ABSTRACT
It is essential for total knee arthroplasty patients to return to their previous level of activity to maintain a healthy lifestyle. This article reviews the current recommendations regarding return to physical activity after total knee arthroplasty and trying to find the balance between levels of activity and prosthetic joint preservation. In general, most total joint replacement patients are able to return to their previous level of activity and to a lesser extent to sports. This article discuss patients' actual levels of activity including their return to work and sport and the factors that influence meeting their expectations for surgery.
Subject(s)
Arthroplasty, Replacement, Hip/rehabilitation , Arthroplasty, Replacement, Knee/rehabilitation , Humans , Return to Sport , Sports/physiologyABSTRACT
INTRODUCTION: Instability is a major complication in revision total hip arthroplasty (THA). Dual mobility (DM) cups were shown to reduce the risk of post-operative implant dislocation. Few case-series studies assessed the outcomes of cemented DM cups when associated to acetabular reconstruction antiprotrusio cages. No published comparative studies were found to look for outcome differences between standard cups (SC) and DM cups in first revision THA associated with a Kerboull plate (KP) and acetabular bone grafting. MATERIALS AND METHODS: This is a retrospective comparative study of two groups of patients in two institutions. All cases were first revision THA with KP reconstruction; a cemented standard cup (SC) was used in one institution (THA-SC group) while a cemented DM cup was used in the second institution (THA-DM group). The posterolateral approach and the same technique for KP placement, the cross technique, were performed in both groups. Primary outcomes were dislocation and revision rates. Survivorship and clinical and radiological results were set to be secondary outcomes. There were ten patients (13 hips) in the first group and 16 patients (16 hips) in the second with a mean follow-up clinical and radiological evaluation of 74.2 ± 47.9 months. RESULTS: Besides age, no significant demographic differences were present between both groups. There were three dislocations (23%) in the first group treated with close reduction compared to none in the second (p = 0.04). No further episode of dislocation or revision surgery occurred until the last follow-up in both groups. The mean Harris Hip Scores for the THA-SC and THA-DM groups were 87.5 ± 10.9 and 87.4 ± 12.1, respectively. When present, radiolucent lines were less than 1 mm thick and were non-progressive in both groups. In all patients, complete trabeculation remodeling or cortical repair of the graft was observed. CONCLUSION: The cup type was the single variable which could account for the observed dislocation rate difference. The mid-term results of using DM cups with KP in first revision THA seem very encouraging. Our findings add to the previously published results on the excellent outcomes in terms of stability in revision THA when using DM cups.
Subject(s)
Arthroplasty, Replacement, Hip/instrumentation , Bone Plates , Hip Dislocation/surgery , Hip Prosthesis , Acetabulum/surgery , Aged , Aged, 80 and over , Arthroplasty, Replacement, Hip/adverse effects , Arthroplasty, Replacement, Hip/methods , Female , Hip Dislocation/etiology , Hip Prosthesis/adverse effects , Humans , Joint Instability/etiology , Joint Instability/surgery , Male , Middle Aged , Prosthesis Design , Prosthesis Failure , Radiography , Range of Motion, Articular , Reoperation , Retrospective StudiesABSTRACT
BACKGROUND: Soft tissue defects in the foot and ankle region are challenging conditions particularly in diabetic patients. We evaluated the reliability of the sural flap in treating such defects among a diabetic population. MATERIAL AND METHODS: This is a continuous retrospective series of 14 patients with type 2 diabetes treated with an ipsilateral sural flap for soft tissue defects around the rear foot (11 cases) and over the malleolar areas (3 cases). Three patients had an open tibia fracture (Gustillo IIIb), four had chronic osteitis and seven had a chronic heel ulcer. RESULTS: The mean follow-up at 28 months showed healing of the flap at a mean of 24 days, donor site healing in two weeks, one case of total flap necrosis, three cases of skin edge necrosis, two cases of temporary venous congestion and 10 cases of hypoesthesia of the lateral border of the foot. No infection or recurrence of infection was encountered. CONCLUSION: We found the sural flap useful, reproducible and reliable in treating soft tissue defects in diabetic patients with a low frequency of serious complications.
