Intraoperative frozen section histopathology for the diagnosis of periprosthetic joint infection in hip revision surgery: the influence of recent dislocation and/or periprosthetic fracture.

AIMS: To evaluate the accuracy of intraoperative frozen section histopathology for diagnosing periprosthetic joint infection (PJI) during hip revision surgery, both for patients with and without recent trauma to the hip. PATIENTS AND METHODS: The study included all revision total hip replacement procedures where intraoperative frozen section histopathology had been used for the evaluation of infection in a single institution between 2008 and 2015. Musculoskeletal Infection Society criteria were used to define infection. 210 hips were included for evaluation. Prior to revision surgery, 36 hips had a dislocation or a periprosthetic fracture (group A), and 174 did not (group B). RESULTS: The prevalence of infection was 14.3% (5.6% in group A and 16.1% in group B). Using Feldman criteria, the sensitivity of histopathology was 50.0%, specificity 47.1%, positive predictive value 5.3% and negative predictive value 94.1% in group A. The sensitivity of frozen section histopathology was 75.0%, specificity 96.5%, positive predictive value 85% and negative predictive value 95.3% in group B. CONCLUSIONS: Intraoperative frozen section histopathology is reliable for the diagnosis of PJI if no dislocation or periprosthetic fracture has occurred prior to hip revision surgery.

Extra-Articular Impingement at the Anterior Inferior Iliac Spine: A Cause of Refractory Periarticular Pain After Total Hip Arthroplasty.

BACKGROUND: Periarticular pain after total hip arthroplasty (THA) can significantly impair the postoperative functionality. Extra-articular impingement between the greater trochanter and the anterior inferior iliac spine is presented as a cause of refractive pain after THA. METHODS: Twenty patients were treated for refractive periarticular pain and limited internal rotation between January 2014 and April 2016. All patients underwent a positive chair rise test, pelvic inclination test, and Marcainisation test. Patients were treated with bone resection of the anterior part of the greater trochanter with or without component revision. RESULTS: At a mean follow-up of 20 months, all functional outcomes had improved significantly. All patients were willing to undergo the surgery again. Sixteen (80%) indicated the result as very good, 3 (15%) as good, and one (5%) as poor. Two patients developed a postoperative heterotopic ossification that required resection. CONCLUSIONS: Extra-articular impingement should be considered as a possible cause of refractive groin pain after THA. Bony resection through the Hueter interval provides immediate pain relief with improved functional outcomes 1 year after surgery.

Modified anconeus muscle transfer as treatment of failed surgical release of lateral epicondylitis of the elbow.

The purpose of this study was to evaluate the safety and the effectiveness of a new modified anconeus transfer technique in revision surgery for refractory lateral epicondylitis of the elbow. A modified anconeus muscle transfer was performed in nine patients with persistent symptoms after previous surgical release of the common extensor origin. The original technique was modified by using only half of the anconeus muscle. Patients were clinically evaluated, including quickDASH score and grip strength measurement. At a mean follow up period of 36 months, 4 patients had an excellent result, 3 a good result and 1 a poor result. All patients rated their clinical situation as better than before surgery. All but one patient said to be happy with the result and they would undergo the procedure again. The mean quickDash score at the follow up was 10.6 (SD 14.4). No complications were observed. The modified Anconeus muscle transfer is a safe and effective procedure in patients with persistent lateral epicondylitis complaints after a previous surgical release.

Return to work after arthroscopic subacromial decompression.

The incidence of arthroscopic subacromial decompression has been increasing over the last few years. Little is known about the duration of sick leave after such a procedure. The aim of this study was to determine the time till return to full duty and to explore the various influencing factors. We retrospectively evaluated a group of 166 patients who consecutively underwent arthroscopic subacromial decompression for subacromial impingement syndrome. One hundred patients were professionally active at the time of surgery; the mean duration till return to full duty was 11.1 weeks. Self-employed workers had the shortest sick leave period (median time of 1 week). No statistically significant difference was seen between the group with a financial compensation from the national health insurance system (median time of 12 weeks) and the group with income replacement by a private insurance company (median time of 8 weeks). Patients performing manual labour typically had a longer period of sick leave than other employees (12 versus 8 weeks). A longer absence from work was also observed in individuals who underwent a concomitant arthroscopic AC resection and patients with a higher BMI.

Iliotibial band traction syndrome in guided motion TKA. A new clinical entity after TKA.

This study aimed at systematic documentation of lateral knee pain in a consecutive series of 1102 cruciate-substituting, guided motion total knee arthroplasties (TKA) (Journey, Smith and Nephew, Memphis, TN, USA) performed in 1085 patients; 1070 knees were available for review. Follow-up time ranged from one to five years, with a mean of 2.5 years. Symptoms mimicking the well known iliotibial band (ITB) friction syndrome were observed in 77 knees (7.2%). Initial conservative treatment consisted of anti-inflammatory medication (77 knees) and local steroid injection (35 knees). The pain persisted in 22 knees (2%), leading to a surgical release of the iliotibial band. Other surgical interventions included revision for infection (6 knees, 0.5%), revision for tibial component loosening (6 knees, 0.5%), revision for tibiofemoral dislocation (3 knees, 0.3%), revision for patellar component loosening (5 knees, 0.4%), revision for instability (1 knee, 0.1%) and secondary patellar resurfacing (1 knee, 0.1%). The overall survivorship with partial or total implant revision as an endpoint was 98%. The development of lateral knee pain in association with the use of a guided motion design can be explained by the forced posterior translation of the lateral condyle in flexion. The asymmetric cam and post mechanism, acting as a hard driver of posterior femoral translation and internal tibial rotation during flexion, does not allow for the natural kinematic variability occurring in native knees. This repetitive and forced stretching of the ITB seems to induce a painful traction syndrome in some patients.