Acta Orthopaedica Belgica
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Cup oversizing as a risk factor for postoperative groin pain in Total Hip Arthroplasty
No full textIntroduction Some patients experience anterior hip pain after total hip replacement, there is evidence that a prominent/malpositioned cup may cause iliopsoas tendonitis. The purpose was to determine whether oversizing the cup is a risk factor for postoperative groin pain.Methods We retrospectively investigated 437 total hip replacements with femoral head diameter measurements. Cup size and positioning was collected from x-rays and clinical data from files.Results Significant correlation between native femoral head and cup size. Mean DS was 5.5 mm in no-pain group, 6.9 mm in anterior hip pain-group and 5.9 mm in non-anterior hip pain-group. The difference in mean DS was significant (P=0.046) in patients experiencing anterior hip pain vs. no-pain or non-anterior pain.Conclusions Patients with anterior hip pain had a significant larger DS of 6.9 mm, it seems that a cup size of more than 6 mm above the native femoral head size should be avoided.
Is high Body Mass Index a potential risk factor for poor outcome after hip arthroplasty
No full textIntroduction: The association between obesity and outcome after hip arthroplasty is controversial. We investigated whether there was an association between the preoperative body mass index in primary total hip arthroplasty patients and their quality of life and physical function 1 year after surgery.Materials and Methods: 98 patients were included in the study. The results were adjusted for age, sex, and comorbidities. The obese group had an increased risk of obtaining a worse physical score and a lower activity in daily living score at the 1-year follow-up than compared with the normal-weight group. In addition, the obese patients’ hospitalization was 1 day longer than that of the normal-weight patients. However, the overweight patients accomplished the largest improvement of general health and hip-related health compared with the normal-weight group.
Protocol and Descriptive Epidemiology of the SIGASCOT Italian Multicentric Registry of Revision ACL Reconstruction:a 1-year pilot study
No full textPurpose: To present the demographic and baseline results of the first year of course of the SIGASCOT Italian registry of Revision ACL reconstruction. Methods: The data of the patients undergoing revision ACL reconstruction, enrolled in by 20 SIGASCOT members from March 2015 to May 2016, were extracted from the Surgical Outcome System (SOS). Results: Overall, 126 patients were enrolled; 18 were excluded due to incomplete data. Mean age at surgery was 30.4 ± 9.3 years (median 29; 23-38), mean BMI was 22.6 ± 2.3 kg/m2 and 77% were males. Revision was performed with a single-bundle technique in 94%, using allograft in 57% of cases and autograft in 43%. Only 28% had both menisci intact, and meniscal repair or replacement was performed in 25% of patients for medial meniscus and 8% for lateral meniscus. Conclusions: During the first year of enrolment, the SIGASCOT Italian ACL revision registry was able to collect the data of more than 100 patients. The revision ACL reconstruction was usually performed with a single-bundle technique, using allograft and autograft almost in the same exten
Clinical results and complications of a two-stage procedure in hip infection using preformed antibiotic-loaded cement spacers
No full text Antibiotic-loaded cement spacers are used in two-stage hip replacement. The aim of our study was to compare our results using a Spacer-G with previous results reported in the literature. From June 2002 to April 2010, all patients treated with a two-stage revision were retrospectively reviewed. On the basis of the results of the first-stage procedure, 52 patients underwent the second stage, six developed a dislocation, in eight the spacer was maintained, and five patients developed an acute infection of the spacer or the infection was not resolved. With regard to the second-stage procedure the revision was successful in 44 patients, a re-infection developed in four patients and the definitive prosthesis presented a mechanical complication in four more. The literature results reported that 97.5% of the spacers were reimplanted, although 12.09% of them developed a dislocation. Surgeons must assess several aspects so as to avoid mechanical complications like dislocation and re-infections during the two stages of the procedure
Use of sliding transphyseal flexible intramedullary nailing in pediatric osteogenesis imperfecta patients
No full textIntroduction. In our country the sliding Flexible Intramedullary Nailing is used alone or in combination with Ilizarov frame in children with osteogenesis imperfecta. The study assesses the results of sliding intramedullary nailing in deformity correction in severe types of osteogenesis imperfecta.Materials and Methods. We retrospectively reviewed 17 consecutive cases (mean age 5.2 y.o.) of types III, IV and VII of osteogenesis imperfecta.In group I (9 patients) the transphyseal FIN was performed using titanium nails. Sliding flexible intramedullary nailing was associated with Ilizarov frame in group II in 8 children.Results. Patients in group I had overall complication rate of 88.9%: proximal nail migration (3), early secondary torsional displacement (4), non-telescoping (12), angular deformity (2), delayed or non-union (2). The reoperation rate was 100%.In group II we observed complications in 6 patients: nail migration (2), bowing of femur (2), non-telescoping (3). The reoperation rate was 87.5%.Conclusion. Flexible intramedullary nailing allows realignment and good functional outcomes. Its major disadvantage is an important complication rate and related reoperation rate. The use of Ilizarov frame provides additional stability and allows early weight-bearing.
Alternating levels versus all levels mini-plate fixation in open door cervical laminoplasty for treatment of degenerative cervical myelopathy
No full textObjectiveː To investigate clinical and radiological results of alternating levels compared with all levels mini-plate fixation in open door cervical laminoplasty for treatment of degenerative cervical myelopathy. METHODSː From January 2011 to April 2014, 64 patients sustained degenerative cervical myelopathy, who underwent cervical laminoplasty with alternating levels (31 patients in group A) or all levels plate fixation (33 patients in group B) were included in this retrospectively study. Clinical and radiological results were calculated. RESULTSːThe mean cost for group B was higher than group A(P < 0.05). No statistical difference was found in the mean operation time, blood loss, axial symptoms，C5 palsy, improvement in JOA and NDI score between group A and B. Open angle in mini-plate fixed levels was significantly more than that in suture fixed levels(P < 0.05). No statistical difference was found in drift back of spinal cord, APD, Pavlov's ratio, CCI and ROM between mini-plate fixed levels and suture fixed levels.CONCLUSIONSː Open door laminoplasty at alternating levels mini-plate fixation is an economical surgical method and can obtain similar satisfactory clinical and radiological results compared to all levels mini-plate fixation.
Infection Risk Analysis of Orthopaedic Surgical Team Double Glove Cuff Interface Moisture
No full textPurpose: Moisture droplets can accumulate at the paired surgical glove interface during long-duration orthopaedic surgery cases. The sterility of this moisture is unknown. This prospective study at an urban university-based level I trauma center analyzed moisture droplets sampled from the double glove cuff interface for bacterial contamination. Methods: Moisture droplet samples were collected from 15 unique orthopedic surgery team members during 15 non-contaminated surgeries of ≥ one-hour duration. Results: After ≥ 72 hours incubation (32° C), all negative controls (opened, unused sterile gloves in operating room environment) displayed no bacterial growth. All positive controls (unwashed surgeon wrists) displayed bacterial growth. All samples collected from beneath the outer cuff of the double glove cuff interface were also negative for bacterial growth. Conclusion: Moisture that accumulates at the paired surgical glove interface during orthopaedic surgery cases is not a source of bacterial contamination
Can a ratio between medial and lateral meniscal volumes be calculated to determine critical meniscal volume in view of post-meniscectomy symptoms?
No full textPartial meniscectomy is a frequently performed treatment strategy for non-suturable meniscal tears. However, the meniscal volume which can be resected without compromising the load-bearing, shock-absorbing function of the meniscus remains a topic of ongoing research. The aim of this study was to calculate the medio-lateral meniscal volume ratio to estimate this volume.In 90 patients (98 pairs of menisci) without meniscal injury, medial and lateral menisci were segmented on MRI imaging and 3D surface models were created to calculate volume.The mean medial meniscal volume was 1928,9mm3 and the mean lateral meniscal volume was 1681,7mm3. A fixed ratio of the medial over the lateral meniscal volume was calculated to be 1,16. The standard deviation of the prediction errors based on this ratio equals 217mm³.This ratio seems a useful parameter in follow-up research to determine whether there is a critical volume which can be resected without post-operative pain and osteoarthritis
Lateral versus crossed K wire fixation for Displaced Supracondylar Fracture Humerus in Children: Our Experience
No full textBackground: Lateral entry and crossed Kirschner (K) wire fixation configuration for treating displaced suprcondylar humerus fracture in children has always been shrouded in controversy as to which is superior. As the closed K wire fixation is the standard of treatment for these fractures, we performed a prospective study comparing the two methods.Method: A prospective study comparing any reduction loss between the two groups was undertaken. Major end points documented were loss of fracture reduction and ulnar nerve injury, in addition clinical alignment, Flynn grade, range of motion, function, and complications. The operative procedure was standardized.Result: Sixty two patients were studied, 32 and 30 in cross K wire and lateral K wire entry group respectively. Two cases of iatrogenic ulnar nerve injury was documented in crossed K wire fixation group but it was insignificant (p value=0.336). No significant difference was observed in terms of change in Baumann or humerocapitellar angle, carrying angle, elbow range of movement.Conclusions : Both techniques are equally effective. Ulnar nerve injury can be minimized by taking certain precaution as in text
Four-corner fusion versus proximal row carpectomy: a retrospective review with a minimal follow-up of 9 years
No full textA retrospective survey on the long-term outcomes of both proximal row carpectomy (PRC) and scaphoidectomy with 4-corner arthrodesis (4CA) was conducted. Seventeen PRC and nine 4CA wrists were retrieved with a minimal follow-up of 9 years. Pain, satisfaction and disability were not significantly different. There was a better flexion and ulnar deviation in the PRC wrists. Conclusion: at long term, the outcome for PRC remains stable despite some series recently reported worsening of the results due to progressive degenerative arthritis. PRC seems to yield comparable clinical results compared to 4CA but a slightly better range of motion than 4CA.