Osteosarcoma in a Child Below 2 Years of Age: Case Report and Review of the Literature.

BACKGROUND: Osteosarcoma in children below the age of 5 is extremely rare. OBSERVATION: We report on a previously well 14-month-old male infant, who presented with a reluctance to weight-bear on his right leg and had an associated limp. Plain imaging and a magnetic resonance imaging scan demonstrated a lytic lesion in the right distal femur. An open surgical biopsy confirmed the diagnosis of osteosarcoma. There was no significant family history of cancer and genetic screening for Li-Fraumeni syndrome was negative. CONCLUSIONS: This case highlights the importance of timely consideration of osteosarcoma in an infant, when the clinical presentation and medical imaging are consistent with that diagnosis.

Direct Anterior Approach Total Hip Arthroplasty: An Adjunct to an Enhanced Recovery Pathway: Outcomes and Learning Curve Effects in Surgeons Transitioning From Other Surgical Approaches.

BACKGROUND: The aim of this study was to investigate whether the direct anterior approach (DAA) to total hip arthroplasty (THA) resulted in a shorter length of stay (LOS) in surgeons new to the approach when compared to their previously used approach. Perioperative complications were also assessed. METHODS: We examined 93 DAA THA performed by 3 hip arthroplasty surgeons at a single institution comparing these to their previous 166 operations performed using the lateral or posterior approach. RESULTS: Fixed-effects generalized linear modeling demonstrated that patients who underwent THA by the DAA had 26% shorter LOS than those who were operated on using lateral or posterior approaches (adjusted risk ratio = 0.74; 95% confidence interval = 0.65-0.84; P < .001). A greater proportion of DAA patients were discharged directly home (98% vs 87%, F (1,233) = 8.12, P = .005) and complication rates were comparable between groups. CONCLUSION: The DAA can reduce patient LOS and may be a valuable addition to enhanced recovery pathways. Our findings also suggest that surgeons transitioning to the DAA do not have an increased complication rate when compared to their previous approach.