Arthroscopic-assisted treatment of a reversed hill-sachs lesion: description of a new technique using cerament.

Purpose. Impaction fractures of the anterior aspect of the humeral head, the reversed Hill-Sachs lesion, are common in posterior shoulder dislocation. We present a new technique to address these lesions arthroscopic-assisted with the use of a bone substitute. Methods. We report the case of a 45-year-old male with a reversed Hill-Sachs lesion after posterior shoulder dislocation. Initially a glenohumeral arthroscopy is performed to address concomitant intra-articular injuries. Guided by the k-wire a cannulated sizer was inserted for reduction of the fracture under arthroscopic visualization. For reduction of the impacted part of the humeral head the subcortical defect was filled with an injectable bone substitute (Cerament) to prevent secondary dislocation. Results. X-ray at follow-up 6 months after the index procedure documents the bony remodeling of the bone substitute. At that time the patient was pain-free (VAS 0) and satisfied with the outcome (Constant score: 78, Rand-36 score: 84, Rowe score: 81) with a good ROM. Conclusions. In conclusion, arthroscopic-assisted reconstruction of reversed Hill-Sachs lesions with an injectable bone substitute is feasible and may provide patients with all the benefits of an anatomic reconstruction with decreased risks related to open surgery.

Treatment of femoral neck fracture with a minimal invasive surgical approach for hemiarthroplasty - clinical and radiological results in 180 geriatric patients.

PURPOSE: The Direct Anterior Approach (DAA) is well established as a minimal access approach in elective orthopaedic hip surgery. For the growing number of elderly patients with femoral neck fractures treated with Bipolar Hip Hemiarthroplasty (BHH), only a few results do exist. The study shows the clinical and radiological outcome for 180 patients treated by a modified DAA with BHH. MATERIALS AND METHODS: The data of 180 geriatric patients with medial femoral neck fractures were evaluated retrospectively. The general and surgical complications, mobilisation using the Timed Up and Go test (TUG), the social environment pre- and postoperative and the radiological results have been compared with established approaches for geriatric hip surgery. RESULTS: After joint replacement, 18 (10%) patients were developed pneumonia, of which 3 (1.7%) died during hospitalisation. In 7 cases (4%), surgical revision had to be carried out: three times (1.7%) because of a seroma, three times (1.7%) because of subcutaneous infection, and one time (0.6%) because the BHH was removed, owing to deep wound infection. One dislocation (0.6%) occurred, as well as one femoral nerve lesion (0.6%) occured. 88.3% of patients were mobilised on walkers or crutches; the Timed Up and Go Test showed a significant improvement during inpatient rehabilitation. 83% were discharged to their usual social environment, 10% were transferred to a short-term care facility and 7% were relocated permanently to a nursing home. 3/4 of patients had a cemented stem alignment in the range between -5° and 5°, while 2/3 of patients had a maximum difference of 1 cm in leg length. CONCLUSION: Using the modified DAA, a high patient satisfaction is achieved after implantation of a BHH. The rate of major complications is just as low as in conventional approaches, and rapid mobilisation is possible.

Modified direct anterior approach in minimally invasive hip hemiarthroplasty in a geriatric population: a feasibility study and description of the technique.

INTRODUCTION: The direct anterior approach (DAA) is generally accepted method for minimal invasive arthroplasty of the hip. As good results for total hip arthroplasty are already published, there is a lack of evidence for the implantation of bipolar hip hemiarthroplasty (BHH) in elderly patients with osteoporosis after femoral neck fracture. MATERIALS AND METHODS: For hip arthroplasty using a direct anterior approach (DAA) in elderly patients with femoral neck fractures, a number of modifications of the original technique are being described. The modified DAA considers in particular the co-morbidity and the bone quality of the geriatric patient population. A consecutive series of 16 hemiarthroplasties using this technique is presented. In all 16 cases, the BHH was implanted in modified DAA technique. Mobility measured by 4-item Barthel Index, pain via visual analogue scale (VAS), duration of surgery, external length of incision and blood loss were evaluated. RESULTS: There was no major operative complication during the procedures. The pain level decreased from 7 (preoperatively) to 0 at postoperative day 40. The Barthel Index increased from 5 at first postoperative day to 40 at day 40. Early postoperative mobilisation is efficiently accelerated. Mean operating time was 71 min; the medium skin incision length was 8 cm. The mean haemoglobin level decreased from 118 g/dl preoperatively to 101 g/dl at first postoperative day. CONCLUSION: The described modifications of the DAA help to implant a BHH gently in elderly patients with increasing risk of complications like iatrogenic fractures, wound or prosthesis infections and haematoma. This will hopefully lead to a faster rehabilitation and lower mortality rate for patients with femoral neck fractures in the future.

[Intermediate and long-term outcome after total joint replacement for hallux rigidus : a retrospective analysis]. / Mittel- und langfristige Ergebnisse nach endoprothetischer Versorgung des Hallux rigidus : Eine retrospektive Analyse.

BACKGROUND: The treatment options for advanced hallux rigidus include arthrodesis, excision arthroplasty (Keller-Brandes) and joint arthroplasty and based on the literature, arthrodesis still appears to be the gold standard. In recent years, technical advances and higher patient demands have led to an increasing use of total joint replacement but comparative data on patient satisfaction and clinical outcome of different forms of treatment are rare. MATERIAL AND METHODS: Between 1995 and 2005 a total of 27 patients were treated with 28 joint replacements of the first metatarsophalangeal joint (MTPJ) in a surgical practice (Bio-Action Great Toe Implant, OsteoMed, Addison, TX). The mean age of the patients was 63.7 years. In a retrospective analysis patients were examined clinically and radiologically after a mean follow-up period of 8.8 years and asked about their satisfaction with surgical results using a questionnaire. RESULTS: After joint replacement 15 patients (53.6%) were free of pain, 8 (28.6%) reported marked improvement, 12 (42.9%) had no limitations in any activity and another 5 (17.9%) had no restrictions in activities of daily life. The maximum walking distance was improved in 21 patients (75%) and walking on rough ground in 24 (85.7%). Of the patients 11 (39.3%) had a good range of motion in the MTPJ, 13 (46.4%) reported a slight restriction, 24 (85.7%) were satisfied or very satisfied with the postoperative result and 22 stated that they would undergo joint replacement again. The results of the Wilcoxon test showed a significant increase in postoperative modified American Orthopaedic Foot and Ankle Society (AOFAS) scores compared with preoperative scores. There was loosening of the phalangeal component in 3 patients (11%), and 2 had to undergo revision. CONCLUSIONS: Many recent studies reported good to excellent long-term results of arthrodesis of the MTPJ for stage III and IV hallux rigidus. The results of this study suggest that similar results can be achieved by an experienced foot surgeon with total joint replacement in strictly selected patients.