The variability of surgical practice during total knee arthroplasty: results of a national survey amongst Belgian knee surgeons.

PURPOSE: Implant registries have been effective in detecting poorly performing implants and surgical strategies. They learn us however little about many variables that may be equally important to the final result. Today, no standards of care exist for performing total knee arthroplasties (TKA), and little is known about the variability that exists amongst surgeons performing this procedure. METHODS: A questionnaire with 39 aspects regarding standard surgical routine during TKA was sent to all 112 members of the Belgian Knee Society. Surgeons were stratified according to surgical experience and surgical volume. RESULTS: An important number of routines were performed as standard by the majority (>70%) of surgeons. Surgeons however significantly differed in the following aspects of the procedure: radiographic evaluation, use of minimally invasive surgery (MIS), preferred landmark for femoral component rotation, method of closure and activities allowed postoperatively. Both surgical experience and surgical volume had a significant effect, but their influence on strategies was different. Less-experienced surgeons used the posterior condylar line as their reference for femoral component rotation significantly more frequent than more-experienced surgeons and were more aggressive towards postoperative sports activities compared to more-experienced surgeons. High-volume surgeons used significantly more frequent MIS and low-volume surgeons preferred a more extensive postoperative radiographic evaluation. CONCLUSIONS: Data of this study show that an important number of routines are performed similarly by the majority of surgeons, and that minor but significant differences exist between high-volume versus low-volume surgeons, and between experienced versus less-experienced surgeons. LEVEL OF EVIDENCE: Case series, Level IV.

Atraumatic avascular necrosis of an index sesamoid.

Avascular necrosis of an index sesamoid is our topic. In literature we found a lot of papers published about Hallux and the thumb sesamoid. There were only few articles concerning index sesamoid pathology. But in contrast to these, there's no evidence for trauma, nor arthritis in the personal history of the case discussed. This pathology is rare. Diagnosis is difficult. Treatment by sesamoid resection was successful.

The HA-coated ABG socket in revision arthroplasty.

The favourable results we achieved in primary THR with the ABG HA-coated hemispheric metal backed cup led us to use this same cup in revision arthroplasty. Changes in inclination and migration of the cup were measured, as well as the radiologic appearance of the bone-cup interface. The most important features are quick osseointegration and immediate stability. The early and three to five years results with the use of the ABG HA-coated cup in revision arthroplasty are promising.

The Judet quadricepsplasty: a retrospective analysis of 16 cases.

Sixteen quadricepsplasties performed for severe extension contractures of the knee were reviewed. Preoperatively all cases showed a severe extension contracture with an average of 23 degrees flexion. Only two patients had more than 30 degrees flexion preoperatively. The average improvement in knee flexion at follow-up was 69 degrees with 11 (68.7%) patients achieving a final flexion of 90 degrees or more. In four cases there was a 15 degrees loss of terminal active extension. In one case a rapid recurrence of the contracture was seen during the initial postoperative weeks. One patient developed a deep infection, and another an acute compartment syndrome.

Paralysis of the peroneal nerve following hip fracture treatment.

A prospective study was performed over a period of 2 years to identify the cause of peroneal palsy following hip fracture treatment. Sixty-eight patients in Group I had their injured leg placed in traction in a splint with a metal frame. In Group II (66 patients) elevation only of the fractured extremity was maintained with a few pillows. There were five cases of peroneal palsy in Group I and none in Group II. The difference is significant. Direct pressure on the nerve in the area of the fibular head during the preoperative traction period seems to be the cause of this transient dysfunction.

Occipital condyle fracture must be considered in the pediatric population: case report.

To our knowledge, no case of occipital condyle fracture after minor head trauma in the pediatric population has been published. We report the case of a 12-year-old girl with a Jefferson's fracture detected on x-ray films. Axial high resolution computed tomography and coronal reconstruction images demonstrated the additional occipital condyle fracture.

Subperiosteal juxta-articular osteoid osteoma.

Subperiosteal osteoid osteoma in a juxta-articular site presents a diagnostic challenge. The clinical features of joint stiffness, synovitis, muscle atrophy and local warmth may suggest arthritis rather than osteoid osteoma, while radiographs, bone scans and angiograms may not be diagnostic. We describe four cases of this rare condition.