THA following deformities due to congenital dislocation of the hip joint.

Total hip replacement is the treatment of choice for the patient suffering from end-stage hip osteoarthritis. Excellent long-term results have been published. In the presence of deformities due to congenital hip dislocation, total hip replacement is, in most of the cases, a difficult task, since the technique of performing such an operation is demanding and the results could vary. This paper presents our experience and preferred strategies focusing on challenges and surgical techniques associated with reconstructing the dysplastic hip.

Combined use of Ilizarov external fixation and Papineau technique for septic pseudoarthrosis of the distal tibia in a patient with diabetes mellitus.

The surgical treatment of open pilon fractures has a high complication rate especially in diabetic patients. In this article, we present a case of an infected tibial non-union after an open reduction and internal fixation in a diabetic patient, treated with Ilizarov external fixation combined with Papineau technique. Combined use of external fixation and Papineau technique can provide an alternative option for the treatment of septic pseudoarthrosis of the distal tibia.

Surveillance of Arc2f polyethylene after 15 years of implantation.

BACKGROUND: To investigate the behavior of Arc2f polyethylene (PE) component after a minimum of 15 years post implantation and its possible reasons for failure. METHODS: Between January 1988 and March 1995, 557 cementless total hip arthroplasties were performed in 578 patients. A total of 435 patients (450 hips) were followed up for 18.6 years (range 15-22). RESULTS: At 10 years follow-up no cup needed revision surgery. After 15 years of implantation, we observed massive PE wear in 140 cups (31%) with large osteolytic lesions. A revision procedure was performed in all cases. Exchange only of the PE liner was sufficient in 78 cases, whilst in 59 the cup was also revised. PE insert thickness and the type of prosthetic head were found to be related to PE wear. CONCLUSIONS: We postulate that the massive failure seen is attributed to the manufacturing of the PE insert. We advocate following all patients that have an implant lasting a decade after implantation for routine monitoring to identify those at risk for accelerated PE wear.

Which patients are at risk for kidney dysfunction after hip fracture surgery?

BACKGROUND: Kidney dysfunction (KD) after hip fracture surgery is a major complication. However, the incidence and risk factors of KD in this population are unclear. QUESTIONS/PURPOSES: We therefore (1) determined the incidence of KD in a large cohort of fracture patients, (2) identified preoperative risk factors predisposing to KD, and (3) determined the effect of KD on length of stay and subsequent function. METHODS: Between April 2011 and June 2012, 450 patients (263 women) with a mean age of 73 years (range, 67-96 years) underwent surgery for hip fracture in our institution. We calculated incidence and retrospectively reviewed suspected predisposing risk factors. We report followup at 6 months. RESULTS: The overall incidence of KD was 11% (n = 52). Forty-five patients (86%) developed acute KD and seven patients developed acute-on-chronic KD. Three of the 52 patients died during the followup time. Thirty-eight of the 52 patients (73%) regained their prior kidney function after treatment. An increased risk of KD was found in those with diabetes, shock during or after surgery, age, and preexisting KD. Mean length of stay was higher for patients with KD compared to those without: 9.6 versus 7.4, respectively. At 6 months, 39 of the 49 surviving patients (80%) were fully weightbearing. CONCLUSIONS: Many patients at risk for postoperative KD can be identified and treated. Most patients recover from their KD and the majority return to full weightbearing.

A two stage re-implantation protocol for the treatment of deep periprosthetic hip infection. Mid to long-term results.

Deep periprosthetic hip infection is a devastating complication. Goal of treatment is infection eradication and durable functional reconstruction. Two-stage re-implantation is the standard of treatment. From January 1998 to December 2004 we treated 38 patients with an infected THA. There were 24 females and 14 males, with a mean age of 67 years (61-75). The infection occurred 13 months to 15 years (mean: 7.2 years) after the index operation. The mean follow-up was 11.6 years (7 to 14). 35 patients were available for review. Almost one third of the patients had been treated before with antibiotics. In 5 cases more than one pathogen were present. In 3 cases, it was not possible to isolate a causative organism. In 15 cases (43%), a resistant pathogen was isolated. We used a two stage re- implantation protocol. Spacer was not used in any of the cases. Femoral revision was performed with uncemented implants, 21 of distal (wagner type) fixation and 14 of modular type with proximal fixation. 24 press fit shells (17 oTMT cups) and 11 Muller rings were used. In 33 cases (94%) eradication of infection was achieved. The mean HHS improved from a mean of 38.2 preoperatively to a mean of 88.6 at final follow-up (p<0.001). There was no case of implant loosening or migration. Chronic late infection can be managed successfully with a two stage re-implantation protocol, without interim spacer, including neglected cases, previous long term antibiotics and cases with resistant pathogens.

Does PFNA II avoid lateral cortex impingement for unstable peritrochanteric fractures?

BACKGROUND: Proximal femoral nail antirotation devices (PFNAs) are considered biomechanically superior to dynamic hip screws for treating unstable peritrochanteric fractures and reportedly have a lower complication rate. The PFNA II was introduced to eliminate lateral cortex impingement encountered with the PFNA. However, it is unclear whether the new design in fact avoids lateral cortex impingement without compromising stability of fixation and fracture healing. QUESTIONS/PURPOSES: We therefore asked whether the PFNA II: (1) eliminates the lateral cortex impingement and fracture displacement experienced with PFNA; and (2) provides stable fracture fixation with a low major complication rate for unstable fractures in European patients. METHODS: We retrospectively reviewed 108 patients with an unstable peritrochanteric fracture, 58 treated with PFNA and 50 with PFNA II. We compared nail positioning, major and minor complication rates, operative and fluoroscopy time, blood transfused, time to mobilization, hospital stay, fracture union, and Harris hip score. The minimum followup was 12 months (mean, 13 months; range, 12-18 months). RESULTS: In the PFNA II group we encountered no impingement on the lateral cortex and no patients with lateral fragment or loss of reduction at insertion, whereas with the PFNA group, we had 10 and five cases, respectively. Fracture union occurred in all patients treated with PFNA II without mechanical failures. PFNA II cases were associated with a slightly shorter surgical time than PFNA cases (23 minutes versus 27 minutes, respectively). CONCLUSION: PFNA II avoided lateral cortex impingement experienced with PFNA, providing fast and stable fixation of the unstable peritrochanteric fractures. LEVEL OF EVIDENCE: Level III, retrospective comparative study. See Guidelines for Authors for a complete description of levels of evidence.

Early increase of serum angiopoietin-2 are associated with early progression to death in experimental injury.

Severe trauma induces systemic inflammatory response syndrome (SIRS) through the release of proinflammatory mediators. Angiopoietin-2 (Ang-2) is over-produced in sepsis and leads to dysfunction of endothelial cells and subsequent multiple organ dysfunction. In order to define the role of Ang-2 in lethal injury, 45 rabbits were studied; eight were administered anesthesia; 11 were sham-operated and 26 were subject to femoral injury. Concentrations of Ang-2, malondialdehyde (MDA), tumor necrosis factor-alpha (TNFα) and endotoxins (LPS) were determined in serum and of Ang-2 in tissues; vital signs and overall survival were recorded. Bacterial growth was quantitatively assessed in liver, spleen and lung of animal that died. Survival of injured animals was shorter than sham operated ones. Serum concentrations of Ang-2 at 4 h was greater among animals where death supervened early, i.e. within 48 h after injury than among rabbits that died later. That was also the case for systolic, diastolic and mean arterial pressures. Serum MDA and TNFα and tissue bacterial growth did not differ between rabbits that died early and rabbits that died late. Serum LPS remained below the limit of detection. These results suggest that circulating Ang-2 participates in the pathogenesis of SIRS after injury connected with early haemodynamic instability.

Treatment of a femoral shaft fracture in a patient with congenital hip disease: a case report.

INTRODUCTION: We present a rare case of two concomitant morbidities treated in one operation. To our knowledge, this is the first report of its kind in the literature. CASE PRESENTATION: A 57-year-old Greek woman was admitted to the emergency department having sustained a spiral mid-shaft femoral fracture. She also suffered from an ipsilateral hip congenital dysplasia with ankylosed hip joint due to severe arthritis. She was treated with a total hip arthroplasty using a long stem performing as an intramedullary nail. CONCLUSION: We undertook a complex operative treatment of both co-morbidities in a one stage procedure with a satisfactory clinical result.

Eicosapentanoic acid prolongs survival and attenuates inflammatory response in an experimental model of lethal trauma.

In an attempt to define the efficacy of intravenously administered n-3 polyunsaturated fatty acids (PUFAs) in an animal model of lethal trauma following femur fracture, an intravenous solution of eicosapentanoic acid (EPA) - one n-3 PUFA - was administered in 25 rabbits; 13 were controls and 12 were treated with EPA 30 min after fracture. Vital signs were recorded and serum concentrations of tumor necrosis factor-alpha (TNFalpha) and respiratory burst of neutrophils were assessed. Survival of controls was 7.7% and of animals treated with EPA 50% (log-rank: 5.162; p: 0.023). Vital signs of both groups did not differ. Oxidative burst of neutrophils was greater among EPA-treated animals compared with controls at 48 h (p: 0.010). Serum levels of TNFalpha of the former group were decreased compared with the latter at 48 h (p: 0.019). Bacterial growth of enterobacteriaceae from liver and spleen after death or euthanasia was lower among EPA-treated rabbits than controls. These results suggest that EPA possesses considerable immunomodulatory activities improving survival in a model of lethal trauma. Restoration of oxidative burst conferring efficient phagocytosis of evading bacteria seems the most probable mechanism of action.

Eight- to ten-year clinical and radiographic outcome of a porous tantalum monoblock acetabular component.

In a prospective study, the authors used a porous tantalum monoblock acetabular component for primary total hip arthroplasty between November 1997 and June 1999. A total of 156 consecutive primary total hip arthroplasty were done in 143 patients younger than 75 years. A total of 151 hips had a follow-up time from 8 to 10 years. The average preoperative total Harris hip score of 44.0 +/- 13.8 increased to 97.0 +/- 6.2 at the latest follow-up. The average preoperative Oxford hip score of 43.3 +/- 6.5 improved to 13.9 +/- 2.3 at the latest follow-up. Radiographic evaluation including the Ein-Bild-Röntgen-Analyse (EBRA) digital system showed no radiographic evidence of gross polyethylene wear, progressive radiolucencies, osteolytic lesions, acetabular fracture, or component subsidence. There were 7 (4.5%) postoperative complications all unrelated to the acetabular component.