Catastrophic failure due to massive osteolysis of both acetabular and femoral components in a metal-on-metal hip arthroplasty: a demonstrative case report.

Metal-on-metal (MOM) bearing surfaces in total hip arthroplasty have been recently shown to have acceptable survivorship properties, and they have certain advantages and disadvantages when compared to conventional metal-on-polyethylene bearing surfaces. Like traditional metal-on-polyethylene bearings, these metal-on-metal implants may also suffer from catastrophic failure. Patients can develop a local reaction to the metal ions produced by the articulation and present with pain or early loosening due to the local inflammatory reaction. The possible effects of MOM wear debris and its corrosion products are still the subject of debate. This case report represents an unusual situation in a 63-year-old woman in which extensive lysis derived in massive femoral osteolysis and hip arthroplasty catastrophic failure.

Recombinant factor VIIa treatment for asymptomatic factor VII deficient patients going through major surgery.

Factor VII deficiency is the most common among the rare autosomal recessive coagulation disorders worldwide. In factor VII deficient patients, the severity and clinical manifestations cannot be reliably determined by factor VII levels. Severe bleeding tends to occur in individuals with factor VII activity levels of 2% or less of normal. Patients with 2-10% factor VII vary between asymptomatic to severe life threatening haemorrhages behaviour. Recombinant factor VIIa (rFVIIa) is the most common replacement therapy for congenital factor VII deficiency. However, unlike haemophilia patients for whom treatment protocols are straight forward, in asymptomatic factor VII deficiency patients it is still debatable. In this study, we demonstrate that a single and very low dose of recombinant factor VIIa enabled asymptomatic patients with factor VII deficiency to go through major surgery safely. This suggestion was also supported by thrombin generation, as well as by thromboelastometry.

The percutaneous surgical approach for repairing acute Achilles tendon rupture: a comprehensive outcome assessment.

BACKGROUND: Treatment modalities for acute Achilles tendon rupture can be divided into operative and nonoperative. The main concern with nonoperative treatment is the high incidence of repeated ruptures; operative treatment is associated with risk of infection, sural nerve injury, and wound-healing sequelae. We assessed our experience with a percutaneous operative approach for treating acute Achilles tendon rupture. METHODS: The outcomes of percutaneous surgery in 29 patients (25 men; age range, 24-58 years) who underwent percutaneous surgery for Achilles tendon rupture between 1997 and 2004 were retrospectively evaluated. Their demographic data, subjective and objective evaluation findings, and isokinetic evaluation results were retrieved, and they were assessed with the modified Boyden score and the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale. RESULTS: All 29 patients demonstrated good functional outcome, with no- to mild-limitations in recreational activities and high patient satisfaction. Mean follow-up was 31.8 months. Changes in ankle range of motion in the operated leg were minimal. Strength and power testing revealed a significant difference at 90 degrees /sec for plantarflexion power between the injured and healthy legs but no difference at 30 degrees and 240 degrees /sec or in dorsiflexion. The mean modified Boyden score was 74.3, and the mean Ankle-Hindfoot Scale score was 94.5. CONCLUSIONS: Percutaneous surgery for Achilles tendon rupture is easily executed and has excellent functional results and low complication rates. It is an appealing alternative to either nonoperative or open surgery treatments.

Percutaneous Achilles tendon repair combined with real-time sonography.

BACKGROUND: When encountering complaints of pain in the area of Achilles tendon with a suspected lesion, the clinician seldom reaches a precise diagnosis based only on X-ray and clinical examination. Ultrasonography is useful for evaluating the pathology and treatment. OBJECTIVES: To assess the relative contribution of real-time intraoperative ultrasound examination and immediate postoperative ultrasound in patients with acute rupture of the Achilles tendon treated by percutaneous suture method. The combination of both procedures provides a unique advantage that could facilitate better results. METHODS: Ultrasound examination was used in 20 patients with acute rupture of the Achilles tendon who were treated surgically. Intraoperative as well as postoperative ultrasound examinations were performed in 5 patients while 15 patients underwent an immediate postoperative ultrasound. RESULTS: Ultrasound pathologies were found in all patients. Percutaneous surgical correction of ruptured Achilles tendon with accurate positioning of the foot using real-time sonography was successful in all the patients. CONCLUSION: As in many other soft tissue lesions, ultrasonography is a useful tool for evaluating the pathology and for planning the surgical correction of ruptures in the Achilles tendon.

Total hip arthroplasty after avascular necrosis of the femoral head: does etiology affect the results?

INTRODUCTION: The aim of the study was to evaluate the results of total hip arthroplasty (THA) due to avascular necrosis (AVN) of the femoral head and to establish whether the cause of AVN affects the results. MATERIAL AND METHODS: A group of 68 patients, 17-82 years of age (mean: 49.9 years) underwent 84 total hip arthroplasties due to AVN. The patients were divided into subgroups according to the etiology of AVN of the hip joint. The results of each group were evaluated by the Harris Hip score (HHS) at 3-18 years (mean: 6.2 years). The complication rate was also assessed. RESULTS: The mean preoperative HHS was 28.5+/-4.5 as opposed to a postoperative HHS of 86+/-10. The revision rate was 16.7%. Etiology does not affect the final outcome, but less favorable long-term results were found in the steroid-induced AVN patients. CONCLUSIONS: Despite the previously reported, less favorable results, THA is a good option for the younger population, even with AVN, especially in bilateral disease. Etiology did not affect the final outcome. However, patients with steroid-induced AVN should be informed that although their final functional results will equal those of other groups, the longevity of the implants is limited.

Total hip arthroplasty in patients younger than 30 years of age.

BACKGROUND: Previously reported results of total hip arthroplasty in patients under the age of 30 indicate a high complication rate and questionable durability. OBJECTIVES: To estimate the results of THA in extremely young patients. METHODS: We report the results of 69 THA procedures in 56 patients who were under the age of 30 at the time of surgery (mean age 23.23 +/- 4.31 years) and were followed postoperatively for 2-23 years (mean 7.4 +/- 3.79 years). RESULTS: Loosening of the cup (11/69) and early traumatic dislocation (5/69) accounted for the majority of complications. CONCLUSION: The final average Harris hip scores of 90.59 +/- 9.36 in these patients indicated that THA is a successful and durable treatment modality for young patients with disabling diseases affecting the hip joint. However, due to the likelihood of complications it should be used with caution in this patient group. Efforts should be made to diminish the complication rate.