Search

Introduction: Performing total hip arthroplasty (THA) after failed internal fixation of proximal femoral fractures (PFF) is known to be associated with high rates of complications. Dual mobility cups (DMC) are known to lower dislocation events in high-risk patients. Very few reports investigated the outcomes of THA using DMC following failure of internal fixation for PFF. Methods: This is a retrospective monocentric continuous study of 31 patients who underwent THA with DMC after failed internal fixation of PFF. The clinical assessment was based on the modified Harris hip score (mHHS) at the last follow-up. The complication rates and radiological analyses were recorded. Results: The mean follow-up period was 5.96 ± 4.2 years. At the last follow-up, the mean mHHS was 92.9 ± 9.1 with 71% of the patients describing their operated hip as a forgotten hip. No dislocation or aseptic loosening events were noted. One patient developed a septic loosening of the implant. No significant radiological changes were recorded. Sixteen stems (51.6%) were placed in a neutral position, 13 (42%) in valgus (2.74 ± 1.72°), and 2 (6.4%) in varus (6.94 ± 2.02°). Conclusion: This study emphasizes the advantage of using DMC following failed internal fixation of PFF in reducing dislocation and complication events in this high-risk population.

Every time a paper is submitted to the journal, we realize the effort and amount of work it takes for performing the study, writing, formatting, and submitting the paper for peer review. However, how many of these papers are suitable for publication? Medical writing considerations, including an understandable text that does not confuse reading, formality, and ethics in writing, should be kept in mind when preparing and writing a paper to be submitted for publication to a journal. This editorial note offers useful advice for the authors submitting their papers to a journal on what to keep in mind before submission, how to prepare a quality submission, how to win the editor for their paper to avoid rejection, and how to make it to the review process and maybe to get published. It is our belief that these tips and advice on medical writing apply to any author and any journal.

Introduction: Total hip replacement provides mostly fair functional and clinical results. Many factors play an essential role in hip stability and long-term outcomes. Surgical positioning remains fundamental for obtaining accurate implant fit and prevent hip dislocation or impingement. Different categories of robotic assistance have been established throughout the previous years and all of the technologies target accuracy and reliability to reduce complications, and enhance clinical outcomes. Materials and methods: An overview is proposed over the principles of robotic assistance in hip arthroplasty surgery. Accuracy, reliability, management of the bone stock, clinical outcomes, constraints and limits of this technology are reported, based on recent literature. Results: Potential advantages regarding pre-operative planning accuracy, cup positioning, maintenance of the center of rotation, preservation of an adequate bone stock nay clinical short- and mid-term outcomes are balanced with some reported disadvantages and limits like hip anatomical specificity, cost-effectiveness, engineering dependence. Discussion: The use of robotic-assisted THA presents clear and evident benefits related to accurate implant positioning and maintenance of a minimal bone while allowing. For some authors, an early improvement in functional results and patient’s recovery. This technology demonstrated a shorter surgical time and a short learning curve required to optimize its use and this technology presents promising outcomes and results and potential use in routine clinical application but its limitation of use is still present especially the cost of the robot, the need for the presence of an engineer during the surgery, its availability of use in all hospitals as well as the difficulty presented in dysplastic or dysmorphic hip joints.

Introduction: In 1979, in his first book dealing with low-friction arthroplasty (LFA), Charnley highlighted the use of a cement restrictor. Breusch and Malchau described in 2005 the “second-generation cementing technique.” The main objective of this study was to report on the clinical survival of 100 cases of Charnley femoral component implanted in 2007 and 2008 using a permeable and resorbable cement restrictor and a low-viscosity antibiotic-loaded cement. The secondary objectives were to analyze the complications and side effects and the accuracy of the device positioning. Material and methods: This was a monocentric retrospective review of a prospectively compiled database. Diaphyseal restrictor was biodegradable and permeable to gas, blood, and fluids to avoid intramedullary over pression during cementation. The cement was a low-viscosity antibiotic-loaded cement. Among 3555 patients, we selected the first continuous 100 cases of patients where we implanted the device. Survival probability was computed according to Kaplan–Meier method. Results: Mean follow-up was 6.55 ± 2.6 (range 1–11). Considering femoral component revision as the endpoint, survival rate was 100%. No patients died intraoperatively, none in the first month and the first year after surgery. No early periprosthetic fractures have been reported. Discussion: As described initially by Charnley, the use of a cement restrictor was highly recommended through the different generations of cementing techniques. Hypotensive episodes and cardiac arrest have been reported during cement insertion. In our series, we did not deplore any adverse effect related to the cementation. Conclusion: Our study demonstrates a 100% survival rate of a cemented femoral component without adverse effects when using routinely a resorbable and permeable cement restrictor and a low-viscosity cement. Bone cement is still a fantastic ally for the surgeon and the patients.

Acetabular reconstruction aims at filling bony defects and positioning the acetabular component in its anatomical place. To this, the use of Kerboull plate would give an automatic optimal positioning while reconstructing the acetabular cavity. We developed a technique, the cross technique, that approaches acetabular reconstruction in a systematic way. It consists of placing the KP following its cross design, in reference to a vertical plane (hook, center, palette) and a horizontal plane (horizontal flanges). The cross technique has three steps; the preparation of the acetabular cavity, the cross technique itself and cementation. We recommend a downsizing of the plate in relation to the size of the acetabular cavity in addition to another downsizing of the acetabular implant in relation to the plate size whenever a dual mobility cup is used.

Several surgical approaches could be used in hip arthroplasty or trauma surgery: anterior, anterolateral, lateral, posterior (with or without trochanterotomy), using or not an orthopedic reduction table. Subtrochanteric and extra-capsular trochanteric fractures (ECTF) are usually treated by internal fixation with mandatory restrictions on weight bearing. Specific complications have been widely described. Mechanical failures are particularly high in unstable fractures. Hip fractures are a major public health issue with a mortality rate of 12%–23% at 1 year. An alternative option is to treat ECTF by total hip arthroplasty (THA) to prevent decubitus complications, to help rapid recovery, and to permit immediate weight bearing as well as quick rehabilitation. However, specific risks of THA have to be considered such as dislocation or cardiovascular failure. The classical approach (anterior or posterior) requires the opening of the joint and capsule, weakening hip stability and the repair of the great trochanter is sometimes hazardous. For 15 years, we have been treating unstable ECTF by THA with cementless stem, dual mobility cup (DMC), greater trochanter (GT) reattachment, and a new surgical approach preserving capsule, going through the fracture and avoiding joint dislocation. Bombaci first described a similar approach in 2008; our trans fractural digastric approach (medial gluteus and lateral vastus) is different. A coronal GT osteotomy is performed when there is no coronal fracture line. It allows easy access to the femoral neck and acetabulum. The THA is implanted without femoral internal rotation to avoid extra bone fragment displacement. With pre-operative planning, cup implantation is easy and stem positioning is adjusted referring to the top of the GT after trial reduction and preoperative planning. The longitudinal osteotomy and trochanteric fracture are repaired with wires and the digastric incision is closed. This variant of Bombaci approach could be use routinely for hemiarthroplasty or THA in the cases of unstable ECTF. It reduces complications usually linked to this procedure. Blood loss, operating time, and pain are limited, allowing fast recovery in order to decrease morbidity and mortality.

Introduction: Since the first measurement method of patella height in 1929 (Janssen), more than 16 methods have been described. Most of these measures are not suitable to measure patella height after total knee arthroplasty (TKA). One of us (JC) modified the original Caton Deschamps (oCD), index with a new relative index called modified Caton Deschamps (mCD) index, by using new landmarks. The purpose of this study was to determine how patella height is modified after TKA.Material and Method: Sixty primary TKAs were consecutively prospectively enrolled. One type of implant was used (cementless postero-stabilized TKA, rotating plateau, cemented patella resurfacing). Patient's characteristics, functional and radiological outcomes were recorded pre-operatively and at one year follow-up. Pre-operative and post-operative outcomes were compared by paired t-test. Post-operative outcomes were compared between groups by one-way analysis of variance.Results: Average difference between pre and post-operative mCD was 0.19 in this series. In 81.7% of cases, patella was lowered. Patients were classified in three groups according to patella height lowering. Between these three groups, no significant statistical differences (IKS score knee and function, range of motion) could be identified.Discussion: In TKA, patella assessment in sagittal plane is as important as frontal or horizontal planes. True patella infera (TPI) is mostly due to patella tendon shortening measured by oCD. Pseudo patella infera (PPI) measured by mCD is mostly due to joint line elevation (over femoral cut with an over thickness of the tibial component). In this study a moderate patella lowering (minor than 15%) does not have a significant impact on the functional results (IKS, ROM) nevertheless in 80% patella is lowered. The next step will be to analyze precisely what factors are influencing this lowering and what prevention could be suggested in primary and revision TKA. [ABSTRACT FROM AUTHOR]

Background: The dual mobility cups (DMCs) were shown to reduce dislocation rate following total hip arthroplasty for any etiology, including femoral neck fractures. No reported studies evaluating DMC results for femoral neck fracture in a Middle Eastern population were found in the literature.Methods: This study aims to look for mortality rate, clinical, and functional outcomes in a population having specific rituals involving extreme hip positions as part of their daily activities.Results: Of an initial sample of 174 patients (177 operated hips), 18 (10.3%) patients (20 hips) died after a mean of 39.6 ± 13.8 months (ranging from 2 to 49 months) with only 3 (1.7%) during the first post-operative year. Twelve patients (13 hips) were lost to follow-up and 19 patients (19 hips) had their radiological data incomplete. In the final sample of 125 patients (125 hips), no dislocation, aseptic loosening, or infection was encountered. The mean modified Hip Harris Score was of 94.8 ± 8.4. The mean modified Hip Harris Score of 40 patients who used to practice regularly oriental sitting position or prayers was 94.1 ± 3.1. After surgery, 36 of these 40 patients (90%) described their hip as "a forgotten hip." Multivariate analyses found correlation only between mortality and cardiovascular co-morbidities.Conclusion: DMC implants showed excellent clinical and functional results. The majority of patients having rituals and customs involving extreme hip positions were able to resume their daily activities. The observed low mortality rate should incite future research to investigate its correlation with the use of DMCs. [ABSTRACT FROM AUTHOR]

Background: Hip fractures are serious injuries associated with relatively high mortality rates and disabilities, commonly seen in elderly persons. There is an ongoing debate regarding the advantages of various hip arthroplasty devices. This study aimed to analyze the long-term advantages of 2 different surgical procedures and assess if the dislocation rate, Harris Hip Score (HHS), and functional independence measure (FIM) are more favorable in dual mobility (DM) than those in hemiarthroplasty (HA)., Hypothesis: Dual mobility procedures provide better postoperative outcomes than HA in terms of HHS, FIM, and dislocation rate., Materials and Methods: The survey was a prospective, comparative interventional single-blinded study performed at the University Clinical Center of Kosovo, a tertiary health-care institution. A total of 94 patients underwent DM or conventional bipolar HA for repair of displaced femoral neck fractures within 2 weeks of injury. Primary outcomes were postoperative dislocation rate, FIM, and HHS. Secondary outcomes included duration of surgery, estimated intraoperative blood loss, time to first postoperative full weight-bearing, time to walking ability with and without crutches, mortality rate, and postoperative infection rate., Results: There were no significant differences for most parameters between the groups. We found a significant difference in the dislocation rate between the 2 groups, wherein there were no dislocations in the DM group and 3 dislocations in the HHS group (0% vs 6.4%). In terms of postoperative HHS at 12 months and 3 years, DM provided better outcomes (<0.034 and <0.014, respectively)., Discussion: Dual mobility compares favorably to HA in terms of dislocation rate and HHS, while no difference was found for FIM. In order to have a more complete overview, we recommend more intense long-term studies including several heterogeneous parameters to compare the clinical outcomes between DM and HA., Level of Evidence With Study Design: Level II., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: Recently, increased interest has developed for patellofemoral arthroplasty as treatment for isolated patellofemoral arthritis. However, there are very few reports of the experience with the modern generation of patellofemoral arthroplasties. The new patellofemoral arthroplasty Hermes design is described. The design and technique of insertion are detailed., Methods: The indications were isolated patellofemoral disease with advanced arthritic damage. Ten-year followup is available for treatment of 70 knees. Postoperative radiographs of patients were assessed for Oxford deterioration and maltracking of the patella. Tracking was categorised as follows: normal tracking, patellar subluxation, patellar dislocation., Results: There were no late complications attributable to the arthroplasty. Disease progression in the tibiofemoral joint occurred in five patients requiring revision in three of these patients. Persistent anterior knee pain was recorded in four knees. The long-term results using this new design were better than those in the literature that described earlier designs, especially concerning malalignment. Only four knees in four patients had slight lateral patellar subluxation., Conclusions: This implant offers a reasonable alternative to total knee replacement in patients with isolated patellofemoral disease.