Minimally invasive hip surgery: the approach did not make the difference.

BACKGROUND: We hypothesized that minimally invasive surgery was superior to conventional surgery for total hip arthroplasty procedure. PURPOSE: To compare the results of total hip replacement (THR) made by minimally invasive lateral approach with the results of THR made by conventional lateral approach. MATERIALS AND METHODS: Prospective, randomized trial. Fifty patients were selected and then divided into two groups based on utilized approach. DATA COLLECTED: Perioperative bleeding, postoperative pain, time of recovery, components orientation, complications and functional results. Five-year follow-up. RESULTS: No differences were found in blood loss, postoperative pain, surgical time, components orientation, rate of complications or functional result. Minimally invasive lateral approach produced faster recovery with less hospital stay and earlier walking start. CONCLUSION: Our results suggested that minimally invasive lateral approach has not provided significant benefits over conventional lateral approach for the implantation of a total hip arthroplasty.

Minimally invasive osteosynthesis in stable trochanteric fractures: a comparative study between Gotfried percutaneous compression plate and Gamma 3 intramedullary nail.

AIM: Our objective was to compare the results of PCCP (Percutaneous Compression Plate) device and Gamma 3 nail for the treatment of stable trochanteric hip fractures and to demonstrate that PCCP device is a minimally invasive system. METHOD: Prospective, randomized trial. Eighty patients aged 60 and over with stable trochanteric fracture were selected and then randomized using a table of randomized numbers. Length of time of operative procedure, hemoglobin levels at 6 and 48 h after surgery, packed cells units administered, and hospital stay were recorded. In addition, the postoperative complications in the first year after the surgery was collected. RESULTS: No differences were found in hospital stay, surgical time, blood loss, functional outcome at 1-year follow-up, neck-shaft angle, fracture collapse, and mortality. CONCLUSIONS: PCCP and Gamma 3 have not presented significant differences in any measured parameter for treatment of stable trochanteric fractures. Therefore, the PCCP system is shown to be as minimally invasive as the Gamma 3.

[Clinical-radiological evaluation of the impaction allografting and cemented rod technique in revision knee surgery]. / Evaluación clínico-radiológica de la técnica de aloinjerto compactado y vástago cementado en cirugías de revisión de cadera.

OBJECTIVE: Long term clinical and radiological evaluation of results, survival, and peri- operative and post-operative complications of the patients who have been operated on for revision total hip arthroplasty using the impaction allografting and cemented rod technique. MATERIAL AND METHODS: An observational, analytical, prospective and non-random study was conducted on 26 patients who underwent revision total hip arthroplasty in our Hospital (1997-98). They were clinically and radiologically assessed, and a survival analysis of the implant was performed. RESULTS: Statistically significant differences were identified in the pre- and post-operative values, according to Harris and Merle D́Aubigne scores. The femoral components survival was considered as an endpoint of the revision replacement, which was 84% at a mean of 13 years. There were 9 intraoperative complications (6 were fractures) and they significantly affected the length of hospital stay. No post-operative complications were observed in 70% of the patients. None of the analysed variables had any influence on the radiological subsidence of the femoral component. DISCUSSION: Several techniques aim to solve the bone stock deficiency in revision total hip arthroplasty, but only impaction grafting attempts to recover it. CONCLUSIONS: The Ling's technique shows an improvement over the Merle D́Aubigne and Harris scores, in the medium-long term. The intraoperative complications are mainly an increase in the length of hospital stay and the number of days needed to be able to sit down. Ling's technique is a good option to consider in young patients where it is foreseeable that there is a new revision surgery in the future.

Behavior of the femoral stem in the Bihapro hip prosthesis.

This study evaluated the hydroxyapatite-coated femoral stem of the Bihapro hip prosthesis (Biomet Ltd, Bridgend, United Kingdom) using radiography, TC-99 scintigraphy, and bone densitometry. Thirty stems with >2 years of follow-up (mean: 31 months) were evaluated. No loosening or changes in the position of the implant were seen, and the mean subsidence was 2.2 mm. Radiography revealed a densification in the metaphyseal zone with reconstruction of the trabecular lines in 21 cases, while in 22 patients, radiolucent lines in the distal area of the femoral component were observed. Scintigraphy showed a diaphyseal normo-captation in 19 cases and a hypercaptation <1.4 with a mean index of 1.1 in 10 patients. Metaphyseal hypercaptation >1.4 was seen in 24 patients. Bone densitometry revealed increased density in the metaphyseal zones in 29 patients with a periprosthetic/normal bone quotient of 1.4.

[Results of the latest generation dual-mobility cup in Spain (135 THAs followed-up for a mean of 32 months)]. / Resultados del cotilo con doble movilidad de última generación en España (135 PTC seguidas durante una media de 32 meses).

INTRODUCTION: This multi-center study (Cabuenes Hospital and Santa Lucia University Hospital) assessed the results of a retrospective and ongoing series of 135 total hip arthroplasties (THA) in which a latest generation dual-mobility cup was implanted. MATERIAL AND METHODS: A total of 135 THAs performed between 2005 and 2008 were analyzed. Mean follow-up was 32 months. The causes of surgery were: coxarthrosis in 31.8% and hip fracture in 68.1%. Mean age was 82.1 years. All patients were seen at regular follow-up visits for clinical and radiological assessments. RESULTS: The follow-up lasted over 24 months in 121 THAs (14 patients died). In the most recent follow-up, in May 2011, 119 cups did not show any loosening. Complications were as follows: 2 postoperative dislocations; 4 DVTs; 3 infections; 5 periprosthetic fractures; 2 loosened cups, and one subsided stem. The mean preoperative Harris Hip Score (HHS) was 45, 83; the mean postoperative HHS was 80.03. Only two of the 135 cups analyzed had radiographic modifications without clinical signs. Isolated cup survival at 12 months was 97.03% (87.3-99.2) with a 95% confidence interval; survival at 5 years was 96.7% (85.4-98.8). DISCUSSION: In our study, the new dual-mobility cup showed good results for the following indications: primary coxarthrosis and femur neck fractures. CONCLUSION: The complication rate in our series was similar to the one reported in other series in the literature, except for dislocation. The latter was considerably less frequent (1.48%) in our series compared to the rates reported by the classical series, especially in patients with neuromuscular or cognitive problems (one third of patients).

Resultados del cotilo con doble movilidad de última generación en España (135 PTC seguidas durante una media de 32 meses) / Results of the latest generation dual-mobility cup in spain (135 THAs followed-up for a mean of 32 months)

Introducción: En este estudio multicéntrico (Hospital de Cabueñes y Hospital Universitario Santa Lucía) se evalúan los resultados de una serie retrospectiva y continua de 135 PTC realizadas implantando un cotilo doble movilidad de nueva generación. Material y métodos: Se estudiaron 135 PTC intervenidas entre 2005 y 2008. El seguimiento medio fue de 32 meses. Las causas de la cirugía fueron 31.8% coxartrosis y 68.1% fracturas de cadera. La edad media era de 82.1 años. Todos los pacientes eran revisados periódicamente haciendo una valoración clínica y radiográfica. Resultados: El seguimiento pudo ser realizado durante más de 24 meses en 121 PTC (14 pacientes fallecidos). En la última revisión, mayo 2011: 119 cótilos no presentaban aflojamiento. Las complicaciones fueron: 2 luxaciones postquirúrgicas; 4 TVP; 3 infecciones PTH; 5 fracturas peri PTC; 2 aflojamientos cetilo y 1 hundimiento vástago. HHS preoperatorio medio: 45, 83 y postoperatorio medio: 80, 03. De los 135 cotilos revisados sólo dos presentaban modificaciones radiográficas sin signos clínicos. La supervivencia aislada del cótilo a los 12 meses fue 97.03% (87.3-99.2) con un intervalo de confianza del 95% y a los 5 años, un 96.7% (85.4-98.8). Discusión: En nuestro estudio el nuevo cótilo doble movilidad ha mostrado buenos resultados en las siguientes indicaciones: coxartrosis primaria y fracturas de cuello de fémur. Conclusión: Las complicaciones obtenidas en esta serie aparecen en el mismo porcentaje que en otras series de la literatura excepto para la luxación. En ésta, el porcentaje (1.48%) era mucho más pequeño que el de las series clásicas, especialmente en los pacientes con problemas neuromusculares o cognitivos (un tercio de los pacientes).

Introduction: This multi-center study (Cabueñes Hospital and Santa Lucía University Hospital) assessed the results of a retrospective and ongoing series of 135 total hip arthroplasties (THA) in which a latest generation dual-mobility cup was implanted. Material and methods: A total of 135 THAs performed between 2005 and 2008 were analyzed. Mean follow-up was 32 months. The causes of surgery were: coxarthrosis in 31.8% and hip fracture in 68.1%. Mean age was 82.1 years. All patients were seen at regular follow-up visits for clinical and radiological assessments. Results: The follow-up lasted over 24 months in 121 THAs (14 patients died). In the most recent follow-up, in May 2011, 119 cups did not show any loosening. Complications were as follows: 2 postoperative dislocations; 4 DVTs; 3 infections; 5 periprosthetic fractures; 2 loosened cups, and one subsided stem. The mean preoperative Harris Hip Score (HHS) was 45, 83; the mean postoperative HHS was 80, 03. Only two of the 135 cups analyzed had radiographic modifications without clinical signs. Isolated cup survival at 12 months was 97.03% (87.3-99.2) with a 95% confidence interval; survival at 5 years was 96.7% (85.4-98.8). Discussion: In our study, the new dual-mobility cup showed good results for the following indications: primary coxarthrosis and femur neck fractures. Conclusion: The complication rate in our series was similar to the one reported in other series in the literature, except for dislocation. The latter was considerably less frequent (1.48%) in our series compared to the rates reported by the classical series, especially in patients with neuromuscular or cognitive problems (one third of patients).

A simple technique for handling morcellized bone-graft during impaction grafting.

Handling morcellized bone-graft during impaction grafting can be a slow and laborious procedure. An alternative quick technique is described.

A simple method for bone-graft handling during spine surgery.

Morsellized bone-graft handling during spine surgery to get vertebral fusion can be a slow, laborious and time-consuming procedure. It is not absolutely exempt from complication risk. An easy, quick and inexpensive alternative technique is described.

Hydroxyapatite-coated hip prostheses. Early results from an international study.

A hydroxyapatite-coated hip prosthesis designed to stimulate proximal femoral stress transfer was studied in 222 patients undergoing primary total hip arthroplasty with a minimum followup of 2 years. The femoral component was a roughened titanium alloy with a 50-mu coating of hydroxyapatite applied to the proximal third. A proximal press-fit technique was applied with distal femoral over-reaming as standard procedure. The hydroxyapatite-coated acetabulum was of hemispherical design. Analysis of the clinical results showed a mean Merle D'Aubigné score of 16.7 points at 6 months and 17.4 points at 2 years. Mild residual thigh pain of unknown origin was reported in 3.6% of patients at 2 years. Radiographic evaluation showed complete acetabular and proximal femoral osseointegration without any loosening. No radiolucency or reactive line formation was observed around the hydroxyapatite-coated areas of the prostheses. Femoral bone densification occurred at the coated-uncoated transition zone (54%); 4% to 6% of cases showed cortical hypertrophy at the uncoated area of the stem. Reactive lines were seen around the distal stem in 52% of patients after 2 years. The clinical outcome was excellent, and the radiographic data pointed mainly to proximal femoral stress transfer.