The Use of Barbed Sutures in Total Hip Arthroplasty: A Systematic Review on Clinical-Surgical Outcomes, Costs, and Complications.

PURPOSE: Total hip arthroplasty is among the most successful procedures in orthopaedic surgery. As the total number of total hip arthroplasties is constantly rising and it is expected to further increase, efforts oriented to optimise surgical pathways are investigated, aiming to reduce complications and diminish costs. The wound suturing phase is one of the steps that may be addressed. Barbed sutures have proved to reduce surgical times and enhance suture stability, then reducing wound-related complications in many surgical fields. The evidence on the use of this technology in total hip arthroplasty is still sparse, and its effect on patient outcomes and costs must still be clarified. METHODS: A systematic search of studies published from 1 January 2000 to 1 March 2023 was performed. Two authors independently reviewed the literature available in eight electronic databases to identify papers eligible for inclusion. RESULTS: A total of nine studies investigating 6959 procedures on 6959 patients were included in the final analysis. Five studies were randomised controlled trials, and the overall quality of studies ranged from moderate to high. The mean age of patients ranged from 43.8 to 70 years. BMI ranged from 25 to 31.9 kg/m2. The mean follow-up of studies ranged from 3 to 6 months. CONCLUSIONS: Evidence included in the systematic review suggested that the use of barbed sutures is associated with lower suturing times, complication rates, and overall costs when compared to the use of traditional suturing techniques. LEVEL OF EVIDENCE: II, systematic review of level I and II studies.

Adult Hip Flexion Contracture due to Neurological Disease: A New Treatment Protocol-Surgical Treatment of Neurological Hip Flexion Contracture.

Congenital, traumatic, or extrinsic causes can lead people to paraplegia; some of these are potentially; reversible and others are not. Paraplegia can couse hip flexion contracture and, consequently, pressure sores, scoliosis, and hyperlordosis; lumbar and groin pain are strictly correlated. Scientific literature contains many studies about children hip flexion related to neurological diseases, mainly caused by cerebral palsy; only few papers focus on this complication in adults. In this study we report our experience on surgical treatment of adult hip flexion contracture due to neurological diseases; we have tried to outline an algorithm to choose the best treatment avoiding useless or too aggressive therapies. We present 5 cases of adult hips flexion due to neurological conditions treated following our algorithm. At 1-year-follow-up all patients had a good clinical outcome in terms of hip range of motion, pain and recovery of walking if possible. In conclusion we think that this algorithm could be a good guideline to treat these complex cases even if we need to treat more patients to confirm this theory. We believe also that postoperation physiotherapy it is useful in hip motility preservation, improvement of muscular function, and walking ability recovery when possible.

Cerebrospinal fluid fistulas after iliosacral screw removal in post-traumatic pseudomeningocele.

Sacral fractures are rare but severe injuries. They are often associated with neurological impairment and pelvic instability. We present a case of a 28-year-old woman who sustained an H-type fracture of the sacrum with complete cauda equina syndrome treated with cauda equina decompression and pelvic percutaneous stabilization with an iliosacral screw. Two years after she underwent screw removal, but complained of back and nape pain after the operation. A lumbosacral MRI showed the presence of a lytic lesion involving the S1 and S2 bodies that was judged to be a pseudomeningocele leaning against the sacral screw hole and cerebrospinal fluid fistulas through this. To our knowledge, this is the first case of such a complication after sacral screw removal to be reported.

Nonunion of a sacral fracture refractory to bone grafting: internal fixation and osteogenic protein-1 (BMP-7) application.

Nonunion of a sacral fracture is a serious clinical condition: chronic pain, sitting discomfort, limp, neurological implications, and inability to work are frequent findings. Surgical treatment of these injuries often turns out to be technically difficult also for the expert pelvic surgeon and not infrequently provides poor radiographic and clinical results. The gold standard treatment at present is open excision, reaming of the nonunion site and internal fixation, performed by a multi-stage approach; as an adjunct, autologous cancellous bone grafting is usually performed in most severe cases. We report a case of a sacral nonunion in which traditional techniques failed, successfully treated by osteogenic protein-1 (BMP-7) application. The employment of BMPs demonstrated successful results in various types of fracture, but there is limited experience about their use in pelvic ring injuries: Further studies are necessary to better know the possible complications and to define their actual potential.

Minimally invasive reduction of vertically displaced sacral fracture without use of traction table.

BACKGROUND: Treatment of vertically displaced sacral fracture can be difficult even for the expert traumatologist. Traditional reduction methods can show some limitations; we suggest a minimally invasive technique, which could be effective, tissue sparing and economic in terms of equipment needed. MATERIALS AND METHODS: Our retrospective study included 11 patients with average age of 40.2 years (range 24-59 years), with type C pelvic ring disruption with monolateral sacral fracture (C1.3), who underwent surgical treatment from April 2007 to March 2008 using the minimally invasive technique. Radiographic examination, using Matta's criteria, was carried out pre-operatively, post-operatively and at least at 1 year after surgery. All patients were functionally evaluated using Majeed's grading scale with mean follow-up time of 18.9 months (range 14-25 months). RESULTS: Pre-operative displacements averaged 10.8 mm (range 7-21 mm); post-operative displacements averaged 5.4 mm (range 3-12 mm), with excellent or good reduction in 91% of cases. No major complications occurred. On functional evaluation, 82% of patients obtained good or excellent results. CONCLUSION: The minimally invasive reduction technique, requiring a limited surgical approach and a standard radiolucent table, is in our experience a satisfactory procedure for management of monolateral vertically displaced sacral fracture.

A treatment protocol for abdomino-pelvic injuries.

BACKGROUND: Abdomino-pelvic injuries often present a challenge for the emergency department. Although literature reports several protocols on the treatment of abdomino-pelvic injuries aiming at defining the most advisable treatment line, optimal treatment is still controversial. This paper describes a protocol that has been used to treat abdomino-pelvic injuries in our hospital since 2002. MATERIALS AND METHODS: In literature different protocol of abdomino-pelvic injuries are described and comparing them most of the difference are the timing of CT scan, the angiography and the laparotomy when treating a lesion of pelvic ring. If patient is haemodynamically instable and presents a lesion of pelvic ring our protocol suggest the simplest and fastest stabilization (pelvic external fixator) in emergency room and delay exam such as CT scan as second level exam. In the presence of an abdominal injury, with a positive focused assessment with sonography for trauma test, the first step should be a pelvic ring stabilization, as laparotomy decreases the abdominal pressure and reduces the tamponade effect on the retroperitoneum. According to presented protocol the angiography is not be a first choice treatment. This protocol was applied to 58 cases of abdomino-pelvic injury with unstable pelvic lesions from October 2002 to December 2005. Mean injury severity score was 27.2 (CI 24.1-30.3). RESULTS: Five patients (8%) died, three due to haemorrhagic shock and two due to pulmonary embolization. Four patients (6.9%) had a partial or complete cauda equina syndrome, four patients (6.9%) complained of mild incontinence, whilst 1 (1.7%) complained of urinary retention with multiple cystitis. Two patients (3.4%) with retention and multiple cystitis, had a malunion and a painful non-union of the fracture. Seven patients (12.3%) had neurological impairment: 5 (8.6%) sciatic nerve palsy, 1 (1.7%) lumbosacral root lesions in a C2-type fracture and there was one case (1.7%) of inconstant lumbago with sciatic pain. Twelve patients reported different levels of sexual dysfunction (20.7%). CONCLUSIONS: Although validation with a larger cohort is required, our preliminary clinical data are similar to, or better than, those reported in the most recent publications on this question, suggesting that this protocol could well reduce both the mortality rate and the long term complications of abdominopelvic injuries.