Reconstruction of Intercalary Bone Defects After Tumour Resection with the Use of a Free Vascularised Fibular Graft: the Concealed Advantages of the External Fixator.

The free vascularised fibular graft represents the mainstay of intercalary bone defect reconstruction after tumour resection. Different reconstruction techniques are described, favouring internal fixation and possibly overlooking potential advantages of external fixation. This series is a description of the technique performed at our institution using an external fixator for the reconstruction of segmental bone defects which enables to maintain limb length and rotational alignment after large segmental bone resection. Data collected were demographic, surgical and histological data, perioperative complications and postoperative data. Eighteen different complications were encountered in seven patients. Mean reoperation rate was 1.3 per patient but no patient required further interventions in order to correct limb length or rotational alignment. Pin-track infection rate was 6%. The limb salvage rate was 100%. Solid final bone healing was obtained in all patients. External fixation for the reconstruction of intercalary bone defects after tumour resection is a safe technique which might offer the advantage of limb length and alignment preservation.

Complication rates after direct anterior vs posterior approach for hip hemiarthroplasty in elderly individuals with femoral neck fractures.

BACKGROUND: Dislocation rates after hemiarthroplasty reportedly vary from 1% to 17%. This serious complication is associated with increased morbidity and mortality rates. Approaches to this surgery are still debated, with no consensus regarding the superiority of any single approach. AIM: To compare early postoperative complications after implementing the direct anterior and posterior approaches (PL) for hip hemiarthroplasty after femoral neck fractures. METHODS: This is a comparative, retrospective, single-center cohort study conducted at a university hospital. Between March 2008 and December 2018, 273 patients (a total of 280 hips) underwent bipolar hemiarthroplasties (n = 280) for displaced femoral neck fractures using either the PL (n = 171) or the minimally invasive direct anterior approach (DAA) (n = 109). The choice of approach was related to the surgeons' practices; the implant types were similar and unrelated to the approach. Dislocation rates and other complications were reviewed after a minimum follow-up of 6 mo. RESULTS: Both treatment groups had similarly aged patients (mean age: 82 years), sex ratios, patient body mass indexes, and patient comorbidities. Surgical data (surgery delay time, operative time, and blood loss volume) did not differ significantly between the groups. The 30 d mortality rate was higher in the PL group (9.9%) than in the DAA group (3.7%), but the difference was not statistically significant (P = 0.052). Among the one-month survivors, a significantly higher rate of dislocation was observed in the PL group (14/154; 9.1%) than in the DAA group (0/105; 0%) (P = 0.002). Of the 14 patients with dislocation, 8 underwent revision surgery for recurrent instability (posterior group), and one of them had 2 additional procedures due to a deep infection. The rate of other complications (e.g., perioperative and early postoperative periprosthetic fractures and infection-related complications) did not differ significantly between the groups. CONCLUSION: These findings suggest that the DAA to bipolar hemiarthroplasty for patients with femoral neck fractures is associated with a lower dislocation rate (< 1%) than the PL.

Acute total hip replacement by direct anterior approach combined with intrapelvic fixation for geriatric acetabular fracture of the anterior column.

Management of anterior column acetabular fracture in the elderly is challenging. Open reduction and internal fixation do not allow early weight bearing and are associated with a high risk of failure compared to younger patients. Therefore, acute fixation and total hip arthroplasty may be an option. This technical note describes a combined procedure: anterior intrapelvic approach for fracture fixation and a direct anterior approach to the hip for THR. Fracture reduction and arthroplasty were achievable in all five patients. The mean operative time was 289min, and the mean blood loss was 2120mL. At short term, no complication was noticed. Combining these two "muscle-sparing" approaches could help manage anterior column fractures in elderly patients. Level of evidence: IV.

Treatment of Hip Microinstability with Arthroscopic Capsular Plication: A Retrospective Case Series.

Purpose: Hip microinstability is defined as hip pain with a snapping and/or blocking sensation accompanied by fine anatomical anomalies. Arthroscopic capsular plication has been proposed as a treatment modality for patients without major anatomic anomalies and after failure of properly administered conservative treatment. The purpose of this study was to determine the efficacy of this procedure and to evaluate potential predictors of poor outcome. Materials and Methods: A review of 26 capsular plications in 25 patients was conducted. The mean postoperative follow-up period for the remaining patients was 29 months. Analysis of data included demographic, radiological, and interventional data. Calculation of pre- and postoperative WOMAC (Western Ontario and McMaster Universities Osteoarthritis) index was performed. Pre- and postoperative sports activities and satisfaction were also documented. A P<0.05 was considered significant. Results: No major complications were identified in this series. The mean pre- and postoperative WOMAC scores were 62.6 and 24.2, respectively. The WOMAC index showed statistically significant postoperative improvement (P=0.0009). The mean satisfaction rate was 7.7/10. Four patients with persistent pain underwent a periacetabular osteotomy. A lateral center edge angle ≤21° was detected in all hips at presentation. We were not able to demonstrate any difference in postoperative evolution with regard to the presence of hip dysplasia (P>0.05), probably because the sample size was too small. Conclusion: Capsular plication can result in significant clinical and functional improvement in carefully selected cases of hip microinstability.

A low dislocation rate after revision total hip arthroplasty performed through the anterior approach.

BACKGROUND: Dislocation is a major complication in revision total hip arthroplasties. This study aimed to evaluate the dislocation rate, complications, and functional scores of revision total hip arthroplasty performed through the direct anterior approach. METHODS: Between January 2014 and March 2020, 84 patients undergoing revision total hip arthroplasty were retrospectively reviewed. All operations were performed through the direct anterior approach. At the final follow-up, incidences of dislocation, reoperation, acute deep infections, periprosthetic fractures and psoas impingement were assessed. The median postoperative Oxford Hip Score was also calculated. RESULTS: At revision surgery, the mean age was 66 ± 12 years (range, 28-91). During an average follow-up of 4.2 ± 1.2 years, reoperation rate for major complications in the non-infected revisions was 15% (n = 11), including five acute deep infections (7%), four periprosthetic fractures (5%), one dislocation and one psoas impingement (1%). The median postoperative Oxford Hip Score was 39 (interquartile range = 14). CONCLUSION: In our series, revision total hip arthroplasty through direct anterior approach was associated with a very low dislocation rate, acceptable complication rates and good functional results. Our results suggest that this procedure is safe and reliable. TRIAL REGISTRATION: Ethical approval for this study was obtained, before enrollment of the first participant, by CUB Erasme's research ethics committee (P2020/323) and C.H.U Ambroise Paré's research ethics committee.

Evaluation of hip arthroscopy using a hip-specific distractor for the treatment of femoroacetabular impingement.

BACKGROUND AND STUDY AIMS: Hip arthroscopy using an orthopaedic traction table has been associated with traction-related neurovascular complications. Since the use of a hip-specific distractor for performing hip arthroscopy hasn't been associated with those specific complications we hypothesized that a hip-specific distractor might facilitate the learning curve of hip arthroscopy for beginner surgeons. MATERIAL AND METHODS: We reviewed retrospectively the first 56 hip arthroscopies performed to treat femoro-acetabular impingement using a hip-specific distractor. We tried to analyse the learning curve of this procedure using operative time, peri- and postoperative complications, hospital stay and patient satisfaction. We also evaluated pre- and postoperative sports activities and tried to identify some factors as poor postoperative prognostic factors. RESULTS: Only 1 major complication occurred. No traction-related complications have been encountered. The curves analysing intervention time and postoperative satisfaction rate showed improvement after 30 cases performed. In all cases, we were able to perform the whole planned gesture without difficulties accessing the hip joint. CONCLUSION: The hip-specific distractor is a safe and reproducible method in performing hip arthroscopy without any traction-related complications or time limits.

Aseptic Loosening after Total Hip Arthroplasty in an Acromegalic Patient: A Case Report.

INTRODUCTION: Acromegaly is a rare disorder characterized by excess secretion of growth hormone and its principle mediator, insulin-like growth factor-1. Although acromegaly is frequently associated with osteoarthritis, the outcome of arthroplasty in this population is not documented. CASE REPORT: We report here a case of aseptic loosening of an uncemented total hip arthroplasty acetabulum in an acromegalic patient that was revised with a cemented cup. It has been suggested that the incidence of this complication is increased in other pathology with a similarly high bone-turnover (e.g., Paget's disease), but this complication has however not yet been reported in the setting of acromegaly. CONCLUSION: Although coincidence cannot be ruled out, multiple metabolic hypotheses could account for an altered osseointegration process in the presence of acromegaly, which could lead to a higher risk of loosening.