The Aquamantys system--an alternative to reduce blood loss in primary total hip arthroplasty?

To evaluate the effectiveness of the Bipolar Sealer 6.0-VT (BPS 6.0-VT) (Tissue Link Medical, Inc, Dover, NH) in reducing blood loss compared with a conventional electrocautery (Erbe ICC 350) (Erbe ICC 350 (ERBE Elektromedizin GmbH, Tübingen, Germany). A prospective randomized trial of 105 patients with primary total hip arthroplasty (Erbe ICC 350: 50 patients; BPS 6.0-VT: 55 patients). On the basis of the calculation of the preoperative blood volume the total and postoperative blood loss were calculated. No statistically significant difference could be shown for total intraoperative and postoperative blood loss (group A 1846 mL; group B 1740 mL) (t test). Due to the lack of reduction of blood loss and the high costs of the BPS 6.0-VT, its use is not recommended in primary total hip arthroplasty.

Partial weight bearing after surgery for fractures of the lower extremity--is it achievable?

Partial weight bearing is a generally accepted principle of rehabilitation following trauma or reconstructive surgery of the lower extremity. Individual dynamic loads during partial weight bearing to a given load level of 200 N were compared in 23 patients who had sustained a fracture of the lower extremity and 11 healthy volunteers using dynamic sole pressure measurements. Excessive dynamic loading compared with the statically pre-tested 200 N level was observed in all groups. Maximum force levels were up to 690 N in young patients and up to 580 N elderly patients beyond the prescribed static load. None of the healthy volunteers was able to keep within the given load of 200 N. The set load level was exceeded by at least 38 N (119%) in the elderly patient group. In comparison, elderly patients showed statistically significantly higher maximum forces than young patients during the first two test days (p=0.007 and 0.013). On the 3rd test day the maximum ground contact forces were on average 71 N higher than in the young patients group. Analysis of the force time integrals (impulses transferred to the ground) displayed higher values in the older again than in young patients. The differences were statistically significant during the first two test days (p=0.006 and 0.037). This study implies that the conventional concept of postoperative partial weight bearing starting from 200 N and a stepwise increase of the load level until full weight bearing is not valid during clinical practice.

Detection of fibular torsional deformities after surgery for ankle fractures with a novel CT method.

BACKGROUND: Substantial fibular torsional deformities were detected after surgery for ankle fractures combined with a lesion of the syndesmotic complex using a novel CT analyzing method. METHODS: In a prospective study, 61 patients with ankle fracture dislocations were treated with trans-syndesmotic screw fixation of the distal tibiofibular joint. Postoperative axial CT scans of both lower legs under standardized leg positioning conditions were made and analyzed with three different methods. Method 1 (M1) used proximal and distal CT planes of the lower leg for detection of the fibular torsional angle, method 2 (M2) considered only the angle at the distal tibiofibular joint, and method 3 (M3) measured the angles between the fibular and tibial tangents at the distal tibiofibular joint. Twenty patients with fibular torsional asymmetries of more than 10 degrees were evaluated clinically 6 to 34 months postoperatively with the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score. RESULTS: Thirty-five of the 61 patients had torsional side-to-side differences of more than 10 degrees. M1 and M2 showed statistically significant differences compared to M3 (p = 0.001). Validity was controlled by interobserver data, variation coefficients were low for M1 and M2. Clinically, six of 20 patients with torsional differences of more than 10 degrees had excellent results, while seven had good results and seven had moderately functional results. Six of the seven with moderate results had fibular torsional differences of more than 15 degrees, two of the seven patients with good outcomes. Torsional results of M1 and M2 correlated with the AOFAS score (r = -0.506). CONCLUSIONS: Of the 61 ankle fractures with ruptures of the syndesmotic complex, 25% showed torsional side-to-side differences of more than 10 degrees on proximal and distal CT planes. This CT technique correlated with the AOFAS score and could help determine when early operative revision is indicated.