Outcome of revision surgery in recurrent dislocation of primary total hip arthroplasty.

BACKGROUND: The cause of recurrent dislocation following primary total hip arthroplasty (THA) is multifactorial. A re-dislocation rate of up-to 34% following revision is reported. The aim of this study was to determine the re-dislocation rates following revision for recurrent THR dislocation. METHODOLOGY: Patients who underwent revision for recurrent dislocation between January 2008 and January 2015 were identified. We identified the date and type of primary implant, overall number and reasons for dislocation, revision implant details and complication data. RESULTS: Over an 8-year period, 24 patients underwent revision. The median age was 77 (68-85) years, median time to first dislocation was 78 (23-160) months and median number of dislocations was 3 (2-4) with a mean follow-up of 18 months. Socket Mal-Orientation (10) and Abductor deficiency (5) were the main causes of recurrent dislocation. 21 patients (88%) underwent revision of both components, 1 patient underwent isolated cup revision and 2 patients had revision of acetabular component with insertion of a BioBall. There were no dislocations within 90 days of revision surgery. 4 patients had late dislocations (3 recurrent, 1 isolated). There was no significant increase risk of dislocation after revision surgery in the neck of femur group (p = 0.467). CONCLUSIONS: We report favourable outcomes for revision of both components for recurrent dislocation with no dislocations within 90 days. The overall late dislocation rate was 16.7%, however, these patients have settled following closed reduction. Due to its multifactorial aetiology, both component revision can be considered in this patient population.

A Prospective Cohort Comparative Study of Rivaroxaban, Dabigatran, and Apixaban Oral Thromboprophylaxis in 2431 Hip and Knee Arthroplasty Patients: Primary Efficacy Outcomes and Safety Profile.

BACKGROUND: Direct oral anticoagulants (DOACs) have promised superior efficacy to low molecular weight heparins in the prevention of venous thromboembolism (VTE) in total hip and knee arthroplasty. However, there are concerns about raised associated bleeding and wound problems with these agents. This study aims to evaluate and compare the efficacy and safety of the 3 DOAC drugs: rivaroxaban, dabigatran and apixaban. METHODS: The primary outcome measures were rate of symptomatic VTE and major bleeding. Secondary outcome measures were wound healing problems and requirement for return to theater. A total of 2431 patients received one of the DOAC drugs as thromboprophylaxis following total hip arthroplasty (35 days) or total knee arthroplasty (14 days) between 2011 and 2015. Binary variables were compared between the 3 groups by using the chi-squared test or Fisher's exact test. Relative risks of selected primary and secondary end points were also calculated for the prespecified pairwise comparison. RESULTS: The overall symptomatic VTE rate was 2%. Rivaroxaban had a statistically significant superior efficacy for overall VTE prevention (0.8% vs 2.6%) compared with dabigatran (P < .01) and apixaban (P < .01), and deep vein thrombosis prevention (0.3% vs 2.2%) over dabigatran (P < .01). The overall rate of major bleeding was 1.2% with no significant difference observed between the 3 studied drugs. CONCLUSION: All 3 drugs had symptomatic VTE rates comparable with low molecular weight heparin from the published literature. Rivaroxaban appears to have superior efficacy in VTE prevention over apixaban and dabigatran. No statistical difference was observed for major bleeding with any of the 3 agents.

Implant removal following surgical stabilization of patella fracture.

Patella fractures are relatively common injuries. Tension band wiring is commonly used to treat displaced patella fractures. The goal of this study was to assess the outcome and implant removal rate following surgical stabilization of patella fracture. A consecutive series of 67 patients over a 6-year period was reviewed. Minimum follow-up to fracture healing (3 months) was available in 63 patients. Forty-three men and 24 women with a mean age of 49 years (range, 14-90 years) underwent surgical stabilization of patella fracture. Three open fractures and associated injuries were noted in 22 patients. Surgical treatment methods used were: tension band wiring in 44, tension band wiring with cerclage wire in 13, tension band wiring with screws in 4, and screw fixation in 6. All fractures united. Two superficial infections responded to oral antibiotics. One patient had revision surgery at 6 weeks. Twenty-two patients required implant removal for implant-related symptoms. Mean follow-up in asymptomatic patients was 8 months (range, 3-18 months) and in patients with implant-related problems was 17 months (range, 10-36 months). Four patients were lost to follow-up. Surgical stabilization of patella fractures by current techniques demonstrated satisfactory fracture union. However, 1 in 3 required surgery for implant-related symptoms. In the younger than 60 years group, the implant removal rate was 40%. This high rate of implant removal must be discussed with the patient prior to surgery. Newer techniques to avoid skin irritation should be considered.

The AO/ASIF proximal femoral nail antirotation (PFNA): a new design for the treatment of unstable proximal femoral fractures.

INTRODUCTION: PFNA design compacts the cancellous bone to provide increased stability and has been bio-mechanically proven to retard rotation and varus collapse. METHODS: Between 2006 and 2007, 62 consecutive patients with unstable proximal femoral fractures were treated with the PFNA. RESULTS: Twenty males and 42 females with a mean age of 78 years (44-94) were reviewed. In 48 patients, the fracture resulted from a low energy injury. The majority of the fractures belonged to AO/ASIF types 31A2.3 (22) and 31A3.2 (29). Twelve patients required open reduction. The PFNA blade position was central in 52 patients with a mean tip-apex distance (TAD) of 12 mm (range 4-34 mm). Post-operatively, five patients died within 3 months and two patients were lost to follow-up. Forty-nine fractures united between 3 and 4 months. Four patients had delayed union. The PFNA blade cut out rate was 3.6%. CONCLUSIONS: Unstable proximal femoral fractures were treated successfully with the PFNA. The PFNA blade appears to provide additional anchoring in osteoporotic bone. No results have been published on this new design.