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Recent attention in THA has focused on minimally invasive techniques and their short-term outcomes. Despite much debate over the outcomes and complications of the two-incision and the mini-lateral and mini-posterior approaches, complications arising from use of the anterior THA on a fracture table are not well documented.We determined the intraoperative and postoperative complications with the anterior approach to THA through an extended single-surgeon patient series.We reviewed 800 primary THAs performed anteriorly with the aid of a fracture table over 5 years and recorded all intraoperative and postoperative complications up to latest followup (average, 1.8 years; range, 0-5 years). Patients with severe acetabular deformity or severe flexion contractures were excluded and those surgeries were performed with a lateral approach during the time period of this study.Intraoperative complications included 19 trochanteric fractures, three femoral perforations, one femoral fracture, one acetabular fracture, one bleeding complication, and one case of cardiovascular collapse. There were no ankle fractures. Postoperative complications included seven patients with dislocations; seven with deep infections; one with delayed femur fracture; 37 with wound complications, among which 13 had reoperation for local débridement; 14 with deep venous thrombosis; and two with pulmonary embolism; and 31 other nonfatal medical complications.The main intraoperative complications of trochanteric fractures and perforations occurred mostly early in the series, while the main postoperative complications related to wound healing were prevalent throughout the entire series. Despite potential advantages of use of a fracture table, surgeons should be aware of the potential complications of trochanteric fractures, perforations, and wound-healing problems associated with this technique.Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

SUMMARY Background: In 2009, the World Health Organisation issued a worldwide recommendation for the use of its Surgical Safety Checklist in all operative proce dures. In this review, we present the available data on the implementation of this checklist and its effect on perioperative morbidity and mortality and on operating-room safety culture. We also survey the experience with the checklist to date and give some recommendations for its practical implementation. Methods: We reviewed pertinent original publications retrieved by a selective search in the PubMed and Medline databases on the search term “Surgical Safety Checklist”. All papers published before February 2012 were analyzed. Results: The 20 studies that we analyzed included a single prospective ran dom ized trial concerning the effect of the WHO checklist on safety-related behavior in the operating room. The two surgical outcome studies documented a relative improvement of perioperative mortality by 47% in one study (from 56 in 3733 cases [1.5%] to 32 in 3955 cases [0.8%]) and by 62% in the other (from 31 in 842 cases [3.7%] to 13 in 908 cases [1.4%]), as well as a relative improvement of perioperative morbidity by 36% in one study (from 411 in 3733 cases [11.0%] to 288 in 3,955 cases [7.3%] ) and by 37% in the other (from 151 in 842 cases [17.9%] to 102 in 908 cases [11.2%]). Improved interdisciplinary communication was also found. Factors that aided effective use of the checklist included exemplary implementation by team leaders and structured training. Conclusion: These results support the WHO’s recommendation to use the Surgical Safety Checklist in all operative procedures. The checklist should be understood not merely as a list of items to be checked off, but as an instrument for the improvement of communication, teamwork, and safety culture in the operating room, and it should be implemented accordingly.

Long-term results over a period of more than 10 years give evidence of the superiority of the through-knee compared to the above-knee stump. However, failures in through-knee stumps before, during and after operation and pitfalls in prosthetic fitting are still too frequent. They are mostly due to errors because the peculiarities of the stump and the prosthetic management are not recognised. This paper emphasizes frequent causes of failure in the selection of the level of amputation, the operative technique, post-operative treatment and prosthetic rehabilitation in order to reduce the complication rate.