End Stage Hip Osteoarthritis in Klippel-Trenaunay Syndrome - A Case Report.

Introduction: Klippel-Trenaunay syndrome (KTS) affects the development of blood vessels, soft tissues (such as skin and muscles), and bone. It is a rare cause of severe degenerative joint disease at an early age. Orthopedic interventions in these patients bring numerous difficulties for various reasons. Up to this point, only six cases of attempted total hip arthroplasty (THA) in patients with KTS have been reported in the literature. The two most recent cases were prematurely aborted due to excessive bleeding and imminent risk of exsanguination. One of the most recent published case reports suggested that hip joint replacement should be avoided in this patient population. Case Report: A middle-aged female presented with end stage coxarthrosis secondary to KTS. A thorough workup was performed and magnetic resonance imaging revealed that the direct anterior interval was relatively free of vascular malformations. After intensive work-up, uneventful THA was performed, resulting in dramatic improvement of quality of life. Conclusion: Effort should be put into identifying those patients with a relatively easy accessible joint so they are not unnecessarily being denied successful joint replacement.

Excellent Long-Term Survival Rate of Polished, Tapered, Cemented Stems in Patients Aged 35 Years or Younger With Avascular Necrosis or Inflammatory Arthritis of the Hip.

BACKGROUND: Total hip arthroplasty (THA) for avascular necrosis (AVN) or inflammatory arthritis (IA) comes with a relatively high risk of aseptic stem loosening, especially in young patients. There are limited long-term data on the survivorship of polished, tapered, cemented stems in this population. We therefore performed a single-center retrospective study investigating the survival of this particular stem type in young patients with AVN or IA. METHODS: All patients aged ≤35 years who had received a THA for AVN or IA operated on by the senior author between 1990 and 2010 at the University Hospitals Leuven were identified. In total, 85 THAs in 62 patients were included. Primary endpoint was revision of the femoral component for aseptic loosening. Secondary endpoints were revision of the acetabular component for aseptic loosening, revision for other reasons, and the presence of radiolucencies around the components. RESULTS: The mean follow-up for the entire cohort was 18.0 ± 5.3 years (range 8.0-28.9). Taking revision for aseptic loosening as endpoint, the survival of cemented stems was 100% after 15 years and 95.1% after 20 years. Survival of uncemented cups (91.3%) was significantly better than survival of cemented cups (50.3%) after 20 years of follow-up for aseptic loosening. Taking revision for any reason as endpoint, the survival of THAs with uncemented and cemented cups was 90% and 43.1% at 20 years respectively. Radiolucencies developed in the cement mantles around 11 of the 81 nonrevised stems, mainly in zones 1 and 7. CONCLUSION: In this cohort of young patients with high-risk profiles for aseptic stem loosening, polished, tapered, cemented stems showed excellent long-term survival rates and they therefore remain a viable alternative to uncemented stem designs.

Clinical outcomes of kinematic alignment versus mechanical alignment in total knee arthroplasty: a systematic review.

Although mechanical alignment (MA) has traditionally been considered the gold standard, the optimal alignment strategy for total knee arthroplasty (TKA) is still debated.Kinematic alignment (KA) aims to restore native alignment by respecting the three axes of rotation of the knee and thereby producing knee motion more akin to the native knee.Designer surgeon case series and case control studies have demonstrated excellent subjective and objective clinical outcomes as well as survivorship for KA TKA with up to 10 years follow up, but these results have not been reproduced in high-quality randomized clinical trials.Gait analyses have demonstrated differences in parameters such as knee adduction, extension and external rotation moments, the relevance of which needs further evaluation.Objective improvements in soft tissue balance using KA have not been shown to result in improvements in patient-reported outcomes measures.Technologies that permit accurate reproduction of implant positioning and objective measurement of soft tissue balance, such as robotic-assisted TKA and compartmental pressure sensors, may play an important role in improving our understanding of the optimum alignment strategy and implant position. Cite this article: EFORT Open Rev 2020;5:486-497. DOI: 10.1302/2058-5241.5.190093.