Etiology of coxarthrosis in patients with total hip replacement.

OBJECTIVE: We aimed to find out the distribution of etiological factors in patients who had total hip replacement for coxarthrosis. METHODS: The medical records of the 965 hips of 886 patients operated with total hip replacement between 2001 and 2012 in two separate arthroplasty clinics were analyzed by two separate senior surgeons. Each patient's pre- and postoperative X-rays and demographic data such as gender, age, side and probable etiologic factors were noted. RESULTS: Six hundred and eighty-four patients were women and 202 were men. The mean age were 62.7±14.3 (range: 16 to 91) in women, 58.8±17.1 (range: 25 to 91) in men. 52.1% of the surgeries were performed on the right side, 39% on the left, and 8.9% bilaterally. In women 36.2% of the cases were primary coxarthrosis, while the etiology was developmental dysplasia of the hip (DDH) in 43.5% of the cases, avascular necrosis in 10%, romatoid diseases in 7%, slipped capital femoral epiphysis in 5%, posttraumatic coxarthrosis in 3.9%, pathologic coxarthrosis in 1.9%, and Perthes sequel in 1.7%. In men, 24.4% of the cases were primary coxarthrosis, while the etiology was avascular necrosis in 21% of the cases, DDH in 17.6%, posttraumatic coxarthrosis in 16.8%, romatoid diseases in 10.9%, Perthes sequel in 4.2%, slipped capital femoral epiphysis in 2.5%, and pathologic coxarthrosis in 2.5%. The most common etiologic factor was DDH with a rate of 37.1%. CONCLUSION: Despite the heterogeneity of our study population, our results may reflect the distribution of coxarthrosis etiologies in Turkey. Developmental dysplasia of the hip appears to be the most frequent cause of coxarthrosis among the patients undergoing total hip replacement.

Locked anatomic plate fixation in displaced clavicular fractures.

OBJECTIVE: We aimed to evaluate the results and complications of open reduction and internal fixation by locked anatomic plates in adult midshaft clavicular fractures. METHODS: Sixteen patients (11 males, 5 females; mean age: 39.6 years) who underwent open reduction and internal fixation with locked anatomic plate for displaced-comminuted midshaft clavicular fractures and were followed-up for at least one year were reviewed retrospectively. Complications in the early and late postoperative periods and functional scores according to the Constant and DASH scoring systems from the latest follow-up were evaluated. RESULTS: Mean follow-up period was 24.6 (range: 12 to 52) months and mean union time was 13.3 (range: 10 to 23) weeks. None of the patients had superficial and/or deep infections in the early postoperative period or neurovascular complications. Two (12.5%) patients had implant irritation. In two (12.5%) patients, implant failure was detected in the late postoperative period. Delayed union was suspected in these patients and they were operated with longer plate and grafting in the 4th month. At the final follow-up, none of the patients had nonunion or malunion and the mean Constant and DASH scores were 85.5 and 12.8, respectively. Constant scores in patients with complications (p=0.007) and DASH scores in patients with no complications (p=0.001) were significantly lower. CONCLUSION: Fixation with locked anatomic plates in displaced midshaft clavicular fractures has lower complication rates. Possible postoperative complications are generally associated with implant irritation and failure. These problems can be avoided with the development in implant technology and new implant designs.