Direct anterior total hip arthroplasty in supine position using regular OR table : case series and review of complication and reoperation rate.

Direct anterior approach total hip arthroplasty (DAA- THA) has gained popularity in the last decades due to multiple advantages : reduced blood loss, muscle sparing, reduced pain, reduced dislocation rate, shorter hospital stay and faster recovery. However, initial studies have reported an unacceptable high intra-operative complication rate, especially during the learning curve. The complications and reoperations in a consecutive series of 356 DAA- THA's using a supine positioning on a regular OR table, without femoral hyperextension, were analysed retrospectively. Conclusion : This study could not confirm the previously reported high complication rate in DAA-THA. The supine positioning without femoral hyperextension is a safe technique, little susceptible by the surgeon's learning curve.

Predisposing factors which are relevant for the clinical outcome after revision total knee arthroplasty.

PURPOSE: The objective of this study was to investigate the outcome of revision total knee arthroplasty (TKA) in relation to the cause of index failure, the characteristics of the index procedure, and the elapsed time between index TKA and revision. METHODS: A retrospective review based on a prospective database was performed on 146 consecutive revision TKA's. Variables tested were the cause of index failure; the elapsed time between the index and revision procedure; patient age at time of revision; partial or total revision of the implants; the performance of a tibial tubercle osteotomy; the presence of radiolucent lines; postoperative patellar tracking; and coronal plane alignment. Outcomes were measured with the Knee Society Knee Score (KS), Function Score (FS), and X-ray evaluation. RESULTS: Mean KS improved from 27.6 (SD 21.6) to 71.5 (SD 24.2) after revision (P < 0.0001), mean FS from 27.5 (SD 22.7) to 53.3 (SD27.7), P < 0.0001. Overall survival rate was 90% at 5 years and 85% at 10 and 14 years. The cause of index failure had no significant influence on any of the outcome parameters. Significantly, better outcomes were noted for partial revisions and for revisions in older patients. Early revisions (<2 years) were mostly performed for infection and instability, whereas late revisions (>2 years) were mostly performed for polyethylene wear and loosening. The survival rate for late revisions was significantly better than for early revisions (P = 0.002). CONCLUSION: Revision TKA leads to a significant reduction in symptoms and improvement in function. The worst results can be expected for early revisions in young patients. Revision TKA is a demanding procedure with variable results and should therefore be performed by experienced surgeons. LEVEL OF EVIDENCE: Therapeutic study-Level IV.

Endoscopically assisted core decompression in avascular necrosis of the femoral head.

The authors have used bone endoscopy (medulloscopy) to improve the accuracy of the conventional technique for core decompression and grafting in 36 hips with avascular necrosis of the femoral head. Endocopy was found to facilitate debridement of the necrotic bone and to decrease the risk of perforation of the cartilage during debridement. The endoscopy-assisted technique failed, however, to improve the final outcome of core decompression and grafting in more advanced stages of osteonecrosis. Based on this experience, the authors do not recommend core decompression, with or without endoscopic assistance, in advanced stages of avascular necrosis, but they suggest using endoscopic assistance during decompression in small-size lesions.

Hip arthroscopy: outcome and patient satisfaction after 5 to 10 years.

We retrospectively evaluated outcome, complications, reoperations and global patient satisfaction 5 to 10 years after an arthroscopy of the central compartment of the hip joint in 56 consecutive patients. All patients suffered from unsolved hip pain for at least 6 months, had a positive Flexion-Adduction-Internal rotation test (FADIR-test) and a normal radiograph. The mean follow-up was 72 months (range: 60 to 120 months). Thirty-seven patients were male and 19 female, with a mean age of 34 years (range, 17 to 59 years). Forty-five were improved (6 only temporarily) and 11 had no improvement (7 underwent total hip arthroplasty). Outcome and patient satisfaction differ significantly and are primarily determined by the grade of cartilage damage. Patient satisfaction 5 to 10 years after an arthroscopy of the central compartment of the hip is high: 80% (n = 45) of the patients would undergo the same procedure again.

Post-traumatic incongruent hip in a 12-year-old boy.

Traumatic hip dislocation is uncommon in the paediatric population. Post reduction radiographs often show an incongruent hip because of tissue interposition. We report the case of a 12-year-old boy who was transferred to our hospital with an incongruent hip after a skiing accident, without a history of hip dislocation.