The walls of the femoral neck as an auxiliary tool for femoral stem positioning.

BACKGROUND: Femoral anteversion is a major contributor to functionality of the hip joint and is implicated in many joint pathologies. Accurate determination of component version intraoperatively is a technically challenging process that relies on the visual estimation of the surgeon. The following study aimed to examine whether the walls of the femoral neck can be used as appropriate landmarks to ensure appropriate femoral prosthesis version intraoperatively. METHODS: We conducted a retrospective study based on 32 patients (64 hips) admitted to our centre between July and September 2020 who had undergone a CT scan of their lower limbs. Through radiological imaging analysis, the following measurements were performed bilaterally for each patient: anterior wall version, posterior wall version, and mid-neck femoral version. Anterior and posterior wall version were compared and evaluated relative to mid-neck version, which represented the true version value. RESULTS: Mean anterior wall anteversion was 20° (95% CI, 17.6-22.8°) and mean posterior wall anteversion was -12° (95% CI, -15 to -9.7°). The anterior walls of the femoral neck had a constant of -7 and a coefficient of 0.9 (95% CI, -9.8 to -4.2; p < 0.0001; R2 0.77).The posterior walls of the femoral neck had a constant of 20 and a coefficient of 0.7 (95% CI, 17.8-22.5; p < 0.0001; R2 0.60). CONCLUSIONS: Surgeons can accurately obtain femoral anteversion by subtracting 7° from the angle taken between the anterior wall and the posterior femoral condyles or by adding 20° to the angle taken between the posterior wall and the posterior femoral condyles.

Stop Searching under the Streetlight! A Primer and Practical Guide to the Diagnosis of Joint Pain and Inflammation.

It is impossible to achieve a diagnosis without a comprehensive list of possible diagnostic explanations for a certain symptom or syndrome. Joint complaints are very frequent in general practice, paediatrics, emergency medicine and naturally rheumatology and orthopaedics. The differential diagnosis of joint and surrounding tissue pain and inflammation is impressively challenging. Orthopaedic surgeons and rheumatologists deal with different aspects of this subject, while primary care physicians need to have a wider perspective that includes both orthopaedic and rheumatic disorders. The purpose of this paper is to provide a unified, comprehensive, clear and concise guide to this subject that will include both orthopaedic and rheumatic disorders and may serve the practitioner as basic reference for differential diagnosis. Short dictionary-style definitions would be given for each disorder in order to provide a 'bird's-eye view', rather than an in-depth description of many diseases. Medical students, residents and primary care physicians are the primary target audience, but we believe that even the experienced orthopaedic surgeon or rheumatologist may benefit from a systematic and well-organised method.

A Quick and Comprehensive Guide to Differential Diagnosis of Neck and Back Pain: a Narrative Review.

The list of diagnostic options when approaching a patient with axial pain is impressively complex. Many offer limited diagnostic workups, but we could not find a truly comprehensive diagnostic guide to assist in the diagnostic evaluation. In this short paper, we briefly described a long list of medical conditions, each of which can manifest as back or neck pain, and whose prevalence ranges from common to very rare. We then proposed an algorithm for classifying them into subgroups. Further referral to diagnostic tests and specialist consultations, after assignment to one of those subgroups, could save time and unnecessary tests. We believe that this review and the proposed diagnostic algorithm can be valuable for medical education and for use in the primary care setting for the diagnostic evaluation of any type of back or neck pain in all patient groups.

The Clinician's Guide to Differential Diagnosis of Non-Localized Musculoskeletal Pain A Primer on Musculoskeletal Medicine.

Orthopedic surgeons may encounter patients with musculo- skeletal complaints that are not localized to a specific joint or anatomical area. The list of diagnoses that may cause generalized pain originating from bones, muscles, fasciae, and joints, including surrounding tissues like tendons, ligaments, and bursae, is vast; starting with influenza or fibromyalgia and ending with mycetism and ultra-rare he- reditary disorders. A systematic multidisciplinary approach is required. Many of these patients require referral to rheu- matology, endocrinology, or other specialties but at least a basic understanding of differential diagnosis is needed. The purpose of this review is to comprehensively examine the clinical presentation of various causes of generalized musculoskeletal pain and create a mental framework to aid the diagnostician in achieving the correct diagnosis in an orderly and efficient manner.

Antibiotic prophylaxis in orthopedic surgery; has the time to reconsider the current practice arrived?

Introduction: The current practice of antibiotic prophylaxis in orthopedic surgery has existed almost 50 years yet little changes have been made. The incidence of methicillin resistant Staphylococci and multi-drug resistant Gram-negative bacteria is growing. Methods: We studied the positive cultures after primary hip and knee joint replacement and trauma surgery at our department. Results: Our investigation substantiates the current reports of an increase in oxacillin resistance of Staphylococci and an increase in incidence of Gram-negative bacteria. Conclusions : The standard use of cephalosporins for prophylaxis does not provide the necessary protection that it used to. We suggest that the recommendations and practice of antibiotic prophylaxis should be reconsidered. Level of Evidence: Level III - retrospective cohort study.

Screening for hereditary haemochromatosis in patients undergoing knee arthroplasty : a retrospective cohort study of 2,035 patients.

AIMS: Hereditary haemochromatosis is a genetic disorder that is caused by several known mutations in the human homeostatic iron regulator protein (HFE) gene. Abnormal accumulation of iron causes a joint disease that resembles osteoarthritis (OA), but appears at a relatively younger age and is accompanied by cirrhosis, diabetes, and injury to other organs. Increased serum transferrin saturation and ferritin levels are known markers of haemochromatosis with high positive predictive values. METHODS: We have retrospectively analyzed the iron studies of a cohort of 2,035 patients undergoing knee joint arthroplasty due to OA. RESULTS: No patients had HFE gene C282Y, S65C, or H63D mutations testing. In total, 18 patients (2.96%) of the male cohort and 51 (3.58%) of the female cohort had pathologically increased ferritin levels that may be indicative of haemochromatosis. Seven patients (0.34%) had serum transferrin saturation above 45%. CONCLUSION: The awareness for the diagnosis of this disorder in Orthopaedics is low and needs improvement. Osteoarthritic patients undergoing knee arthroplasty should be routinely screened for haemochromatosis by iron studies and referred to genetic testing when needed. Level of evidence: Level III - Retrospective cohort study. Cite this article: Bone Jt Open 2021;2(12):1062-1066.