Simultaneous versus staged bilateral direct anterior Total Hip Arthroplasty: Are early patient-centered outcomes equivalent?

While accumulating data on the direct anterior approach to total hip arthroplasty (THA) have demonstrated clinical benefit and durable results, there is little data that exists on patient-centered outcomes and satisfaction when comparing simultaneous bilateral procedures with staged arthroplasty. The aim of this study was to determine whether simultaneous bilateral THA and staged arthroplasty result in equivalent early (1) patient-centered outcomes and patient satisfaction; while maintaining acceptable rates of (2) objective clinical outcome scores, (2) complication rates; and (3) radiographic results. In retrospective review, 41 patients who underwent bilateral one-stage THA were compared to 44 patients who underwent staged bilateral THA during the same time period. The minimum clinical follow up was two years. Generic (EQ-VAS and EuroQoL-5D index) and condition-specific (Oxford Hip Score) instruments were used to assess patient-reported outcomes. Other variables included length of hospital stay (LOS), operative and anesthetic times, blood loss, intra- and post-operative (local and systemic) complications, and radiographic analysis. No significant differences between the two groups were found for patient-reported outcomes, complications, or radiographic assessment. The simultaneous THA group had shorter LOS and operative and anesthetic times, as well as less blood loss.

[Palmar plating with the locking compression plate for dorsally displaced fractures of the distal radius--first clinical experiences]. / Die winkelstabile palmare Plattenosteosynthese bei der dorsal dislozierten distalen Radiusfraktur--Anwendung und erste klinische Erfahrungen.

Injuries and irritation of extensor tendons are common problems in the treatment of fractures of the distal radius when plating is used via a dorsal approach. By the development of locking compression plates the possibility of palmar plating for dorsally displaced fractures of the distal radius is available. In this study our first clinical experiences using the 3.5 mm radius locking compression plate (LCP) are reported. Between February 2002 and September 2002 24 patients with dorsally displaced fractures of the distal radius were treated using a palmar approach with the LCP and included in a prospective study. The mean age of the patients was 52 years (28-87 years). Six weeks and six months after surgery a clinical assessment was done, the range of motion of the injured wrist was measured, and an X-ray control of the injured joint was performed. The preliminary results demonstrate the option of early functional treatment using the locking compression plate. Most of the patients had a good to excellent range of motion of the injured wrist which resulted in an early return to former activity. There were few intra- and postoperative complications. No irritation of the median nerve, no infection was observed. In one case a screw which was placed intraarticularly was removed prematurely. The palmar locking compression plate has been proven as a safe and effective implant for the treatment of dorsally displaced fractures of the distal radius.