An evaluation of intra- and post-operative blood loss in total hip arthroplasty at the national orthopaedic hospital, Lagos

Background: Severe hip pain with associated significant functional limitation is the major indication for total hip replacement, a rewarding and gratifying procedure. However, significant blood loss can occur in the intra- and post-operative periods, posing a major challenge and necessitating prompt restoration of circulating blood volume to minimize morbidity and mortality. The aim of this study was to evaluate blood loss after primary total hip replacement, and to determine the effect of surgical time on blood loss. Patients and Methods: A prospective study of blood loss after total hip arthroplasty in 41 patients. All cases were primary total hip arthroplasty done by one surgeon. Intra- and post-operative blood losses were recorded in two groups of patients (surgical time <2 h and surgical time >2 h), and the effect of these on blood loss was evaluated. Results: The mean intra- and post-operative blood losses were 1222.7 ml and 574.3 ml, respectively. These showed a strong positive correlation with total blood loss (r = 0.790, P< 0.001 and r = 0.517, P< 0.001). Higher intra- and post-operative blood losses were recorded in patients with surgical time >2 h, with a significant difference on postoperative days 2 and 3 (P = 0.003 and P = 0.014, respectively). Conclusion: Blood loss in total hip replacement is an important factor and may be influenced by a shorter surgical time

Arthroplastie cervico-céphalique pour fracture du col fémoral à Brazzaville: résultats anatomiques et fonctionnels au recul de 28 mois

Introduction: Les fractures du col du fémur sont fréquentes chez le sujet âgé. Elles sont en général traitées par des prothèses cervico-céphaliques. Le but de cette étude était d'évaluer les résultats anatomiques et fonctionnels obtenus avec ce type de prothèse. Matériel et méthodes: Cette étude rétrospective réalisée entre janvier 2008 et mai 2014 a concerné 30 patients totalisant 31 fractures. L'âge moyen était 71 ans (42 -87ans). On notait quatre fractures Garden III et 27 Garden IV. Vingt-sept patients étaient classés ASA II et trois patients ASA I. Le score de Parker était côté à 9/9 chez 23 patients et à 6/9 chez sept. Les prothèses étaient la prothèse de Moore (n=28 ; 90%), la prothèse de Thompson (n= 2 ; 7%) et la prothèse de Merle d'Aubigné(n= 1; 3%). Les résultats anatomiques ont été évalués selon les critères de Sharif. Les résultats fonctionnels ont été analysés selon Postel Merle d'Aubigné et Parker. Le recul moyen était 28 mois (6-61 mois). Résultats: Initialement toutes les prothèses étaient bien implantées. Au dernier recul, les complications anatomiques étaient une cotyloïdite (n=7), une bascule en varus (n=4) une prothèse perchée par lyse de l'éperon de Merckel (n=3), un enfoncement de la prothèse (n=7), une fracture périprothétique (n=1), et une subluxation de la prothèse (n=1). Selon Postel Merle d'Aubigné les résultats étaient très bons (n=1 ; 3%), bons (n=3 ;10%), moyens (n=4 ; 13%) , médiocres (n=14 ; 47%), et mauvais (n=8 ; 27%).Selon Parker, 24 patients étaient côtés à 7/9, cinq à 6/9 et un à 0. Conclusion: Au recul moyen de 28 mois les résultats des prothèses cervico-céphaliques n'étaient pas satisfaisants. Par nécessité, elles restent une option thérapeutique dans notre contexte socio-économique

A Biomechanical Analysis of Strength and Motion Following Total Shoulder Arthroplasty

Background: The primary goal of total shoulder arthroplasty (TSA) has traditionally been pain relief and motion improvement. The literature contains multiple studies that have documented the restoration of motion and consistent pain relief following the procedure. However; there has been little attention placed on strength following TSA. Therefore; the purpose of this study was to determine in an objective manner whether strength and motion improve with shoulder arthroplasty and over what time course this may occur. aterials and Methods: Between April 2002 and January 2004; 15 patients who underwent TSA for osteoarthritis had biomechanical strength testing preoperatively; at 6 and 12 months postoperatively. The mean age at the time of TSA was 66 years (range; 52-82). None of the patients had full thickness rotator cuff tears at the time of surgery. Peak forces for shoulder flexion; extension; abduction; internal rotation and external rotation strength were recorded. In addition; patients had shoulder range of motion measurements performed.Findings: Range of motion improved significantly with TSA from preoperative to 6 months postoperative: flexion 104o to 147o ( P = 0.0034); abduction 86o to 145o ( P = 0.0001); internal rotation 43o to 54o ( P = 0.0475) and external rotation 25o to 50o ( P = 0.0008). There was minimal improvement in range of motion from 6 to 12 months. In contrast; there continued to be improvements in strength from the 6 month to the 12 month postoperative time frame: extension 18.3 kg to 22.4 kg ( P = 0.006); abduction 11.3 kg to 12.8 kg (0.0474) and external rotation 8.8 kg to 10.1 kg ( P = 0.016). Despite these improvements; compared to normative values; there continued to be relative weakness of the shoulder following TSA.Interpretation: The data from this study suggest that recovery of strength and motion follow different time frames after TSA. The results of this study may allow the surgeon to more accurately discuss with the patient over what time course strength and motion may return. In addition; this study raises important questions in regard to the current rehabilitation program used after shoulder arthroplasty and whether development of new protocols may improve the functional outcome from surgery

An optimised method for quantifying glenoid orientation

A robust quantification method is essential for inter-subject glenoid comparison and planning of total shoulder arthroplasty. This study compared various scapular and glenoid axes with each other in order to optimally define the most appropriate method of quantifying glenoid version and inclination. Six glenoid and eight scapular axes were defined and quantified from identifiable landmarks of twenty-one scapular image scans. Pathology independency and insensitivity of each axis to inter-subject morphological variation within its region was tested. Glenoid version and inclination were calculated using the best axes from the two regions. The best glenoid axis was the normal to a least-square plane fit on the glenoid rim, directed approximately medio-laterally. The best scapular axis was the normal to a plane formed by the spine root and lateral border ridge. Glenoid inclination was 15.7° ± 5.1° superiorly and version was 4.9° ± 6.1°, retroversion. The choice of axes in the present technique makes it insensitive to pathology and scapular morphological variabilities. Its application would effectively improve inter-subject glenoid version comparison, surgical planning and design of prostheses for shoulder arthroplasty

Perioperative fracture-dislocation of the humeral head during a resurfacing hemiarthroplasty

We report a case of perioperative fracture-dislocation of the humeral head produced during the reaming for a resurfacing replacement hemiarthroplasty (RRH) in a 79-year old woman. This is a surgical complication not previously described in the literature for this type of prosthesis design. Resurfacing humeral head implant has been noted as a useful treatment for glenohumeral arthropathies; also in elderly people; with a very low incidence of complications. However; as we report; they are possible. It is advisable that conven- tional stemmed implants could be available when RRH is performed

Pulmonary embolism following rotator cuff repair

Background: Previous studies have provided data on the incidence of pulmonary embolism following shoulder arthroplasty and repair of fractures of the proximal humerus. However; there is no information on the risk of pulmonary embolism following the surgical management of rotator cuff tears. Methods: We performed a review of 1176 patients who underwent operative procedures for rotator cuff tears between January 1 st ; 2001 and December 31 st ; 2005 to identify all patients who developed a symptomatic pulmonary embolism postoperatively. Results: Three patients developed pulmonary embolisms that were diagnosed with computed tomography angiography. The overall incidence was calculated to be 0.26. None of the patients died as a result of the pulmonary embolism. Conclusions: The data from this review indicates that the risk of pulmonary embolism following surgery for rotator cuff repair is low; but not nonexistent. The most common presenting symptoms of pulmonary embolism were chest pain; shortness of breath; and hypoxia. This study should raise surgeons' awareness about this possible complication following rotator cuff repair surgery

Antituberculous treatment and total hip arthroplasty in ald tuberculous hip. A case report

We report a case of Total Hip Arthroplasty using cemented Charnley prothesis. This was done in an old tuberculous hip without using antituberculous chemoprophylaxis. The patient developed periprosthetic bacterial infection not related to tuberculous site reactivation. We report our experience with this case and review of relevant literatures

Utilisation de la prothese de Moore dans la chirurgie de la hanche : a propos de 5 cas

"Les auteurs rapportent dans ce travail retrospectif cinq observations d'arthroplastie de hanche par prothese de Moore. La coxarthrose et les sequelles de fractures du col du femur representent les principales indications; l'utilisation de la prothese ""tete de Moore"" garde encore; dans les milieux sous-equipes; une place de choix dans la chirurgie de la hanche; compte tenu du cout du materiel; de la simplicite de la technique et des resultats post-operatoires"