated with the fully HA-coated collarless stem (Group A) with 101 patients treated with a partial neck preserving, HA-coated short stem (Group B). 87 and 62 males were in groups A and B, respectively (p = 0.11). The mean age of the series was 46 years (17-55) (p =0.16). The mean follow-up of groups A and B were 9.9 (7-12) years and 9.7 (7-12) years, respectively (p =0.21). RESULTS: Mean Harris Hip Score improved from 55 to 92 in group A (p <0.001) and from 54 to 95 in group B (p <0.001), without differences between groups. Mean femoral neck length preservation in groups A and B was 13.6 (0-28) mm and 26 (11-38) mm, respectively (p =0.001). 13 (8.9%) and 1 (1%) patients in groups A and B presented postoperative complications, respectively (p =0.008). The conventional stem group had more aseptic loosening (Group A 3.4% vs. Group B 0%, p =0.06) along with more Symptomatic radiolucent lines (Group A 3.4% vs. Group B 0%, p =0.06). CONCLUSIONS: Both conventional and short stems showed excellent implant survival rates and functional outcomes at a mean follow-up of 9.8 years. However, complications and radiolucent lines were more frequent with a collarless conventional-length stem. Bone preservation of the femoral neck and diaphysis may be preferred in active young patients.

Pathological femoral neck fracture in a male patient due to non-simultaneous bilateral transient hip osteoporosis: A case report: Statements and Declarations.

We report a case of a 31-year-old man who developed a non-simultaneous bilateral transient hip osteoporosis (THO) complicated with an atraumatic undisplaced pathological femoral neck fracture (FNF) of his left hip. He was successfully treated with internal fixation on the left hip, and a follow-up Magnetic Resonance Imaging evidenced satisfactory resolution on the right side. Diagnosis and management of THO are usually challenging as symptoms before pathological FNFs might be misdiagnosed. This case highlights the importance of suspecting pathological FNFs when pain persists despite conservative treatment. Finally, surgical treatment is strongly recommended if a pathological FNF is confirmed. Level of evidence: Level IV.

Short-Term Results of Osteochondral Autologous Transfer and Femoral Neck Osteochondroplasty for the Treatment of Osteochondral Lesions of the Femoral Head and Concomitant Femoroacetabular Impingement Syndrome: A Case Series.

This study aimed to analyse the initial results of five patients with symptomatic osteochondral lesions (OCL) and femoroacetabular impingement (FAI) who were treated successfully with osteochondral autologous transfer (OAT) and femoral neck osteochondroplasty (OCP) through surgical dislocation of the hip. Five patients with FAI and OCL of the femoral head who underwent surgery between 2015-2018 were studied retrospectively. All patients had a grade IV OCL, and the median defect size was 2 cm2 (interquartile range [IQR], 2-2). At the final follow-up, the modified Harris hip score showed a median value of 94 (IQR, 91-95) (P=0.04). Pain evaluation using the visual analogue scale showed a median value of 1 (IQR, 1-2) (P=0.04). Adequate graft union and healthy formation of the chondral surface were observed by magnetic resonance imaging. Although the procedure is demanding, the combination of OAT and femoral neck OCP appears to be an effective alternative in young patients.

Adverse Local Tissue Reaction Associated With Ceramic-On-Metal Bearing Surface in Primary Total Hip Arthroplasty: Report of Two Cases.

Total hip arthroplasty (THA) is one of the most common and successful surgical procedures worldwide. At the same time, it is constantly evolving, and as a consequence, advances in implant technology have led to significant improvements in the different materials of the acetabular and femoral components. The selection of bearing surfaces and their tribology are critical to achieving a successful outcome. Pseudotumors are important, and usually misdiagnosed, complications associated with hard bearing surfaces such as metal-on-metal couples. They belong to a group of reactions called adverse local tissue reaction, which can occur in the vicinity of any THA. We present 2 cases of adverse local tissue reaction associated with the use of ceramic-on-metal bearings surfaces in 2 primary THAs that were treated with modular component exchange during single-stage revision surgery. Level of Evidence: IV.

[Septic hip arthritis after a closed acetabulum fracture treated conservatively. Case report]. / Artritis séptica de cadera luego de una fractura cerrada de acetábulo tratada en forma conservadora. Reporte de caso.

Necrotizing fasciitis is a life-threatening infection. Inmediate diagnosis and treatment are essential. Acetabulum fractures are a frequent identity in older adults today, associated with low-energy trauma. The indication for surgical or conservative treatment depends on multiple factors such as the age and comorbidities of the patient, the type and location of the fracture, and the socio-economic environment. We described an unusual case of infected hematoma, secondary to a closed acetabulum fracture, which led to septic arthritis of the hip joint.

Las fracturas de acetábulo asociadas a traumatismos de baja energía, son una identidad frecuente hoy en día en los adultos mayores. La indicación del tratamiento quirúrgico o conservador, depende de múltiples factores como la edad y las comorbilidades del paciente, el tipo y localización de la fractura, y el medio socio-económico. Independientemente del tratamiento elegido, ninguno está exento de complicaciones. Se describe a continuación un paciente con una fractura de acetábulo cerrada, de tratamiento conservador, que derivó en artritis séptica de la articulación coxofemoral.

[Isolated elbow dislocation in pediatric patients: non-operative treatment and complications associated with an infrequent pathology. Series of 4 cases]. / Luxaciones puras de codo en pacientes pediátricos: tratamiento conservador y complicaciones asociadas a una patología poco prevalente. Serie de 4 casos.

Even though the elbow is the most often dislocated joint in children, this injury accounts for 3-6 % of elbow pathology. Dislocations without associated fractures are extremely rare. They result from a fall onto an outstretched hand. The patient is always referred with a painful joint, movement impairment and even clinical deformity. Acute treatment aims to achieve quick reduction and adequate joint stability, avoiding neurovascular injuries. We sought to analyze the functional outcomes and the complications after non-operative treatment. Our 4 patients Luxaciones puras de codo en pacientes pediátricos: tratamiento conservador y complicaciones asociadas a una patología poco prevalente. Serie de 4 casos Isolated elbow dislocation in pediatric patients: non-operative treatment and complications associated with an infrequent pathology. Series of 4 cases had excellent functional results at the latest follow-up, and one of them suffered from a median nerve palsy without further consequences. In our experience, these injuries presented excellent outcomes and we would like to highlight the importance of a quick and precise neurovascular examination with the possibility of non-surgical management of nerve injuries. A short period of immobilization with early rehabilitation should be indicated to avoid joint stiffness.

Si bien el codo es la articulación más frecuentemente luxada en niños, representa el 3-6 % de las lesiones en ese sitio. Las luxaciones sin fracturas asociadas son muy raras y son producto de una caída con el codo en extensión. El paciente consulta por dolor, impotencia funcional y deformidad evidente. La finalidad del tratamiento es restaurar la congruencia articular, lograr estabilidad y minimizar los riesgos de posibles lesiones neurovasculares. Se presentan 4 pacientes tratados con manejo conservador con excelentes resultados funcionales, incluso aquel que presentó una neuropraxia del mediano con restitución ad integrum. Según nuestra experiencia, suelen ser lesiones con buena evolución. Se destaca la importancia de un rápido y preciso examen neurovascular, optando, de ser posible, por una conducta expectante ante las lesiones nerviosas. Se resalta la indicación de una inmovilización acotada con movilización temprana que evite rigidez del codo.

Sequelae of late diagnosis and treatment of developmental dysplasia of the hip: case report and surgical technique description. / [Secuela de diagnóstico tardío y tratamiento en displasia del desarrollo de la cadera: reporte de caso y descripción de técnica quirúrgica.]

Developmental hip dysplasia (DHD) is a common entity that affects 4 out of every 1000 live births and is a recognized cause of secondary hip osteoarthritis despite routine perinatal controls. In most patients, the early diagnosis of the pathology allows an evolution without sequelae. However, in the basis that patients diagnosed late and with multiple surgeries are patients with open physis, ossification nuclei present and previous surgeries in the approach area, the late diagnosis represents a real challenge for the orthopedist. We report below the case of a patient treated in our center since birth, who evolved with complications associated with late diagnosis and surgical interventions, describing rescue surgery performed at 12 years of age and finally highlighting the importance of routine perinatals and early diagnosis of DHD.

La displasia del desarrollo de la cadera (DDC) es una entidad frecuente que afecta a 4 de cada 1000 nacidos vivos y es una causa reconocida de artrosis de cadera secundaria a pesar de los controles perinatales de rutina. En la mayoría de los pacientes, el diagnóstico precoz de la patología permite una evolución sin secuelas. Sin embargo, el diagnóstico tardío con múltiples intervenciones representa un verdadero reto para el ortopedista, ya que se trata de pacientes con fisis abierta, nucleos de osificación presentes y cirugías previas en la zona de abordaje. Se reporta a continuación el caso de una paciente tratada en nuestro centro desde su nacimiento, que evolucionó con complicaciones asociadas al diagnóstico tardío y a las intervenciones quirúrgicas, describiendo la cirugía de salvataje realizada a los 12 años de edad y destacando finalmente la importancia de los controles perinatales de rutina y el diagnóstico precoz de la DDC.

Are lateral view radiographs necessary to properly classify femoral neck fractures? Intra and interobserver analysis using Garden's classification system / [¿Es necesaria la incidencia radiográfica de perfil para clasificar las fracturas mediales de cadera? Análisis intra e inter observador utilizando la clasificación de Garden]

INTRODUCTION: Femoral neck fractures have been historically diagnosed by anteroposterior (AP) and lateral (L) radiographic views. We analyzed the importance of the L view for management of femoral neck fractures, using the Garden's classification system. MATERIALS AND METHODS: Slides were elaborated with AP and L radiographic views of 100 patients with femoral neck fractures admitted to our emergency department. Three hip surgeons assessed independently AP views only and then AP and L views together using Garden's classification system. RESULTS: No statistically significant differences (Kruskal Wallis 0, p=1) were found while comparing categories among Garden's classification system, after assessing L views. There was an 81 % (p < 0.001) agreement of Garden category between AP and AP combined with L views. When analyzing patients with changing categories between displaced and non displaced after assessing L view images, we found a 5% (n=5, CI 95% 1-11%) of change. For comparing AP Garden with L view Garden, we used a quadratic weighted kappa method. CONCLUSIONS: There is a high agreement in the Garden category when comparing AP with combined AP and L observations. Five patients would have received a different surgical treatment dependent on the hip surgeon who assessed the radiographs. This highlights the relevance of routinely L radiographs whenever a femoral neck fracture is suspected.

INTRODUCCIÓN: Históricamente, el diagnóstico de una fractura medial de cadera requiere de una radiografía anteroposterior (AP) y de perfil (P). Nos propusimos analizar la importancia de la radiografía de perfil en la evaluación y planificación del tratamiento de las fracturas mediales de cadera, utilizando la clasificación de Garden. RESULTADOS: Se utilizó el método de Kruskal Wallis para comparar los rangos en la clasificación de Garden después de ver la proyección de P y no se encontraron diferencias estadísticamente significativas (Kruskal Wallis 0, p=1). El acuerdo ponderado entre AP y el AP combinado con el P del Garden promedio fue de 81 % (p < 0.001). Se analizó el porcentaje de pacientes recategorizados entre fracturas no desplazadas y desplazadas, tras observar el perfil: 5% (n=5, IC 95% 1-11%) . Para comparar el Garden AP con el Garden P, se utilizó el método kappa ponderado cuadrático. MATERIALES Y MÉTODOS: Se prepararon diapositivas con radiografías AP y de P de 100 pacientes con fracturas mediales de cadera admitidos en nuestra central de emergencias.  Tres cirujanos de cadera evaluaron de forma independiente las incidencias AP únicamente y luego las vistas AP y P, utilizando la clasificación de Garden. RESULTADOS: Se utilizó el método de Kruskal Wallis para comparar los rangos en la clasificación de Garden después de ver la proyección de P y no se encontraron diferencias estadísticamente significativas (Kruskal Wallis 0, p=1). El acuerdo ponderado entre AP y el AP combinado con el P del Garden promedio fue de 81 % (p < 0.001). Se analizó el porcentaje de pacientes recategorizados entre fracturas no desplazadas y desplazadas, tras observar el perfil: 5% (n=5, IC 95% 1-11%) . Para comparar el Garden AP con el Garden P, se utilizó el método kappa ponderado cuadrático. CONCLUSIONES: Existe una alta concordancia en la clasificación de Garden al comparar las observaciones de las radiografías AP, con las observaciones AP y P juntas. Cinco pacientes hubiesen recibido un tratamiento quirúrgico diferente dependiendo del especialista que interpretaba las radiografías. Esto permite destacar la importancia de solicitar la incidencia de perfil de rutina en pacientes con sospecha de fractura medial de cadera. palabras clave: cadera; fracturas de cadera; prótesis de cadera; lesiones de la cadera; radiografía.

Intramedullary nail for the surgical treatment of unstable fractures of the femur in previously amputated patients / [Clavo endomedular para el tratamiento quirúrgico de fracturas inestables de fémur en pacientes previamente amputados]

Introduction: Femoral fractures in previously amputated patients (PAP) have been poorly reported in international literature, however it is worth mentioning that advances in the manufacture of orthotics for lower limbs have allowed these patients to remain functionally active. Surgery is then an option but difficulties may appear in positioning the patient for surgery due to the absence of the foot or ankle from where to pull and optimize the fracture reduction. Objective: We report 3 cases of PAP with ipsilateral unstable femur fractures, treated surgically with cervicodiaphyseal endomedular nail. The surgical technique used in each case is described. Results: Good long-term results were obtained demonstrating the effectiveness of surgical treatment and the reduction technique used. Conclusion: Surgical treatment of unstable fractures of the proximal femur with an endomedullary nail should be considered a valid therapeutic option.

Introducción: Las fracturas de fémur en pacientes previamente amputados (PPA) han sido escasamente reportadas en la literatura internacional, sin embargo, cabe mencionar que los avances en la fabricación de ortesis para miembros inferiores han permitido que estos pacientes, se mantengan funcionalmente activos. La cirugía entonces es una opción, pero representa una dificultad en el posicionamiento del paciente a la hora de planificar su cirugía debido a la ausencia del pie o tobillo del cual traccionar y optimizar la reducción de la fractura. Objetivo: Reportamos a continuación 3 casos de PPA con fracturas inestables ipsilaterales de fémur, tratadas mediante reducción y osteosíntesis con clavo endomedular cervicodiafisario. Se describe la técnica quirúrgica utilizada en cada caso. Resultados: Se obtuvieron buenos resultados a largo plazo demostrando la efectividad del tratamiento quirúrgico y la técnica de reducción utilizada. Conclusión: El tratamiento quirúrgico de fracturas inestables de fémur proximal con clavo endomedular, ha de ser considerado una opción terapéutica válida.

Simultaneous Bilateral Femoral Neck Fracture Due to a Tonic-Clonic Seizure and High-Dose Steroid Therapy.

Simultaneous bilateral femoral neck fractures (FNFs) are extremely rare and usually associated with an underlying condition affecting the bone quality and mineralization. Convulsions have also been described as a possible cause, mostly as a consequence of epilepsy, hyponatremia, and hypocalcemia. We present a 52-year-old female patient, with bilateral displaced FNFs due to a tonic-clonic seizure and high-dose steroid therapy related to a frontal lobe anaplastic oligodendroglioma brain tumor resection. Two days after admission, bilateral one-stage uncemented total hip arthroplasty (THA) under general anesthesia and through a posterolateral approach was performed using a metal-on-polyethylene bearing surface. Several risk factors can be identified in this unique case, such as the high-dose steroid therapy, the low-demand activity of the patient due to her functional sequelae, and finally, the convulsive episode. Surgeons should be aware of this uncommon injury to ensure early diagnosis and treatment in all patients with a previous history of seizures, chronic steroid use, severe hip pain, and inability to walk. For bone metabolic diseases, preventive measures should be indicated to avoid these complications. Bilateral one-stage uncemented THA represents an effective procedure with a low complication rate allowing early rehabilitation.

Conversion total hip arthroplasty with a proximally modular, distal fixation reconstruction prosthesis following cephalomedullar nail failure.

BACKGROUND: The goals of intertrochanteric hip fracture (IHF) treatment are stable fixation, early mobilisation and function restoration. If the attempt to reduce, stabilise and fracture healing utilising a femoral cephalomedullar nail (CMN) fails, options for subsequent attempts are limited. PURPOSE: Evaluate the clinical and radiographic outcomes of conversion total hip arthroplasty (THA) using a modular stem following a CMN failure. MATERIALS AND METHODS: We retrospectively reviewed a consecutive series of patients with an IHF between 2012 and 2014 to identify CMN patients that went on to the subsequent failure and conversion to THA utilising a modular femoral stem (MFS). In all cases, MP Reconstruction Prosthesis (Waldemar Link, Hamburg, Germany) was implanted. Primary clinical outcomes were assessed using Harris Hip Score (HSS) before conversion procedure, 3 months, 6 months and recent office visit post-conversion THA thereafter. The secondary outcome was to analyse intra and postoperative complications. Serial radiographs at each follow-up interval were assessed for clinical success or to confirm adverse events. RESULTS: 28 patients were included in the study; 17 were females. The average age was 72.7 years (SD ± 10.5); the average time from the index procedure to conversion THA was 12.6 months (SD ± 3.5). At baseline, average HHS was 42.1 (SD ± 3.6), improved to 80.7 (SD ± 5.1) at 3 months, 86.0 (SD ± 3.9) at 6-months which levelled off to 86.1 (SD ± 4.0) at final follow-up. There were 4 (14%) post-conversion complications: 2 dislocations, 1 superficial wound infection, 1 patient with symptomatic abductor deficiency. All 4 cases were conservatively treated successfully, the implants were retained, and the patients progressed without further issue. CONCLUSIONS: MFSs allow to successfully treat failed CMN and adverse variations in femoral anatomy with a device that will permit simultaneous correction of leg length, offset and version to relieve pain, restore function and create a durable prosthetic to host composite.

Who Restores Hip Biomechanics More Effectively after a Femoral Neck Fracture? Comparison of Total Hip Arthroplasties Performed by Either Hip Surgeons or Orthopaedic Residents.

BACKGROUND: This study aims to analyze the ability to restore hip biomechanics in patients who undergo total hip arthroplasty for displaced femoral neck fractures operated by either hip surgeons (HSs) or orthopaedic residents (ORs). METHODS: We retrospectively compared 95 patients treated by HSs (group A) with 110 patients treated by ORs (group B). Leg-length discrepancy, femoral offset (FO), center of rotation (COR), acetabular inclination, and acetabular anteversion were evaluated on postoperative radiographs using the healthy contralateral hip as control. RESULTS: The median leg-length discrepancy was 2 mm for both groups (P = .74). The leg length was increased in 54% of the HS group and 57% of the OR group (P = .13). The median FO difference of groups A and B were 7 mm and 5.5 mm, respectively (P = .14). FO was increased in 80% of the HS group and 69% of the OR group (P = .19). Median discrepancies of the horizontal and vertical CORs were not statistically relevant, with P-values of .69 and .14, respectively. The horizontal COR was slightly medialized in 58% of the HS group and 53% of the OR group (P = .003). The vertical COR was slightly proximal in 66% of the HS group and 76% of the OR group (P = .28). The median acetabular inclination angles of groups A and B were 41° and 40°, respectively (P = .62). The median anteversion angle was 19° for both groups (P = .89). CONCLUSIONS: The horizontal COR was the only measurement with statistical significance. To conclude, ORs under supervision are as reliable as HSs to properly restore hip biomechanics in patients who undergo total hip arthroplasty for displaced femoral neck fractures.

Unusual Listeria monocytogenes hematogenous infection in total knee replacement treated with one-stage revision surgery.

Septic arthritis due to Listeria monocytogenes (LM) is extremely rare and most infections due to this organism are seen in immunocompromised patients. We describe a patient without immunological compromise, with a late total knee arthroplasty infection caused by LM treated with one-stage revision surgery. She had an elevated erythrocyte sedimentation rate (79 mm/h) and C-reactive protein (13 mg/dL). Aspiration of the knee joint yielded purulent fluid; cultures showed LM. The patient was given 6 weeks of intravenous ampicillin, followed by trimethoprim/sulfamethoxazole, and finally amoxicillin orally for 7 months. Two years after revision surgery, radiographs showed no evidence of implant loosening. This is a single case and although one-stage approach seemed to have worked, it should not be recommended on the basis of a single report.

Cement leakage into the hip joint during TFN-A cement augmentation in a revision surgery of an extra-capsular hip fracture.

INTRODUCTION: The intra-articular migration of the spiral lamina or screw, after close reduction and internal fixation (CRIF) with an intramedullary cervicodiaphyseal nail (cut-through), is one of the most frequent postoperative complications. We present a patient with a cut-through and cement leakage into the hip joint after TFN-A cement augmentation and spiral lamina replacement. METHODS: A 83-year-old man, suffered a cut-through after CRIF of his left extracapsular hip fracture during the third postoperative month. A revision surgery was planned, including spiral lamina replacement and cement augmentation. Cement leakage into the hip joint was confirmed in the immediate postoperative radiograph and a new intervention was indicated with the removal of the third bodies. RESULTS: The patient presented good clinical evolution, without functional limitation or pain. In routinely postoperative radiographic controls, no differences were observed respect to the immediate postoperative one. DISCUSSION: Current literature dealing with implant revision surgery and associated cement augmentation are scarce. CONCLUSION: As far as we are concerned, this is the first case in the literature of a re-revision surgery of an extracapsular hip fracture due to a three months postoperative cut-through and a posterior cement leakage into the hip joint after TFN-A cement augmentation and spiral lamina replacement with the need of a posterolateral approach for removal.

THA conversion rate comparing decompression alone, with autologous bone graft or stem cells in osteonecrosis.

INTRODUCTION: Core decompression (CD) with or without the addition of autologous bone graft (CDBG) is currently the most widely accepted treatment for hip osteonecrosis in stages of pre-collapse. The use of bone marrow mesenchymal stem cells (CDSC) is emerging as a promising biological alternative. We sought to determine the total hip arthroplasty (THA) conversion rate for patients treated with CD, CDBG or CDSC. MATERIAL AND METHODS: Between 1996 and 2012, 97 cases were evaluated in 72 patients: 47 CD cases, 34 CDGB cases and 16 CDSC cases. The mean age was 39 (20-63) years, 25 bilateral, 19 female and 53 male, 14 Ficat 1 and 83 Ficat 2. Bilateral cases with asymmetric stage and equal treatment were excluded. RESULTS: Conversion rate to THA was 44% for the CD group (21/47) at an average of 77 (24-324) months; 50% for the CDBG group (17/34) at an average of 34 (24-240) months and 50% for the CDSC group (8/16) at an average of 48 (24-72) months (p = 0.619). Log Rank test for survivorship analysis was not significant (p = 0.2011). Immunodeficiency or corticosteroid treatment history was associated with 16/47 of the CD group, 7/34 in the CDBG group and 1/16 in the CDSC group. Trauma was associated with 2/47 of the CD group, 5/34 of the CDBG group and none of the CDSC group. Hazard ratio considering risk factors was not significant (p = 0.252). CONCLUSIONS: In these series of cases including patients with pre-collapse osteonecrosis, we observed non-significant results regarding rate of conversion to THA with CD, CDBG or CDSC at an average of 5.5 years.

Vástagos femorales cortos para el reemplazo total de cadera primario en pacientes jóvenes. Resultados clínicos y biomecánicos / Short femoral stems for primary total hip arthroplasty in young patients. Clinical and biomechanical outcomes

La artroplastia total de cadera es una cirugía eficaz para tratar la artrosis. Con el aumento de la necesidad de una mejor calidad de vida, este procedimiento se está realizando en pacientes más jóvenes. Pero, con la mayor expectativa de vida, también crece la demanda de múltiples cirugías de revisión para el mismo paciente. Esto plantea desafíos técnicos debido a la pérdida de hueso. Existe una necesidad creciente de identificar implantes duraderos y altamente funcionales que sean adecuados para la revisión futura. Aunque los vástagos femorales cementados eran la opción principal en el pasado, los vástagos femorales no cementados han logrado una fijación a largo plazo y excelentes resultados. Sin embargo, aún se pueden mejorar algunos problemas relacionados con la fijación. Los vástagos femorales cortos han sido desarrollados para abordar algunos de estos desafíos, mientras se mantienen los buenos resultados obtenidos con los vástagos convencionales. En este artículo, se analiza la experiencia tras 10 años de uso de vástagos femorales cortos en cirugías de cadera en pacientes jóvenes. Se comparan los resultados biomecánicos y la preservación ósea femoral, se reportan los resultados posoperatorios en relación con el regreso al deporte, y se evalúan las complicaciones relacionadas con su uso. El empleo de vástagos cortos en cirugía primaria de cadera brinda múltiples ventajas. La indicación de este tipo de implante está justificada en pacientes jóvenes y activos, con el objetivo de reproducir los resultados de los implantes convencionales con un menor consumo de hueso y la posibilidad de una revisión futura. Nivel de Evidencia: IV

Total hip arthroplasty is an effective surgery to treat osteoarthritis. Given the rising demand for a higher quality of life, this procedure is being performed on increasingly younger patients. However, a longer life expectancy is also tied to a higher demand for multiple revision surgeries for the same patient. This poses technical challenges due to bone loss. There is a growing need to identify durable and highly functional implants that are suitable for future revision. Although cemented femoral stems were the main option in the past, uncemented femoral stems have demonstrated long-term fixation and excellent results. However, some issues related to fixation can still be improved. Short femoral stems have been developed to address some of these challenges while maintaining the good results obtained with conventional stems. This study analyzes the experience after 10 years of using short femoral stems in hip surgeries on young patients. Biomechanical outcomes and femoral bone preservation are compared, postoperative outcomes regarding return to sports are reported, and complications related to their use are evaluated. Short stems have multiple advantages when used in primary hip surgery. The indication for this type of implant is justified in young and active patients, to reproduce the results of conventional implants with less bone consumption and the possibility of future revision. Level of Evidence: IV