Femoral revision using long hydroxyapatite-coated interlocking stem.

INTRODUCTION: Cementless femoral revision has become increasingly popular because the cementless implants provide the potential for long-term biologic implant fixation. The IOTA interlocking femoral stem is a hydroxyapatite-coated stem with the option of interlocking the stem distally. The aim of the current study was to evaluate the short-term results of IOTA interlocking stem. MATERIALS AND METHODS: We retrospectively reviewed the results of 18 total hip arthroplasties in 17 patients performed between July 2002 and 2004 using the IOTA interlocking stem. In-patient records were retrieved and in addition to demographic data the indication for revision, the preoperative and postoperative Harris Hip scores, need for allografts were noted. The bone deficiency was classified based on the AAOS classification. Intraoperative complications and problems if any were retrieved from the authors' operative notes. Radiographs at the final follow up were evaluated by the criteria described by Engh et al. (Clin Orthop 257:107-128, 1990) RESULTS: Average age at the time of revision was 57 years. Preoperatively five femora showed type I deficiency, type II deficiency was seen in three, type III in nine and type IV deficiency in one femur. In five hips the calcar replacing prosthesis was implanted to manage the proximal calcar defect, in one hip allograft was used to reconstruct the calcar. One patient sustained intraoperative fracture of the shaft of the femur while implanting the trial prosthesis and one patient had a perforation of the posterior cortex of femur while trying to remove the cement. The mean follow up period was 33.5 months (range 27-45 months). The mean preoperative Harris Hip score was 36 (range 23-50), which improved to 77 (range 68-92) at the time of final follow up. None of the stems required revision and at minimum 27 months follow up, bony ingrowth was noted in 83.33% of the stems. CONCLUSION: IOTA interlocking stem has shown promising short-term results for femoral revisions. The advantages are initial axial and rotational stability and consistent bony in growth owing to hydroxyapatite coating. Intraoperative fracture is a potential drawback because of the straight nature of the stem. The calcar replacing option of the stem is especially useful in patients with deficient calcar as a substitute for the allograft.

Endoscopic versus open carpal tunnel release: A short-term comparative study.

OBJECTIVE: To compare the results of endoscopic carpal tunnel release (CTR) with open CTR in patients with idiopathic Carpal tunnel syndrome (CTS). MATERIALS AND METHODS: Seventy-one patients with CTS were enrolled in a prospective randomized study from May 2003 to December 2005. All patients had clinical signs or symptoms and electro-diagnostic findings consistent with carpal tunnel syndrome and had not responded to nonoperative management. Sixty-one cases were available for follow-up. Endoscopic CTR was performed in 30 CTS patients and open CTR was performed in 31 wrists (30 patients). Various parameters were evaluated, including each patient's symptom amelioration, complications, operation time, time needed to resume normal lifestyle and the frequency of revision surgery. All the patients were followed up for six months. RESULTS: During the initial months after surgery, the patients treated with the endoscopic method were better symptomatically and functionally. Local wound problems in terms of scarring or scar tenderness were significantly more pronounced in patients undergoing open CTR compared to patients undergoing endoscopic CTR. Average delay to return to normal activity was appreciably less in group undergoing endoscopic CTR. No significant difference was observed between the endoscopic CTR group and open CTR group in regard to symptom amelioration, electromyographic testing and complications at the end of six months. CONCLUSION: Short-term results were better with the endoscopic method as there was no scar tenderness. Results at six months were comparable in both groups.

Comparison of total knee arthroplasty in stiff and ankylosed knees.

We compared the results of total knee arthroplasties in patients with stiff or ankylosed knees. We retrospectively reviewed 90 total knee arthroplasties in 52 patients with minimum 2 years followup who had less than a 50 degrees arc of flexion preoperatively. Preoperative and intraoperative data were retrieved from a computerized database. Patients were followed for an average of 6.5 years at an outpatient department. Knee Society knee scores improved from 34.6 points preoperatively to 89.5 points postoperatively in the stiff knees and from 47 points preoperatively to 75 points postoperatively in the ankylosed knees. The arc of flexion improved from 35 degrees -69 degrees preoperatively to 1 degrees -94 degrees postoperatively in the stiff knees and from 0 degrees to 3 degrees -77 degrees in the ankylosed knees. There were major complications in four of the 26 ankylosed knees and in two of the 64 stiff knees. The data suggest results of total knee arthroplasty are better in patients with stiff knees than in patients with ankylosed knees.

Haemarthroses after total knee arthroplasty caused by an isolated platelet factor 3 availability defect.

We present seven patients with recurrent haemarthroses after total knee arthroplasty, caused by an inherent platelet function defect. These patients developed painful knee swelling, persistent bleeding and/or wound breakdown, a platelet factor 3 availability defect being identified in all cases. Surgical exploration, with joint debridement, lavage and synovectomy, was performed in four patients who did not improve with conservative therapy. Histopathological examination of synovium revealed a focal synovial reaction with histiocytic infiltration, and occasional foreign-body giant cells. One patient required an early revision because of aseptic loosening of their tibial component. The condition was treated by single-donor platelet transfusions with good results. The diagnosis, management, and relevance of this disorder are discussed.

A comparison of fixed-bearing and mobile-bearing total knee arthroplasty at a minimum follow-up of 4.5 years.

BACKGROUND: Durable long-term independent results with the Low Contact Stress rotating-platform (mobile-bearing) and the Insall Burstein-II (fixed-bearing) total knee prostheses have been reported, but no studies describing either the mid-term or long-term results and comparing the two prostheses are available, to our knowledge. METHODS: Thirty-two patients who had bilateral arthritis of the knee with similar deformity and preoperative range of motion on both sides and who agreed to have one knee replaced with a mobile-bearing total knee design and the other with a fixed-bearing design were prospectively evaluated. Comparative analysis of both designs was done at a mean follow-up period of six years, minimizing patient, surgeon, and observer-related bias. Clinical and radiographic outcome, survival, and complication rates were compared. RESULTS: Patients with osteoarthritis had better function scores and range of motion compared with patients with rheumatoid arthritis. However, with the numbers available, no benefit of mobile-bearing over fixed-bearing designs could be demonstrated with respect to Knee Society scores, range of flexion, subject preference, or patellofemoral complication rates. Radiographs showed no difference in prosthetic alignment. Two knees with a mobile-bearing prosthesis required a reoperation: one had an early revision because of bearing dislocation and another required conversion to an arthrodesis to treat a deep infection. CONCLUSIONS: We found no advantage of the mobile-bearing arthroplasty over the fixed-bearing arthroplasty with regard to the clinical results at mid-term follow-up. The risk of bearing subluxation and dislocation in knees with the mobile-bearing prosthesis is a cause for concern and may necessitate early revision. LEVEL OF EVIDENCE: Therapeutic Level II.

Surgical management of the severely displaced supracondylar fracture of the humerus in children.

We reviewed 44 children with a widely displaced supracondylar fracture of the humerus (Gartland grade III) treated with primary open reduction and cross pinning. The average age was 8 years and the mean delay in presentation was 34 h. Comminution of the medial supracondylar pillar was seen in 57% of the cases. After treatment, the range of the elbow motion was restricted in eight patients. Cubitus varus was not seen. There was no deep infection or myositis ossificans. Post-operatively, five children had a temporary nerve palsy. According to Flynns' criteria, 42 patients had a satisfactory outcome.