Rod Link Reducer system in adolescent idiopathic scoliosis: a retrospective observational trial.

PURPOSE: The Rod Link Reducer (RLR) (Globus Medical, PA, USA) allows direct three-dimensional correction of the spine deformity follows the direct vertebral rotation (DVR) theories. The purpose of this retrospective study is to compare RLR with traditional correction technique (TCT) in two cohorts of patients with adolescent idiopathic scoliosis (AIS). METHODS: Fifty-four patients (M:F = 1:8) between 2018 and 2020 were included. The first group (n = 22) was treated by RLR while the second one (n = 32) by TCT. All spines were classified as per the Lenke system. Length of hospitalization, days in intensive care unit (ICU), operative time, and blood loss were recorded. SRS-30 and SF-36 questionnaires were administered pre-operative and post-operative. We collected radiological data: pre-operative and post-operative Cobb angles, coronal and sagittal balance, trunk and thoracic height. RESULTS: RLR and TCT groups are homogeneous in age (p = 0.317), sex ratio (p = 0.347), and Risser stage (p = 0.222). Between both groups there was no significant statistical difference in haemoglobin value, hospitalization length, days in ICU, operative times, SF-36, SRS-30, NRS, and perceived satisfaction. RLR group shows a better improvement of correction of main thoracic (MT) curve (RLR 54.2% ± 15.9%/TCT 38.1% ± 20.4%, p = 0.031). Nevertheless, RLR group shows a worse thoracic kyphosis correction (RLR 16.82° ± 9.13°/27.12° ± 12.13°, p = 0.015). CONCLUSION: RLR system allows a more effective MT curve correction than TCT systems, but it seems to give a hypokyphosis effect.

Direct anterior total hip arthroplasty: a retrospective study.

BACKGROUND: The quest for less invasive surgical approaches for total hip arthroplasty has gained much attention recently. There is very little information regarding differences about the main surgical access. The purpose of this study was to collect data regarding patients' subjective perceptions of the direct anterior hip arthroplasty, heterotopic ossification degrees, range of movement and complication and comparing these satisfaction results with the other surgical techniques. METHODS: The study involved 51 patients operated in our Orthopedic clinic with direct anterior total hip arthroplasty between 2016 and 2017. We recorded and compared clinical and radiographic data at 1 year with anterolateral hip arthroplasty. RESULT: Only one patient described less than an 8/10 satisfaction; 5.45% of the patients restored the physiological ROM and 21.82 % lost only 5° of range of motion. According to Brooker Classification 58.33 % did not develop any Heterotopic Ossification. CONCLUSION: All standard approaches to the hip have been shown to be safe and efficacious, with particular advantages and disadvantages for each approach. DAA has some short term advantages like a faster recovery, less blood loss and less heterotopic ossification. Long term studies are required to demonstrate a cost benefit or quality of care advantage to other hip approaches.

Fourth generation head fracture in ceramic-on-polyethylene bearing after hip revision surgery: a case report.

Fourth generation ceramic bearings (BIOLOX delta, CeramTec AG; Phlochingen, Germany) were developed to reduce wear debris and improve fracture resistance. A case of a fourth generation head fracture in ceramic-on-polyethylene (COP) coupling after hip revision surgery is reported. A 58-year-old man was admitted to our department for increasing hip pain following a direct trauma which occurred during skiing activity 4 months before. Six years earlier, he had undergone a right cementless revision surgery with a 36-mm BIOLOX delta femoral head on polyethylene liner for metallosis and foreign body reaction after primary total hip replacement for hip osteoarthritis. At admission, radiological evaluation revealed a fracture of ceramic femoral head requiring a new revision surgery. Extensive synovectomy, lavage and capsulectomy were performed. Both acetabular cup and femoral stem were well fixed with no damage of trunnion, and therefore they were retained. A 36-mm internal diameter polyethylene acetabular liner was inserted along a 36-mm BIOLOX delta head with a BioBall adapter XL. The postoperative course was uncomplicated. At 1-year follow-up, the patient had a complete functional recovery. To our knowledge, BIOLOX delta ceramic femoral head fracture after COP hip revision surgery has not been previously reported.

Incomplete, stable-like, peri-prosthetic Vancouver B fracture around an ha-coated stem. Is there a case for strategic thoughtful neglect?

The Periprosthetic fracture of the proximal femur is usually treated by internal fixation of the fracture or revision of the femoral stem depending on the characteristics of the fracture and stability of the implant. This case report shows an early periprosthetic fracture around an uncemented straight stem which is treated conservatively with an excellent clinical radiographic result and explains the biomechanics related to this non-operative choice. A conservative treatment of periprosthetic fracture is possible but only after a careful analysis of the fracture pattern, the characteristics of the prosthetic stem and the time elapsed from implanting the prosthesis to the fracture.