Covering of wound infection in hip arthroplasty with local cutaneous flaps.

Total hip arthroplasty is a very common procedure to treat osteoarthritis. One of the complication is the infection which occurs in about 1% of the cases. The manifestation of infection can be poor wound healing with dehiscence and exposition of bone or prosthetic components. Hip arthroplasty infections are difficult to treat. It required an associated multidisciplinary approach with infectiology, orthopedic and plastic surgeries. The study included five patients with hip wound dehiscence after total hip arthroplasty. Coverage after orthopedic surgery was provided by local cutaneous flap. These cutaneous flaps were either a deep inferior epigastric perforator flap (DIEP) or a transposition flap. The orthopedic and the plastic treatment were done at the same time. Two deep inferior epigastric flaps were performed for patients with a deep defect with bone or prosthesis exposure. Four transposition flaps were done in three patients with wound dehiscence but without direct contact with the prosthesis. Three transposition flaps were done from the abdominal wall and one from the posterior thigh. The mean follow up was 18 months, ranging from 10 to 24months. After healing, there was no recurrence of the infection. In all cases, the coverage was obtained. The prosthesis was salvage and the gait was possible. Cutaneous flaps are easy and safe to cover the hip. They are reliable flaps even in patients with multiple co-morbidities. They do not cause sequelae on the recipient site. This study is the first about cutaneous flap for covering hip defects in hip arthroplasty infections.

[A pedicled deep inferior epigastric flap to cover a hip arthroplasty infection]. / Couverture d'une prothèse de hanche infectée par un lambeau perforant épigastique inférieur profond pédiculé.

The deep inferior epigastric perforator (DIEP) flap is a reliable flap mostly used in skin resurfacing after signifiant resection for sarcoma or correction contour deformities. This case is about a pedicled DIEP flap covering the trochanteric region after a total hip arthroplasty infection. A 62years old woman with a BMI at 42kg/m2 presents an infected total hip arthroplasty with a cutaneous defect. The hip prosthesis is changed and covered with a pedicled DIEP flap. This original case reports the used of pedicled DIEP flap in hip coverage. This local fasciocutaneous flap covered the hip osteoarticular infection. The limb is salved and the patient can walked again. The success of this surgery is the collaboration between infectious disease specialist, orthopedic surgeon and plastic surgeon.

Treatment of aseptic osteonecrosis of the femoral head: Historical aspects.

The treatment of aseptic osteonecrosis (ON) of the femoral head has been the subject of numerous therapeutic and surgical proposals due to the absence of medical treatment with proven efficacy. For many years, the goal of surgical treatment was to avoid total hip replacement (THR) with uncertain survival in patients considered too young (30-50 years) for this procedure. Numerous conservative treatments were thus proposed: core decompression with numerous variants, non-vascularized and vascularized bone grafts, intertrochanteric and rotational transtrochanteric osteotomies, cementing. The lack of a common classification and a lack of knowledge of natural history complicated the interpretation of the results for a long time. Nevertheless, it appeared that these treatments were effective only in the very early stages and among these in the limited ONs, medial rather than central and especially lateral, with discrepancies according to etiologies apart from sickle cell disease recognized by all as being pejorative. For the same reason, partial arthroplasties have been attempted and abandoned in turn: femoral head total and partial resurfacing and femoral prosthesis. The most recent advances are stem-cell-enhanced core decompression and progress in total arthroplasty, whose reliability has made it possible to extend the indications to increasingly younger patients seeking treatment with guaranteed or near-guaranteed efficacy. Most of the other interventions have disappeared or almost disappeared because of their lack of effectiveness especially in extensive and post-fracture ONs, sometimes because of their complexity and the length of their post-operative management, and also because they complicate and penalize a future total arthroplasty. This argues for early detection of ON at an early stage where the "head can be saved" by stem cell augmented core decompression, a minimally invasive treatment that leaves the chances of success of a THR intact.

[Perspective of the transition from reusable instruments to single use ancillary in orthopedic surgery]. / Ancillaires orthopédiques : évolution du matériel restérilisable vers l'usage unique, quels impacts ?

OBJECTIVES: Since 2009, single-use (SU) ancillaries for total knee arthroplasty (TKA) and total hip arthroplasty (THA) have been marketed to replace reusable ancillaries. The concept is not innovative but their use in orthopedics is still uncommon. An assessment has been done for the use of SU ancillary in Assistance publique-hôpitaux de Paris with the consequences for the patient, the surgeon and the hospital. METHODS: A technical and a clinical review has been done with those devices in 2015. The economic and organizational impacts were identified and submitted for opinion to committee experts in orthopedics. RESULTS: Three SU ancillaries are commercialized. No clinical studies are currently available. There is no reimbursement for SU ancillaries whereas reusable ancillaries are included in prosthesis reimbursement price. Although SU ancillaries (TKA and THA) saving costs for sterilization, the annual additional budget estimated for their purchase would approximately be 2.5 times higher. Nevertheless, indirect savings could be also considered in the long-term period (global costs for sterilization, volume effect…). For the same quality, according to the experts, organizational impacts are low for the patient and the surgeon but potentially important for the hospital, the nursing and pharmaceutical staff, and logistical activities. CONCLUSIONS: On logistic, clinical and financial aspects, SU ancillaries need more evaluation. The switch to SU ancillaries allows saving sterilization costs and time, and provided an immediate mobilization of the equipment but their interest must be demonstrated by clinical and economic data.

[Algorithms for the identification of hospital stays due to osteoporotic femoral neck fractures in European medical administrative databases using ICD-10 codes: A non-systematic review of the literature]. / Algorithmes d'identification des séjours pour fracture du col du fémur d'origine ostéoporotique dans les bases médico-administratives européennes utilisant la CIM-10 : revue non systématique de la littérature.

BACKGROUND: Osteoporotic hip fractures (OHF) are associated with significant morbidity and mortality. The French medico-administrative database (SNIIRAM) offers an interesting opportunity to improve the management of OHF. However, the validity of studies conducted with this database relies heavily on the quality of the algorithm used to detect OHF. The aim of the REDSIAM network is to facilitate the use of the SNIIRAM database. The main objective of this study was to present and discuss several OHF-detection algorithms that could be used with this database. METHODS: A non-systematic literature search was performed. The Medline database was explored during the period January 2005-August 2016. Furthermore, a snowball search was then carried out from the articles included and field experts were contacted. The extraction was conducted using the chart developed by the REDSIAM network's "Methodology" task force. RESULTS: The ICD-10 codes used to detect OHF are mainly S72.0, S72.1, and S72.2. The performance of these algorithms is at best partially validated. Complementary use of medical and surgical procedure codes would affect their performance. Finally, few studies described how they dealt with fractures of non-osteoporotic origin, re-hospitalization, and potential contralateral fracture cases. CONCLUSIONS: Authors in the literature encourage the use of ICD-10 codes S72.0 to S72.2 to develop algorithms for OHF detection. These are the codes most frequently used for OHF in France. Depending on the study objectives, other ICD10 codes and medical and surgical procedures could be usefully discussed for inclusion in the algorithm. Detection and management of duplicates and non-osteoporotic fractures should be considered in the process. Finally, when a study is based on such an algorithm, all these points should be precisely described in the publication.

Wear products of total hip arthroplasty: The case of polyethylene.

Among the bearing surfaces involved in a total hip arthroplasty, ultra-high molecular weight polyethylene (UHMWPE) is the weak link. It is submitted to the friction of a harder bearing, producing wear particles, which, in turn, initiate an inflammatory reaction ultimately leading to osteolysis. This kind of bone deterioration sometimes turns out to an aggressive granuloma and may provoke implant loosening. Wear resistance of UHMWPE depends on its molecular weight and crystallinity. Some steps of the manufacturing process were improved to optimize its tribological properties and to slow down degradation resulting from mechanical (abrasion) and chemical (oxidation) phenomena. Its preparation and conservation must be performed in an inert atmosphere, i.e. without ambient oxygen. Its resistance to abrasion depends on its cross-linking degree. Its cross-linking rate was observed to increase proportionally to the irradiation doses, improving its wear resistance. However, its mechanical properties are impaired and moreover, it becomes oxidation sensitive. It is therefore necessary to submit it to a thermal treatment to eliminate free radicals that were produced during irradiation. More recently impregnation by vitamin E, a powerful anti-oxidant product, was proposed to preserve the polymer from in vivo oxidation while maintaining its mechanical properties. We raised the hypothesis that last-generation UHMWPE could offer the same wear resistance as the most performing bearings (ceramic-on-ceramic). Recent clinical results confirm the tribological performance of highly crosslinked UHMWPE in vivo. However, it remains to be seen whether this excellent wear resistance would persist under eccentric load such as edge loading, and if, in the long run, this kind of bearing proves capable of reducing the risk of osteolysis in young and active patients.

[Total hip replacements in a country with limited resources: evaluation of medium-term results]. / Arthroplasties totales de hanche dans un pays a ressources limitees : evaluation des resultats a moyen terme.

INTRODUCTION: Total hip arthroplasty (THA) has been regularly performed in the public hospital in Bobo-Dioulasso since 2010. The objective of thisstudywas to assess the medium-termresults of total hip arthroplastyat the Bobo-Dioulasso UniversityHospital. Dioulasso. PATIENTS AND METHODS: This was a non-randomized single-center retrospectivestudydesigned in accordance with the recommendations of the Declaration of Helsinki. Wereviewed the medical files and evaluated 29 patients, i.e. 33 hipsoperated for THA at the Bobo-Dioulasso UniversityHospitalfromJanuary 1st, 2010 to December 31, 2015. RESULTS: ONATF was the indication for ATH in 78.79% of cases (n = 28). THA wascementedin 43% of cases. Complications wereposterior dislocations (n = 4), infection (n = 1) and loosening (n = 2). The meanfollow-up was 78.3 months. At the last follow-up, the mean PMA was 15.13 and the mean Harris score was 84.36. The inclination of the cupswasbetween 45 ° and 50 °. The femoral stems werecenteredin 94% of cases (n = 32). There was one case of peri-prosthetic ossification and one case of acetabularrim. CONCLUSION: Total hip arthroplasty has become a common and well-codified practice in orthopedicsurgerywithreliable and veryencouragingresults.

INTRODUCTION: L'arthroplastie totale de la hanche (ATH) est régulièrement pratiquée dans l'hôpital public à Bobo-Dioulasso depuis 2010. L'objectif de cette étude était d'évaluer les résultats à moyen terme des arthroplasties totales de hanches au CHU de Bobo-Dioulasso. PATIENTS ET MÉTHODES: Il s'agissait d'une étude rétrospective monocentrique non randomisée rédigée conformément aux recommandations de la déclaration d'Helsinki. Nous avons revu les dossiers médicaux et évaluer 29 patients soit 33 hanches opérées pour PTH au CHU de Bobo-Dioulasso du 1er Janvier 2010 au 31 Décembre 2015. RÉSULTATS: L'ONATF était l'indication de l'ATH dans 78,79% des cas (n=28). Les PTH étaient cimentées (n=14) ou non. Les complications étaient les luxations postérieures (n=4), l'infection (n=1) et le descellement (n=2). Le recul moyen était de 78,3 mois. Au dernier recul, le PMA moyen était de 15,13 et le score de Harris moyen de 84,36. L'inclinaison des cupules était comprise entre 45° et 50°. Les tiges fémorales étaient centrées 94% des cas (n=32). Il a été noté un cas d'ossification péri prothétique et un cas de liséré acétabulaire. CONCLUSION: L'arthroplastie totale de hanche est devenue une pratique courante et bien codifiée en chirurgie orthopédique avec des résultats fiables et très encourageants.

Hip pain in an elite cyclist with Non-Hodgkin's Follicular Lymphoma: a case report.

OBJECTIVE: We present a case of an elite cyclist that hesitated to follow the medical advice from her practitioners, as she was determined to train and compete resulting in delayed diagnosis and management of a rare hip pathology. CASE PRESENTATION: A 51-year old elite female cyclist had a history of years of hip pain with insidious onset. The chiropractor in this case observed a lack of response to treatment, and advised the patient to get an MRI with suspicion of a labral tear. She eventually agreed to further investigations and was diagnosed with Non-Hodgkin's follicular lymphoma and a labral tear. SUMMARY: Elite athletes are not immune to serious pathology. Chiropractors should be vigilant and ensure to investigate any patients with a lack of response to conservative management. Chiropractors should be aware of the risk of athletic patients that continue to train and compete when advised not to.

OBJECTIF: Nous présentons le cas d'une cycliste d'élite qui a hésité à suivre les conseils médicaux de ses praticiens, car elle était déterminée à s'entraîner et à participer à des compétitions, ce qui a retardé le diagnostic et la prise en charge d'une pathologie rare de la hanche. PRÉSENTATION DU CAS: Une cycliste d'élite de 51 ans avait des antécédents de douleurs à la hanche depuis des années; le début de ses douleurs avait été insidieux. Le chiropraticien a observé une absence de réponse au traitement et a conseillé à la patiente de subir un examen par IRM en soupçonnant une déchirure du labrum. La patiente a fini par accepter de subir des examens complémentaires. Un lymphome folliculaire non hodgkinien et une déchirure labrum ont été diagnostiqués. RÉSUMÉ: Les athlètes d'élite ne sont pas à l'abri d'une pathologie grave. Les chiropraticiens doivent être vigilants et s'assurer d'examiner tous les patients réfractaires à un traitement conservateur. Les chiropraticiens doivent être conscients du risque que représentent les patients sportifs qui continuent à s'entraîner et à participer à des compétitions alors qu'on leur a conseillé de ne pas le faire.

Pigmented villonodular synovitis of the hip in a recreational runner: a case report.

OBJECTIVE: To present the diagnostic, clinical, and radiological features of pigmented villonodular synovitis (PVNS), create awareness of this rare condition, and provide guidance for conservative healthcare practitioners for further referral and appropriate management. CASE PRESENTATION: We present the case of a 41-year-old recreational runner who presented to the clinic with anterior hip pain of one year duration. Following a clinical history and examination, the patient was diagnosed with clinical femoroacetabular impingement. Radiographs taken at that time displayed mild degenerative joint disease of the left hip joint with coxa profunda. After four weeks of conservative care, the patient reported no improvement in symptoms. The patient was then referred for an MRI, while conservative care continued. Ten weeks later, the patient's symptoms and functional abilities had worsened. The MRI was obtained and the diagnosis of PVNS was made. SUMMARY: PVNS is a rare disease that can mimic mechanical hip pain. A high index of suspicion should be utilized when symptoms worsen despite conservative care. Referral for advanced imaging is critical for appropriate diagnosis of PVNS.

OBJECTIF: Présenter les caractéristiques diagnostiques, cliniques et radiologiques de la synovite villonodulaire pigmentée (PVNP), sensibiliser le public à cette maladie rare et fournir aux praticiens de santé conservateurs des conseils pour le renvoi des patients et la prise en charge. PRÉSENTATION DU CAS: Nous présentons le cas d'un coureur amateur de 41 ans qui s'est présenté à la clinique avec une douleur antérieure de la hanche depuis un an. Après une anamnèse et un examen clinique, on a diagnostiqué un conflit fémoroacétabulaire. Les radiographies prises à ce moment-là révélaient une légère maladie dégénérative de la hanche gauche avec coxa profunda. Après quatre semaines de soins conservateurs, les symptômes du patient n'étaient pas soulagés. On lui a demandé de subir un examen par IRM et on a poursuivi les traitements conservateurs. Dix semaines plus tard, les symptômes et les capacités fonctionnelles du patient s'étaient aggravés. On a obtenu les résultats de l'examen par IRM et on a diagnostiqué une PVNP. RÉSUMÉ: La PVNP est une maladie rare qui peut imiter une douleur mécanique de la hanche. L'indice de suspicion est élevé lorsque les symptômes s'aggravent malgré des soins conservateurs. Un examen par imagerie avancée est essentiel pour un établir un diagnostic de PVNP.

A clinical crossover trial of the effect of manipulative therapy on pain and passive and active range of motion of the painful hip.

OBJECTIVES: This study aims to determine whether manipulative therapy of the hip joint can increase range of motion (ROM) and/or decrease pain in individuals experiencing symptomatic hip pain. METHODS: Non-disabled young adults were recruited on campus of a chiropractic college for this randomized crossover study. Subjects' hip active and passive ROM and pain perception were measured. Subjects then received a drop-piece hip manipulation (DPHM) or an alternative treatment, followed by measurement of active and passive ROM and pain. RESULTS: Eight males and 12 females (n=20) between the ages of 21-32 years completed the study. Statistically significant improvements in numeric pain scale (NRS) and passive abduction were observed for the manipulation group when compared to the alternative treatment. No significant change was observed for all other hip ranges. CONCLUSIONS: DPHM of the symptomatic hip joint in a small sample of young adults resulted in statistically significant improvements in pain and passive abduction when compared to sham manipulation. Due to low sample size, further research is recommended.

OBJECTIFS: Cette étude vise à déterminer si les manipulations de la hanche peuvent augmenter l'amplitude du mouvement et/ou diminuer la douleur chez les personnes ayant des douleurs à la hanche. MÉTHODOLOGIE: On a recruté de jeunes adultes non handicapés sur le campus d'un collège chiropratique pour participer cette étude croisée à répartition aléatoire. L'amplitude des mouvements actifs et passifs de la hanche et la perception de la douleur ont été mesurées. Les sujets ont ensuite subi des manipulations de la hanche sur une table à sections mobiles qui chutent ou un autre traitement, puis on a mesuré l'amplitude des mouvements actifs et passifs et l'intensité de la douleur. RÉSULTATS: Huit hommes et 12 femmes (n=20) âgés de 21 à 32 ans ont participé à l'étude. Des améliorations statistiquement significatives sur l'échelle numérique de la douleur et de l'abduction passive ont été observées dans le groupe ayant eu des manipulations par rapport à l'autre traitement. Aucun changement significatif d'amplitude n'a été observé pour les autres mouvements de la hanche. CONCLUSIONS: Les manipulations sur table à sections mobiles qui chutent pour traiter la hanche symptomatique sur un petit échantillon de jeunes adultes a permis d'obtenir des améliorations statistiquement significatives de la douleur et de l'abduction passive par rapport à la manipulation fictive. En raison de la faible taille de l'échantillon, des recherches supplémentaires sont recommandées.

[From Pathomorphology to Hip Osteoarthritis - Femoroacetabular Impingement as an Example]. / Von der Fehlform zur Coxarthrose ­ Beispiel Hüftimpingement.

From Pathomorphology to Hip Osteoarthritis - Femoroacetabular Impingement as an Example Abstract. Femoroacetabular impingement (FAI) occurs due to abnormal morphology and subsequent contact between the proximal femur and the acetabulum and can be a source of labral and chondral damage in the hip joint. While there is evidence that Cam-type FAI is correlated with hip osteoarthritis, there is yet no clear link between osteoarthritis and Pincer-FAI in which primarily the labrum gets injured. Hips with evident deformity and beginning chondral and/or labral damage should undergo surgery. Most cases (80-90 %) can be successfully treated by hip arthroscopy. At the time of surgery, the typical FAI-patient is 30 years old. With correct indication and proper surgical technique, favorable outcomes are achieved in more than 80 % of the cases at a short- to mid-term follow-up.

Implant retention and high rate of treatment failure in hematogenous acute knee and hip prosthetic joint infections.

OBJECTIVES: Only few studies evaluated hematogenous prosthetic joint infections. We aimed to describe the characteristics of these infections and factors associated with management failure. METHODS: We selected hematogenously-acquired infections, defined by the occurrence of infectious symptoms more than a year after implantation among records of patients treated for hip and knee prosthetic joint infections at Montpellier University Hospital between January 2004 and May 2015. Failure was defined by death due to prosthesis-related infection, need for prosthesis removal in case of conservative treatment, or recurrence of infectious signs on a new prosthesis. RESULTS: Forty-seven patients with hematogenous prosthetic joint infection were included (33 knee infections and 14 hip infections). Infectious agents were streptococci (43%), Staphylococcus aureus (43%), Gram-negative bacilli (13%), and Listeria monocytogenes (2%). Thirty-one patients were initially treated with debridement and implant retention and 15 with prosthesis removal (three with one-stage surgery, 10 with two-stage surgery). The median duration of antibiotic therapy was 66.5 days. The overall failure rate was 52% (24/48), 71% (22/31) with implant retention strategy, 13% (2/15) with prosthesis removal, and 63% (12/19) in case of Staphylococcus aureus infection. Conservative treatment was appropriate (arthrotomy on a well-implanted prosthesis without sinus tract and symptom onset <21 days) in 13/31 patients (42%) with a failure rate still high at 69% (9/13). The only factor associated with failure was conservative surgical treatment. CONCLUSION: The high risk of failure of conservative treatment for hematogenous prosthetic joint infections should lead to considering prosthesis replacement as the optimal strategy, particularly with Staphylococcus aureus.

[Treatment of a hip and patella luxation in a toy dog]. / Behandlung einer Hüftgelenks- und Kniescheiben-Luxation bei einer Zwerghunderasse.

INTRODUCTION: The present case report describes the surgical treatment of a traumatic craniodorsal luxation of the hip and a concomitant medial congenital luxation of the patella (3rd grade) in an 11-year-old Yorkshire Terrier. First the hip luxation was corrected with a cemented hip prosthesis. The femoral stem was inserted in slight anteversion (15°) with respect to the preoperative condition (5°), this contributed contrasting the medial traction of the femoral quadriceps on the patella, improving patellar luxation from 3rd to 2nd grade. However, the persistent patellar luxation and intermittent lameness reduced limb function and made a second intervention necessary. Four weeks after prosthetic surgery, a femoral trocleoplasty and lateral transposition of the tibial crest were performed to definitively re-establish a correct replacement of the patella in the femoral trochlea. No perioperative complications were found. At the final examination the patient did not show any lameness or pain that could be evoked when manipulating the surgically corrected limb. The surgical treatment allowed a restoration of the hip function and the alignment of the extensor mechanism of the femoral quadriceps and ensured a complete return to normal motor activities.

INTRODUCTION: Nous décrivons le traitement chirurgical d'une luxation traumatique cranio-dorsale de la hanche et d'une luxation patellaire de degré 3 concomitante chez un chien Yorkshire Terrier âgé de 11 ans. La luxation de la hanche a d'abord été traitée avec une prothèse totale cimentée. L'insertion de la tige fémorale en légère antéversion (15°) par rapport à l'état préopératoire (5°) contrecarrait la traction médiale des muscles quadriceps sur la rotule et réduisait la luxation patellaire du degré 3 au degré 2. Cependant la présence d'une boiterie intermittente due à la luxation patellaire de degré 2 persistante a réduit la fonction du membre et a rendu nécessaire une seconde intervention chirurgicale. Quatre semaines après le remplacement total de la hanche, une trochléoplastie fémorale et une transposition latérale de la crête tibiale ont été réalisées afin d'établir définitivement un alignement correct de la rotule dans la trochlée fémorale. Aucune complication périopératoire n'a été rencontrée. Lors de dernier contrôle, le patient ne présentait pas de boiterie ni de douleur lors de la manipulation du membre opéré Le traitement chirurgical a permis de rétablir la fonction de la hanche et d'aligner correctement le mécanisme extenseur des muscles quadriceps, tout en garantissant un retour complet du patient à une activité physique normale.

[A muscular calcium pyrophosphate deposition pseudo-abscess: An atypical localization of chondrocalcinosis]. / Pseudo-abcès musculaire d'origine microcristalline : une localisation exceptionnelle de chondrocalcinose.

INTRODUCTION: Chondrocalcinosis results from calcium pyrophosphate crystals deposition in the joints. We report an exceptional case of aseptic psoas abscess with a deposition of calcium pyrophosphate crystals. CASE REPORT: A 92-year-old man presented to our department for an acute onset of inflammatory pain in the left hip. Computed tomography detected a coxofemoral arthritis and multiple intramuscular collections located in the iliopsoas muscle and the gluteus minimus. A sample of the fluid was obtained with a guided aspiration, and its analysis revealed an inflammatory liquid with no bacteria but numerous calcium pyrophosphate crystals. The final diagnosis was thus a muscular calcium pyrophosphate deposition pseudo-abscess, associated with a hip arthritis. CONCLUSION: Hip chondrocalcinosis is unusual, and the association with intramuscular deposition of calcium pyrophosphate crystals seems extremely rare as we found only four other published cases. A microcrystalline arthritis could have spread from the coxofemoral joint through the iliopsoas bursa and into the muscle. However, the imaging aspect with an abscess and a predominant muscular injury might suggest a mechanism of crystal formation originating directly within the muscle. The outcome was always favourable even if some patients required surgery.

Characteristics and Outcomes of Patients in Rehabilitation with Hip Fracture: A Retrospective Chart Review.

ABSTRACTHip fracture rehabilitation has two streams: high tolerance short duration (HTSD) and low tolerance long duration (LTLD). This study examined patient characteristics and outcomes in HTSD and LTLD associated with length of stay (LOS) and discharge destination. We retrospectively examined patients' medical charts following hip fracture surgery and collected demographic, functional, and health characteristics. A statistical analysis was done to describe the differences between HTSD (n = 73) and LTLD (n = 57) patient characteristics and their relationship with LOS and discharge destination. Those in LTLD were significantly older, less independent with prefracture bathing and instrumental activities of daily living, had lower Functional Independence Measure (FIM) admission scores, and more co-morbidities. Higher FIM motor score on admission in HTSD and greater change in FIM total score in LTLD was significantly correlated with discharge home. Diabetes in LTLD and lower total admission FIM in HTSD was significantly associated with increased LOS.

Impact of a competition with two consecutive matches in a day on physical performance in young tennis players.

The purpose of this study was to analyze the effects of playing 2 tennis matches on the same day on physical performance in young tennis players. Twelve well-trained young tennis players took part in a simulated tennis competition consisting of 2 tennis matches on the same day (morning and afternoon sessions). Before and the day after the competition, physical performance was measured using a battery of countermovement jumps; a 10 m sprint; the 5-0-5 agility test; hip, grip and shoulder maximal isometric strength; shoulder range of motion; and a serve velocity test. Postcompetition results showed reduced performance in 10 m (-3.3%, effect size (ES) = small), dominant and nondominant 5-0-5 agility test (-4.6%, ES = moderate; -4.2%, ES = moderate, respectively), bilateral (-5.2%, ES = small), and unilateral countermovement jumps (dominant leg: -7.2%, ES = small; non-dominant leg: -9.1%, ES = small). Both dominant and nondominant shoulder external rotation range of motion increased (12.2%, ES = moderate; 5.6%, ES = small), whereas internal rotation decreased (-4.2%, ES = small; -3.3%, ES = small) in the postcompetition tests, together with the dominant shoulder external rotation (-10.7%, ES = moderate) and internal rotation (-9.3%, ES = small) strength. Physical impairments occurred in neuromuscular performance variables involving lower (e.g., jumping, sprinting, and change of direction) and upper (e.g., isometric strength and range of motion) limbs the day after playing a competition with 2 consecutive matches on the same day. These alterations in neuromuscular and sport-specific performance need to be taken into consideration when planning tournament schedules for young tennis players, as well as preparing match and recovery strategies.

Validation of the Hexoskin wearable vest during lying, sitting, standing, and walking activities.

We tested the validity of the Hexoskin wearable vest to monitor heart rate (HR), breathing rate (BR), tidal volume (VT), minute ventilation, and hip motion intensity (HMI) in comparison with laboratory standard devices during lying, sitting, standing, and walking. Twenty healthy young volunteers participated in this study. First, participants walked 6 min on a treadmill at speeds of 1, 3, and 4.5 km/h followed by increasing treadmill grades until 80% of their predicted maximal heart rate. Second, lying, sitting, and standing tasks were performed (5 min each) followed by 6 min of treadmill walking at 80% of their ventilatory threshold. Analysis of each individual's mean values under each resting or exercise condition by the 2 measurement systems revealed low coefficient of variation and high intraclass correlation values for HR, BR, and HMI. The Bland-Altman results from HR, BR, and HMI indicated no deviation of the mean value from zero and relatively small variability about the mean. VT and minute ventilation were provided in arbitrary units by the Hexoskin device; however, relative magnitude of change from Hexoskin closely tracked the laboratory standard method. Hexoskin presented low variability, good agreement, and consistency. The Hexoskin wearable vest was a valid and consistent tool to monitor activities typical of daily living such as different body positions (lying, sitting, and standing) and various walking speeds.

Luxación recidivante de la cadera en la neurofibromatosis tipo-1 / Recurrent hip dislocation in neurofibromatosis type-1

RESUMEN Introducción: La neurofribomatosis tipo 1 es un desorden genético común que puede afectar el esqueleto de forma frecuente. Las manifestaciones esqueléticas de la neurofibromatosis tipo 1 incluyen escoliosis, pseudoartrosis congénita de tibia y lesiones quísticas intraoseas. Objetivo: Describir las características clínicas e imagenológicas de esta enfermedad, encontradas en el caso que se presenta, así como el tratamiento realizado y la evolución de la paciente. Presentación del caso: Se presenta una luxación de la cadera resultante de un neurofibroma intraarticular en una paciente femenina de 17 años que sufrió un trauma menor. La luxación y su causa en esta paciente fueron sospechadas en un inicio por el cuadro clínico y los hallazgos anormales en las primeras radiografías de pelvis, y más tarde fue confirmada con tomografía axial computarizada e imágenes por resonancias magnéticas. Se le realizó una reducción cerrada bajo anestesia general con posterior tracción por partes blandas durante cuatro semanas. El caso fue seguido por consulta externa durante un año sin presentar un nuevo episodio de luxación de cadera. Conclusiones: La luxación recidivante de cadera asociada con neurofibromatosis tipo 1 es una ocurrencia rara y está poco reportada en la literatura. Este caso ilustra las características clínicas y sobre todo imagenológicas de la neurofibromatosis tipo 1, mediante las radiografías, imágenes por resonancia magnética y tomografía axial computarizada con reconstrucción. El tratamiento realizado, reducción cerrada bajo anestesia general con posterior tracción por partes blandas durante cuatro semanas, fue satisfactorio(AU)

ABSTRACT Introduction: Neurofribomatosis type 1 is a common genetic disorder that can frequently affect the skeleton. Skeletal manifestations of type 1 neurofibromatosis include scoliosis, congenital pseudoarthrosis of the tibia, and intraosseous cystic lesions. Objective: To describe the clinical and images characteristics of this disease, which are present in the case we report, and to describe the treatment and evolution of the patient. Case report: A hip dislocation resulting from an intra-articular neurofibroma is presented in a 17-year-old female patient who suffered minor trauma. Dislocation and its cause in this patient were initially suspected due to the clinical condition and abnormal findings on the first pelvis x-rays and later it was confirmed by computed tomography and magnetic resonance imaging. Closed reduction was performed under general anesthesia with posterior soft tissue traction for four weeks. The case was followed by outpatient consultation for one year with no new episode of hip dislocation. Conclusions: Recurrent hip dislocation associated with neurofibromatosis type 1 is a rare occurrence and it is poorly reported in the literature. This case illustrates the clinical and particularly imaging characteristics of type 1 neurofibromatosis, using x-rays, magnetic resonance imaging, and computed tomography with reconstruction. Closed reduction under general anesthesia was the treatment performed followed by soft tissue traction for four weeks, which was satisfactory(AU)

RÉSUMÉ Introduction: La neurofibromatose de type 1 (NF1) est un trouble génétique commun qui peut affecter fréquemment le squelette. Les manifestations squelettiques de la neurofibromatose de type 1 comprennent la scoliose, la pseudarthrose congénitale du tibia et les lésions kystiques intra-osseuses. Objectif: Décrire les caractéristiques cliniques et radiographiques de cette maladie rencontrées dans ce cas, ainsi que le traitement appliqué et l'évolution de la patiente. Présentation du cas: Le cas d'une patiente âgée de 17 ans atteinte de luxation de la hanche dû à un neurofibrome intra-articulaire et souffrant un traumatisme insignifiant, est présenté. Dès le début, la luxation et sa cause ont été suspectées, étant donné le tableau clinique et les résultats anormaux des premières radiographies du bassin, qui ont été confirmés plus tard par tomographie axiale assistée par ordinateur et IRM. Une réduction fermée sous anesthésie générale avec une traction postérieure des parties molles pendant quatre semaines a été réalisée. Ce cas a été suivi en consultation externe pendant un an sans présenter un nouvel épisode de luxation de hanche. Conclusions: La luxation récidivante de hanche liée à une neurofibromatose de type 1 est une affection rare et peu abordée dans la littérature. Ce cas met en évidence les caractéristiques cliniques, et particulièrement radiographiques, de la neurofibromatose de type 1 au moyen de radiographies, IRM et tomographie avec reconstruction. Le traitement appliqué, c'est-à-dire, la réduction fermée sous anesthésie générale avec une traction postérieure des parties molles pendant quatre semaines, a été satisfaisant(AU)

Offset femoral en los resultados clínicos y funcionales de los pacientes / Femoral offset in the clinical and functional results of patients; Le déport fémoral dans les résultats cliniques et fonctionnels des patients

Introducción: La restauración de las fuerzas biomecánicas a través del ajuste del offset y la longitud de miembros se ha convertido en un objetivo importante cuando el cirujano busca un buen resultado funcional postoperatorio. Sin embargo, las ventajas clínicas de la restauración del offset femoral y las complicaciones del fallo en la restauración no han sido claramente establecidas. Objetivo: Evaluar el efecto del offset o voladizo femoral en los resultados clínicos y funcionales de los pacientes. Adquisición de la evidencia: Se realizó una exploración en la base de datos Pubmed, con las palabras clave: artroplastia de cadera, prótesis de cadera, resultado clínico y resultado funcional.Se buscaron artículos publicados entre 2008 y 2018, basados en humanos y escritos en inglés, español o francés. Se seleccionaron seis artículos que incluían la presencia de una medición radiológica del offset femoral claramente explicada, escalas validadas y análisis comparativo. Resultados: La literatura consultada reflejó resultados heterogéneos. En el grupo de pacientes con offset disminuido, un artículo mostró menos función. En otro estudio se observó mejor puntuación en el grupo de enfermos con offset aumentado. A su vez, en una investigación se comprobó menos dolor en el grupo de offset disminuido. Conclusiones: Debido a la inconsistencia en los resultados y en las metodologías empleadas, no ha sido posible reconocer el beneficio clínico y funcional de la restauración del offset. Algunos autores incluidos en esta revisión, después de no encontrar diferencias estadísticamente significativas, afirmaron que la restauración o el aumento del offset femoral aportó buenos resultados, sin efectos negativos(AU)

Introduction: The restoration of biomechanical forces through offset adjustment and limb length has become an important objective when the surgeon seeks a good postoperative functional result. However, the clinical advantages of femoral offset restoration and complications of restoration failure have not been clearly established. Objective: To evaluate the effect of offset or femoral cantilever on the clinical and functional results of the patients. Acquisition of evidence: An exploration was carried out in the Pubmed database, with the keywords: hip arthroplasty, hip prosthesis, clinical result and functional result. We searched for articles published from 2008 to 2018, based on humans and written in English, Spanish or French. Six articles were selected because they clearly explained the presence of a radiological measurement of the femoral offset, including validated scales and comparative analysis. Results: The literature consulted reflected heterogeneous results. In the group of patients with decreased offset, one article showed less function. In another study, a better score was observed in the group of patients with increased offset. In turn, one investigation reported less pain was found in the reduced offset group. Conclusions: Due to the inconsistency in the results and the methodologies used, it has not been possible to recognize the clinical and functional benefit of offset restoration. Some authors included in this review, after not finding statistically significant differences, stated that the restoration or increase of the femoral offset provided good results, without negative effects(AU)

[Total hip replacement: between normal rehabilitation and complication]. / Hüftgelenkersatz-Operationen: Grenze zwischen Normalverlauf und Komplikation.

Total hip replacement is a common and succesful treatment of the osteoarthritis of the hip. According to the demographical trends in Switzerland in the coming decades, there will be a significant increase in the demand for total hip replacement surgery. The 20-year survival of a total hip prosthesis is approximately 85%. New prosthesis designs aim to improve the hip biomechanics, sacrifice less bone stock and facilitate "minimal-invasive"' approaches to the hip joint. Severe complications in total hip replacement comprise dislocation, aseptic loosening, infection, periprosthetic fracture and limping. The painful total hip replacement requires thourough and systematic work up of extrinsic and intrinsic causes. A referral to the orthopaedic specialist should be considered early.

L'arthroplastie totale de hanche est un traitement fréquent et efficace de l'arthrose de hanche symptomatique. Sur la base de l'évolution démographique ayant cours en Suisse il faut s'attendre à une nette augmentation du besoin d'implantation de prothèses de hanche durant les années à venir. Actuellement, 85% des prothèses de hanche ont une survie de 20 ans. De nouveaux modèles de prothèse essaient d'optimiser la biomécanique de l'articulation prothétique, de minimiser la perte osseuse, et de simplifier l'utilisation des voies d'abords 'mini-invasives'. Les complications sévères de l'arthroplastie totale de hanche sont la luxation et l'infection de la prothèse, et les fractures périprothétiques. Si des douleurs de hanche se développent après une arthroplastie totale de hanche il est nécessaire d'effectuer un examen systématique et minutieux. Ainsi, dans un tel cas, il est recommandé de recourir rapidement à un spécialiste.