Minimally invasive total knee arthroplasty: a comparative study to the standard approach.

BACKGROUND: Minimally invasive surgery has gained popularity over the past several years. Early results have shown better functional outcome with early recovery and rapid rehabilitation. AIM: Evaluation of the short-term clinical and functional outcome of minimally invasive surgery total knee arthroplasty (MIS-TKA) compared with the traditional total knee arthroplasty (TKA). MATERIALS AND METHODS: During 2009, all cases scheduled for primary TKA through the modified mini-mid-vastus approach (MIS group) were studied. This group included 40 knees and was compared to a cohort control group of similar number of patients (40 knees) that underwent the procedure through the standard conventional technique (standard group). RESULTS: Patients in the MIS group showed significant decrease in postoperative pain, blood loss in first 24 hours, and in hospital stay. Furthermore, they achieved motion considerably faster than the standard group with earlier return of quadriceps function and greater early flexion. CONCLUSION: This study proved that MIS-TPA has the ability to couple the benefits of less invasive surgical approach.

Osteochondral mosaicplasty of the femoral head.

Young adults with osteochondral lesions of the femoral head are at risk of rapid progression to symptomatic arthritis of the hip joint. Between January 2008 and July 2009, 10 patients were treated for femoral cartilage damage by a osteochondral mosaicplasty of the femoral head through a trochanteric flap with dislocation of the hip. The consecutive series had the following exclusion criteria: acetabular chondropathy, age above 25 years, and femoral head osteonecrosis. Patients were followed up after surgery using the Oxford-12 score, Harris hip score and the Merle d'Aubigné score, and activity assessed by the UCLA and Devane scores. Radiological evaluation by computed tomographic (CT) arthrography was undertaken in all patients at 6 months and plain radiographs. Mean follow-up was 29.2 months (20-39 months). The Postel Merle d'Aubigné score improved from the pre-operative period to the latest follow-up, from 10.5 points (8-13) to 15.5 points (12-17). Global range of motion increased from 175.4° (140-215) to 210.7° (175-240). All radiological investigations at latest follow-up showed that the autograft plugs were well-incorporated at the site of osteochondroplasty in the femoral head with intact cartilage over them and smooth interfaces between articulating bony surfaces. Osteochondral autograft transplantation may be a new alternative option for osteochondral lesions of the femoral head, but this has to be confirmed with longer follow-up and in a larger number of patients. The results of similar surgery in the knee have been mixed, and in the hip the technique is demanding, requiring familiarity with surgical hip dislocation.

The effectiveness of primary bipolar arthroplasty in treatment of unstable intertrochanteric fractures in elderly patients.

BACKGROUND: The treatment of unstable intertrochanteric fracture in the elderly patient is still controversial. Traditionally, internal fixation using a dynamic hip screw was of choice. Recently, some authors advocated the use of cemented bipolar arthroplasty or hemiarthroplasty which results in better functional outcome. AIM: The aim of this study is to find out which of these treatment options can lead to the best clinical and functional outcomes. PATIENTS AND METHODS: One hundred and two patients admitted to Makassed General Hospital between 2002 and 2007 with a diagnosis of unstable intertrochanteric fracture of femur were selected. Preoperative and operative data was retrieved from inpatient hospital files. Postoperative radio clinical data at follow up visits was collected from outpatient department files. Functional outcomes were assessed with use of Harris hip score. The main clinical measures were early postoperative full weight bearing, postoperative complications and functional outcome. RESULTS: The time to full weight bearing, the rate of postoperative complications, and the functional outcomes was significantly better in the cemented bipolar arthroplasty group. CONCLUSION: According to our results, we believe that cemented bipolar hemiarthroplasty is of choice in freely mobile elderly patients above seventy years of age with an intertrochanteric femoral fracture.

Post-graduation migration intentions of students of Lebanese medical schools: a survey study.

BACKGROUND: The international migration of physicians is a global public health problem. Lebanon is a source country with the highest emigration factor in the Middle East and North Africa and the 7th highest in the World. Given that residency training abroad is a critical step in the migration of physicians, the objective of this study was to survey students of Lebanese medical schools about their intentions to train abroad and their post training plans. METHODS: Our target population consisted of all students of Lebanese medical schools in the pre-final and final years of medical school. We developed the survey questionnaire based on the results of a qualitative study assessing the intentions and motives for students of Lebanese medical schools to train abroad. The questionnaire inquired about student's demographic and educational characteristics, intention to train abroad, the chosen country of abroad training, and post-training intention of returning to Lebanon. RESULTS: Of 576 eligible students, 425 participated (73.8% response rate). 406 (95.5%) respondents intended to travel abroad either for specialty training (330 (77.6%)) or subspecialty training (76 (17.9%)). Intention to train abroad was associated with being single compared with being married. The top 4 destination countries were the US (301(74.1%)), France (49 (12.1%)), the United Kingdom (31 (7.6%)) and Canada (17 (4.2%)). One hundred and two (25.1%) respondents intended to return to Lebanon directly after finishing training abroad; 259 (63.8%) intended to return to Lebanon after working abroad temporarily for a varying number or years; 43 (10.6%) intended to never return to Lebanon. The intention to stay indefinitely abroad was associated male sex and having a 2nd citizenship. It was inversely associated with being a student of one of the French affiliated medical schools and a plan to train in a surgical specialty. CONCLUSION: An alarming percentage of students of Lebanese medical schools intend to migrate for post graduate training, mainly to the US. A minority intends to return directly to Lebanon after finishing training abroad.

Why are you draining your brain? Factors underlying decisions of graduating Lebanese medical students to migrate.

In the context of a worldwide physician brain drain phenomenon, Lebanon has the highest emigration factor in the Middle East and North Africa. In this manuscript we aim to identify and develop a conceptual framework for the factors underlying the decisions of graduating Lebanese medical students to train abroad. We conducted two focus groups and seven semi-structured individual interviews with 23 students. In the deductive analysis (based on the push-pull theory), students reported push factors in Lebanon and pull factors abroad related to five dimensions. They focused predominantly on how training abroad provides them with a competitive advantage in an oversaturated Lebanese job market. An inductive analysis revealed the following emerging concepts: repel factors abroad and retain factors locally; societal expectations that students should train abroad; marketing of abroad training; and an established culture of migration. The marketing of abroad training and the culture of migration are prevalent in the academic institutions.